Chapter 1


Appropriate communication between health care providers and patient’s family is a vital element of health management. In the care setting, nurses are a crucial component in clinical care delivery and provide a close link between the family and treatment team. Because they are the most accessible asset in clinical setting, nurses offer a bridge for communication with patient’s families (Anderson et al­., 2020). Nurses are frequently tasked with the responsibility of helping family members and coping with their concerns and anxiety. Thus, an ICU nurse’s relationships with patients and their families are exceptionally demanding and intensive, serving as confidante, educator, advocate, cultural liaison, and interpreter (Anderson et al­., 2020). Family members assess their satisfaction with their loved one’s ICU hospitalization depending on the communication quality they experienced, opposed to the quality of care provided (Achury et al., 2015). While family members expressed high levels of satisfaction with the ICU’s treatment and confidence in the health care team, studies have showed they expressed dissatisfaction with the communication, information exchange, and emotional support they received (Carlson et al., 2015).

In the hospital setting, communication faces several obstacles, including the necessity to deliver devastating news. Communicating information about care can be distressing for family members and professional personnel (Edward et al., 2020). However, transactional model of communication in the ICU environment offers a model for communication that includes a two-way interaction between the patient and families, which will be discussed in detail in conceptual framework.

Background of the Problem

Healthcare practitioners recognize that efficient communication with the relatives of terminally ill patients is a critical component of intensive care delivery (Norouzadeh, 2020). In such contexts, nurses’ strategies, views, and sentiments in end-of-life circumstances are tied to their perspective on bereavement and their interactions with others and their surrounding (Norouzadeh, 2020). Effective communication is a critical component of nurses’ responsibilities when giving great care to patients’ families. Effective collaborative care requires communication with the family to offer expressive and divine sustenance as well as facilitate effective family-centered decision-making (Norouzadeh, 2020). Nelson et al. (2010) proposed that attempts to enhance palliative care quality should prioritize the procedures and areas that are most useful to the family. One way is communicating with the family regarding the client’s health, interventions, and prediction in a apt, continuous, clear, comprehensive, and empathetic way.

Effectively communicating and informing a dying patient’s family on the treatment course can boosts the satisfaction level and prepares them for quality bereavement and make appropriate decisions (Norouzadeh, 2020). By utilizing excellent communication, nurses may alleviate the family’s psychological stress. Ineffective communication, on the other hand, contributes to family conflict, pain, anxiety, sadness, and difficult bereavement among critical patients’ families (Jo et al., 2019). According to Johannesdottir and Hjorleifsdottir (2018), family’s encounters with appropriate communication and proper interaction during end-of-life care are an essential element for effective interpersonal contact with health professionals.

Problem Statement

The COVID-19 pandemic-related healthcare protocols and visiting restrictions have caused tremendous changes in the ability to establish communication among healthcare stakeholders, including patients, their families, and medical professionals. Emerging research on communication between families and healthcare providers concerning the end f life because o COVID-19 highlights the significance of effective communication. During the pandemic, the number of visitors and the time spent in hospitals were restricted, depriving relatives of ample time with their patients. A common outcome of strained communication among caregivers is profound stress, which affects the quality of grief. Thus, the issue at hand about strained communication between families and HCPs compounded by the visiting restrictions is worth investigating to understand how communication and collaboration with healthcare workers influences outcomes and interactions with families of patients in ICU with COVID-19.

Research Objective

The objective of this qualitative narrative analysis is exploring the experience of communication between five nurses, COVID-19 patients, and families in the Eastern New York region. Research indicates that ineffective communication among care units affects the outcomes and perceptions of services and the facility (Amoah et al., 2019). There is a persistent barrier to efficient interaction and communication between care providers and clients which frequently leads to transpersonal miscommunication among patients, caregivers, and nurses (Yoo et al., 2020).

Other communication-related barriers may include inadequate communication skills, and patients’ unable to convey messages owing to their health status, particularly in intensive care units and hospices (Madula et al., 2020). Madula et al. (2020) demonstrated in a study of maternity care that linguistic blockades impeded smooth communication between healthcare workers and expecting parents. According to a research participant, although some nurses are empathetic and communicate with patients well, others encountered difficulties using Chitumbuka language to communicate with patients. These communication challenges significantly affected interaction between nurses and the service users (Madula et al., 2020).

Population and Sample

Within a research study, the population refers to the entire collection of individuals to be studied, or, more accurately, about which conclusions are sought (Majid, 2018). A sample in a research study is used to represent the entire population from which the sample was drawn (Majid, 2018).  For this research, a sample of five nurses and 13 family members of patients hospitalized due to COVID-19 will be field tested to explore strategies within effective communication.

Significance of the Study

By effectively communicating, nurses can provide new information, understand patients’ reactions to wellness concerns, evaluate care opportunities, support decision making, and facilitate the welfare of their patients (Yoo et al., 2020). In addition, among the most critical aspects of improving patient safety and quality of care is effective communication with clients and their treatment partners (Yoo et al., 2020).

