Physician–patient communication in single-bedded versus four-bedded hospital rooms

https://doi.org/10.1016/j.pec.2008.07.004Get rights and content

Abstract

Objective

To examine whether physician–patient communication in multi-bedded rooms differs from communication in single rooms during ward rounds.

Methods

Ward rounds in single-bedded patient rooms and ward rounds in four-bedded rooms were audiotaped and analyzed with an adapted version of MIARS. The researcher completed an observational checklist of each encounter. We measured: the duration of speech time, the types of verbal and nonverbal communication, the extent to which patients and physicians raise intimate subjects.

Results

Encounters during ward rounds in single rooms significantly took up more time than encounters in four-bedded rooms. The patients asked more questions and made more remarks in single rooms compared to four-bedded rooms. Empathic reactions of the physician were scored significantly more often in single rooms than in four-bedded rooms. No differences were observed concerning the extent to which intimate subjects were brought up.

Conclusion

This study is the first that investigated this subject. Findings suggest that single rooms contribute positively to physician–patient communication.

Practice implications

The research findings indicate the relevance of taking account of the context in which physician–patient communication takes place.

Introduction

Hospital architecture and design is changing from functional, unified and standardized hospital buildings into ‘healing environments’. A ‘healing environment’ is based on designing an environment that has therapeutic effects on patients [1], [2], [3], [4], [5], [6]. One rather new aspect of hospital architecture and design is the shift from multi-bedded patient rooms to single patient rooms, which is seen as an ultimate condition of a therapeutic environment for both patients and staff [4], [7], [8]. Although the effects of single rooms have not been studied systematically yet, ever still more hospitals choose to build single rooms [9]. Some authors have mentioned that they expect that single rooms have significance for physician–patient communication [1], [3], [10], [11]. In view of the importance of good bedside communication the introduction of single rooms raises the question: what do single patient rooms mean for the physician–patient communication on the hospital ward?

Physician–patient communication on a nursing ward generally takes place at the bedside of the patient, traditionally located in a multi-bedded hospital room. An evident question is if the presence of other patients affects the communicative behaviour of physicians and patients. Ong et al. [12] have pointed out that “Little attention has been devoted to privacy, which can be considered as a relevant aspect of the doctor–patient dyad.” According to Ong et al., physical privacy concerns the extent to which a patient is physically accessible to others. When patients share their room during hospitalization they have little privacy: one can overhear conversations and even see parts of each others body.

Despite the fact that several authors raise this subject, little research has been conducted on privacy and quality of communication during ward rounds. Vincent's study suggests that, compared to paper visits, bedside visits do have benefits for the patient [13]. Patients seem better informed and educated, experience more comfort, feel more encouraged and consider their physician more interested in the illness and the person and not just the disease. They also report less frequently that something is being hidden from them [13]. Another study found that physicians often ignore patients’ feelings and concerns during bedside visits: in 53% of all bedside communication during ward rounds patients expressed emotional ‘clues’ but physicians responded adequately to these clues in only 38% of the cases [14].

It has been claimed that communication research should broaden its context [15]. With this study, we introduce a new viewpoint in communication-research by investigating physician–patient communication within the context of place and space. The aim is to examine whether physician–patient communication in multi-bedded rooms differs from communication in single rooms during ward rounds. We expect that communication in a single room takes more time, in terms of patient speech-time and the total duration of patient and physician talk. We also expect that physicians display more affective behaviour in single rooms and that both physician and patient ask more questions about intimate subjects in single rooms.

Section snippets

Procedures and sample

The urological hospital ward of the Erasmus Medical Centre in Rotterdam was rebuilt into 10 single patient rooms on one side and four traditional four-bedded patient rooms on the other side of the ward. Patients and physicians were invited to participate in the study between December 2006 and May 2007. Informed consent was asked at the patients’ bedside, 1 day prior to the ward round. The aim of the study was concealed for the physicians and the patients. The encounters during the morning ward

Results

Fifty-two encounters during 12 different ward rounds were observed and audiotaped; 21 encounters in single rooms and 31 encounters in four-bedded rooms. The average length of stay on this hospital ward is 7 days, consequently ward rounds could be observed only once a week to include new patients. In the end we only obtained a substantial number of encounters of one physician due to shifting jobs by 2 other physicians. We chose to only analyze the encounters of that one physician, because of the

Discussion

The aim of this study was to establish whether the physician–patient communication during hospital ward rounds differs between multi-bedded rooms and single rooms. Similar research has hardly been done before.

We found in this explorative study that encounters during ward rounds took up more time than encounters in four-bedded rooms. The patients asked more questions and made more remarks in single rooms compared to four-bedded rooms. Furthermore empathic reactions of the physician were scored

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