Factors that enable nurse-patient communication in a family planning context: a positive deviance study

Int J Nurs Stud. 2008 Oct;45(10):1411-21. doi: 10.1016/j.ijnurstu.2008.01.002. Epub 2008 Mar 4.


Background: Family planning programmes in developing countries need a better understanding of nurse-patient communication in order to improve the quality of counselling.

Objectives: To identify factors in the clinic and in the community that enable nurses and patients to communicate effectively with one another.

Design: The study explored the personal experiences of nurses and patients who communicate especially effectively during family planning consultations (so-called "positive deviants").

Setting: Sixty-four randomly selected public clinics located in East Java, Indonesia.

Participants: Seven positive deviant nurses and 32 positive deviant patients were identified from among 64 nurses and 768 patients who participated in an earlier patient coaching study. Flooding prevented 5 patients from participating in the study, reducing their number to 27.

Methods: Investigators conducted: (1) a content analysis of qualitative data collected by structured in-depth interviews and focus-group discussions (FGDs) with positive deviant nurses and patients, and (2) analyses of variance (ANOVA) of quantitative data on clinic, nurse, and patient characteristics.

Results: Positive deviant nurses identified four factors, listed in rough order of importance, that helped them communicate effectively: independent study to strengthen their knowledge and skills; communication aids; feedback from colleagues; and motivation stemming from a desire to help people, patients' appreciation, husband's support, and increased income. Positive deviant patients identified five enabling factors: motivation due to their need for a service; confidence in their own communication skills; positive feedback from nurses; belief in patients' right and responsibility to communicate with nurses; and communication aids.

Conclusions: Insights from positive deviant nurses and patients suggest that efforts to improve nurse-patient communication should go beyond conventional communication skills training. Managers should consider a mix of clinic-based interventions (such as peer feedback, communication aids, and better management of patient flow) and community-based interventions (such as patient education and mass media).

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Analysis of Variance
  • Attitude of Health Personnel*
  • Attitude to Health*
  • Audiovisual Aids
  • Clinical Competence
  • Communication*
  • Family Planning Services / education
  • Family Planning Services / organization & administration*
  • Feedback, Psychological
  • Focus Groups
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Indonesia
  • Middle Aged
  • Motivation
  • Nurse-Patient Relations*
  • Nursing Methodology Research
  • Nursing Staff / education
  • Nursing Staff / psychology*
  • Qualitative Research
  • Self Efficacy
  • Social Support
  • Surveys and Questionnaires
  • Total Quality Management