Improving Patients' Experiences Communicating With Nurses and Providers in the Emergency Department

IntroductionAs health care becomes increasingly patient centered, organizations strive to improve patients’ ratings of satisfaction with care. Communication with nurses and providers drives overall satisfaction, yet little evidence exists to guide them in ensuring effective communication in the emergency department.MethodsA semistructured interview guide based on the Hospital Consumer Assessment of Healthcare Providers survey was used to elicit qualitative data from 30 patients seen in the emergency department and fast track regarding communication with nurses and providers. Data were analyzed using content analysis methodology.ResultsTwo types of overarching themes emerged. Foundational themes include behaviors that convey courtesy and respect and are required for participants to view their interactions with nurses and providers as positive. Interactive themes describe humanistic ways in which nurses and providers conveyed courtesy and respect, reassurance through careful listening, attentiveness, and explaining things in an understandable way.DiscussionThe findings underscore existing evidence regarding patients’ perceptions of being treated with courtesy and respect via nurses’ and providers’ use of positive verbal phrasing and nonverbal body language. They reveal new insights into the importance of specific communication behaviors used by nurses and providers during interactions. Treating patients as individuals amidst a fast-paced care environment, proactively recognizing and responding to patients’ fears and concerns, and explaining information clearly to ensure understanding were critical.     

Culturally sensitive communication at the end-of-life in the intensive care unit: A systematic review

ObjectivesThe objectives of this systematic review were the following: (i) to describe whether culturally sensitive communication is used by clinicians (nurses and physicians) when communicating with patients and families at the end-of-life in the intensive care unit and (ii) to evaluate the impact of culturally sensitive communication at the end-of-life. The systematic review question was how is culturally sensitive communication used by clinicians when communicating with patients and families at the end-of-life in the intensive care unit?Data sourcesA search of CINAHL, MEDLINE, Embase, and PsycINFO databases identified all peer-reviewed research evidence published in English between January 1994 and November 2017. Two authors independently assessed articles for inclusion. From the 124 articles resulting from the search, nine were included in this systematic review.Review methodsArticles were independently assessed for quality by two authors using Caldwell et al.'s framework to critique health research. The data available in this systematic review were heterogeneous, with varied study designs and outcome measures, making the data unsuitable for meta-analysis. The most appropriate method for data synthesis for this systematic review was narrative synthesis.ResultsFrom the narrative synthesis, two major themes emerged: communication barriers and cultural and personal influences on culturally sensitive communication. Communication barriers were identified in eight studies, influencing the timing and quality of culturally sensitive communication at the end-of-life. Cultural and personal influences on communication at the end-of-life was present in eight studies.ConclusionsThe findings of this systematic review show that clinicians lack the knowledge to enable effective interaction with culturally diverse patients and families at the end-of-life.     

２０１１年全国健康教育机构传播材料制作状况分析

摘要：目的　分析２０１１年全国健康教育机构传播材料制作情况,以期为全国健康教育工作提供科学依据。
方法　采用自制调查表,全面调查全国各省（自治区、直辖市）、市、区县三级健康教育机构［包括独立健
康教育所、隶属疾病预防控制中心或卫生厅（局） 等的健康教育所（科）、卫生宣教科］２０１１ 年度健康教
育传播材料制作情况。结果　全国各级行政区已设置健康教育机构数为２６７８个,全国健康教育机构设置
率为８２．７０％,其中省级机构设置率为１００．００％、地市级机构设置率为９５．９３％、区县级机构设置率为
８０．３９％。各级机构制作的健康教育传播材料形式主要包括传单与折页、小册子与书籍、宣传画、音像制
品、手机短信与实物。按机构级别分类分析,省级机构自主制作传播材料居多,地市级模板制作传播材料
居多,区县级自主制作和模板制作材料均较少;按经济区划分析,东部、中部制作传单与折页、音像制品、
手机短信与实物种类和份数高于西部地区,西部地区以制作小册子与书籍、宣传画居多。结论　目前我国
健康教育传播材料种类和数量均有较大发展,但西部地区和区县级健康教育机构仍需加强传播能力建设。
关键词：健康教育;机构;传播材料;制作
中图分类号：Ｒ１９３　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０２ ０１４３ ０５     

临床沟通风险分析及对策建议

临床沟通逐渐成为医疗实践的核心.通过分析临床沟通的风险因素,提出风险控制对策：尊重患者,主动与患者沟通,鼓励患者参与临床决策,建立沟通评价体系等.风险控制对策对改善医疗质量,保障患者安全,提高患者满意度等有重要意义.     

