Contextual Barriers to Communication Between Physicians and Nurses About Appropriate Catheter Use

doi:10.4037/ajcc2019372

. 2019 Jul;28(4):290-298.

doi: 10.4037/ajcc2019372.

Contextual Barriers to Communication Between Physicians and Nurses About Appropriate Catheter Use

Milisa Manojlovich¹, Jessica M Ameling², Jane Forman², Samantha Judkins², Martha Quinn², Jennifer Meddings²

Affiliations

¹ Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System. mmanojlo@umich.edu.
² Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System.

PMID: 31263012
PMCID: PMC6760297
DOI: 10.4037/ajcc2019372

Contextual Barriers to Communication Between Physicians and Nurses About Appropriate Catheter Use

Milisa Manojlovich et al. Am J Crit Care. 2019 Jul.

. 2019 Jul;28(4):290-298.

doi: 10.4037/ajcc2019372.

Authors

Milisa Manojlovich¹, Jessica M Ameling², Jane Forman², Samantha Judkins², Martha Quinn², Jennifer Meddings²

Affiliations

¹ Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System. mmanojlo@umich.edu.
² Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System.

PMID: 31263012
PMCID: PMC6760297
DOI: 10.4037/ajcc2019372

Abstract

Background: Indwelling urinary and vascular catheters are a common cause of health care-associated infections. Interventions designed to reduce catheter use can be ineffective if they are not integrated into the workflow and communication streams of busy clinicians.

Objectives: To characterize communication barriers between physicians and nurses and to understand how these barriers affect appropriate use and removal of indwelling urinary and vascular catheters.

Methods: Individual and small-group semistructured interviews were conducted with physicians and nurses in a progressive care unit of an academic hospital. Common themes were identified, analyzed, and then organized using a conceptual framework of contextual barriers to communication: organizational, cognitive, and social complexity.

Results: Several barriers to communication between physicians and nurses contributed to inappropriate use and delayed removal of catheters. Workflow misalignment between clinicians was a barrier associated with organizational complexity, issues with electronic medical records and pagers were associated with cognitive complexity, and strained relationships between clinicians and rigid hierarchies were associated with social complexity.

Conclusions: Communication is contextual, and improving physician-nurse communication about appropriate catheter use may require innovations that address the identified contextual barriers.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr. Meddings has reported receiving honoraria for lectures and teaching related to prevention and value-based purchasing policies involving catheterassociated urinary tract infection. The remaining authors report no conflicts of interest.

Figures

**Figure 2:**
Communication Barriers in Three Contextual Dimensions

See this image and copyright information in PMC

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References

1. Apisarnthanarak A, Rutjanawech S, Wichansawakun S, et al. Initial inappropriate urinary catheters use in a tertiary-care center: incidence, risk factors, and outcomes. Am J Infect Control. 2007;35(9):594–599. doi:10.1016/j.ajic.2006.11.007. - DOI - PubMed
1. Fakih MG, Watson SR, Greene MT, et al. Reducing Inappropriate Urinary Catheter Use: A Statewide Effort. Arch Intern Med. January 2012:1–6. doi :10.1001/archinternmed.2011.627. - DOI - PMC - PubMed
1. Gokula RRM, Hickner JA, Smith MA. Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. Am J Infect Control. 2004;32(4):196–199. doi:10.1016/j.ajic.2003.08.007. - DOI - PubMed
1. Climo M, Diekema D, Warren DK, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: Results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol. 2003;24(12):942–945. - PubMed
1. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med. 2014;370:1198–1208. doi:10.1056/NEJMoa1306801. - DOI - PMC - PubMed

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[1] Apisarnthanarak A, Rutjanawech S, Wichansawakun S, et al. Initial inappropriate urinary catheters use in a tertiary-care center: incidence, risk factors, and outcomes. Am J Infect Control. 2007;35(9):594–599. doi:10.1016/j.ajic.2006.11.007. - DOI - PubMed

[2] Apisarnthanarak A, Rutjanawech S, Wichansawakun S, et al. Initial inappropriate urinary catheters use in a tertiary-care center: incidence, risk factors, and outcomes. Am J Infect Control. 2007;35(9):594–599. doi:10.1016/j.ajic.2006.11.007. - DOI - PubMed

[3] Fakih MG, Watson SR, Greene MT, et al. Reducing Inappropriate Urinary Catheter Use: A Statewide Effort. Arch Intern Med. January 2012:1–6. doi :10.1001/archinternmed.2011.627. - DOI - PMC - PubMed

[4] Fakih MG, Watson SR, Greene MT, et al. Reducing Inappropriate Urinary Catheter Use: A Statewide Effort. Arch Intern Med. January 2012:1–6. doi :10.1001/archinternmed.2011.627. - DOI - PMC - PubMed

[5] Gokula RRM, Hickner JA, Smith MA. Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. Am J Infect Control. 2004;32(4):196–199. doi:10.1016/j.ajic.2003.08.007. - DOI - PubMed

[6] Gokula RRM, Hickner JA, Smith MA. Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. Am J Infect Control. 2004;32(4):196–199. doi:10.1016/j.ajic.2003.08.007. - DOI - PubMed

[7] Climo M, Diekema D, Warren DK, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: Results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol. 2003;24(12):942–945. - PubMed

[8] Climo M, Diekema D, Warren DK, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: Results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol. 2003;24(12):942–945. - PubMed

[9] Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med. 2014;370:1198–1208. doi:10.1056/NEJMoa1306801. - DOI - PMC - PubMed

[10] Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med. 2014;370:1198–1208. doi:10.1056/NEJMoa1306801. - DOI - PMC - PubMed

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Contextual Barriers to Communication Between Physicians and Nurses About Appropriate Catheter Use

Affiliations

Contextual Barriers to Communication Between Physicians and Nurses About Appropriate Catheter Use

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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Publication types

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