TORG-MAG Vol 1 Issue 2, Dec. 2024, PP. 41-49
Authors: Olapeju Olamuyiwa¹, Zeenat Akoivo Orahachi¹, Danjuma Aliyu², Sarah Faleke Apeabu^3
1School of Post Basic Perioperative Nursing, University College Hospital, Ibadan
²Department of Perioperative Nursing, College of Nursing Sciences, Tudun Wada, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State.
³School of Post Basic Otorhinolaryngology, National Ear Care Centre, Kaduna State.
Cite this article: Olamuyiwa, O., Orahachi, Z. A., Aliyu, D., and Apeabu, S. F. (2024) ‘Communication Failure Among Perioperative Nurses in a Developing Country: A Study at University College Hospital, Ibadan, Nigeria’, TORG-MAG, Vol. 1, Issue 2, pp. 41-48. Available at: https://torgevents.org/communication-failure/

Introduction

Effective communication within interdisciplinary surgical teams operating in the perioperative setting is crucial for the seamless execution of surgical procedures worldwide. Understanding healthcare professionals’ communication patterns and identifying factors contributing to communication failure (CF) are essential steps toward enhancing patient safety and the quality of care within the perioperative environment (Herawati et al., 2018). The fast-paced and production-oriented nature of the perioperative setting, characterized by tight deadlines and intricate procedures, predisposes surgical teams to errors that jeopardize patient well-being and survival (Penprase et al., 2010).

Studies indicate that approximately one-third of sentinel events and medical errors stem from communication breakdowns (Birkmeyer et al., 2013; CRICO Strategies, 2019; Institute of Medicine et al., 1999). The interdisciplinary composition of perioperative teams, coupled with the urgent nature of patient care, heightens the risk of miscommunication (Braaf et al., 2012). Various factors, including timing, content accuracy, purpose, and audience misalignment, contribute to CF within the operating room (Arslan, 2020). Notably, high rates of information transfer failures have been observed in pre-procedural teamwork and postoperative handover processes (Nagpal et al., 2010).

Institutional factors, such as employee noncompliance with policies, physicians’ misconceptions of nurses’ roles, and resource inadequacies, have been identified as determinants of CF (Isil et al., 2020). Inadequate resources for preoperative preparation, staffing shortages, excessive workloads, and individual factors like disruptive behavior and anger management further exacerbate communication challenges (Arslan, 2020).

Moreover, adherence to standard practices regarding sterilization, aseptic techniques, and patient verification can mitigate a significant portion of surgery-related iatrogenic complications (Boluwaji et al., 2016). Delay, inefficiency, patient discomfort, procedural errors, and team tension are among the consequences of CF (Işl et al., 2020). Environmental factors such as noise, lack of privacy, and essential amenities also contribute to communication breakdowns (Işl et al., 2020).

Studies conducted in Nigeria highlight additional challenges within the operating room environment, including information gaps, structural barriers, disruptive behaviors, and fragmented communication (Mfuh et al., 2020). These challenges, coupled with varying levels of team member experience and workload pressures, further complicate communication dynamics.

The repercussions of CF encompass patient mortality, wrong-site surgeries, cancellations, unnecessary interventions, and compromised patient care (Mller et al., 2015). Importantly, the severity of perioperative CF correlates with intra-operative violence, staff retention issues, diminished patient care, and threats to patient safety (Arslan, 2020). CF can manifest at any stage of surgical treatment, underscoring the need for comprehensive interventions to address communication challenges within perioperative settings (Braaf et al., 2011; Nagpal et al., 2010; The Joint Commission National Patient Safety Goals Effective 2019).

Procedure for Data Collection 

Questionnaires were administered by the researcher with permission from the Assistant Director of Nursing overseeing the operating theatre. Eighty copies of the questionnaire were distributed randomly to PONs on duty during various visits, after obtaining verbal consent. Completed questionnaires were retrieved following sufficient time allowance for respondents to complete them. Data collection took place between October and November 2020.

Method of Data Analysis 

Data were analyzed using Statistical Package for Social Science (SPSS) version 22. Analysis involved presenting results using simple frequency and percentage tables, charts, means, and standard deviations. The Chi-squared test (chi-square) was employed to assess the statistical significance of the association between years of experience and communication management (p < 0.05).

