For every patient who is hospitalized, a team of clinicians seeks to improve his health in order to help discharge him or to transfer him to another facility. During a hospital stay, physicians and nurses are the two main providers who interact with each patient. Depending on the illness, pharmacists, occupational and physical therapists, social workers and a number of additional healthcare providers can be involved with the care of a patient. Healthcare has become a team endeavor, placing a high priority on proper and effective communication among those providers.
The transformation from individual to team-based collaborative practice has taken on such a significant role that in 2010, the World Health Organization (WHO) proposed a framework for how interprofessional education should move forward. The year before, the American Association of Colleges of Nursing (AACN), American Association of Colleges of Osteopathic Medicine (AACOM), American Association of College of Pharmacy (AACP), American Association of Medical Colleges (AAMC), American Dental Education Association (ADEA) and Association of Schools and Programs of Public Health (ASPPH) came together to create the Interprofessional Education Collaborative (IPEC) with a goal to improve communication for care. So what are some of the barriers to effective communication across these teams, and how can advances in technology make a difference?
Currently, when patients talk to physicians and nurses, they get complementary but not identical information from the providers. In cases with poor communication, the nurse and the doctor can provide contradictory information to the patient, and the patient needs to decide which instructions to follow. This clearly creates a problem in the communication funnel within healthcare facilities, an inefficiency that should be corrected, but the problems start within the current education system for each professional.
For instance, nurses and physicians complete advanced study to acquire state licensure. However, they are trained and licensed separately with different curricula and concentrations. While the IPEC does provide a framework to help all of the health professions recognize the scope of their practice, there are limitations to how closely the curricula can or should overlap. The goal is not to make the professions identical but to allow them to interact in a complementary and synergistic manner. Rarely will two individuals describe an illness or future care in the same way, so how can the healthcare community evaluate the effectiveness of communication?
A study by researchers including myself and published in Studies in Health Technology and Informatics examined how often physicians and nurses used similar language by evaluating 8 years of physician discharge summaries from an academic teaching hospital. A physician discharge summary is the physician’s brief note about what happened during the hospital stay, which is one part of the legal record of care. A total of 53,423 health concepts were extracted from the physician summaries using a computer program called Natural Language Processing. Term frequency was not recorded, but if a concept was used once, the term was listed. The study also compiled a separate list of nursing care terms from three different structured nursing terminologies — NANDA (nursing diagnosis), NIC (nursing interventions) and NOC (nursing outcomes) — creating a list of over 1,011 nursing terms. The research mapped the two lists of terms to a common language to compare how often physicians used nursing terms.
The results of the study showed that physicians at the hospital only used 21 percent of the nursing terms over the course of 8 years. The nursing terms only represented 0.4 percent of the terms physicians used. For example, physicians never documented the terms role relationship, growth/development, family health, community health, health system or community. This study does not state that the physicians and nurses need to use identical language, but when working on a team, the fact that almost 80 percent of nursing terms were never documented by the physician shows the divergent nature of care between the two professions. To highlight the differences, a few examples of the nursing terminology categories that physicians never documented in are listed: Role Relationship, Growth/Development, Family Health, Community Health, Health System and Community.
This study has multiple limitations. First, the research was conducted at a single hospital. Second, a computer program was used to extract the physician terms from the discharge summaries, which could introduce bias in the terms selected. A third limitation of the study is that usage was measured and not frequencies of terms, so the terms that are overlapping might be used frequently. However, the study does reveal that patients feel that the doctors and nurses talk about different things. The challenge going forward is not to make the professions equivalent, but to help the professions understand the other’s differences and strengths to provide patients with the highest quality care.
As technology provided a way to link the languages with a common vocabulary in the study, technology can help to reveal challenges and areas for growth. One benefit of mobile computing is the ability to draw on more diverse languages and larger resources than a single local computing environment. Also, with mobile devices, diverse languages can be compared directly while interacting with a patient in any environment. Additional resources and research are needed to examine the large challenge of interprofessional education and treatment to create a truly optimized healthcare environment, improving the lives of patients.
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