Communication partner training of enrolled nurses working in nursing homes with people with communication disorders caused by stroke or Parkinson’s disease

Purpose: To evaluate the effect of a communication partner training programme directed to enrolled nurses working with people with communication disorders in nursing homes, using an individualised approach. Method: Five dyads consisting of a person with stroke-induced aphasia (n?=?4) or Parkinson’s disease (PD) (n?=?1) living in different nursing homes and his/her enrolled nurse participated in the study, which had a replicated single-subject design with multiple baselines across individuals. The main element of the intervention was supervised analysis of video-recorded natural interaction in everyday nursing situations and the formulation of individual goals to change particular communicative strategies. Results: Outcome was measured via blinded assessments of filmed natural interaction obtained at baseline, intervention and follow-up and showed an increased use of the target communicative strategies. Subjective measures of goal attainment by the enrolled nurses were consistent with these results. Measures of perceived functional communication on behalf of the persons with communication disorders were mostly positive; four of five participants with communication disorders and two of five enrolled nurses reported improved functional communication after intervention. Conclusions: The use of an individualised communication partner training programme led to significant changes in natural interaction, which contributes importantly to a growing body of knowledge regarding communication partner training.

• Implications for rehabilitation

• Communication partner training can improve the communicative environment of people with communication disorders.

• For people with communication disorders who live in institutions, the main conversation partner is likely to be a professional caretaker.

• An individualised approach for communication partner training that focussed on specific communication patterns was successful in increasing the use of supportive strategies that enrolled nurses used in natural interaction with persons with communication disorders.

• The training also positively affected the perceived functional communication of the persons with communication disorders.

     

Communication between nurses and simulated patients with cancer: evaluation of a communication training programme.

In this paper the effect of a communication training programme on the instrumental and affective communication skills employed by ward nurses during the admittance interview with recently diagnosed cancer patients was investigated. The training focused on teaching nurses skills to discuss and handle patient emotions. For this purpose, 46 nurses participated in 92 videotaped admittance interviews with simulated patients. The study had a randomized pre-test-post-test design. Multi-level analysis was used to measure the effects of the training. The results revealed that the trained nurses significantly increased asking open-ended psychosocial questions, which indicates that they were actively exploring patients' feelings. Furthermore, the patients showed a significant increase in affective communication. In conclusion, the results of this study demonstrate that, although limited, training can induce favourable changes in the communication skills of nurses, and can even affect patient communication. Future studies should focus on the further evaluation of educational programmes to enhance communication skills.     

The content of morning time conversations between nursing home staff and residents

Aim. The aim of this paper was to investigate what nursing home staff and residents converse about when they first meet each other in the morning and to investigate who starts the conversation. It is a pilot project about communication in a nursing home in Sweden and a basis for a practice development programme. Background. Studies in Sweden have shown that nurse assistants working in care of the older people felt they had too little training in how to communicate. Communicative behaviour influences patients, but little is known about the content of morning time communication in nursing homes. Method. Non‐participant observation of 18 staff was carried out using an observation schema. Content analysis was performed. Results. The findings were that it was the staff who initiated conversation and chose the content of conversation. The most common topic in morning time conversation was residents’ health and sickness. Conclusion. Staff in nursing homes, both nurses and nurse assistants need to reflect on their interaction with residents and be conscious of their important role because they create the climate on the ward through conversation. Further studies are needed in order to explore residents’ opinions of what the content of a good communication could be and also to find out how nurses and other staff members’ communication with residents could be improved. Relevance to clinical practice. Staff need more training and knowledge about how to communicate with older people.     

A community-oriented programme for rehabilitation of persons with arthritis

A community-oriented programme for rehabilitation of persons with arthritis is described. It combines an 8–week ambulatory rehabilitation course (including patient education) at a rehabilitation institution, with long-term self-rehabilitation (at patients' homes), supervised by primary-care nurses. Sixty persons (mean age 54; 80% females) with a 13–year average duration of arthritis, were suffering pain, physical limitations, difficulties in social activities, tension and a tendency to depression. They had completed the course and a 12–month self-rehabilitation at home, and were assessed with the Arthritis Impact Measurement Scales (AIMS) questionnaire on admission to the course, at its completion and 1 year thereafter. Assessment upon completion of the course showed improvement in all areas studied. Measurements at follow-up showed that the majority carried out self-rehabilitation activities and preserved the improved functional status. The programme provided a much-needed service to arthritis sufferers living in the community, and promoted both the reorientation of institution-based rehabilitation professionals towards the community and self-rehabilitation and the cooperation between the institution and primary care.     

