Indiana University-Purdue University Indianapolis (IUPUI) / Intraoperative adverse events (IAEs) due to interprofessional miscommunication
continue to occur despite implementation of surgical checklists and focused
communication trainings. Much of the previous intraoperative communication research
has focused on the content and quantity of interprofessional communication instead of its
context and quality, and current communication interventions seem to have varying levels
of engagement, effectiveness, and persistence. The purpose of this dissertation study was
to explore the psychosocial processes involved during the establishment and maintenance
of interprofessional communication surrounding IAEs or potential IAEs in the
intraoperative environment and to identify the perceived facilitators and barriers to
communication. Twenty surgical team members participated in semi-structured
interviews and described their experiences with interprofessional communication during
IAEs.
Grounded theory methodology was used to identify the central process, Testing
the Water, and two subprocesses, Reading the Room and Navigating Hierarchy. Testing
the Water describes the situational nature of interprofessional communication as surgical
team members navigate factors influencing the context and probable trajectories of
surgical cases and the perceptions of professional rights and responsibilities within
surgical teams. Participants in this study experienced Testing the Water differently based
on their professional roles and tenure; findings were organized around three emerging
groups identified as inexperienced nurses, experienced nurses, and surgeons. Interprofessional communication surrounding IAEs occurred for study participants in
fluid, iterative phases identified as 1) Recognition, 2) Reconnaissance, 3) Rallying, 4)
Reaction, and 5) Resolution. Participants recognized IAEs or potential IAEs, gathered
information through reconnaissance, rallied other team members, reacted to stabilize
patients, and resolved IAEs through individual or surgical team reflection.
Study participants reported using strategies during communication to accomplish
two psychosocial goals, preserving the flow of surgical cases, and protecting the ‘face’ of
themselves and other surgical team members. Supporting these psychosocial goals
through increased psychological safety for all surgical team members potentially leads to
more effective, timely surgical team communication. More effective interprofessional
communication facilitates the improved situational awareness, collective sensemaking,
and integrated team mental models that are critical to coordinated responses to IAEs. The
findings of this study suggest practical implications to increase the effectiveness of
interprofessional communication in the intraoperative environment.
| Identifer | oai:union.ndltd.org:IUPUI/oai:scholarworks.iupui.edu:1805/27137 |
| Date | 11 1900 |
| Creators | McNealy, Kimberly Renee |
| Contributors | Reising, Deanna L., Draucker, Claire Burke, Wonder, Amy Hagedorn, Parrish-Sprowl, John |
| Source Sets | Indiana University-Purdue University Indianapolis |
| Language | en_US |
| Detected Language | English |
| Type | Dissertation |
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