Nurses' communication skills: an evaluation of the impact of solution-focused communication training

Nurse-based counselling on thirst in patients with advanced chronic heart failure : Study protocol for a pilot before-after study and process evaluation

BACKGROUND

Many patients with chronic heart failure (CHF) are critically ill and experience increased thirst. Study aims are to develop and evaluate a nurse-based counselling intervention to promote self-care competencies related to thirst in hospitalised patients with advanced CHF eligible or listed for heart transplantation.

METHODS

A mixed-methods approach will be adapted with three study phases: (1) development of the nurse-based counselling intervention, (2) feasibility testing and training of nurses, and (3) implementation of the intervention and, evaluation of initial effects and process measures. In phase (1), interviews with hospitalised patients with advanced CHF listed for heart transplantation (n = 10), focus groups (n = 2) and a Germany-wide survey with nurses will be performed. In phase (2), experts experienced with caring for patients with advanced CHF and patients with advanced CHF will be consulted for content validation and pretest of the counselling intervention. The training concept for nurses will be evaluated using questionnaires. In phase (3), a pilot before-after study will be conducted (n = 60). Primary patient-related outcome for the pilot study is thirst intensity using a numeric rating scale. Furthermore, a process evaluation (interviews with patients [n = 10], survey with nurses and physicians) will be performed. Quantitative data will be analysed descriptively, and qualitative data will be analysed using content analysis. Mean values of thirst intensity of the individual measurement points will be evaluated as interrupted time-series analysis using regression analyses.

CONCLUSION

The development and implementation of a counselling intervention is influenced by various factors. Therefore, it is important to consider all factors throughout the process from development to evaluation.

Should I call psycho-oncology? Training nurses on psycho-oncological screening reduces uncertainties

PURPOSE

Psycho-oncological screening is required to identify distressed patients and direct them to psycho-oncological care. In practice, screening procedure and related communication are still insufficient due to various barriers on the side of the medical team. The aim of this study is to evaluate the specifically developed training (OptiScreen training) on screening from nurses' perspective.

METHODS

N = 72 nurses from visceral-oncological care at Hanover Medical School received the 6-h training, which consisted of three modules and targeted topics around screening, psycho-oncology and communication. The training was evaluated using a pre- and post-questionnaire assessing screening knowledge, uncertainties and further satisfaction outcomes.

RESULTS

Personal uncertainties were significantly reduced by the training (t(63) = - 13.32, p < .001, d = 1.67). General satisfaction with the training was achieved (62.0-98.6% satisfied with the training elements). Feasibility (69%) and general acceptance (94.3%) for the training were rated positively.

CONCLUSION

The nurses rated the training as useful to reduce personal uncertainties regarding the screening process. Acceptability, feasibility and satisfaction with the training from the nursing perspective were achieved. The training contributes to minimizing barriers to inform about psycho-oncology and to recommend appropriate support services to patients.

OptiScreen – ein Schulungskonzept für Pflegekräfte zur Durchführung des psychosozialen Distress-Screenings

Hintergrund

Eine angemessene, bedarfsgerechte psychoonkologische Versorgung reduziert Depressivität und Ängste von Krebserkrankten sowie ihren Angehörigen und erhöht die Lebensqualität. Psychisch belastete Krebserkrankte werden jedoch nicht flächendeckend identifiziert, um ihnen psychoonkologische Unterstützung anzubieten. Screeningfragebögen haben sich zur Identifikation bewährt, allerdings bestehen bei der Anwendung im klinischen Alltag Hürden. Pflegekräfte haben durch ihren kontinuierlichen Kontakt zu Patient_innen, die vielfältigen klinischen Eindrücke und ihre Verbindung zu anderen Berufsgruppen eine Schlüsselrolle.

Ziele

Die OptiScreen-Schulung soll Pflegekräfte in der Onkologie zur Durchführung des Distress-Screenings befähigen, entsprechendes Expert_innenwissen vermitteln und Hürden sowie Unsicherheiten im Screeningprozess abbauen, um somit belastete Erkrankte zielgerichtet identifizieren und einer psychoonkologischen Versorgung zuführen zu können.