The impact of brief team communication,leadership and team behavior training on ad hoc team performance in trauma care settings

Background

Communication breakdowns and care coordination problems often cause preventable adverse patient care events, which can be especially acute in the trauma setting, in which ad hoc teams have little time for advanced planning. Existing teamwork curricula do not address the particular issues associated with ad hoc emergency teams providing trauma care.

Methods

Ad hoc trauma teams completed a preinstruction simulated trauma encounter and were provided with instruction on appropriate team behaviors and team communication. Teams completed a postinstruction simulated trauma encounter immediately afterward and 3 weeks later, then completed a questionnaire. Blinded raters rated videotapes of the simulations.

Results

Participants expressed high levels of satisfaction and intent to change practice after the intervention. Participants changed teamwork and communication behavior on the posttest, and changes were sustained after a 3-week interval, though there was some loss of retention.

Conclusions

Brief training exercises can change teamwork and communication behaviors on ad hoc trauma teams.     

情景模拟法在护士长后备人才培养中的应用

目的探讨运用情景模拟法培养护士长后备人才沟通技巧的实际应用效果。方法对2010年竞聘上岗的20名护士长后备人才,应用情景模拟法进行培训。比较护士长后备人才培训前后,沟通技巧的变化。结果运用情景模拟法训练后,护士长后备人才沟通技巧、风险评估能力和急救技能显著高于培训前（P〈0.05）。结论运用情景模拟训练法对护士长后备人才进行培训,能够确保护士长后备人才接受系统的理论知识辅导,并且有助于提高护士长后备人才的沟通、协调能力,值得推广应用。     

Effect of a multi-level intervention on nurse–patient communication in the intensive care unit: Results of the SPEACS trial

Objective

To test the impact of two levels of intervention on communication frequency, quality, success, and ease between nurses and intubated intensive care unit (ICU) patients.

Design

Quasi-experimental, 3-phase sequential cohort study: (1) usual care, (2) basic communication skills training (BCST) for nurses, (3) additional training in augmentative and alternative communication devices and speech language pathologist consultation (AAC + SLP). Trained observers rated four 3-min video-recordings for each nurse–patient dyad for communication frequency, quality and success. Patients self-rated communication ease.

Setting

Two ICUs in a university-affiliated medical center.

Participants

89 intubated patients awake, responsive and unable to speak and 30 ICU nurses.

Main results

Communication frequency (mean number of communication acts within a communication exchange) and positive nurse communication behaviors increased significantly in one ICU only. Percentage of successful communication exchanges about pain were greater for the two intervention groups than the usual care/control group across both ICUs (p = .03) with more successful sessions about pain and other symptoms in the AAC + SLP group (p = .07). Patients in the AAC + SLP intervention group used significantly more AAC methods (p = .002) and rated communication at high difficulty less often (p < .01).

Conclusions

This study provides support for the feasibility, utility and efficacy of a multi-level communication skills training, materials and SLP consultation intervention in the ICU.     

Exploring what patients think when answering the Interpersonal Skills Questionnaire (ISQ): A ‘think aloud’ study

BackgroundThe Interpersonal Skills Questionnaire (ISQ) was developed to collect patient feedback on consultation skills of practitioners. However, it has not yet been evaluated with pharmacists.ObjectiveTo explore the thinking process of patients as they completed the ISQ following a consultation with a pharmacist.MethodsA qualitative think aloud (TA) methodology was used to explore patients' thinking while completing the ISQ following a consultation with a pharmacist. The study was conducted in secondary care with outpatients ≥18 years old. Interviews were carried out in rounds and were informally analysed (i.e., by writing notes while listening to recordings) to identify any associated major problem(s). Discussions were held between researchers to determine whether changes were needed based on patients' comments.ResultsEight patients in total (50% females) participated in this study (mean age: 48 years). Three rounds of TA were conducted. Most items of the ISQ were interpreted similarly by all participants with no major problems necessitating refining the ISQ.ConclusionsModification of the ISQ was unnecessary as interviews demonstrated no major problems with its use. The ISQ is thus a potentially suitable tool to collect patient feedback on pharmacists' consultations.