NURSING ISSUES

Nursing Issues

Nursing

There is ample evidence of a bias favoring males as study participants in medical research, but gender bias in nursing research had not been formally studied until recently.

Communication with Patients who Doesn't Speak English as Their First Language

The importance of teaching and learning about communication with patients who do not speak English as their first languages is well established within nursing. Less emphasis is placed on learning about communicating with other health care professionals and especially communication within specialised working environments such as the operating theatre (OT).

Media reports in the United Kingdom have revealed poor outcomes for some patients who do not speak English as their first languages as a direct consequence of ineffective communication in theatre or indirectly in conjunction with personal, technical and/or organisational issues. The Bristol Royal Infirmary Inquiry investigating the high mortality rates of a paediatric surgical unit, identified that communications were "strained" and these exacerbated as a consequence of an anaesthetist who spoke out about what he observed in theatre. Many of the recommendations from the Inquiry were based on improving communication both within and outside of the OT promoting basic qualities of respect, honesty and openness between the health professionals, National Health Service management, patients who do not speak English as their first languages and the public.

There are many journal publications that provide guidance to nurses for communication in the OT. The content and number suggest that problems of communication in theatre have long been recognised. However, there is much less empirical research to support what is apparently well known. General themes are identified in this anecdotal and advisory literature targeting nurses. Reference is made to the importance of verbal and non-verbal communication in the OT with emphasis placed on active listening. There is little recognition of the unique environment in which the communication takes place or factors external to the setting that may influence the way in which participants interact. This literature also deals with stereotypes such as the overtly combative communication style of surgeons or with communication crises rather than everyday occurrences.

Importantly, the research base of communication within the OT is increasing. Two papers published by a research team in Canada are based on observational and interview data and analysed using a grounded theory approach. In the first study, Lingard et al report the following key findings:

• Patterns of communication

Observed communicative events in the OT were thematically categorised into discussions about time (patients who do not speak English as their first language cancellations, sending for the next patients who do not speak English as their first language; preparation of the theatre); resources (booking and provision of equipment; personnel); roles (responsibilities, constraints) and relationships; safety and sterility (aseptic technique) and situation control (temperature regulation, data recording activities). Although communications were complex, identifiable patterns also emerged such as the rhetoric demonstrated by surgeons when making requests of nurses. Rather than issuing a command, surgeons asked a question or made a statement to achieve their goal.

• Sites of tension

Communicative tension occurred regularly in relation ...