Das Training

Die OptiScreen-Schulung gliedert sich in drei Module à 1,5–2 h zu den Themen psychische Störungen bei Krebs, psychoonkologische Versorgung, psychische Belastung, Distress-Screening, Kommunikation im Screeningprozess und Psychohygiene (vermittelt durch Vorträge, Videos, Rollenspiele, Übungen).

Ergebnisse und Diskussion

Erste praktische Erfahrungen weisen auf eine erfolgreiche Umsetzung des Schulungskonzepts hin. Weitere Ziele sind es, den Wissenszuwachs und die zunehmende Sicherheit der Pflegekräfte im Screeningprozess zu stärken sowie die Effekte langfristig aufrechtzuerhalten. Zusätzlich soll die Schulung in verschiedenen Settings etabliert und die Auswirkungen der Schulung in Bezug auf die Informiertheit und Zufriedenheit der Patient_innen mit dem Screeningprozess untersucht werden.

Assessing emergency department nurses' ability to communicate with angry patients and the factors that influence it

Aims

To assess emergency department (ED) nurses' ability to communicate with angry patients and to explore the factors that influence nurses' communication skills.

Design

A cross-sectional survey design.

Methods

This study was conducted in November and December 2020. Stratified sampling was adopted to recruit ED nurses from 18 tertiary hospitals in western, eastern, and central China to complete an online questionnaire. The Nurses' Communication Ability with Angry Patients Scale (NCAAPS) and the General Self-Efficacy Scale were used to assess ED nurses' communication ability and self-efficacy, respectively. Descriptive statistics, the Mann-Whitney U-test, the Kruskal-Wallis H test, Spearman's correlation analysis, and the generalized linear model were used for data analysis.

Results

A total of 679 valid questionnaires were collected. The mean total score for the NCAAPS was (3.79 ± 0.47), while the scores for its four dimensions were (3.87 ± 0.59) for communication skills, (3.82 ± 0.59) for anger perception, (3.79 ± 0.53) for self-preparation, (3.73 ± 0.54) for exploring the cause of anger. The generalized linear regression analysis result showed that a longer employment duration, previous communication ability training, and higher self-efficacy were significantly and independently associated with higher NCAAPS scores (p < 0.05).

Conclusions

The mean total score and the four dimensions score for the NCAAPS were moderate. But there is still room for improvement in ED nurses' ability to communicate with angry patients. "Exploring the cause of anger" was the lowest score among the four dimensions. To improve ED nurses' ability to communicate with angry patients, future studies should focus on constructing specific communication training, improving nurses' ability to explore the cause of anger and self-efficacy.

Impact

The findings of this study provide important insights into ED nurses' ability to communicate with angry patients and can thus guide the future development of intervention programmes to improve this ability among ED nurses.

Effect of solution-focused approach on anxiety and depression in patients with rheumatoid arthritis: A quasi-experimental study

Introduction

Anxiety and depression are common psychological problems in rheumatoid arthritis (RA) patients. However, few effective nursing intervention models have been designed specifically to improve anxiety and depression in RA patients. Solution-focused approach (SFA) is an effective intervention method for psychosocial issues. There have been no studies involving SFA yet in RA patients. This study investigated the effects of SFA-based nursing intervention on anxiety and depression in RA patients.

Methods

A quasi-experimental study using a convenience sampling of RA patients was conducted. The 48 RA patients were divided into the control group (n = 24) and the experimental group (n = 24). The control group received routine nursing intervention, while the experimental group received SFA-based nursing intervention. The scores on the self-rating anxiety scale (SAS), self-rating depression scale (SDS), arthritis self-efficacy scale-8 (ASES-8), and questionnaire on patient satisfaction with nursing care were collected before and after nursing interventions.

Results

Between-Group Comparison: Before the nursing intervention, there was no statistically significant difference in the SDS, SAS, and ASES-8 scores between the two groups (p > 0.05). However, after the nursing intervention, the SDS and SAS scores of the experimental group were statistically significantly lower than those of the control group (p < 0.05). In contrast, the ASES-8 score of the experimental group was statistically significantly higher than that of the control group (p < 0.05). In addition, patient satisfaction with nursing care of the experimental group was better than that of the control group (p > 0.05). Within-Group Comparison: There was no statistically significant difference in the SDS, SAS, and ASES-8 scores in the control group before and after routine nursing intervention (p > 0.05). However, in the experimental group, the SDS and SAS scores before SFA-based nursing intervention were statistically significantly higher than those after SFA nursing intervention (p < 0.05), and the ASES-8 score before SFA-based nursing intervention was considerably lower than that after SFA nursing intervention (p < 0.05).

