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Int J Nurs Stud. 2008 Oct;45(10):1411-21. doi: 10.1016/j.ijnurstu.2008.01.002. Epub 2008 Mar 4.

Factors that enable nurse-patient communication in a family planning context: a positive deviance study.

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Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Baltimore, MD 21202, USA.



Family planning programmes in developing countries need a better understanding of nurse-patient communication in order to improve the quality of counselling.


To identify factors in the clinic and in the community that enable nurses and patients to communicate effectively with one another.


The study explored the personal experiences of nurses and patients who communicate especially effectively during family planning consultations (so-called "positive deviants").


Sixty-four randomly selected public clinics located in East Java, Indonesia.


Seven positive deviant nurses and 32 positive deviant patients were identified from among 64 nurses and 768 patients who participated in an earlier patient coaching study. Flooding prevented 5 patients from participating in the study, reducing their number to 27.


Investigators conducted: (1) a content analysis of qualitative data collected by structured in-depth interviews and focus-group discussions (FGDs) with positive deviant nurses and patients, and (2) analyses of variance (ANOVA) of quantitative data on clinic, nurse, and patient characteristics.


Positive deviant nurses identified four factors, listed in rough order of importance, that helped them communicate effectively: independent study to strengthen their knowledge and skills; communication aids; feedback from colleagues; and motivation stemming from a desire to help people, patients' appreciation, husband's support, and increased income. Positive deviant patients identified five enabling factors: motivation due to their need for a service; confidence in their own communication skills; positive feedback from nurses; belief in patients' right and responsibility to communicate with nurses; and communication aids.


Insights from positive deviant nurses and patients suggest that efforts to improve nurse-patient communication should go beyond conventional communication skills training. Managers should consider a mix of clinic-based interventions (such as peer feedback, communication aids, and better management of patient flow) and community-based interventions (such as patient education and mass media).

[Indexed for MEDLINE]

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