Intensive Care Nurse Managers' Perspectives of Nurse–Patient Communication in Botswana

Purpose: The purpose of this presentation is to share with nurses and nurse managers of general wards and intensive care units how nurse managers in Botswana perceive nurse-patient communication with ventilated patients in the intensive care unit (ICU).

Methods: A qualitative research design using individual in-depth interviews and field notes was conducted with 10 purposively selected nurse managers from two ICUs. Participants took part in 20 – 30 minutes audiotaped interviews which consisted of questions that probed their perceptions of nurse-patient communication in the ICU.  Data from interviews were analyzed using qualitative thematic content analysis according to Bernard (1995). The interview text was analyzed in several steps, starting with naïve reading of texts.  The texts were divided into meaning units, statements that relate to the same central meaning and objectives of the study.

Results: Three main themes emerged from data analysis: (i) perceptions on the importance of nurse-patients communication with its subtheme: communication as the ICU nurses’ role. The nurse managers agreed that it is the nurses’ responsibility to communicate with ventilated patients. A male nurse manager;15 years managerial experience said: “We all know that these patients t really need someone to talk to because most of the time when relatives come to visit they smile (ii) challenges faced by nurses managers with subtheme: minimal communication by the nurses. The importance of communication was emphasized as basic to nursing care. However, the nurse managers acknowledged that, even though communication is essential to basic quality care it is rarely done. A female nurse manager; 4 years managerial experience said: “Most of the nurses rarely communicate with these patients”. (iii) Act of moral distress which also had 2 subthemes: stress related to minimal communication and lack of nurses trained in intensive care.  Nurse Managers advocated for training on nurse-patient communication in ICU. A female nurse manager; 4 years managerial experience stated: “… sometimes they (nurses) use signs or gestures but minimally, in some, it’s very difficult... nurses end up giving up. The nurse managers indicated that they encounter problems to motivate the nurses to communicate with ventilated patients despite their continued effort to encourage them. “Most of the nurses do communicate with the patients even despite our effort encourage them”.

Conclusion: Despite the fact that nurse managers continuously encourage the ICU nurses to communicate with ventilated patients, it is evident that nurses can easily give up on attempting and this frustrates the nurse managers in the process