Nurses talking to patients: exploring conversation analysis as a means of researching nurse-patient communication

As governmental priorities worldwide continue to emphasise the inclusion of patients in healthcare consultations, there is a pressing need for a research approach that accurately captures the contribution of both participants within nurse-patient interaction. With this in mind, this paper examines, via selective data extracts, the contribution that conversation analysis (CA) could make to this area of nursing research. In the United Kingdom (UK) over the last two decades, CA has been neglected as a method for exploring nurse-patient communication, and a case is made here for its entry into the mainstream of nursing research. The case is made particularly persuasive in the light of conversation analysts' use of naturally occurring research data, a form of data that is regrettably lacking in much of the published research on nurse-patient interaction.     

A sanctuary of safety: A study of how patients with dual diagnosis experience caring conversations

The prevalence of dual diagnosis, that is, the combination of psychiatric illnesses and substance use disorders, is high. As a vast majority of previous research in this context focusses on the effects of different treatment methods, rather than interpersonal issues, the purpose of the present study was to explore and illuminate in what way patients with a dual diagnosis experience conversations with nurses in an outpatient clinic to be caring. Five patients were interviewed regarding their experiences of caring conversations. The analysis and interpretation were inspired by a previously‐used hermeneutical process. These yielded three themes: (i) reciprocity creates safety and communion; (ii) suffering is made visible and understandable; and (iii) self‐esteem is restored. When synthesized, these themes gave rise to a main theme – a sanctuary of safety – where suffering is alleviated and dignity and self‐esteem are restored. It is concluded that the caring conversation contributes to experiences of safeness. In this specific context, safety appears to be more fundamental than trust for patients’ recoveries. The caring conversation also contributes to recovery, as it supports the individual's learning and understanding as a way to cope with problems, which also enables patients to make informed decisions about their own care. The caring conversation contributes to the alleviation of suffering and restoration of dignity and self‐esteem for patients with a dual diagnosis. However, there is a need for further research focussing on how the caring conversation can contribute to psychiatric nurses’ caring expertise.     

Interpreting intracorporeal landscapes: how patients visualize pathophysiology and utilize medical images in their understanding of chronic musculoskeletal illness

Medical science and other sources, such as the media, increasingly inform the general public’s understanding of disease. There is often discordance between this understanding and the diagnostic interpretations of health care practitioners (HCPs). In this paper – based on a supra-analysis of qualitative interview data from two studies of joint pain, including osteoarthritis – we investigate how people imagine and make sense of the pathophysiology of their illness, and how these understandings may affect self-management behavior. We then explore how HCPs’ use of medical images and models can inform patients’ understanding. In conceptualizing their illness to make sense of their experience of the disease, individuals often used visualizations of their inner body; these images may arise from their own lay understanding, or may be based on images provided by HCPs. When HCPs used anatomical models or medical images judiciously, patients’ orientation to their illness changed. Including patients in a more collaborative diagnostic event that uses medical images and visual models to support explanations about their condition may help them to achieve a more meaningful understanding of their illness and to manage their condition more effectively.

• Implications for Rehabilitation

• Chronic musculoskeletal pain is a leading cause of pain and years lived with disability, and despite its being common, patients and healthcare professionals often have a different understanding of the underlying disease.

• An individual’s understanding of his or her pathophysiology plays an important role in making sense of painful joint conditions and in decision-making about self-management and care.

• Including patients in a more collaborative diagnostic event using medical images and anatomical models to support explanations about their symptoms may help them to better understand their condition and manage it more effectively.

• Using visually informed explanations and anatomical models may also help to reassure patients about the safety and effectiveness of core treatments such as physical exercise and thereby help restore or improve patients’ activity levels and return to social participation.

     

Assessing Advanced Communication Skills via Objective Structured Clinical Examination: A Comparison of Faculty Versus Self,Peer, and Standardized Patient Assessors

Abstract

Construct: The construct addressed in this study is assessment of advanced communication skills among senior medical students. Background: The question of who should assess participants during objective structured clinical examinations (OSCEs) has been debated, and options discussed in the literature have included peer, self, standardized patient, and faculty assessment models. What is not known is whether same-level peer assisted learning can be utilized for formative assessment of advanced communication skills when no faculty, standardized patients, or other trained assessors are involved in providing feedback. If successful, such an educational model would optimize resource utilization and broaden the scope of topics that could be covered in formative OSCEs. Approach: The investigators developed a 4-station formative OSCE focused on advanced communication skills for senior medical students, and evaluated the concordance of assessment done by same-level peers, self, standardized patients, and faculty for 45 students. After each station, examinees completed a self-assessment checklist and received checklist-based assessment and verbal feedback from same-level peers only. Standardized patients completed checklist-based assessments outside the room, and faculty did so after the OSCE via video review; neither group provided direct feedback to examinees. The investigators assessed inter-rater agreement and mean difference scores on the checklists using faculty score as the gold standard. Findings: There was fair to good overall agreement among self, same-level peer, standardized patient, and faculty-assessment of advanced communication skills. Relative to faculty, peer and standardized patient assessors overestimated advanced communication skills, while self-assessments underestimated skills. Conclusions: Self and same-level peer-assessment may be a viable alternative to faculty assessment for a formative OSCE on advanced communication skills for senior medical students.     