Ethical Consideration 

Ethical approval was obtained from the UI/UCH Ethics Committee of University College Hospital, Ibadan, with approval number UI/EC/20/0389.

RESULTS

Table 1: Socio-demographic data (n=80)

Variables	Frequency	Percentage
Age
20-29	24	30.0
30-39	17	21.25
40-49	29	36.25
50 years above	10	12.5
Gender
Male	15	18.75
Female	65	81.25
Religion
Christianity	70	87.5
Islam	10	12.5
Others	0	0.0
Marital status
Married	59	73.75
Single	21	12.5
Divorced	0	0.0
Widowed	0	0.0
Professional status
DNS	1	1.25
ADNS	15	18.75
CNO	32	40.0
ACNO	2	2.5
SNO	7	8.75
NO I	7	8.75
NO II	16	20.0
Years of work experience
1-10	40	50.0
11-20	28	35.0
21-30	10	12.5
31 years above	2	2.5
Highest educational level
RPON	34	42.5
BNSc.	42	52.5
MSc.	4	5.0
PhD	0	0.0

Table 1 above shows that the mean age of the respondents is 37.37±9.98 (SD) years with more than one-third of respondents (36.3%) were between the ages 40-49 years. Majority of the respondents are females 65 (81.5%) and 70 (87.5%) are Christians with 10 (12.5%). The married are 59 (73.8%) and half of the respondents had 1-10 years of work experience with the mean year of work experience of 12.4±8.3 (SD). A closer inspection of this table shows that more than a third (32) (40%) of the respondents are chief nursing officers, and more than half (42) (52.5%) possess the first-degree certificate in nursing. The findings of this study imply that the majority of the participants were in their mid-30s and still within their youthful years of service.

Table 2: Participants Understanding of Communication Failure (n=80)

Definition of CF	Frequency	Percentage
Exchange of words	5	6.25
A way in which learned people talk to themselves	7	8.75
Message that is unintentionally misleading, ineffective or offensive	68	85.0
Insulting one another with different tribes	0	0.0

What stands out in this table 2, shows that the vast majority 68(85%) of the respondents understand CF as a message that is unintentionally misleading, ineffective, or offensive. It is apparent from this finding that respondents have good knowledge on CF.

Table 3: Types of Communication Methods Employed by Perioperative Nurses

Statements	*SA (%)	*A (%)	*N (%)	*D (%)	*SD(%)
PONs method of communication is poor/ confrontational	20(25.0)	44(55.0)	10(12.5)	6(7.5)	0(0.0)
The method of communicating that enhances effective communication is a non-verbal method	35(43.75)	44(55.0)	0(0.0)	1(1.25)	0(0.0)
Active listening is the most appropriate method to achieve effective communication	30(37.5)	45(56.0)	5(6.25)	0(0.0)	0(0.0)
Communication is achieved if there is a feedback	27(33.75)	34(42.5)	6(7.5)	10(12.5)	3(3.75)
Face to face interaction promotes good understanding among PONs	23(28.75)	41(51.25)	10(12.5)	6(7.5)	0(0.0)

*SA= Stronglyagreed; *A = Agreed; *N= Neutral; *D=Disagreed; *SD= Strongly Disagreed

As shown in Table 3, the interesting data revealed that 64 (80%) of the respondents agreed that the method of communication used by PONs is relatively poor and confrontational, and 79 (98.8%) agreed that the effective method that will enhance communication is the non-verbal method, while 75 (93.5%) reported that active listening is the most appropriate method of achieving effective communication in the operating room. Seventy-six percent of the respondent agreed that communication is achieved when there is feedback and 81 percent also agreed that face-to-face interaction promotes good understanding among PONs.

