It is rare to find many real-life examples of poor communication between nurse and patient in the United States because any admission of error can be grounds for a medical malpractice lawsuit. Furthermore, many theoretical examples fail to take into account the environment in which communications take place.
Poor communication between nurses and patients can have consequences for patient safety inasmuch as it can affect the quality of care and patient outcomes. However, whereas many examples of poor communication between nurse and patient focus on the nurse’s role in the communication, patients can be equally at fault for poor communication.
Examples of Poor Communication between Nurse and Patient
Many examples of poor communication between nurse and patient are theoretical, are based on events that happen overseas, or lack credibility because there is no verifiable evidence to support them. Consequently, when healthcare providers are looking at ways to improve nurse-patient communications, it is important to take the context into account.
One example of where the context is extremely relevant is in the ED – where the objective of nurses is to help keep patients alive rather than to develop a rapport or show empathy. Indeed, in real-life examples of poor communication in the ED, it is most often poor communication between healthcare providers that results in negative patient outcomes.
Additionally, one widely quoted study of nurse-patient interactions attributes poor communications to a lack of nursing staff (in Iran), cultural issues (in Ghana), and language barriers (in Malawi). Although these events can occur in the United States, they are unlikely to be on the same scale (*) and have likely already been accounted for in nurse staffing.
(*) Malawi is about the size of Pennsylvania and has 18 official languages.
Real-Life Examples in Which a Healthcare Provider is at Fault
Of the few real-life examples of poor communication between nurse and patient that exist, one of the most credible is a report compiled by Harvard’s CRICO Strategies in 2015. The report analyzed 7,149 medical malpractice lawsuits closed between 2009 and 2013 in which poor communication contributed to a patient safety issue.
Of the 7,149 medical malpractice lawsuits analyzed, there is almost a 50/50 split between those which are attributable to poor provider-provider communications and those which are attributable to poor provider-patient communications. Although the report does not distinguish between nurses and other healthcare providers is clear the environment can impact the quality of communication.
- In General Medicine, 19% of provider-patient communication cases were due to inadequate education and instructions regarding medications. Analgesics and anticoagulants were the most common drugs involved.
- In Obstetrics, 8% of poor communication cases were due to language barriers and 8% due to inadequate informed consent – the former during the pregnancy stage, and the latter during the labor and delivery stages.
- Fewer than 100 cases were attributable to poor provider-patient communications in the Nursing category – the leading causes being unsympathetic response to patient complaints (16%) and inadequate patient/family education (9%).
- The most cases attributable to poor provider-patient were in the Surgery category. More than 450 cases related to inadequate informed consent (23%), while a further 250 cases resulted from unsympathetic responses to patient complaints (13%).
The report concluded that time spent developing techniques and habits to improve communication during encounters with patients and exchanges with colleagues is considerably less stressful than time spent defending care complicated by communication failures. However, is it always the healthcare provider who should be blamed for poor communication?
Why Patients Can be Equally at Fault for Poor Communication
It was mentioned previously that many examples of poor communication between nurse and patient focus on the nurse’s role in the communication. But patients can be equally at fault for poor communication due to cultural issues (see “Case 2”), anxiety and emotion of the event (see “Obstacles in therapeutic communication”), or a lack of trust.
A lack of trust is most often associated with concerns that confidential information disclosed to a nurse or other healthcare provider will not remain confidential. Unfortunately, according to HHS most recent report to Congress, in 2021 the Office for Civil Rights received 64,180 notifications of data breaches (of all sizes) affecting more than 37,500,000 individuals.
According to an earlier Ponemon report, at least 2 million US citizens are victims of medical identity theft each year – many of whom incur out-of-pocket expenses, are subsequently denied treatment, or are misdiagnosed due to inaccuracies in their medical records after treatment has been provided to someone else using their identity.
The Ponemon report claims that half of medical identity theft victims lose trust in their healthcare providers and limit how much confidential information they are willing to disclose. The connection between data quality and care quality is well documented, and therefore these examples of poor communication between nurse and patient also affect the quality of care and patient outcomes.
How Healthcare Organizations can Reduce Poor Communication between Nurse and Patient
While there are technologies such as automated workflows that can improve provider-to-provider communications, it is difficult for healthcare organizations to reduce poor communication between nurse and patient. Some of the real-life examples of poor communication between nurse and patient listed above could be addressed by better training for patient educators, but most “provider at fault” examples are due to a failure to listen – both by healthcare providers and patients.
Conversely, most “patient at fault” examples of poor communication between nurse and patient are attributable to human nature. If a patient’s culture, anxiety, or lack of trust prevents them from disclosing confidential health information, there is little healthcare organizations can do to reduce poor communication between nurse and patient – except better protect confidential health information to reduce the likelihood of a patient becoming a victim of medical identity theft.
Healthcare organizations can better protect confidential health information by complying with HIPAA, ensuring the safeguards of the Security Rule are effectively implemented, and providing adequate HIPAA training to members of the workforce. If your organization experiences challenges with better protecting confidential health information – or unsure that the measures you have implemented are sufficient to be effective – you should seek professional compliance advice.