Translating knowledge into practice for communication skills training for health care professionals

Rasch analysis of the self efficacy (SE-12) questionnaire measuring clinical communication skills

Objective

The aim of this study was to examine the construct validity and reliability of the Self Efficacy (SE-12) questionnaire using Rasch analysis.

Methods

The SE-12 was administered to Danish health care professionals prior to their participation in a communication skills training program. Analysis of fit to the Rasch model, ordering of response categories, dimensionality-testing, test for differential item functioning, test for local dependency, and calculation of reliability were used to evaluate the psychometric characteristics of the SE-12.

Results

In this study, 1057 respondents were analyzed. Overall, the SE-12 demonstrated an acceptable fit to the Rasch model. Response categories were appropriately ordered for all twelve items. However, items 6 (structure) and item 8 (empathy) demonstrated differential item functioning, with men being more likely to affirm the first and women the last item. Local dependency was observed between five item groups but adjusting for these improved fit indices significantly. The SE-12 exhibited high reliability with PSI ranging from 0.92 to 0.94. A transformation table converting ordinal scores to interval scores is provided.

Conclusion

The SE-12 demonstrates good construct validity and excellent reliability. Minor issues regarding local dependency and differential functioning require attention.Innovation: A 5-item version could be explored without compromising validity and reliability.

Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover-A qualitative study

AIM

To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention.

DESIGN

A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions.

METHODS

We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact.

RESULTS

Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information.

CONCLUSION

Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists.

RELEVANCE TO CLINICAL PRACTICE

Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change.

REPORTING METHOD

We adhered to the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

We interviewed patients on study wards pre and post intervention.

A roadmap to SDGs-emergence of technological innovation and infrastructure development for social progress and mobility

The goal of this study was to conduct a thorough investigation on understanding how infrastructure growth and technological innovation affect social mobility and the Sustainable Development Goals (SDGs). This study aimed to illuminate the underlying mechanisms by exploring the mediating function of psychological empowerment and the moderating impact of community satisfaction. The study carefully chose a sizeable sample of 370 connected to the mega project CPEC. Data collection was carried out using a questionnaire-based approach. Notably, the study confirmed the large and favorable influence of technical innovation and infrastructural development on both the SDGs-13 (climate change) and social mobility. Furthermore, this study provided light on the critical function of environmental impacts identifying it as an important mediating mechanism that magnifies the effects of innovation and infrastructure on long-term development outcomes. It gives decision-makers in government, business, international organizations, and local communities useful information by offering empirical data and insights. This study offers a novel perspective and explores the relationship between infrastructure growth, technological innovation, social mobility, and SDGs-13-climate change. It uncovers the pivotal roles of psychological empowerment and community satisfaction, offering fresh insights into global development strategies influencing SDGs.

Improving musculoskeletal physiotherapists' confidence in patient-centred care informed by acceptance and commitment therapy: A descriptive study

BACKGROUND

Patient-centred care is essential for high quality musculoskeletal care, however, few evidence-based opportunities exist that address the barriers to implementation for clinicians.

OBJECTIVE

To develop and evaluate a simulation-based educational strategy for musculoskeletal physiotherapists to increase knowledge and confidence in patient-centred care.

METHODS

Repeated-measures, single-group educational interventional descriptive study. Primary outcome was participant-reported knowledge and confidence in patient-centred care. Customized survey data was collected at baseline (T1) (N = 22), immediately after a face-to-face workshop (T2) (N = 22), and six weeks after the workshop (T3) (N = 17). Secondary outcomes included sustained implementation using the Normalization Measure Development (NoMAD) tool. Repeated-measures ANOVA was used to analyse primary outcomes.

RESULTS

Our participants were typically female (72%), early career (mean 3.3 years post-graduate) and culturally diverse (67%). Significant increases in participant confidence were noted at all time points on all five learning outcomes (repeated measures ANOVA, p < 0.001 to p = 0.009). Participants had very high baseline knowledge and no further increases were found following the intervention (p > 0.05). Normalization Measure Development data indicated high coherence, high cognitive participation, and high reflexive monitoring, with neutral results for collective action.