Discussion

SFA-based nursing intervention can effectively improve anxiety, depression, and arthritis self-efficacy of RA patients. This study broadens clinical psychological nursing intervention models for RA patients. SFA may be an effective nursing model for various psychosocial problems in the current medical context.

Associations of pediatric nurse burnout with involvement in quality improvement

PURPOSE

Burnout among nurses negatively impacts patient care experiences and safety. Inpatient pediatric nurses are high-risk for burnout due to high patient volumes, inadequate staffing, and needing to balance the demands of patients, families and team members. We examined the associations of inpatient pediatric nurse burnout with their perspectives on the importance of quality at the hospital, patient experience measurement, quality improvement (QI), unit culture, and staffing.

METHODS

We conducted a cross-sectional study at an urban children's hospital. We surveyed pediatric nurses about their perspectives including the single-item Maslach Burnout Inventory. We fit separate regression models, controlling for role, location and unit, predicting outcome measures from the dichotomized burnout scale.

RESULTS

Twenty-seven percent of pediatric nurses reported burnout. Nurses who had more confidence in patient experience measurement, received frequent patient experience performance reports, felt included in QI, and experienced QI efforts as integrated into patient care reported not being burned out (compared to those reporting burnout; all p-values<0.05). More open communication among nurses (e.g., about possible problems with care) and unit-level teamwork were also associated with not being burned out, whereas a larger QI workload was associated with burnout (p-values<0.05).

CONCLUSIONS

Open communication among nurses and nurses being more involved and valued in QI efforts were related to not being burned out. Research is needed to further examine aspects of QI involvement that reduce burnout.

PRACTICE IMPLICATIONS

Supporting open communication among pediatric nurses, engaging them in QI and integrating QI into patient care while minimizing QI workload may decrease burnout.

Themes of Worry Among Psychiatric Inpatients That Persist Through Acute Hospitalization

INTRODUCTION

Problems that worry patients throughout hospitalization are complex and varied, but they fall within the scope of safe, effective, patient-centered care. To our knowledge, there is no evidence describing the problems that worry patients in inpatient psychiatric units.

AIM

The purpose of this quality improvement project was to describe common themes of worry experienced by individuals in psychiatric inpatient units in order to improve patient experience.

METHOD

This project took place at an urban, safety net hospital at an academic medical center in the northeastern United States between March and December 2019. All patients across five inpatient psychiatric units were offered the Combined Assessment of Psychiatric Environments (CAPE) survey as they approached the end of their stay.

RESULTS

A total of 1,800 patients took the survey. Of these patients, 36% (650/1,800) patients responded never/sometimes to "During my hospitalization, I found solutions to problems that worried me," and 46% (297/650) patients provided a response to the follow-up question "What are the problems that worry you the most?" Common themes of worry for inpatient behavioral health patients include (a) life in the hospital, (b) self, and (c) outside life.

CONCLUSIONS

Each of these worry themes that emerged from this thematic analysis has implications for behavioral health staff who are preparing the psychiatric/behavioral health inpatient for discharge. These themes can also be used to focus on a variety of quality improvement initiatives to improve the patients experience while in an inpatient psychiatric/behavioral health unit.

Connecting Through Conversation: A Novel Video-Feedback Intervention to Enhance Long-Term Care Aides' Person-Centred Dementia Communication

Objective

To pilot test a novel communication intervention incorporating a video-feedback component on the person-centred dementia communication skills of long-term care aides.

Methods

Effectiveness was assessed using a single group pre-test/post-test design. 11 care aide-resident dyads participated in the study. Objective outcomes included provider statements demonstrating linguistic (i.e., reciprocity, clarity/coherence, and continuity categories) and relational elements of person-centred dementia communication, measured via video-recorded observations of usual care interactions. Subjective outcomes of care aide communication confidence/competence, satisfaction with the resident relationship, relationship closeness, and self-reflection at work were measured using self-report questionnaires.

