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Running head: EFFECTIVE NURSE PHYSICIAN COMMUNICATION

EFFECTIVE NURSE PHYSICIAN COMMUNICATION


Tamara Stewart Luman
University of Central Florida

EFFECTIVE NURSE PHYSICIAN COMMUNICATION

Teaching Strategies for Health Professionals


College of Nursing at the University of Central Florida
Stewart, Tammie
Teaching Project
Title:
Effective Nurse Physician Communication
Description/Context:
This 2 hour course on effective nurse physician communication is part of 12 week graduate nurse
orientation course. The larger course is specifically designed to orient, train, mentor and educate
graduate nurses into the hospital setting and team nursing. The 2 hour course on effective nurse
physician communication will incorporate teaching strategies encompassing the cognitive,
affective and psychomotor domains. The program focuses on fostering effective communication,
decision making and building critical thinking skills for safe, high quality patient care. The
behavior standards policy for the hospital facility will also be discussed to encourage effective
nurse physician communication along with professional behavior.
Intended Audience:
This program was created to address the learner in an acute care hospital graduate nurse program
demonstrating little or no experience communicating with physicians. The following areas will
be addressed:
1.
2.
3.
4.
5.
6.

Critical thinking skills


Decision making skills
Prioritization
Communication
Safety standards
Professional behaviors

Objectives: condition, learner, performance, criterion


Following the 2-hour presentation on effective nurse physician communication, the graduate
nurse will be able to:
1.
2.
3.
4.
5.

List at least three barriers to effective communication.


Describe how culture may impact communication.
Identify at least three instances when its appropriate to contact a physician.
Anticipate questions the physician may pose regarding your patient.
Demonstrate proper use of the Before Placing a Call to a Physician tip card or
Situation-Background-Assessment-Recommendation, (SBAR) for communicating with
physicians as discussed in class.
6. Employ tips for effective communication while participating in role playing scenarios.

7. Apply the communication techniques discussed in this course to effectively communicate


with physicians in person or on the phone.
Preparation Insurance:
The graduate nurse will be provided the following tools to ensure adequate readiness prior to the
learning session:
1.
2.
3.

4.
5.

Net-learning online course on communication: Graduate nurses are required to


complete the 3 contact hour course titled, Professional Communication: Speak Up,
Speak Well prior to the learning session.
Journal: The graduate nurses will briefly journal any past experiences communicating
with physicians, positive and/or negative. There will be time during the learning session
for sharing these encounters with the class for those that feel comfortable.
Graduate nurse program: This highly structured orientation program consisting of
lecture, hands on, demonstration, return demonstration, case scenarios and group
exercises has provided the graduate nurses an opportunity to become familiar with the
instructor, their peers and their environment. They have also been provided multiple
opportunities for introductions and encounters with hospital physicians during their first
three weeks of orientation.
Self confidence survey on communicating with physicians: This questionnaire will be
administered to graduate nurses prior to the start of the learning session and afterwards to
assess comfort levels of communication with physicians.
Standards of Behavior Policy: Graduate nurses will be required to read this policy prior
to class. This policy addresses the facilities expected behaviors for all hospital staff. It
also outlines disciplinary actions for inappropriate or rude behavior.

Obstacles:
The course is intended to introduce and prepare graduate nurses to effectively communicate with
physicians either in person or on the phone regarding the care of their patients. Everyone
communicates differently and multiple factors affect communication. For patient quality and
safety, it is imperative that nurses feel confident, competent and comfortable communicating
with physicians.
Expected obstacles to learning
Lack of exposure and training on how to
communicate with physicians in a hospital
environment may impede graduate nurses
ability to effectively communicate.

Teaching strategies
Self confidence survey on
communicating with physicians will be
administered before and after the
program to identify areas of increased
confidence (Rowles, 2009).

Resistance towards attending a passive, sit


down, classroom style presentation.

Graduate nurses may experience increased


anxiety about communicating with physicians.
They may feel unprepared for potential
questions, comments, suggestions or
interactions.

