Emergency nurses’ communication experiences with patients and their families during the COVID-19 pandemic: A qualitative study

Elsevier

Available online 21 November 2022, 101240

International Emergency NursingAuthor links open overlay panelAbstractBackground

In the emergency department, essential information is verified primarily through communication with patients and families. Thus, an in-depth understanding of emergency nurses’ communication experiences with patients is required to facilitate the provision of effective therapeutic care.

Objective

To analyze emergency nurses’ communication experiences with patients and their families.

Methods

A qualitative descriptive design was used. Interviews were conducted with 15 nurses between 2021 and 2022. Thematic analysis was carried out. This study was conducted in accordance with the consolidated criteria for reporting qualitative studies (COREQ).

Results

Three themes were identified: transformation of communication approaches due to COVID-19, obstacles in therapeutic communication, and continuous endeavors for improved communication.

Conclusion

Emergency nurses experienced various barriers in communication with patients and their families, which were exacerbated by COVID-19. Nevertheless, nurses attempted to enhance their communication skills. Organizational support is pertinent to establishing effective communication strategies.

Introduction

Unlike nurses in other departments, emergency nurses (ENs) are required to provide care to a wide range of patients. To meet their work scope, ENs must care for both patients and their distressed families [1]. Nursing needs centered on communication, such as patient-centered nursing, communication skills, caring ability, and providing information in laypersons’ terms are important factors affecting patient satisfaction in the emergency department (ED) [2]. ENs’ communication competencies are vital, particularly when dealing with patients and families affected by a sudden deterioration of physical and psychological health [3], [4]. The importance of patient-centered clinically meaningful results in the ED, such as satisfaction of patients receiving acute treatment and their families, is being emphasized more than quality of care indicators such as length of time spent in the ED and return visits.

Section snippetsBackground

Recently, crowding in EDs has led to increased emphasis on nurses’ communication skills and cooperation with team members in uncertain and complex clinical settings [3], [6]. When critical patients are brought, ENs should be able to conduct triage collaboratively and rapidly [7], [8]. Triage in Korean EDs consists of a team of doctors and nurses or led by nurses, using the Korean Triage and Acuity Scale to evaluate symptoms such as consciousness, hemodynamic status, and degree of respiratory

Design

A qualitative descriptive design allows an in-depth analysis of an unknown phenomenon or experience [17]. Thus, this design was considered appropriate for analyzing ENs’ communication experiences. This study was conducted in accordance with the consolidated criteria for reporting qualitative studies (COREQ) [18].

Setting and participants

This study was conducted in two EDs of tertiary medical centers in South Korea. Both centers are among the largest in South Korea. Hospital A consists of 70 nurses, with 12-14 per work

Researcher background

Researcher 1 is a clinical nurse with ED work experience and Researcher 2 is an academic professor with prior experience as a clinical nurse. Both have completed postgraduate qualitative research methodology courses and participated in qualitative seminars and workshops.

Participant characteristics

The study sample comprised 15 nurses (one male and 14 females) with work experience in one of two ED tertiary hospitals. The average age was 33 years, average hospital work experience was 10.1 years, and average ED work experience was 8.9 years (Table 2). No participants dropped out.

Study results

Twenty-five codes were integrated into eight subthemes. Thereafter, the final three themes were derived (Table 3).

Theme 1: Transformation of communication approaches due to COVID-19

COVID-19 brought changes in the emergency nursing process, particularly increasing communication difficulties. Contactless communication caused several changes in the communication process.

Changes in communication process and style: ENs reported changes in emergency care priorities due to COVID-19. They had to screen patients for COVID-19 before triage; nurses used yes/no questions to elicit clear answers from the patients or their families and gradually adopted a unilateral closed

Theme 2: Obstacles in therapeutic communication

ENs recognized the importance of communication with patients and their families, and lamented the difficulties while providing emergency nursing care, particularly with establishing therapeutic communication in ED. Communication obstacles were divided into factors related to nurses and patients and their families.

Factors related to nurses: Communication differences between nurses and patients or families were observed depending on the nurses’ work experience and skill. Nurses with more

Theme 3: Continuous endeavors for improved communication

ENs understood the need to establish therapeutic communication with patients and families and find a feasible way of communicating in ED, despite limiting circumstances.

Establishing interactions with patients and their families: Despite difficulties, the nurses established emotional rapport based on mutual understanding with patients and families who frequently visited ED due to chronic diseases.

Patients who visit ED frequently with a chronic disease and their families have rapport with us. Now

Discussion

This study explored ENs communication experiences with patients and families. This discussion underscores the analyses of the derived themes.

Transformation of communication approaches due to COVID-19

The COVID-19 pandemic changed frontline ENs’ work routine, resulting in drastic communication changes with patients and families [22]. The results revealed that nurses had to screen patients for COVID-19 prior to routine triage, leading them to adopt close-ended communication to elicit accurate information. Furthermore, nurses expressed difficulty conveying verbal and non-verbal messages due to using PPE, resulting in reduced conversations with patients and families [23]. Nurses communicated

Obstacles in therapeutic communication

ENs understood the importance of communication with patients, however they experienced various obstacles. First, communication varied depending on nurses’ work experience and skills. Particularly, during emergencies, novice nurses were overwhelmed by interacting with patients and families while managing their assigned work against the backdrop of an intense and unpredictable ED environment [12]; therefore, it is essential to develop communication training tailored for ENs. Furthermore, ENs’

Continuous endeavors for improved communication

ENs built emotional rapport with patients who visited ED repeatedly due to chronic diseases. Some patients witnessed nurses’ struggles and expressed their gratitude. Building a rapport with, paying attention to, and emotionally connecting with patients can improve communication with them [12], [34]. This study found that nurses strived to understand patient needs based on their positive experiences of undergoing a communication training program. Moreover, ENs perceived communication with

Limitations

This study aimed to identify the communication experience of nurses in the ED setting of a tertiary hospital. In addition, most study participants were female, making it difficult to differentiate the experience of male nurses. Participants were also mostly senior nurses with more than five years of work experience. Thus, additional research is needed to confirm communication considering the characteristics of the region and hospital size; further, novice nurses’ communication experiences

6 Conclusions

This study provides an in-depth understanding of ENs’ communication experiences with patients and families, and the ENs’ constant endeavor to implement effective communication processes. For ENs to develop therapeutic communication with patients and families, hospital organizations and nurse managers should address the barriers underscored in this study.

Ethical Statement

The Dankook university’s Institutional Review Board approved the study (IRB no: 2021-11-034). Written consent was obtained

CRediT authorship contribution statement

Soyoung Shin: Conceptualization, Methodology, Data curation, Formal analysis, Software, Visualization, Writing – original draft. Hye Jin Yoo: Conceptualization, Methodology, Data curation, Investigation, Validation, Supervision, Writing – review & editing.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

We would like to thank Editage (www.editage.co.kr) for English language editing.

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