Results

In respect to observed person-centred dementia communication skills, there was an increase in the use of linguistic statements in the reciprocity and continuity categories, as well as total linguistic statements overall. Relational statements and overall person-centred dementia communication (i.e., linguistic plus relational strategies) increased. Care aide-reported communication confidence and competence, relationship closeness with the resident, and self-reflection at work also increased after the communication intervention.

Discussion

The communication intervention showed promise as an effective approach to enhance person-centred dementia communication behaviours in care aides. These results support undertaking a larger trial to examine the intervention’s effectiveness more fulsomely.

Examining the relationship between solution-focused thinking skills and self-efficacy levels of nursing students in Turkey

BACKGROUND

Learning and developing communication skills fundamental to solution-focused thinking increases the confidence of nursing students towards individuals and improves their self-efficacy, thereby enabling these students to plan appropriate care.

PURPOSE

To evaluate solution-focused thinking skills and self-efficacy levels of nursing students and to determine the factors affecting these variables as well as the relationship among them.

METHOD

This was a descriptive and correlational study. The study was conducted between March and June 2019 with 337 nursing students from two universities with different curricula. Data were collected using a "personal information form," the "solution-focused inventory," and the "self-efficacy scale."

RESULTS

A statistically significant positive relationship was observed in the total scores on the solution-focused inventory and self-efficacy scale and the mean scores on the completing behavior and dealing with obstacles on the self-efficacy scale. In addition, a moderate relationship (r = 0.447, p < 0.01) was observed between the total solution-focused inventory scores and mean scores of completing behavior on the self-efficacy scale.

CONCLUSIONS

The nursing students had above-average mean scores on the solution-focused inventory and self-efficacy scales. However the students can further enhance their problem-solving ability by improving their solution-focused skills and self-efficacy.

What if… I Asked Cancer Patients About Psychological Distress? Barriers in Psycho-Oncological Screening From the Perspective of Nurses-A Qualitative Analysis

INTRODUCTION

Screening questionnaires to assess psychological distress in cancer patients are well-established, but in practice there are difficulties in implementation screening up to referral to psycho-oncology. Interdisciplinary collaboration between psycho-oncology, physicians, and nursing is very important to this process. However, there are barriers and obstacles on all sides.

OBJECTIVE

The aim of this study is to capture in particular the barriers from the perspective of oncology nursing.

MATERIALS AND METHODS

Semi-structured interviews with nursing experts (n = 15; n = 10 female; 24-62 years) from different oncology departments of three university hospitals in Germanys were conducted and qualitative content analysis was carried out by two raters.

RESULTS

The Screening routine is variably well-integrated into daily clinical practice. Structural barriers such as time pressure and a lack of focus on mental distress in nursing are present. Barriers on the side of nurses are primarily a lack of knowledge and communication insecurities when dealing with patients.

CONCLUSIONS

There is a need for training and implementation of a disciplinary screening approach. The structural and organizational barriers, which are a challenge for the successful screening process due to unfavorable interdisciplinary team communication and clinical daily structure, should be addressed in further studies. Implications for Practice: In order to establish an interdisciplinary screening process and to overcome the barriers, trainings to deal with knowledge deficits and insecurities seem to be useful.

Perceived Impacts of Solution-Focused Coaching Training for Pediatric Rehabilitation Practitioners: A Qualitative Evaluation

AIMS

This qualitative evaluation study assessed perceived impacts of a solution-focused coaching (SFC) training rolled out in a Canadian pediatric rehabilitation hospital from the perspective of clinical service providers.

METHODS

Thirteen clinical service providers were interviewed six months after receiving 2-day SFC training. Participants retrospectively described perceived impacts of the training and benefits and challenges pertinent to the implementation of the SFC approach. Interview transcripts were transcribed verbatim and analyzed thematically.

RESULTS

SFC training was considered making a valuable addition to participants' toolbox, increasing their confidence in developing positive therapeutic alliance with clients, and enhancing their strengths-based orientation. The training was also seen improving team cohesion and promoting collaborative solution-finding among team members. Structural barriers such as time constraints, lack of continuous organizational support and clear expectations around the use of the SFC approach were reported as factors impeding effective clinical adaptation. The need for tailoring the SFC approach to unique service contexts was also reported.

CONCLUSIONS

Future SFC training initiatives should integrate a team-based approach and a culturally sensitive lens to help providers better assist clients in identifying their unique strengths. Follow-up training and continuous organizational support mechanisms will be vital for facilitating sustainable implementation after the initial training.