Coping with Client Grief

Most veterinary nurses who have owned and loved animals will be aware not only of the pleasure of their company but also of the anxiety suffered when things go wrong. Although no one really knows what someone else is feeling, personal experience certainly broadens one's understanding and one's ability to empathise.     

What is and isn’t working: Factors involved in sustaining community‐based health and participation initiatives for people ageing with intellectual and developmental disabilities

As people with intellectual and developmental disabilities (I/DD) age, it is important that I/DD agencies are prepared to support healthy ageing in homes and in communities. This study explored supports and barriers to sustaining community‐based health and participation initiatives (CBHPI) for people ageing with I/DD living in group homes managed by agencies. The study utilized interviews and photovoice with 70 participants—35 individuals with I/DD and 35 management/direct support agency staff. Data were analysed through content analysis and triangulation of data where five themes emerged: Agency values and policies related to healthy ageing; resources and staff competencies; communication between management and staff; community/university partnerships; and peer relations. Findings show that I/DD agencies and people with I/DD value CBHPI, but they find them difficult to sustain due to limited resources and lack of training specific to ageing with I/DD. Conducting system‐level research within I/DD agencies to include first‐person accounts of people with I/DD, staff and management provides insight on how to effectively support the needs of people with I/DD to improve their health and community participation as they age.     

Remember that patient you saw last week?

Patient outcome feedback has been defined as ‘the natural process of finding out what happens to one's patients after their evaluation and treatment (in the ED)’. It seems likely that emergency medicine trainees and Fellows will improve their diagnostic accuracy if they increase the frequency with which they find out what happens to their patients. Not only does this allow testing of their own diagnosis with the final diagnosis, but also allows meaningful feedback on therapies commenced in the ED. We believe that seeking outcome feedback should be more actively encouraged by the ACEM training programme.     

Exploring nursing home staff's perceptions of communication and leadership to facilitate quality improvement

Leadership and clinical staff were surveyed to explore communication and leadership in nursing homes. Registered nurses and other professionals perceived communication as better than their nursing colleagues did. Overall, results suggest all factors of communication could improve. In terms of leadership, licensed practical nurses perceived less clarity of expectations, encouragement of initiative, and support than other groups. The study provides insight into what is organizationally necessary to improve quality of care in nursing homes.     

Professional Assessment Tool for Team Improvement: An assessment tool for paediatric intensive care unit nurses' technical and nontechnical skills

BackgroundCardiorespiratory arrests are rare in paediatric intensive care units, yet intensive care nurses must be able to initiate resuscitation before medical assistance is available. For resuscitation to be successful, instant decision-making, team communication, and the coordinating role of the first responsible nurse are crucial. In-house resuscitation training for nurses includes technical and nontechnical skills.ObjectivesThe aim of this study was to develop a valid, reliable, and feasible assessment instrument, called the Professional Assessment Tool for Team Improvement, for the first responsible nurse's technical and nontechnical skills.MethodsInstrument development followed the COnsensus-based Standards for the selection of health Measurement Instruments guidelines and professionals' expertise. To establish content validity, experts reached consensus via group discussions about the content and the operationalisation of this team role. The instrument was tested using two resuscitation assessment scenarios. Inter-rater reliability was established by assessing 71 nurses in live scenario sessions and videotaped sessions, using intraclass correlation coefficients and Cohen's kappa. Internal consistency for the total instrument was established using Cronbach's alpha. Construct validity was assessed by examining the associations between raters' assessments and nurses' self-assessment scores.ResultsThe final instrument included 12 items, divided into four categories: Team role, Teamwork and communication, Technical skills, and Reporting. Intraclass correlation coefficients were good in both live and videotaped sessions (0.78–0.87). Cronbach's alpha was stable around 0.84. Feasibility was approved (assessment time reduced by >30%).ConclusionsThe Professional Assessment Tool for Team Improvement appears to be a promising valid and reliable instrument to assess both technical and nontechnical skills of the first responsible paediatric intensive care unit nurse. The ability of the instrument to detect change over time (i.e., improvement of skills after training) needs to be established.     

