Abstract
Although communication in hospitals is held by most writers to be important, little evidence exists concerning its effectiveness between doctors and nurses, or between ward sisters and nurses. This study looks at the process of communicating instructions for patient care and attempts to identify factors which may affect the interpretation of instructions by nurses. The sample comprised 398 nurses and 30 doctors working in general medical wards and schools of nursing in four District General Hospitals in South-East England. Literature relating to the effectiveness of communication at two levels was reviewed; first, at the professional level between doctor and nurse disciplines and, second, at the personal level between nurses, with the ward sister identified as transmitter of instructions between doctors and nurses. Some factors which may affect nurses' interpretations of instructions were identified. Data collection was by means of self-completed checklists and non-participant observation. These data were analysed by hand and results subjected to tests of statistical significance. Results are presented in relation to doctors' and nurses' interpretations of three instructions, 'Up and about', 'Up in chair', and 'Bedrest'. Observational studies carried out in medical wards are reported in which sisters' instructions for particular patients are compared with the observed care and nurses' checklist categorisations of intended care for the same patients. On the basis of these data it was possible to test a number of hypotheses relating to the interpretation of instructions. Findings are discussed in relation to the effectiveness of communication in the medical wards studied. It was concluded that doctors and nurses interpreted the three instructions differently and that nurses' interpretations were affected significantly by patient diagnosis and age and by the nurses' grade. No attempt has been made to generalise the findings to other situations but a number of areas are suggested for further study.