Exploring Relational Dialogue in Solution-Focused Coaching Sessions: An Analysis of Co-Construction and Reflection

Purpose: To examine solution-focused coaching (SFC) as a means to enhance clinicians' professional development. Methods: Six pediatric rehabilitation clinicians (three physical, two occupational, and one behavior therapist) each received two SFC sessions targeting clinical listening goals. Conversational intervals were noted in session transcriptions. Frequencies of relational strategies and conversational intervals were calculated. The meaning of intervals > 10 s was examined. Results: The most frequent relational strategies indicated that SFC facilitates reflection and critical thinking, and encourages action. An appreciable number of long intervals (>10 s) occurred, indicating substantial reflection by participants. These were embedded in relational dialogue sequences involving coach questions and formulations, and participant pauses. Conclusions: The findings support the use of SFC as a professional development tool and substantiate the view that SFC 'works' through the coach's use of relational strategies designed to facilitate collaborative conversations that build solutions through an emphasis on reflection and action.

Determinants of effective nurse-patient communication based on the health action process approach in Yazd hospitals

Background Nurse-patient communication is one of the most important care relationships that affects the treatment process. The health action process approach (HAPA) has been used to explain a number of behaviors. However, this approach has not been used to explain nurse-patient communication. Therefore, this study was conducted to investigate effective nurse-patient communication using this approach. Materials and methods In this cross-sectional study, 300 nurses from public hospitals in the center of Iran were enrolled in the study. A researcher-developed questionnaire was used to measure the HAPA constructs. The data were analyzed using Pearson's correlation coefficient and one-way analysis of variance with least significant difference (LSD) post hoc tests in SPSS as well as structural equation modeling using AMOUS software. Results In the motivation phase, risk perception, outcome expectancies and task self-efficacy predicted 19% of variance in intention to communicate effectively. In the volitional phase, planning and action self-efficacy predicted 22% of variance in effective communication. The scores of HAPA constructs were different depending on the levels of effective communication. Conclusions The model can serve as a reference framework to promote effective nurse-patient communication.

Assessment of nurse-patient communication and patient satisfaction from nursing care

AIM

Professional communication between nurse and patient has a significant role in patient satisfaction with nursing care. The aim of this study was to assess nurse-patient communication and patient's satisfaction from nursing services in the burn wards of women and men.

DESIGN

Participants were all patients admitted to the Burn wards at the Sina Hospital of Tabriz between September-December 2018. Nurse-patient communication and patient's satisfaction were assessed using at the time of discharge. Data were analysed by SPSS applying descriptive and inferential statistics.

RESULTS

The results show that most patients were dissatisfied with nursing care. More than 80% did not know their nurse. There was a correlation between nurse-patient communication and patient satisfaction with nursing care and the sex variable was found to be significantly correlated with patients' satisfaction level. The weakness of nurses 'communication with patients was evident in our study and patients were dissatisfied from this kind of communication, and consequently, patients' satisfaction was reported very low. Improving the satisfaction of patients in the hospital should be the priorities of the hospital managers. Therefore, by educating staff, especially nurses, identifying motivating factors as well as identifying dissatisfaction factors, improved patient satisfaction.

Evaluating the feasibility of a nurse-led self-management support intervention for kidney transplant recipients: a pilot study

Background

To support effective self-management after kidney transplantation, a holistic nurse-led self-management support intervention was developed using the Intervention Mapping approach. The primary aim was to evaluate the feasibility, acceptability and fidelity of the intervention for kidney transplant recipients and professionals. The secondary aim was to explore preliminary effects on outcomes.

Methods

A pilot study was conducted in 2015–2017 to evaluate the intervention. Nurse Practitioners (NP) guided recipients in assessing 14 life areas using the Self-Management Web. Participants were supported in developing self-regulation skills which can be applied to self-management of the illness. Strategies included goal setting, action planning, and promotion of motivation and self-efficacy. Adult recipients from an outpatient clinic of a Dutch University Hospital who underwent their transplant at least 1 month ago, were invited to participate. NPs, nephrologists and recipients were interviewed to assess feasibility, fidelity and implementation experience. Consultations were videoed and analysed to assess fidelity. To assess the preliminary effects, the intervention group completed baseline (T0) and follow-up (T1) questionnaires on self-management behavior, self-efficacy, quality of life and quality of care. A historical control group of kidney transplant recipients completed the same questionnaires at T1.