CONCLUSION

A novel, psychologically-informed, simulation-based educational strategy is effective in improving musculoskeletal physiotherapist confidence in patient-centred care. Participants reported implementation of skills learnt in the workshop into subsequent clinical practice.

Integrating Patient Involvement Interventions within Clinical Practice: A Mixed-Methods Study of Health Care Professional Reasoning

Background. Patient involvement interventions are complex interventions that improve patient involvement in treatment and care in health care systems. Studies report several benefits of patient involvement interventions and that health care professionals are positive about using them. However, they have not been explored as a collected group of interventions throughout the continuum of care and treatment. In addition, the relationship between patient involvement interventions and the clinical reasoning process of health care professionals has not been thoroughly studied. Design. This mixed-methods study was conducted at Aarhus University Hospital in Denmark between April and November 2022 using interview data from 12 health care professionals and survey data from 420 health care professionals. Informants were medical doctors, nurses, midwives, dietitians, physiotherapists, and occupational therapists who had direct contact with patients during their daily care and treatment. Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed via inductive and deductive content analysis. Results. Communication and interaction were seen as overarching aspects of patient involvement, with patient involvement interventions being defined as concrete tools and methods to enhance health care professionals' explicit clinical reasoning process. Limitations. It is unclear if results are representative of all health care professionals at the hospital or only those with a positive view of patient involvement interventions. Conclusions. Patient involvement interventions are viewed as beneficial for patients and fit with the clinical reasoning of health care professionals. Clinical reasoning may be an active ingredient in the development and implementation of patient involvement interventions. Implications. In practice, health care professionals need training in person-centered communication and the ability to articulate their clinical reasoning explicitly. In research, a more in-depth understanding of the interrelations between patient involvement interventions and clinical reasoning is needed.

Highlights

Communication and interaction are the fundamental goals of patient involvement in practice, regardless of which patient involvement intervention is being used.Clinical reasoning is often an unconscious process using tacit knowledge, but the use of patient involvement interventions may be a way for health care professionals (at both individual and group levels) to become more explicit about and aware of their reflections.Clinical reasoning can be viewed as a mechanism of change in the development and implementation of patient involvement interventions.

Communication, Cognition and Competency Development in Healthcare: A Model for Integrating Cognitive Ethnography and Communication Skills Training in Clinical Interventions

OBJECTIVES

The aim of this study was to conduct and evaluate the Blended Learning communication skills training program. The key objective was to investigate (i) how clinical intervention studies can be designed to include cognitive, organizational, and interactive processes, and (ii) how researchers and practitioners could work with integrated methods to support the desired change.

METHODS

The method combined design and implementation of a 12-week Blended Learning communication skills training program based on the Calgary-Cambridge Guide. The training was implemented in a patient clinic at a Danish university hospital and targeted all healthcare professionals at the clinic. Cognitive ethnography was used to document and evaluate healthcare professionals' implementation and individual competency development, and support the design of in-situ simulation training scenarios.

RESULTS

Thirteen participants completed the program. The synergy within the teams, as well as the opportunities for participants to coordinate, share, discuss, and reflect on the received knowledge with a colleague or on-site researcher, affected learning positively. The knowledge transfer process was affected by negative feedback loops, such as time shortages, issues with concept development and transfer, disjuncture between the expectations of participants and instructors of the overall course structure, as well as participant insecurity and a gradual loss of motivation and compliance.

CONCLUSION

We propose a novel 3-step model for clinical interventions based on our findings and literature review. This model will effectively support the implementation of educational interventions in health care by narrowing the theory-practice gap. It will also stimulate desired change in individual behavior and organizational culture over time. Furthermore, it will work for the benefit of the clinic and may be more suitable for the implementation of communication projects than, for example, randomized setups.

Integrating medical and practical skills in communication skills training: Do students feel it supports them with transfer from classroom to practice?

Objective

To describe innovations in a clinical communication skills training (CCST) program, aimed at facilitating transfer of communication skills from classroom to clinical practice and report student's evaluations regarding this program.

Methods

To facilitate transfer, we integrated CCS with medical and practical skills, and we developed simulation sessions closely resembling clinical practice in case-history's, length of consultation, and patient-population. Feedback was given on communication skills and medical knowledge and skills. Student's opinions about whether these elements were helpful, were evaluated using a questionnaire.

