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COMMUNICATION IN NURSING 1

Communication in Nursing

Alexa M. Smiley

University of Central Florida


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Abstract

This research paper will explore how technological advances have altered nursing

communication and the nurse-patient relationship. It will go in depth on three relevant forms of

technology, those of which consist of information technology, hands-free communication

devices, and video conferencing. There are varying opinions on the effects of technology in the

hospital setting. Some view the improvements as a way to boost efficiency and patient care,

while others see them as a barrier inhibiting direct communication. Communication is essential

in everything you do, especially in nursing because it facilitates the initial trust with the patient

and their family, and allows for any complications to be addressed effectively. This is why

nursing is known as not only a science, but an art as well, because both come into play to deliver

successful care. When technology prevents interpersonal communication, it takes away from the

art aspect of sympathizing for the patient on a human level. After considerable research, I found

that although these improvements have contributed to increased efficiency and patient care, it is

not to be forgotten that they too have also resulted in a separation between the nurse and patient.

Key Words: Nursing Communication, Technology in Nursing, Nurse-Patient Relationship,

Information Technology, Vocera’s Badge, Video Conferencing


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Nursing is a field which is constantly improving and evolving to increase the standards of

healthcare around the world. With the workforce changing, it’s important to take note on what

exactly goes into the role of the nurse. By now, there have been many advancements in

technology that must be implemented into the hospital setting and can affect various aspects of

the patients’ recovery and nurse delivery. In order to truly understand the process, I found it of

particular interest to examine the ways in which advancements in technology have impacted

communication among nurses and ultimately the nurse-patient relationships. To gain a bigger

perspective, I went in depth on three current forms of technology that have revolutionized the

medical field, those of which include information technology, hands-free communication

devices, and video conferencing.

The purpose of this research is to not only shed light for the current nurses who can

improve patient care, but also the patients who will or have been affected. Most people have

taken a trip to the hospital at some point or know people who have, so in order to keep improving

the medical field we need to investigate all perspectives. This research will benefit the patients

and their families by putting them more at ease for what goes into their stay at the hospital and

how they are being treated. Current nurses can learn from the research as well as prospective

nursing students, who can better prepare for their role as a nurse by learning from the mistakes of

today’s nurses. The findings from the study can be implemented into teaching the nursing

curriculum and make for increased patient care in the future. On a global perspective it will

change nurses’ approach to technology around the world and on a more local perspective it will

aid the nearby nurses and patients in our community.


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Background on Nursing Communications

The source in particular that stood out to me was the online article, "Communication and

Technology: Ida Orlando's Theory Applied", by Cynthia Gaudet and Maeve Howett. These

authors are both credible in the field of nursing, because they are both registered nurses. The

main argument of the article is to demonstrate that technology has led to improvement in patient

care but at the same time, it has hindered direct communication. Gaudet and Howett draw on

several studies which include the work of (Tejero's 2011), (Kharasch and Du's 2010),

(Kongsuwan and Locsin's 2011), as well as a (2010 study by Pillemer and colleagues).

Tejero's study described how nursing interventions don't necessarily affect patient outcomes but

the "interactions have a direct effect on patient satisfaction and learning" throughout their stay

(Gaudet and Howett, 2018, p. 370). For Kharasch and Du, their study showed that when nurses

were performing interviews in simulation, they ended up spending more time focused on

the computer screen than with forming actual face to face interactions. According to Kongsuwan

and Locsin's study they began by examining the perspectives of eight nurses. The result of this

being that "technology decreased the nurse's involvement with the patient and that there was a

reduction of the physical space as a result of the technology" (Gaudet and Howett, 2018, p. 371).

Another important study to highlight was with Pillemer and his colleagues in which they

observed the electronic health information system. The findings from this were that although

patients were satisfied, a quarter of them admitted that the electronic system significantly

lessened the amount of interpersonal communication they shared with the nurses. By referencing

these studies, it allows for Gaudet and Howett's theme to be evident in which although

technology increases efficiency in healthcare, "nursing must approach the use of technology

cautiously and train student nurses in the importance of communication" (371).


