Four physician communication styles in routine Japanese outpatient medical encounters

Physicians' Experience of Communication with Nurses related to Patient Safety: A Phenomenological Study Using the Colaizzi Method

PURPOSE

This study attempted to understand the core experiences of physicians related to communicating with nurses in Korea.

METHODS

Ten physicians who worked at four tertiary university hospitals were interviewed. Data were analyzed using the phenomenological method developed by Colaizzi.

RESULTS

The following six categories of participants' experience of communication with nurses were extracted from the analysis: (a) "Complex situations and heavy roles that cannot afford safety," (b) "Forcing a superior position in an authoritative environment," (c) "Different perspectives on patient care and difficulties in establishing relationships," (d) "Communicating key clues and receiving feedback from each other," (e) "Apathetic agreements rather than improvements," and (f) "Gradually developing mutually complementary communication."

CONCLUSION

The present findings revealed that physicians lacked an understanding about the roles and tasks of nurses. The participants engaged in mutually complementary communication with experienced nurses, obtaining desirable patient outcomes and perceived order filtering by nurses as a safety mechanism. It is important for managers to act as proactive change agents to improve communication. Furthermore, the importance and different forms of complementary communication between physicians and nurses need to be described and taught in depth with practical cases.

Cultural factors influencing Japanese nurses' assertive communication: Part 2 - hierarchy and power

Hierarchy and power characterize health-care relationships around the world, constituting a barrier to assertive communication and a risk to patient safety. This issue is more problematic and complex in countries such as Japan, where deep-seated cultural values related to hierarchy and power persist. The current paper is the second of two that present the findings from a study exploring Japanese nurses' views and experiences of how cultural values impact assertive communication for health-care professionals. We conducted semistructured interviews with 23 registered nurses, following which data were analyzed using directed content analysis. Two overarching themes emerged from the analysis: hierarchy/power and collectivism. In the present study, we focus on cultural values related to hierarchy and power, including differences in professional status, gender imbalance, seniority/generation gap, bullying, and humility/modesty. The findings from our research provide meaningful insights into how Japanese cultural values influence and constrain nurses' communication and speaking up behaviors, and can be used to inform educational programs designed to teach assertiveness skills.

Distinct communication patterns during genetic counseling for late-onset Alzheimer's risk assessment

OBJECTIVE

To identify and characterize patient-provider communication patterns during disclosure of Alzheimer's disease genetic susceptibility test results and to assess whether these patterns reflect differing models of genetic counseling.

METHODS

262 genetic counseling session audio-recordings were coded using the Roter Interactional Analysis System. Cluster analysis was used to distinguish communication patterns. Bivariate analyses were used to identify characteristics associated with the patterns.

RESULTS

Three patterns were identified: Biomedical-Provider-Teaching (40%), Biomedical-Patient-Driven (34.4%), and Psychosocial-Patient-Centered (26%). Psychosocial-Patient-Centered and Biomedical-Provider-Teaching sessions included more female participants while the Biomedical-Patient-Driven sessions included more male participants (p=0.04).

CONCLUSION

Communication patterns observed reflected the teaching model primarily, with genetic counseling models less frequently used. The emphasis on biomedical communication may potentially be at the expense of more patient-centered approaches.

PRACTICE IMPLICATIONS

To deliver more patient-centered care, providers may need to better balance the ratio of verbal exchange with their patients, as well as their educational and psychosocial discussions. The delineation of these patterns provides insights into the genetic counseling process that can be used to improve the delivery of genetic counseling care. These results can also be used in future research designed to study the association between patient-centered genetic counseling communication and improved patient outcomes.