Table 4: Distributions of Causes of Communication Failures among Perioperative Nurses

Causes of Communication Failures	*SA (%)	*A (%)	*N (%)	*D (%)	*SD (%)
Prolong shifts	20(25.0)	44(55.0)	10(12.5)	6(7.5)	0(0.0)
Anger related issues	30(37.5)	45(56.25)	5(6.25)	0(0.0)	0(0.0)
Cadres in nursing	27(33.75)	34(42.5)	6(7.5)	10(12.5)	3(2.5)
Lack of personnel	23(28.75)	41(51.25)	10(12.5)	6(7.5)	0(0.0)
Excessive workload	31(38.75)	46(57.5)	0(0.0)	2(2.5)	1(1.25)
Interruptions during handing over	26(32.5)	50(62.5)	1(1.25)	2(2.5)	1(1.25)

*SA= Stronglyagreed; *A = Agreed; *N= Neutral; *D=Disagreed; *SD= Strongly Disagreed

When asked on the causes of CF among the PONs, 80% of the respondents reported prolong shift, anger-related issues (93.7%), cadres in nursing (76.2%), lack of personnel (80%), excessive workloads (96.3%) and interruptions during handing over (95%) were reported as the causes of CF among PONs as showed in table 4.

Table 5: Non-compliance with hospital policies or procedures is a cause of communication failure

Variables	Frequency	Percentage
Yes	63	78.7
No	17	21.3
Total	80	100

Table 3 shows that 63(78.7%) of the PONs agreed that non-compliance with hospital policy or procedures is a cause of CF and 17(21.3%) disagreed with this opinion.

Figure 1: Describe which of the perioperative phases does communication failure occurs most often?

In Fig. 1 there is a clear trend that majority 69(86.3%) of the respondents reported that CF occurs in all the three phases of surgical care to patients.

Table 6: Ways of improving effective Communication among Perioperative Nurses

Statements	*SA (%)	*A (%)	*N (%)	*D (%)	*SD (%)
Reducing workload	52(65.0)	22(27.5)	5(6.25)	0(0.0)	1(1.25)
Employing more personnel	38(47.5)	40(50.0)	1(1.25)	0(0.0)	1(1.25)
Use of appropriate media/methods	23(28.75)	55(43.0)	1(1.25)	0(0.0)	1(1.25)
Use of standard protocols	38(47.5)	42(52.5)	0(0.0)	0(0.0)	0(0.0)
Reward good performance of staffs	43(53.75)	36(45.0)	0(0.0)	0(0.0)	0(0.0)
Avoid noisy environment	48(60.0)	32(40.0)	0(0.0)	0(0.0)	0(0.0)
Utilizing cultural competency	27(33.75)	44(55.0)	9(11.25)	0(0.0)	0(0.0)
Understanding personal differences	34(42.5)	45(56.25)	1(1.25)	0(0.0)	0(0.0)
Avoiding language barrier	50(62.5)	30(31.5)	0(0.0)	0(0.0)	0(0.0)
Utilizing emotional intelligence	48(60.0)	31(38.75)	1(1.25)	0(0.0)	0(0.0)
Preventing stress and burnouts	52(65.0)	27(33.75)	1(1.25)	0(0.0)	0(0.0)

In table 6 above, it was established that, reducing the workload (92.5%), employing more personnel (97.5%), use of appropriate media methods (71.7%), use of standard protocols (100%), reward the good performance of staff (98.7%) avoiding noisy environment (100%), utilizing cultural competency (88.7%), understanding personal differences (98.7%), avoiding language barrier (94%), preventing stress and burnouts (98.7%) were all reported ways of improving effective communication among PONs.

Table 7: Socio-Demographic Data Associated with Participants Knowledge

VARIABLE	*A	*G	*PS	*YE	*LE
	X2      P-value	X2      P-value	X2      P-value	X2      P-value	X2      P-value
Knowledge of CF	6.109   .729	3.802 .284	6.542   .257	5.218    .815	7.425    .283
*A= Age; *G=Gender; *PS= Professional  Status; *YE= Years of Experience; *LE= Level of Education

Table 7 presents some factors associated with knowledge of CF and age (0.729), gender (0.284), professional status (0.257), years of experience (0.815) and level of education (0.283) has no significant associated with participants’ knowledge on CF.

Discussion of Findings

The study revealed that the mean age of respondents was 36.3 years, with a notable proportion aged between 40 and 49 years. Furthermore, the majority of participants were female, married, and identified as Christians. These findings align with previous research by Boluwaji et al. (2016), which reported similar demographic patterns among perioperative nurses. However, disparities were noted in comparison to the study by Mfuh et al. (2020), highlighting variations in participant demographics across different healthcare settings.