Preliminary Psychometric Properties of the Verbal and Nonverbal Interaction Scale: An Observational Measure for Communication in Persons with Dementia

Little attention has been given to sociable/unsociable communication in persons with dementia despite the importance of these behaviors in maintaining engagement in marital relationships. An observational measure of verbal and nonverbal communication in persons with dementia (Verbal and Nonverbal Interaction Scale-CR) who were engaged in conversations with spouses was tested for reliability and validity. Married persons with dementia were video-recorded at home conversing with spouses over 10 weeks (N = 118 recordings). Reliability [inter-coder (.92), test-retest (r =.61-.77), internal consistency (α =.65 -.79)] were adequate. Following an intervention, the Verbal and Nonverbal Interaction Scale-CR predicted improved communication over 10 weeks. The ratio of sociable to unsociable communication improved by 4.46 points per session [β = 4.46, t(10) = 1.96, p =.039]. VNVIS-CR is recommended to describe sociable and unsociable communication in persons with dementia as they engage in conversations with spouses.     

Integration possibilities of graduates of the Vocational Retraining Center Heidelberg with mental handicaps

Persons with chronic mental illness face particular difficulties in finding employment, a fact which is substantiated by the studies referred to in the present article. Placement outlook however is considerably improved by qualified vocational training. Of the 1984-87 programme participants with chronic mental illness of the BFW Heidelberg, the Heidelberg vocational retraining centre, some 60% were occupationally integrated 18 to 30 months after having completed their training. The majority of them had found employment appropriate to their training and disablement, felt neither under- nor over-strained, and were satisfied with their work. The share of occupationally integrated persons was lower when compared with programme participants with other disablements, yet hardly any differences were found relative to placement quality. The share of limited duration employment, however, was greater for those with chronic mental illness. Programme participation had entailed improvements in occupational status, income and/or life situation for about two thirds. Integration and rehabilitation outcomes above all are determined by the baseline situation present as well as by severity and chronicity of the condition. The diagnosis has hardly any influence on occupational course, but is highly relevant in respect of the expectations held and the opinions on what has been achieved. The value of vocational rehabilitation is indicated by the improvements attained vis-à-vis the initial situation, as well as by keeping in mind that great numbers of persons with chronic mental illness retire prematurely within but a few years if no rehabilitation intervention is provided.     

Communication skills of nurses during interactions with simulated cancer patients

AIM: In this paper the balance of affective and instrumental communication employed by nurses during the admission interview with recently diagnosed cancer patients was investigated. RATIONALE: The balance of affective and instrumental communication employed by nurses appears to be important, especially during the admission interview with cancer patients. METHODS: For this purpose, admission interviews between 53 ward nurses and simulated cancer patients were videotaped and analysed using the Roter Interaction Analysis system, in which a distinction is made between instrumental and affective communication. RESULTS: The results reveal that more than 60% of nurses' utterances were of an instrumental nature. Affective communication occurred, but was more related to global affect ratings like giving agreements and paraphrases than to discussing and exploring actively patients feelings by showing empathy, showing concern and optimism. CONCLUSION: In future, nurses should be systematically provided with (continuing) training programmes, in which they learn how to communicate effectively in relation to patients' emotions and feelings, and how to integrate emotional care with practical and medical tasks.     

Consequences of suboptimal communication for patients with limited English proficiency in the intensive care unit and suggestions for a way forward: A qualitative study of healthcare team perceptions

PurposeTo understand the healthcare team's perceptions of the negative consequences of suboptimal communication and their recommendations to improve communication with patients and families who have Limited English Proficiency (LEP) in the Intensive Care Unit (ICU).Materials and methodsWe performed a qualitative study using semi-structured interviews of physicians, nurses, and interpreters from 3 ICUs at Mayo Clinic Rochester, between November 2017 and April 2018.ResultsWe identified 5 consequences of suboptimal communication: 1) Suboptimal assessment and treatment of patient symptoms, 2) Unmet patient and family expectations, 3) Decreased patient autonomy, 4) Unmet end of life wishes and 5) Clinician Distress. Recommendations to improve communication include: 1) Education and training for patients,families, clinicians and interpreters, 4) Greater integration of interpreters into the ICU team 5) Standardized timeline for goals of care conversations with patients and families with LEP.ConclusionsPatients with LEP are at risk of experiencing suboptimal communication with the healthcare team in the ICU. There are several educational and quality improvement strategies that ICUs and institutions can take to mitigate these issues.     

