Perceptions of Nurses and Physicians of Their Communication at Night About Intensive Care Patients' Pain, Agitation, and Delirium

Abstract

Background Ineffective daytime nurse-physician communication in intensive care adversely affects patients' outcomes. Nurses' and physicians' communications and perceptions of this communication at night are unknown. Objectives To determine perceptions of nurses and physicians of their communication with each other at night in the intensive care unit about patients' pain, agitation, and delirium and to develop a qualitative survey instrument to investigate this topic. Methods A validated survey was distributed to nighttime nurses and physicians in 2 medical intensive care units. Results Most nurses (30/45; 67%) and physicians (56/75; 75%) responded. Nurses (35%) and physicians (31%) thought that a similar proportion of communications was related to pain, agitation, and delirium. Most nurses (70%) and physicians (80%) agreed that nurses used good judgment when paging physicians at night because of patients' pain, agitation, and delirium, but physicians (72%) were more likely than nurses (48%) to think that these pages did not portray the situation accurately (P = .004). For many text pages, physicians attributed a heightened level of urgency more often than did the nurses who sent the texts. Nurses often thought that physicians did not appreciate the urgency (33%) or complexity (33%) of the situations the nurses communicated via pages. More physicians (41%) than nurses (14%) agreed that nurses exceeded medication orders for pain, agitation, and delirium before contacting a physician (P = .008). Conclusions Perceptual differences between physicians and nurses about nurse-physician communications at night regarding pain, agitation, and delirium were numerous and should be studied further. (American Journal of Critical Care. 2013;22:e49-e61) Pharmacology in Critical Careby AACN on May 9, 2018 http://ajcc.aacnjournals.org/ Downloaded from because of the fluctuation in pain, agitation, and delirium in critically ill patients, the increased focus on maintaining patients in a light (rather than deep) level of sedation and current recommendations that pain, level of sedation, and delirium be evaluated on a 24/7 basis, the number of issues related to pain, agitation, and delirium that ICU nurses working at night may have to address with the on-call physician most likely has never been greater. [20][21][22] because of these considerations, evaluating communication between ICU nurses and on-call ICU physicians at night about patients' pain, agitation, and delirium provides a good focus for estimating the overall quality of ICU nurse-physician communication at night.Although qualitative research methods are ideal for characterizing the rich, contextual, and likely complex themes that affect communication between nurses and physicians at night, because of the current lack of data on nurse-physician communications at night, we thought that the first step should be a quantitative survey that could serve as the foundation for future qualitative and interventional investigations. [23][24][25] We therefore sought to determine ...

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