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Information Technology

Information Technology is known as any forms of computer systems that help store or

send information, the most common being that of laptops, phones and tablets. This form of

technology is utilized immensely in the hospital setting, not to mention within nursing. It is

commonly relied on to store the health records of patients and to retrieve them when needed to

asses a patient’s medical history or current dosages of medicine. In the article, “Relationship

between smartphone addiction of nursing department students and their communication skills”,

the authors discuss how in a 2015 study conducted by Semerci and Akgun-Kostak, “56% of

students reported that using smartphones weakened individual relationships” (Cerit, B., Bilgin,

N.C., Ak, B., 2018). It is noted that because of the high need for communication skills as a nurse,

it was surprising to find that most nursing students in the study had a negative impact from the

information technology of cell phones. On an everyday basis cell phones are used and when they

aren’t abused they positively influence the clinical setting, but in some cases can lead to an

addictive level that causes the communication skills needed for nursing to suffer. In order to

effectively care for patients, there needs to be a balance between the use of information

technology like cell phones, and the communication towards the patients. Another instance of

complications with information technology was evident in my interview with registered nurse,

Johan Koutouby. After sitting down with her, I was enlightened to hear that in her experience

over the past five years she has found it crucial to implement her use of computer technology,

while also maintaining direct contact with the patient. Koutouby claimed that in the beginning,

she often would focus on either one or the other, but that the key was to ultimately combine the

two for the most successful patient outcomes. She made it clear that the patient is the most
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important aspect and for some of her cases it was the interpersonal communication and face to

face interaction that led to their recovery. Koutouby says, “everyone reacts differently to these

situations and what matters most is how you take into account each patient’s preferences to

deliver the uttermost care for recovery”. Not everyone will respond in the same manners like

with strictly technology use or strictly direct communication, so finding the blend of both is key.

Overall, she stressed the importance of communication in nursing in order to establish a sense of

trust with her patients and to also get a better understanding of how they are progressing with

treatments. “There’s a type of connection you feel with direct communication, that forms of

technology fail to allow” she says. The take away from this is that although yes, these uses of

information technology are evident in the hospital setting, there needs to be a distinct separation

between how much is too much before the patients’ recovery starts to come into question.

Hands-Free Communication Devices

Hands-Free Communication Devices like Vocera’s Badge are another form of technology

constantly seen used by nurses. Devices like this allow for the nurse to be at another end of the

hospital but still communicate with their patients if they ring for assistance. This can be seen as

very useful since the nurses don’t necessarily need to walk all the way back to patients’ rooms to

reach them. However, in times of urgency there may be complications if the nurse decides to rely

directly on the badge to do all the work if there happens to be an emergency. It can also prevent

the patient from receiving face to face contact from the nurse, because they may think this device

will relieve them of their duty to check in on patients. In the article, “Vocera Hands-Free

Communication Improves Satisfaction for Patients, Nurses, and Physicians at DMC Huron

Valley-Sinai Hospital”, they discuss how Vocera’s Badge has increased the productivity of the
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nurse and that the nurses employed there have realized they “no longer had to stop what they

were doing to reach each other or the patient and physician directly” (Vocera). The benefits are

definitely evident when nurses are calling on other health care providers, but when the patients

come in to play it can be more of a risk factor. To combat any criticism based on that theory,

Vocera makes a point to address the additions of the “stroke team” and “code blue team” buttons

on the device that allow for all members of the team to be alerted in case of an emergency. Their

main claim from the article was that “nurses can now spend more time at bedsides doing things

that directly improve patient care, without having to leave the current patient’s bedside to assist

another patient” (Vocera).

Another form of Hands-Free Communication Devices is that of Voice Communications

Technology mentioned in the article, “Voice communications technology: healthcare provider

perceptions and satisfaction”. This article contains a survey that illustrates that “50% reported

that the quality of their communication with patients had improved with the use of voice

communications technology, attributing this to the immediacy with which they were able to

respond to patients’ requests combined with fewer interruptions in direct care activities, and 71%

said that using this technology allowed them to communicate faster with their coworkers”

(Forrester, D., Fowler, S. & Gaidemak, H., 2011). These findings show the positive aspects of

hands-free communication devices and how when the device works, it is indeed beneficial for

the workplace in most circumstances. However, it was often found that this voice

communication device resulted in common malfunctions and misunderstood the staff and

patients with accents. Due to this, it shows that the technology won’t work for everyone and

therefore the communication between the nurse and patient isn’t always guaranteed when

needed. Both Vocera’s Badge and Voice Communications Devices can help facilitate patient
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assistance but once they create a barrier between the two people, it becomes an obstacle in the

way of patient care. In the graph below Joslin and Goldberger show how the response times of

Vocera’s Badge have changed as the device continued to be used in the workplace. At first the

nurse takes longer to respond to patients, but eventually becomes more and more efficient and is

able to respond faster. This shows how hands-free communication devices may take some time

to be effectively implemented into patient care but once done, they are proven to be effective as a

result.
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Video Conferencing

Video Conferencing is another major form of technology used nowadays when patients

are either in remote destinations, suffer from a chronic illness and must stay home, or are

immobile. This is a form of telenursing in which the patient and nurse do not have direct contact

with one another because of the distance between them. Although this may be helpful in those

situations, it may also be hinder patient recovery because there’s no physical touch or direct

communication that some patients rely on. In the article, “Video Conferencing in Nursing

