Navigating communication barriers in phlebotomy: Strategies and ethical tensions in routine care.

Objective: The emotional and ethical experiences of Medical Laboratory Assistants (MLAs) during challenging patient phlebotomy encounters is largely unknown. This study identified verbal and non-verbal strategies used by MLAs and explored how they navigate systemic and interpersonal pressures during patient resistance. Methods: We held four online focus groups with 12 MLAs working in hospital and community settings in Alberta, Canada. Transcripts were analyzed using a combined inductive and deductive thematic analysis guided by the Framework method. Results: Participants described using plain-language explanations, distraction, translation resources, and support to facilitate phlebotomy involving pediatric patients, cognitive impairment, and language barriers. When these strategies failed, restraint was described as a last resort. These accounts suggest that escalation occurred within perceived constraints on authority and under pressure, rather than a preferred course of action. Conclusion: Phlebotomy communication challenges are ethically and relationally complex. MLAs describe balancing procedural demands with patient assent under conditions of limited authority, suggesting a need for training and guidance that extends beyond technical proficiency. Innovation: This study moves beyond the traditional technical view of phlebotomy by examining the ethical and relational challenges experienced by MLAs during routine patient care. It identifies experiences consistent with moral distress and constrained clinical agency as underexplored features of communication barriers in phlebotomy practice.