Results

Responses of 144 students were analyzed. The majority of the respondents agreed that this CCST program helped them with transfer of CCS from classroom to clinical practice, as did the feedback on medical content and communication skills in the same session.

Conclusion

Students indicate that simulations resembling clinical practice and feedback on both CST and medical content facilitate the transfer of their skills to clinical practice.

Innovation

This CCST program is innovative because it integrates medical and practical skills, with elements aiming to create an educational environment resembling clinical practice as closely as possible in order to facilitate transfer to clinical practice.

Stimulating existential communication - first steps towards enhancing health professionals' reflective skills through blended learning

Introduction

Talking about existential issues with patients is often experienced as challenging for healthcare professionals. This paper describes our first steps towards developing existential communication training with particular attention to reflective learning methods. Blended learning was chosen to support reflection and an easier transition to classroom conversations, and through Participatory Action Research (PAR), patients were involved in developing the curriculum.

Method

To develop the most valuable and relevant communication training, patients, relatives, healthcare professionals and researchers were involved in a PAR process including 1) three theatre workshops and 2) collaborative meetings to develop the blended learning curriculum and reflection videos. The evaluation of the communication training was based on semi-structured interviews with the healthcare professionals participating in the blended learning communication training.

Discussion and innovation

The results indicate that a blended learning format involving a high degree of reflection is valuable for developing skills related to existential communication. Engaging patients in the process may be essential to develop a training curriculum for healthcare professionals that accommodates the patient's needs.

Conclusion

Future communication training on existential communication may benefit from adopting a blended learning format, including reflective learning methods and the involvement of patients in curriculum development.

Perceptions of medical students and their facilitators on clinical communication skills teaching, learning, and assessment

Introduction

Despite various efforts to develop communication skills (CS) in the classroom, the transfer of these skills into clinical practice is not guaranteed. This study aimed to identify barriers and facilitators of transferring CS from the classroom to clinical environments.

Methods

A qualitative study was conducted at one Australian medical school to explore the experiences and perceptions of facilitators and students in relation to teaching and learning clinical CS. Thematic analysis was used to analyze data.

Results

Twelve facilitators and sixteen medical students participated in semi-structured interviews and focus-group discussions, respectively. Primary themes included the value of teaching and learning, alignment between approaches to teaching and actual clinical practices and students' perceptions of practice, and challenges in different learning environments.

Discussion

This study reinforces the value of teaching and learning CS by facilitators and students. Classroom learning provides students with a structure to use in communicating with real patients, which can be modified to suit various situations. Students have limited opportunities, however, to be observed and receive feedback on their real-patient encounters. Classroom session that discussed CS experiences during clinical rotation is recommended to strengthen learning both the content and process of CS as well as transitioning to the clinical environment.

Motivations of patients and their care partners for visiting a memory clinic. A qualitative study

OBJECTIVE

We investigated motivations of patients and care partners for their memory clinic visit, and whether these are expressed in consultations.

METHODS

We included data from 115 patients (age 71 ± 11, 49% Female) and their care partners (N = 93), who completed questionnaires after their first consultation with a clinician. Audio-recordings of these consultations were available from 105 patients. Motivations for visiting the clinic were content-coded as reported by patients in the questionnaire, and expressed by patients and care partners in consultations.

RESULTS

Most patients reported seeking a cause for symptoms (61%) or to confirm/exclude a (dementia) diagnosis (16%), yet 19% reported another motivation: (more) information, care access, or treatment/advice. In the first consultation, about half of patients (52%) and care partners (62%) did not express their motivation(s). When both expressed a motivation, these differed in about half of dyads. A quarter of patients (23%) expressed a different/complementary motivation in the consultation, then reported in the questionnaire.

CONCLUSION

Motivations for visiting a memory clinic can be specific and multifaceted, yet are often not addressed during consultations.

PRACTICE IMPLICATIONS

We should encourage clinicians, patients, and care partners to talk about motivations for visiting the memory clinic, as a starting point to personalize (diagnostic) care.