Education Now Includes Telepresence Robots”, video conferencing is described as “the future of

emergency medicine, providing privacy for HIV patients through virtual clinics, and bringing

patients, caregivers, and families together in spite of distance” (T. Charlotte, 2017). This shows

that there are also positive sides to video conferencing and how it provides convenience within

the work place. Rygg, Brataas and Nordtug (2018) found that “technological challenges must be

solved at an organizational level, because they can affect the communication between patient and
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health personnel”. This appears to be a major issue with the technology of today because of the

unpredictability with how each device will operate and the network connections available.

Whenever considering the use of video conferencing it’s important to consider network access,

stability and patient relationships to ensure the conference will be successful on both ends.

However, putting aside these complications, conversations through video conferencing were

found to be “more targeted and thorough than face-to-face conversations” according to the

article, “The use of videoconferencing in nursing for people in their home” (Rygg, Brataas,

Nordtug, 2018). This is partially due to the fact that video calls are scheduled and set up for

specific times, allowing for the nurse to be fully focused on the individual patient at hand. In the

hospital setting, it would be different because the nurse would be visiting several patients at a

time and the dedication to a single patient may be compromised. Depending on the patient, there

were some cases that proved a need for direct contact and others where the use of video

conferencing allowed for the promotion of self-management among patients. Since there is no

physical nurse next to you, it let patients take the information gained through the call and apply it

to their treatment. This made them feel a sense of accomplishment and even encouraged

recovery because they didn’t feel as helpless and dependent on the nurse’s physical touch (Rygg,

Brataas, Nordtug, 2018).

Results

The use of information technology, hands-free communication devices, and video

conferencing has allowed nurses and the medical field to become more advanced, accurate, and

efficient. Although they have contributed to efficiency in nursing, they have also decreased the

communication between patients and health care providers. A lack of face to face contact can
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affect each patient differently and alter the road to recovery, depending on their needs. In order

to combat the difficulties associated with advancements in technology, it’s important to assess

each patient’s situation and the resources available to facilitate recovery. These findings will in

turn help the nursing workforce of today and of the future to continue improving the field. Each

nurse utilizes technology at different levels and will adapt to each patient’s case differently

depending on how they take on their role as the nurse. The nurse-patient relationship plays a big

part in the communication involved because of the amount of trust established and how

comfortable the patient feels within the environment. Technology can either inhibit the

communication between the two by causing a barrier, or help facilitate it when either physical or

mental distance comes into play. Overall, the technological advances have revolutionized the

medical field and have allowed for improved treatment of patients. Not every innovation will

work perfectly, but in this case the productivity of technology outweighs the occasional obstacles

of communication.
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References

Cerit, B., Bilgin, N.C., Ak, B. (2018, March 14). Relationship between smartphone addiction of

nursing department students and their communication skills. Contemporary Nurse

Journal, Vol. 54, Issue 4-5. Retrieved February 12, 2019, from

https://www.tandfonline.com/doi/10.1080/10376178.2018.1448291

Forrester, D., Fowler, S. & Gaidemak, H. (2011, February). Voice communications technology:

healthcare provider perceptions and satisfaction. Official Journal of ANA, Vol.6, No.2.

Retrieved February 13, 2019, from https://www.americannursetoday.com/voice-

communications-technology-healthcare-provider-perceptions-and-satisfaction/

Gaudet, C., Howett, M. (2018). Communication and Technology: Ida Orlando’s Theory Applied.

Retrieved February 13, 2019, from

https://journals.sagepub.com/doi/pdf/10.1177/0894318418792891

Joslin, Jeremy, Goldberger, David. (2016). Use of the Vocera Communications Badge Improves

Public Safety Response Times. Retrieved April 25, 2019 from

https://www.semanticscholar.org/paper/Use-of-the-Vocera-Communications-Badge-

Improves-Joslin-Goldberger/96dd27091932808ce900857a7f26246e8d6831d5

Koutouby, Johan. Personal Interview. (2019).

Rygg, Lisbeth O., Brataas, Hildfrid V., Nordtug, Bente. (2018, October 18). Introducing

Videoconferencing on Tablet Computers in Nurse-Patient Communication: Technical and

Training Challenges. International Journal of Telemedicine & Applications. Retrieved

February 15, 2019, from


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