Lecture: provides a structured forum


for introduction and clarification of
concepts as well as a foundational
background into the material related to
nurse physician communication.
Power point will be used to stimulate
the visual thinker and active learning
will be encouraged through the use of
class participation, discussion, visual
aids and handouts and opportunities
for question and answer session
(Rowles, C. & Russo, B., 2009).

Group Concept Mapping: Graduate


nurses will have the opportunity to
discuss as a group and actively
participate in mapping out appropriate
nurse responses to physicians with the
use of concept mapping. They will ask
and anticipate physician questions and
responses. This instructional tool
encourages team building, negotiation,
delegation and critical thinking
(Herrman, 2008).
The graduate nurses may not feel comfortable
Role Play: will be incorporated into
participating in role play with their peers.
the course to provide graduate nurses
Feelings of shyness, intimidation or anxiety can with the opportunity to experience
interfere with active participation in role play
scenarios and situations involving
and the learning process. Over dramatization of communication with physicians in
assigned role may impede and interfere with the person or on the phone. This method
learning process.
will encourage learners to begin to
understand other people and how
emotions play a role in communication
(Rowles, C. & Russo, B., 2009).
Debriefing will occur after each role
play scenario to reinforce expected
actions and behaviors.
Lack of focus or interest in material being
Vignettes/Video clips: will be utilized
presented. Graduate nurses with extensive prior to demonstrate appropriate and
experience communicating with physicians
inappropriate nurse physician
maybe from a previous job may feel they do not communication. Some vignettes will
need the information.
be stopped prior to their conclusion so
the group can discuss the appropriate
responses to the conversations.
Utilizing media/video with discussion
encourages active learning and

participation.
Journaling exercise: Even experienced
nurses will find stories shared by their
peers involving physician
communication interesting and
engaging. Reflecting on the stories
will allow the participants to make
connections with classroom material
and real life stories while analyzing
meaningful incidents (Burrows, 1995).
Group discussions may get off track and need to Storytelling/Peer Sharing: The
be refocused by instructor.
instructor presents several true to life
stories of her own interactions with
physicians. The stories engage and
encourage students to make the
connection between what is being
learned and what happens in real life.
Graduate nurses also have an
opportunity to share their own stories
pertaining to physician communication
with the class. Creating relevance and
peer sharing promotes active learning.
(Rowles, C. & Russo, B., 2009).
Teaching/Learning strategies
Domains of Learning:
Cognitive: addressing the categories of knowledge, comprehension, application, analysis,
synthesis, and evaluation.
Graduate nurse will attend and participate in the lecture component of effective nurse
physician communication. This course is 2 hours and encompasses information on types
of communication, barriers, placing and receiving calls from the physician and tips for
effective communication.
*Power point attached
Graduate nurse will participate in the concept mapping exercise with peers. Class will be
divided into groups of four each group will receive a nurse physician scenario. Groups
receive post it notes with appropriate and inappropriate nurse physician responses. Each
group works together to place the appropriate responses in the correct order for the
scenario. Each group will present their completed scenario responses to the class and
share their reasoning for the chosen responses.
Teaching strategies:
1. Lecture and online communication course.
2. Concept mapping exercise.

Psychomotor: addressing fine motor, manual, and gross motor skills.


Graduate nurse will participate in written simulation scenario with the use of a case study.
Case study will require the graduate nurse to describe how they would handle
communicating information to a physician utilizing the tip card or SBAR.
Speak Up, Speak Well course completion with an 80% by participants.
Teaching strategies:
1. Written simulation with case studies enhances problem solving, group sharing and
active learner involvement.
2. Online course on Professional Communication-gives immediate individual
feedback on knowledge comprehension of material.