An international study identified unexpected difficulties that influenced the interaction of healthcare professionals and families of patients in intensive care settings (Yoo et al., 2020).  Patients in critical units and support devices require constant monitoring and nurses maintain their health and well-being. The nurses working in such environments must communicate with the patients’ families and caregivers and make timely decisions based on their expertise, including communicating effectively within a healthcare system to determine the patient’s needs and their families (Kwame & Petruka, 2021). Patient-centered care and effective communication may be affected by a nurse manager’s management style. Several management styles have been identified among nursing managers, which may facilitate or hinder the delivery of patient-centered care (Kwame & Petruka, 2021). In addition, if nurses’ managers fail to take care of the mental health needs of their employees, this may harm the way nurses attend to their patients’ care needs (Yoo et al., 2020). Observations have shown that nurses’ communication with patients is adversely affected if their nurse manager is not present on-site and is unsupportive or insensitive to their needs.

Nature of the Study

This study uses qualitative narrative inquiry to explore nursing communication experiences from participants’ perspectives (Clandinin & Connelly, 2000). Narrative inquiry seeks to understand the experience of individuals by retaining an orientation to the stories that are being told (Clandinin & Connelly, 2000). Narrative investigations allow better understand the continuity and wholeness of nursing professionalization from the perspective of nurse participants by examining their accounts of their experience of effective communication from nursing leadership.

Research Questions

The research questions that guide this narrative inquiry

  • Share your experience of how the hospital has reacted to COVID-associated communication and collaboration complexities?
  • Is there anything else your institution could have done to enhance communication with families?
  • What were some communication methods used between nurses and COVID-19 patients families?
  • What challenges did nurses have to communicate with COVID-19 families?

Conceptual Framework

This study is an exploration of strategies to improve effective communication between nurses and COVID-19 patients and families. By using the transactional model of communication, three communication theories provided a conceptual framework, for this narrative inquiry: Intrapersonal, interpersonal, and transactional. While nurses intentions are treating patients and their families empathetically, when time is limited in the intensive care unit, for example, they frequently conduct one-way conversations (Farshad et al., 2021). Additionally, the typical mode of communication, including language and inflection, can occasionally be misinterpreted and seem offensive (Farshad et al., 2021). As a result, participants struggled to express their sincerity to patients and their families.

Gaining critical insights into the themes surrounding communication implores the adoption of sociological and philosophical standpoints. As detailed in Scambler’s communicative action theory, Habermas’s proposal is concept of system and lifeworld, which implies a compliment to the system and related policy. The lifeworld and system elements are critical in a contemporary setting, although we must be keen on the likelihood of systems dominating the lifeworld resulting in reification (Bernild, Missel, & Berg, 2021. This theory’s appropriateness to evaluate communication between families and healthcare providers during the pandemic is subject to numerous standardization and operational guidelines such as visiting restrictions and family members who are stakeholders in the patient’s lifeworld, where they interact in everyday lives.

Since this review dwells on communication, the specific element of Habermas’s speech act applies. Here the proponent suggests a normative idea of effective communication void of asymmetrical power relations amid the criticism for being naïve, unrealistic, and to some level, simplified, although it is worth pursuing. When applied in this review, it specifies what families of COVID-19 hospitalized patients are seeking concerning communication with medical professionals and highlights the conditions for such (Bernild, Missel, & Berg, 2021). The application of this conceptual communication framework enables us to critically analyze and understand how families experience communication and collaboration with healthcare employees in patient management in COVID-19 pandemic.

Definition of Terms

Therapeutic communication (Yoo et al., 2020), a critical constituent of care delivery, entails the application of various strategies to elicit and convey patients’ opinions and ideas, as well as to prove empathy and esteem.

Empathy – entails the ability to appreciate and feel with another person (Yoo et al., 2020).

Interpersonal communication is defined as the course by which information is conveyed and interpreted, and it is a critical factor in determining an organization’s success (Farooqi et al., 2020).

Transactional model of communication is defined as an interaction between two persons.

Assumptions, Limitations, and Delimitations

Assuming this study will be conducted in the ICU unit of a community hospital, the results of the study cannot be applied to the general context of nurses working in other medical disciplines such as the out-patient setting or other institutions that provide end of life care (EOL).

Limitations may erode the study’s credibility. Biased results are possible because the researcher works for a local healthcare organization. Participants in research must be able to express their thoughts and experiences honestly and without fear of bias. There is a possibility that information will be misreported during the interview process. The narrative inquiry method evaluates participants’ stories but does not identify any causal relationships.

The delimitations of this study pertain to the inclusion and exclusion criteria for participation in the research. This review’s sample was selected from one community local hospital in Eastern New York region. The researcher limited participants to individuals who were in the ICU unit and receiving EOL care. Because of the tiny sample size used in the community hospital, the researcher did not generalize the findings to other regions.

Chapter 1 Summary

This section includes the overview, context of the issue, a statement of the problem, and the importance of the research. Chapter 1 also includes conceptual framework, four questions, nature of the study, meanings of terms, and a summary of the chapter. Because disease is more than an individual concern, families play a critical role in the healthcare delivery, especially with the ravaging pandemic. This part explores the compounding issues and profound concerns about the prognosis and course of the illness including visiting restriction to contain the spread thus setting new frames of interaction and collaboration during in-facility care. Chapter 2 includes an in-depth review of the transactional model of communication in connection to strategies used between nurses, COVID-19 patients, and families.  Additionally, chapter 2 identifies a gap in the literature, historical content, current content, the conceptual framework, methodology literature, research design, summary, and conclusion. This part focuses on the experiences of families to COVID-19 admitted patients with regards to communication and interaction with medical professions.




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