Table 3.
Contextual Dimensions of Communication with Representative Quotes
| Dimensions | Theme | Representative Quotes |
|---|---|---|
| Organizational complexity | Differences in workflows within and across provider types. |
“Sometimes they are [nurses] busy and so our rounding…you know, maybe it’s during the hour where they have to administer the morning medications. There’s conflicts during that timing.” - Physician, site 3 “I usually write down the physician’s name and their number, and depending upon who it is, I have some idea of when they might be here or not. So say if it’s going to be the oncologists, Dr. X I know comes in early… If it’s one of the hospitalists, they could be rounding any time…” -Nurse, site 4 |
| Cognitive load | Nurse participation in rounds decreases nurse-to-physician pages later in the day. | “Now, Dr. X…does call us [for rounds]. Because he [does not] want to be paged.” - Nurse, site 2 |
| Nurses remind doctors of additional information and forgotten orders. | “…I’ll see 4, 5 patients one time... Sometimes I might forget to order those things…So they [nurses] call me, ‘you said this thing,’ but I did not order so far, so that helps me a lot.” - Physician, site 4 | |
| Patients play a role in reducing or contributing to cognitive load. |
“Or sometimes, if I have not seen them [physicians], I’ll ask the patient ‘has…your doctor rounded today?’ ‘Oh yeah, they were in.’” – Nurse, Site 4 “I learn a lot of stuff from my patients.” – Nurse, site 3. |
|
| Social context | Physicians’ higher social status allows them to include or exclude nurses during rounds. |
“We try as best we can to get the nurse. .. to be present when the patient is being either seen or we are discussing during rounds.” – Physician, Site 3 “Yeah, sometimes you go in with the team when they are rounding, and they’ll look at you like why are you standing there. Are we in your way, and you are like no, I just want to be on the same page.” – Nurse, site 2 “But there’s a few that try to walk around and avoid you at all costs, because they are like, ‘well I have not even seen the patient yet, so I do not even wanna listen to you.’” – Nurse, site 1 |