Affective: encompassing attitudes; beliefs and values; and feelings and emotions.
The instructor will present several true to life stories of her own experiences and
interactions with physicians. Stories will demonstrate examples of effective and
ineffective nurse physician communication. Graduate nurse will also have the
opportunity to share personal stories of experiences with physician communication.
Graduate nurse will participate in several role playing scenarios as nurse and physician
addressing disrespectful, negative, positive and difficult communication. Instructor will
conduct debrief after each scenario for reinforcement of effective communication
components.
Graduate nurse will bring journal of past experiences communicating with physicians to
class for discussion and debriefing of situations.
Several vignettes of nurses communicating with physicians will be shown-some will be
stopped before completion so that class discussion can ensure regarding the
communication.
Teaching strategies:
1. Storytelling/Peer Sharing-allows connection to real life stories and situations.
2. Role playing scenarios encourage active learning and participation thereby
reinforcing concepts and expected behaviors.
3. Journaling of past experiences communicating with physicians.
4. Vignettes/video clips appeal to visual and auditory learners. A useful tool for
demonstrating examples of appropriate and inappropriate types of
communication.
Critical Thinking
The course on effective nurse physician communication for graduate nurses is meant to focus on
establishing the framework of basic communication concepts and encouraging the connection
between knowledge and practice; therefore migrating towards the initial, integral steps of critical
thinking. Effective nurse physician communication requires effective communication skills,

critical thinking skills and professional behavior which will take place throughout the program in
deliberate, methodical, and purposeful methods of instruction.
1. Lecture: the program will provide a focused review of communication techniques,
strategies and barriers. The lecture format is a key element for relating classroom
knowledge to the clinical arena. The adult learner will be presented with multiple aspects
of learning to include lecture, case studies, audiovisual, online activities, and group
discussion. The philosophy of the course is to enhance critical thinking through a safe
environment that allows students to explore the content, make mistakes, reflect and
transform the content into knowledge (Rowles & Russo, 2009).
2. Vignettes/Video Clips: Presenting vignettes demonstrating appropriate and inappropriate
exchanges of information between nurses and physicians and stopping some of the
vignettes prior to completion while open discussion ensues regarding the appropriate next
steps encourages active participation and problem solving. This instructional method
fosters active learning, critical thinking and reasoning. Graduate nurse are given the
opportunity to utilize skills of inquiry and the ability to apply what was taught in lecture
into this session (Rowles, C. & Russo, B., 2009).
3. Role Playing: The implementation of role playing in this course allows learners to
actively participate and improve their decision making skills. The instructor can provide
immediate feedback on demonstrated attitudes and behaviors thereby reinforcing
appropriate methods of communication. Graduate nurses are provided with a non
threatening, safe environment to practice the expected behaviors. A debriefing session
after each role play offers the opportunity for discussion, analysis and evaluation of the
experience thereby once again reinforcing the expected behaviors and critical thinking
skills involved (Rowles, C. & Russo, B., 2009).
4. Story Telling/Peer Sharing: The use of this instructional method encourages critical
thinking by: allowing participants to experience multiple points of view, fostering of
reflection and promotes active learning and engagement. True to life stories assist
students with making a connection and demonstrate the critical thinking process by
experienced nurses.
5. Concept Mapping: Utilization of concept mapping in this course provides a venue for
graduate nurses to experience similarities and differences of communication. Concept
mapping also provides the nurses with an opportunity to collect and organize their
thoughts prior to making the phone call to the physician. Active involvement with
choosing and weighing appropriate responses in the correct order also enhances critical
thinking skills.
6. Written Simulation with Case Studies: This instructional method stimulates critical
thinking by allowing the participants to choose and weigh their decisions based on past
experiences and present knowledge. Discussion and debriefing after the simulation will
provide opportunities for reflection. Simulation as a teaching strategy enhances problem
solving ability in a safe, non-threatening environment (Bastable, 2008).

Outcome evaluation plan

1.
2.
3.
4.
5.
6.

Graduate nurses will complete an evaluation of the course content, objectives and
planned activities after completion of the course.
Graduate nurses will also complete the Self Confidence Survey on Communicating with
Physicians prior to and after the completion of the course to determine their own
comfort/confidence.
After participation and completion of the role playing scenarios, the instructor will
conduct a debriefing session on the scenarios, evaluating the expected communication
behaviors of graduate nurses.
After participation and completion of the written simulation case scenarios, the instructor
will conduct a debriefing session.
After participation and completion of the concept mapping exercise, each group will
present their chosen responses with justification and the instructor will review with the
class.
Successfully complete and pass the online course titled, Professional Communication:
Speak Up, Speak Well with an 80% or higher.