基于IPA的冠心病患者居家护理方案的构建与实践

目的探讨基于重要性-表现程度分析法(IPA)的冠心病患者居家护理方案的应用效果。方法采用目的抽样法,选择2018年10月—2019年9月在台州市立医院心内科住院的128例冠心病患者为研究对象。将2018年10月—2019年3月纳入的64例患者分为对照组,2019年4—9月纳入的64例患者分为干预组。对照组采用常规护理,干预组实施基于IPA的冠心病患者居家护理方案。比较干预前后两组患者冠心病知识、自我效能、遵医性和生活质量的差异。结果干预后,干预组患者冠心病知识得分高于对照组,差异具有统计学意义(P<0.05)。干预后,干预组患者自我效能总分及各维度得分均高于对照组,差异有统计学意义(P<0.05)。干预后,干预组患者遵医性优于对照组,差异有统计学意义(P<0.05)。干预后,干预组患者SF-36健康调查量表各维度得分均高于对照组,差异有统计学意义(P<0.05)。结论基于IPA的冠心病患者居家护理方案可提高冠心病患者疾病知识和自我效能,改善患者遵医性和生活质量。     

89 锶在老年骨转移癌止痛康复治疗中的意义

目的：明确放射性核素^89锶(^89Sr)对老年骨转移癌的止痛疗效、对骨转移灶影像学的影响以及患者在治疗中的耐受情况，评价其在老年骨转移癌止痛康复治疗中的意义。方法：观察27例老年骨转移癌患者使用^89Sr治疗后的止痛效果，比较治疗前、后骨转移灶的影像学变化，监测一般不良反应及血液学毒副反应。结果：止痛总有效率为70．4％，来源于前列腺癌及乳腺癌的骨转移癌止痛有效率为78．9％。治疗后部分患者转移灶消失或放射性浓聚变淡。副反应主要表现为对骨髓造血功能的轻度可逆性损害，而对肝、肾功能无明显不良影响。结论：^89Sr是治疗老年骨转移癌疼痛的一种安全有效的方法，为老年骨转移癌止痛康复治疗提供了一种有益的新方法。     

Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study

Objective

To identify elements of the physiotherapist–patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings.

Design

A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach.

Setting

Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain).

Participants

Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries.

Results

Patients based their evaluations of quality of care on their assessment of physiotherapists’ willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist–patient interaction emerged under all these themes, except for friendly and respectful communication.

Conclusion

This study identified which elements of the physiotherapist–patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients’ experiences of the physiotherapist–patient interaction in rehabilitation services to provide empirical and quantitative evidence.     

基于共词分析及可视化网络图的国内护理绩效研究现状及热点分析

【】目的 了解我国护理绩效研究的现状和热点,为相关人员确定研究方向提供参考依据。方法 以CNKI数据库为数据源,检索2008—2017年护理绩效相关研究的文献,利用书目共现分析系统(bibliographic item co-occurrence matrix builder, Bicomb)软件生成词篇矩阵和共现矩阵,并进一步通过SPSS 23.0软件进行聚类分析,Ucinet软件进行可视化分析。结果 共检索到相关文献1197篇,提取高频关键词27个。国内护理绩效的研究热点主要集中在4个方面：绩效管理的内容和临床意义;绩效管理的模式和工具;基于岗位和工作量的绩效管理;绩效评价指标体系的构建。结论 国内护理绩效研究处于初步发展阶段,尚未形成一套系统、全面、高效的绩效管理体系。     

Reflections on patient involvement in research and clinical practice: A secondary analysis of women's perceptions and experiences of egg aspiration in fertility treatment

The importance of patient involvement is increasing in healthcare, and initiatives are constantly implemented to reach the ideal of involved and educated patients. This secondary analysis was initially embedded in a randomized controlled study where the aim was to gain insight into perceptions and experiences within a group of women undergoing fertility treatment through two focus group interviews. In this secondary analysis, we investigated how patient involvement was strived for in both clinical practice and research. During the analysis, it became apparent that the women exercised and maintained a clear perspective on their hope for a child, Project Child, while the interviewer pursued a treatment perspective, Project Treatment. Despite different perspectives, the conversation during the interviews seemed effortless, and it became apparent how the interviewer and the participants were actually focusing partly on the same, but primarily on different issues but without addressing or acknowledging this. Knowledge and awareness of the difference in perspectives is important when healthcare professionals seek to involve patients both in clinical practice and in research. Patient involvement in both research and clinical practice has shown to be a challenge and entails that pathways are organized and decisions shared by healthcare professionals.     

大肠癌患者及其家庭照料者生活质量的调查分析

目的了解大肠癌患者及其家庭照料者的生活质量.方法采用基本情况调查表和生活质量综合评定问卷对46例大肠癌患者及其家庭照料者45人进行调查.对照组资料来自赵敏等的研究报告.三组间比较用方差分析,患者与照料者比较用t检验.结果三组之间生活质量比较,"住房"、"社区服务"、"生活环境"等因子分差异无统计学意义,其他方面均有统计学意义;患者与家属比较,患者的"进食与性生活"、"娱乐与学习"、"躯体运动与感官功能"、"认知功能"受影响更明显.结论大肠癌患者及其家庭照料者的生活质量总体较差,应引起医务人员关注.