Abstract
Purpose
Although the importance of communication skills in anesthetic practice is increasingly recognized, formal communication skills training has hitherto dealt only with limited aspects of this professional activity. We aimed to document and analyze the informally-learned communication that takes place between anesthesia personnel and patients at induction of and emergence from general anesthesia.
Methods
We adopted an ethnographic approach based principally on observation of anesthesia personnel at work in the operating theatres with subsequent analysis of observation transcripts.
Results
We noted three main styles of communication on induction, commonly combined in a single induction. In order of frequency, these were: (1) descriptive, where the anesthesiologists explained to the patient what he/she might expect to feel; (2) functional, which seemed designed to help anesthesiologists maintain physiological stability or assess the changing depth of anesthesia and (3) evocative, which referred to images or metaphors. Although the talk we have described is nominally directed at the patient, it also signifies to other members of the anesthetic team how induction is progressing. The team may also contribute to the communication behaviour depending on the context. Communication on emergence usually focused on establishing that the patient was awake.
Conclusion
Communication at induction and emergence tends to fall into specific patterns with different emphases but similar functions. This communication work is shared across the anesthetic team. Further work could usefully explore the relationship between communication styles and team performance or indicators of patient safety or well-being.
Résumé
Objectif
Ľimportance de la communication est de plus en plus reconnue en anesthésie, mais la formation structurée sur le sujet n’a porté jusqu’ici que sur des aspects limités. Nous voulions documenter et analyser la communication apprise de façon informelle et qui a cours entre le personnel ďanesthésie et les patients au moment de ľinduction et du retour à la conscience lors ďune anesthésie générale.
Méthode
Notre approche, ethnographique, était fondée sur ľobservation du personnel au travail dans les blocs opératoires et sur ľanalyse subséquente des observations transcrites.
Résultats
Lors de ľinduction, nous avons noté trois principaux styles ďinformations ordinairement combinés. En ordre de fréquences, la communication était : (1) descriptive, oò les anesthésiologistes expliquaient au patient ce qu’il pouvait s’attendre à ressentir ; (2) fonctionnelle, elle semblait organisée pour aider les anesthésiologistes à maintenir la stabilité physiologique ou à éva luer la différence de profondeur de ľanesthésie et (3) évocatrice, elle faisait appel à des images et à des métaphores. La conversation décrite était en principe dirigée vers le patient, mais elle indiquait aussi aux autres membres de ľéquipe comment ľinduction se déroulait. Dans certains contextes, ľéquipe pouvait aussi participer à la communication. Au réveil, la communication visait habituellement à démontrer que le patient était éveillé.
Conclusion
La communication lors de ľinduction et du retour à la conscience tend vers des modèles spécifiques comportant des aspects dominants qui ont toutefois des fonctions similaires. Ce travail de communication est partagé par les membres de ľéquipe ďanesthésie. Il reste à explorer la relation entre les styles de communication et la performance de ľéquipe ou les indicateurs de la sécurité ou du bien-être du patient.
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Smith, A.F., Pope, C., Goodwin, D. et al. Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence. Can J Anesth 52, 915–920 (2005). https://doi.org/10.1007/BF03022051
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DOI: https://doi.org/10.1007/BF03022051