Teaching Effectiveness: Assessment plan


Graduate nurses enter the medical field with varying backgrounds including education, work
history, personal beliefs and varying cultures. One of the vital roles of being a professional nurse
is the ability to effectively communicate with physicians regarding patient status, medications,
interventions, family and crises. After completing this course the main goal would be for the
graduate nurses to feel empowered, confident and competent to communicate with physicians.
With the use of lecture, role playing, story telling, concept mapping and vignettes, learners of all
types have been addressed. Assessing the graduate nurses several weeks after the course with
respect to how they are communicating with physicians will also help to evaluate the
effectiveness of what was taught in the program.
In the future, I would love to invite a physician to the course to discuss communication with
nurses from their perspective-what types of information they need, how to deal with
misunderstandings or conflict, how to put the patient first and be their advocate. The physician
could also discuss the policies in place to address inappropriate behaviors demonstrated by
physicians, nurses or any healthcare staff. Intimidation, fear of embarrassment and retaliation
are all viable concerns for nurses reporting inappropriate physician behavior. The students
evaluation of the course will also be analyzed as to whether or not the objectives were met, what
were the strengths and weaknesses as well as suggestions for improvement. As critical thinking
of graduate nurses continues to develop, communication with physicians will improve. My goal
is to arm them with the resources needed to approach, discuss and decide with the physician, the
best, safest way to take care of patients.

References:

Bastable, S. (2008). Nurse as Educator: Principles of Teaching and Learning for Nursing
Practice (3rd edition ed.). Sudbury, MA: Jones and Bartlett.
Burrows, D. (1995). The Nurse Teacher's Role in the Promotion of Reflective Practice. Nurse
Education Today, 15, 346-350.
Herrman, J. (2008). Strategies for Large Classrooms. In J. Herrman, Creative Teaching
Strategies for the Nurse Educator (pp. 55-56). Philadelphia: F.A. Davis Company.
Rowles, C. & Russo, B. (2009). Strategies to promote critical thinking and active learning. In D.
&. Billings, Teaching in nursing: A guide for faculty (pp. 238-261). St. Louis: Saunders
Elsevier.
Rowles, C. (2009). Improving Teaching and Learning. In D. &. Billings, Teaching in Nursing: A
Guide for Faculty (pp. 262-267). St. Louis: Saunders Elsevier.
Shortell, S. & Rousseau, D. (1989). The Organization and Management of Intensive Care Units.
Berkeley, California, United States of America: University of California, Berkeley.

Attachments:
1. Outline of Effective Nurse Physician Communication Course
2. Outline of online course-Professional Communication: Speak Up, Speak Well
3. Self Confidence Survey on Communicating with Physicians
4. Before Calling the Physician Tip Card and SBAR form (both contained in Power point)
5.

Nurse Physician Role Playing Scenarios-examples

6. Written Simulation-example
7. Course Evaluation Summary

Effective Nurse Physician Communication


Course Outline
I.

Self Confidence Survey on Communicating with Physicians-initial

II.

Lecture-power point
A. Course Objectives
B. Getting to know physicians
C. Culture and Communication
a. Spoken word-intonation of voice
b. Eye contact
c. Body language
d. Respect
D. Types of Communication with Physicians
a. Change in medical status/patient condition
b. Patient or family wants to speak with physician
c. Consult
d. Orders
e. Critical labs
E. Barriers to communication
a. Noise
b. Emotions/Stress
c. Lack of Sleep
d. Prior bad experience
e. Lack of knowledge
f. Too much or too little information
g. Tone of voice and dialect
F. Before calling the physician tip card
G. Situation-Background-Assessment-Recommendation (SBAR)
H. Tips for effective communication

III.
IV.
V.
VI.
VII.
VIII.
IX.

Storytelling/Peer sharing
Vignettes/Video clips
Role Playing Scenarios
Concept Mapping Exercise
Written Simulation
Self Confidence Survey on Communicating with Physicians-post course
Course Evaluation

Professional Communication: Speak Up, Speak Well


3 contact hours
Author: Dr. Bette Case Di Leonardi
Outline of course:
I.
II.
III.