Consistent with prior studies, the majority of participants demonstrated a good understanding of CF. This finding is consistent with the findings of Boluwaji et al. (2016) and Danjuma et al. (2015), indicating a high level of awareness among perioperative nurses regarding safety practices and preoperative patient visits.

The study identified perceived shortcomings in the methods of communication utilized by perioperative nurses, with a significant proportion describing communication as poor and confrontational. Interestingly, non-verbal methods were regarded as more effective, and active listening was highlighted as crucial for achieving effective communication. These findings contrast with those of Norton and Rangel (2010), suggesting geographical variations in communication dynamics within healthcare teams.

Various factors contributing to CF were identified by participants, including prolonged shifts, anger-related issues, staffing shortages, excessive workloads, and interruptions during handovers. These findings echo previous research by Greenberg et al. (2007) and Mazzocco et al. (2009), underscoring the detrimental impact of poor communication on patient safety and healthcare outcomes.

Respondents proposed several strategies to enhance communication effectiveness among perioperative nurses, including workload reduction, increased staffing, adherence to standard protocols, and the provision of rewards for exemplary performance. These recommendations align with the findings of Rangel (2010) and underscore the importance of addressing organizational and environmental factors to foster a culture of effective communication in healthcare settings.

Interestingly, socio-demographic and professional factors such as age, gender, professional status, years of experience, and level of education did not emerge as significant predictors of participants’ knowledge on CF. These findings mirror those of Aliyu et al. (2015) and Boluwaji et al. (2016), suggesting that demographic characteristics may not substantially influence perioperative nurses’ understanding of patient safety and the practice of preoperative nurses visit.

Largely, the study contributes to the growing body of literature on communication dynamics within perioperative settings, highlighting the need for targeted interventions to address communication challenges and enhance patient safety.

Limitations of the Study

This research was confined to a single facility, limiting the generalizability of its findings to perioperative nurses (PONs) across Nigeria. Moreover, the study’s use of a simple random sampling technique may have introduced selection bias, potentially affecting the representativeness of the sample.

Implications for Perioperative Nursing Practice and Education

The literature review and study findings underscore the prevalence of communication failure (CF) among PONs, emphasizing the importance of implementing suggested strategies for enhancing effective communication. Therefore, there is a pressing need for standardized national job descriptions, clear standard operating procedures, and streamlined workflows throughout the perioperative continuum in Nigeria. Additionally, fostering a culture of self-reflection among PONs on their practice is essential.

Furthermore, the study highlights the critical role of perioperative nurse educators in educating both students and new staff members on the significance of effective team communication within perioperative settings. Hospital policies and procedures governing the scope and practice of surgical team members, along with regular briefings and debriefings, should be rigorously enforced to foster team cohesion and cultivate a positive organizational and departmental climate. However, further research is warranted to ascertain any temporal changes in the dynamics of communication within perioperative teams.

Conclusion

The study revealed that the majority of perioperative nurses (PONs) were in their mid-30s, indicating a youthful demographic within the profession. Despite this, the findings demonstrated that PONs generally possessed a good understanding of communication failure (CF). However, the method of communication employed by PONs was often described as poor and confrontational, highlighting the need for improvement. Effective communication, as perceived by participants, was achieved through feedback and non-verbal cues.

Various factors contributing to CF among PONs were identified, including prolonged shifts, anger-related issues, staffing shortages, and excessive workloads. Conversely, several strategies were suggested to enhance effective communication among PONs, such as workload reduction, increased staffing, adherence to standard protocols, and cultural competency.

Recommendations

Based on the study findings, it is recommended that perioperative nurses prioritize effective communication with other surgical team members to enhance patient safety in operating theatres. Furthermore, the implementation of Mandatory Continuous Professional Education Programs (MCPDP), training workshops, and annual conferences for PONs in Nigeria is crucial to keeping them updated on emerging trends in perioperative nursing practice.

Additionally, future research endeavours should consider conducting qualitative studies with larger sample sizes to gain a deeper understanding of the factors influencing effective communication among PONs. This will facilitate the development of targeted interventions to address communication challenges and improve patient outcomes in perioperative settings.

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