Communication between Dutch community nurses and general practitioners lacks structure: An explorative mixed methods study 

Abstract

Background

Community nurses and general practitioners evaluate their patient-related communication to be poor. However, their actual communication has hardly been investigated and specific strategies for improvement are unclear.

Objectives

To explore actual community nurse-general practitioner communication in primary care and gain insights into communication style, and conversation structure and their determinants.

Methods

A mixed-methods design was applied. Telephone conversations between community nurses and general practitioners in the Netherlands were recorded and transcribed verbatim. We measured structure and the duration of their conversations, and community nurses’ self-confidence towards general practitioners and their trust in and familiarity with the conversation partner. A thematic analysis was applied to the transcripts of the conversations. Correlations between these determinants were calculated using Spearman’s correlation coefficient.

Results

The 18 community nurses recorded 23 conversations with general practitioners. Qualitative analysis revealed that many conversations lacked structure and conciseness, i.e. the nurses started conversations without a clearly articulated question and did not provide adequate background information. The mean duration of their conversations with doctors was 8.8 min. Community nurses with higher self-confidence towards doctors communicated in a more structured way (p = 0.01) and general practitioners were more satisfied about the conversations (p = 0.01).

Conclusion

This exploratory study of actual community nurse-doctor telephone conversations in primary care identified communication structure and nurse self-confidence towards general practitioners as key targets for the improvement of interprofessional communication, which may increase the effectiveness of community nurse-general practitioner collaboration.

Keywords:

• Communication
• integrated care
• general practice/family medicine
• geriatrics/multimorbidity
• qualitative designs and methods

Acknowledgements

The authors would like to thank Daan van Osta (DO) for his efforts related to the data acquisition and rating of telephone recordings and Leny Theunisse (LT) for leading the focus group interviews.

Ethical approval

According to the local ethical committee, this study could be carried out without formal ethical approval (File number CMO: 2016-2604).

Disclosure statement

The authors report no conflicts of interest.

BOX 1.  

• Community Nurses and General Practitioners in the Netherlands [24,25].

• Community Nurses are educated with a Bachelor of Science degree and perform a variety of nursing roles in patient homes. Their tasks focus on four care categories: prevention of illness, care for the chronically ill, patient recovery after illness or hospitalisation, and terminal care. They are employed by homecare organisations that operate in a regulated market system with several nursing teams working in the same region or community.

• General Practitioners (GPs) are educated with a Master of Science degree and act as ‘gatekeepers’ for medical care. GPs are responsible for the coordination of care for chronic conditions, such as diabetes, COPD, and cardiovascular risk management, and mental healthcare. Generally, minor problems are treated within the GP practice while more severe cases are referred to specialised care. Dutch GPs are generally non-interventionist, which is reflected in low prescription and referral rates.

Additional information

Funding

This research project was funded by Gieskes Strijbis fonds and ZonMw [project number: 633300005].