Verbal and Nonverbal Communication


Personal Appearance and Courtesy
Barriers to Communication
A. Language
B. Disabilities
IV.
Confidentiality
V.
Legal Issues and Implications
VI.
Assertiveness
VII. SBAR
A. Situation
B. Background
C. Assessment
D. Recommendation
VIII. Crucial Conversations
IX.
Healthy Work Environment
X.
The Code of Conduct
XI.
Zero Tolerance for Ineffective or Rude Behavior
XII. National Patient Safety Goals
XIII. Rapid Response Team
XIV. Verbal and Telephone Orders
XV. Hand off Responsibility
XVI. Reconciliation
XVII. Errors
XVIII. Documentation and Spoken Communication: an Important Relationship

Self Confidence Survey on Communicating with Physicians

Question

Strongly
Disagree

Disagree

1. Speaking to physicians is easy


for me.
2. I find talking with physicians to
be a pleasant experience.
3. It is easy for me to ask for
advice from a physician.
4. The thought of speaking with
physicians causes me anxiety.
5. I feel confident in my ability to
effectively communicate with
physicians regarding the care of
my patient.
6. I feel comfortable questioning a
physicians order if I feel I need
clarification or its
inappropriate.
7. I have what it takes to
effectively communicate with
physicians.

Excerpted from: (Shortell, S. & Rousseau, D., 1989)

Neither
Disagree
or Agree
3

Agree Strongly
Agree
4

BEFORE CALLING THE PHYSICIAN


Make sure you cant solve the issue, using your resources

Investigate patient complaints & symptoms by talking with


patient, family, & other staff to get additional info
Review orders and recent labs
Have the chart in front of you
Review flow sheets from past 2-3shifts looking for trends
Understand diagnosis-both physiologic & psychological
issues related to it
Review the latest progress notes.

ANTICIPATE questions physician might ask


write down your answers.

SPECIFICS FOR DIAGNOSIS:

Write down pertinent lab results.


I and O information ready.
Vital signs. Any trends.
Blood sugars, if applicable.
Know patient meds/times last dose given.
Family issues or concerns.

ADVOCATE for your patient! Have some ideas


and suggestions written down and
ready for physician consideration.

Physician Communication Role Playing Scenarios


1. Its 1am and your C.N.A. reports to you that Mr. Colemans urine output for the last 12
hours is 100cc. He does not have a history of kidney disease. You go into assess him and
his bladder is distended and he is very uncomfortable. Its now 1:30 in the morning and
you need an order for a Foley catheter. You call the physician and report your findings:
Nurse:
- The patients output is 100cc for the last 12 hours
- His bladder is distended and the patient is uncomfortable
Physician:
- I cant believe you are telling me this at 1:30 in the morning
- Why wasnt I notified of this earlier?
- I wish you would get it together!
2. Your patients B/P is 75/45. You call the physician to inform him. He wants to know:
Physician:
- What has his pressure been running?
Nurse:
- HOLD ON.(goes to look in computer)
Nurse:
- Its been low for the last 24 hours
Physician:
- What is doing on the monitor?
Nurse:
- HOLD ON(goes to look in chart)
Nurse:
- Sinus brady I think.
Physician:
- What meds did he receive this morning?
Nurse:
- HOLD ON..Physician hangs up
Written Simulation Case Scenario-example
1. You have had a prior difficult situation with a particular physician. You have to speak to
him/her regarding their patients status. You are very apprehensive and nervous. How
will you handle the situation?

Course Evaluation

TOPIC: _______________________________

DATE______________________

Using the scale below, please circle one response for each question that best describes how you feel about the
program presented.
1 = Poor

2 = Fair

3 = Good

4 = Very Good

1.

The program met the stated objectives

2.
3.

The subject matter was current, accurate and applicable to my needs.


Overall, the speaker
Was knowledgeable about the subject (a)
Used effective teaching methods (b)
Presented material in an understandable manner (c)
Managed the time well (d)
If the speaker needs to improve in any of the above areas, please indicate
which one(s) by circling the letters a,b,c,d.

4.

5 = Excellent

VG

No

1.
2.

This course supports PMCs mission to create Healing experiences for everyone all the time.
Was the room/facilities adequate to provide a good learning environment?

COMMENTS:
3.

Topics you would like to see presented at future programs:

4.

Additional comments:

Ye