Difficult Communication in Nursing

PURPOSE: To describe difficult communication in nurse-patient interactions from nurses' perspectives. DESIGN: Grounded theory methodology and follow-up questionnaire. Focus groups of nurses were conducted to explore nurses' perceptions of difficult communication in nurse-patient interactions. METHODS: Using a semistructured interview script, the moderator guided six unit-based focus groups at a 220-bed, Roman Catholic, community hospital, and a recorder took field notes of the interactions. The sessions were audiotaped for transcription and analysis. Level I coding was done by the moderator and recorder after each group. Level II coding was done with the transcripts and conferral of two of the researchers. A follow-up questionnaire with a 5-point Likert scale was used to validate the 13 categories of difficult communication derived from the focus groups. FINDINGS: Five themes were identified: specific diagnoses and clinical situations, patient and family emotions, nurses' emotions, triangle of nurse-physician-patient communication, and nurse coping behaviors with difficult communication. Emotion was the core variable that made communication more difficult. CONCLUSIONS: The groups described five major themes in difficult communication. They also identified the heavy emotional component of nurse-patient communication and the difficulties arising in work relationships that complicated communication.