Storybook-based communication intervention for girls with Rett syndrome and their mothers

PURPOSE: Storybook reading provides a natural language learning context in which to support early symbolic communication. In this study, we explored the impact of (1) resting hand splints, (2) light tech augmentative communication systems such as voice-output devices and symbols, and (3) very basic parent training on the symbolic communication and labelling behaviours of six girls with Rett syndrome. METHOD: Mothers and daughters were videotaped as they read familiar and unfamiliar storybooks in their homes. RESULTS: Group and individual data collected from the six girls indicated that they became more active and successful participants in the interactions during storybook reading. The girls employed a wider range of communication modes and increased the frequency of their labelling. Familiar storybook reading encouraged greater symbolic communication than unfamiliar storybooks in half the girls. CONCLUSION: This study suggests that motivated parents may not require expensive technologies or lengthy training in order to enhance their children's early communication and participation in storybook reading.     

District nursing--sharing an understanding by being present. Experiences of encounters with people with serious chronic illness and their close relatives in their homes

Background. In the homecare setting, district nurses assume a heavy responsibility and are involved in a variety of care activities. They view themselves as having a central role in care at home that centres on the development of a relationship with those who are ill and their families. Aim. The aim of this study was to elucidate the meaning of district nurses experiences of encounters with people with serious chronic illness and their close relatives in their homes. A purposive sample of 10 district nurses (female) was interviewed using a narrative approach. Method. To achieve the aim, a phenomenological hermeneutic interpretation inspired by the philosophy of Ricoeur was used to interpret the interview text. Results. This study proposes that district nurses’ experiences of encounters with people with serious chronic illness and their close relatives in their homes can be understood as district nurses being welcomed into the ill people's privacy, to share their intimacy and their understanding of being ill. This close relationship enables them to alleviate and to console the suffering and loneliness caused by illness. This is expressed in the three themes: being in a close relationship, sharing an understanding and weaving a web of protection. Conclusion. It seems that by being entirely present, in a close relationship, district nurses share the experiences of illness and through interpretation of the whole persons’ expressions; they share an understanding of this illness experience. In this close relationship, at the home of the ill people and their close relatives, district nurses are available to alleviate people's suffering and loneliness caused by illness. Relevance to clinical practice. This study reveals the need to be entirely present in encounters between the district nurses and people with serious chronic illness and their close relatives. This relation makes it possible to establish a shared understanding of the illness experience. Being aware of the importance of this shared understanding within a relationship, will increase the health care personnel's possibility to alleviate and console those suffering of illness. This proposed interpretation could be useful for reflection of care interventions, in education and supervision of district nurses.     

2-5年急诊护士沟通技能培训的效果研究

目的：探讨以Calgary-Cambridge指南为框架的沟通技能培训对护士沟通能力和促进护患关系的效果。方法：选取59名工作2-5年护士 ,按照简单随机法分为观察组和对照组。观察组参与Calgary-Cambridge沟通技能培训,对照组不参与培训。培训结束后采用《护理沟通能力测试量表》和《住院患者满意度调查表》进行评价。结果：培训后两组在沟通过程各维度表现上观察组均高于对照组,比较差异有统计学意义(P<0.01),从患者满意度来看,培训前两组成员满意度差异无统计学意义,培训后患者对观察组护理成员满意度普遍高于对照组(P<0.01),也高于观察组培训前的满意度,两者差异有统计学意义(P<0.01)。结论：以Calgary-Cambridge指南为理论框架的护患沟通技能培训,提高了护士护患沟通能力和患者满意度,具有可行性。     

Videotaped behavioral observations: Enhancing validity and reliability

Observing and quantifying behaviors in natural or clinical settings has long produced challenges for researchers and clinicians. Although nurses are uniquely positioned to conduct behavioral research, they may not be well acquainted with behavioral observation strategies. The author identifies several problems commonly encountered while studying behavior in natural settings and suggests methods for enhancing validity and reliability through videotaped observations. Results of a newly developed calibration procedure are discussed with implications for rater training. Nurse clinicians and researchers should find this information useful for evaluating interventions in clinics, homes, and other applied settings.