Results

Twenty-seven recipients agreed to participate in the intervention group, of which 24 completed the intervention and 16 completed baseline and follow-up surveys. The control group consisted of 33 recipients. Professionals and recipients appraised the open, holistic focus of the intervention as a welcome addition to standard care and felt that this helped to build a relationship of trust. Recipients also felt they became more competent in problem-solving skills. The within-group analysis showed no significant increase in patients’ self-management skills. The between-groups analysis showed significantly higher medication adherence among the intervention group (P = 0.03; G = 0.81). The within-groups analysis showed a significantly higher perceived quality of care (P = 0.02) in the intervention group.

Conclusion

This holistic nurse-led self-management support intervention was found to be feasible and acceptable by professionals and recipients alike. This pilot had a small sample therefore further research is needed into the potential effects on self-management behavior and well-being of transplant recipients. ISRCTN Trial Registry: ISRCTN15057632 (registered retrospectively on 20-07-2018).

Electronic supplementary material

The online version of this article (10.1186/s12882-019-1300-7) contains supplementary material, which is available to authorized users.

A communication skills intervention to minimise patient perpetrated aggression for healthcare support workers in New Zealand: A cluster randomised controlled trial

Healthcare support workers face challenging situations in their day-to-day work but may have minimal training on how to deal with such incidents. Although staff training is often recommended as an essential part of any comprehensive approach for preventing and managing workplace violence, there is paucity of evidence on the content and effectiveness of such training. This study aimed to evaluate the effect of an intervention (communication skills training) to reduce the experience of aggression for healthcare support workers. A two arm, cluster randomised, single-blinded, controlled trial among healthcare support workers in nongovernmental organisations (NGOs) and District Health Boards (DHBs) in New Zealand was conducted. The trial was conducted across 14 NGOs and DHB in Otago, Southland, and Auckland regions of New Zealand. One hundred and twenty-seven participants were randomised to one of two groups. Both the intervention (communication skills) and control condition (mindfulness) were group-based, fully scripted, and structured training interventions that consisted of four once weekly workshops that were facilitated by one of two nonclinical facilitators. Measurements of perceived aggression, psychological well-being, and distress and communication competence were taken pre-, post-, 3 months' post-, and 6 months' postintervention. There was a significant drop in the rate of aggression over time with a mean score and standard deviation of 10.37 (9.169) at baseline dropping to 6.07 (6.923) for the Perception of Patient Aggression Scale-New Zealand across both intervention and control. Equivalent results were noted with increased psychological well-being and communication competence and decreased distress with both interventions. This was sustained at 6 months' follow-up. However, the between groups effect did not demonstrate a statistically significant difference between the intervention and control groups. Both mindfulness and communication skills training can reduce the experience of aggression reported by healthcare support workers.

Introducing solution-focussed brief therapy to mental health nurses across a local health district in Australia

Solution-focussed brief therapy (SFBT) can be applied to effectively address a broad range of mental health-, alcohol-, and substance-related challenges. The compatibility that SFBT has with mental health nursing practice has been widely recognized. The aim of the present mixed-methods study was to introduce and evaluate the utility of SFBT principles, strategies, and techniques to the clinical work of mental health nurses from a local health district in Sydney, Australia. Following a 4-hour introductory SFBT workshop, participants were invited to complete a one-page evaluation and undertake a follow-up individual telephone interview with a research assistant. Participants (n = 65) were positive about the workshop content and recognized the potential benefits of SFBT in clinical practice. Interviewed participants (n = 14) were enthusiastic about SFBT. However, they also identified that using SFBT was challenging, particularly as the approach was considered different to current practices in mental health services. A lack of confidence with incorporating SFBT in their clinical work was also acknowledged, and participants expressed interest in additional training, including more time to practise SFBT strategies and techniques. Widespread training for mental health nurses in SFBT is indicated, including opportunities for supervision and to observe SFBT being employed by experienced clinicians.

Using root metaphors to analyze communication between nurses and patients: a qualitative study

BACKGROUND

Metaphors in communication can serve to convey individuals' backgrounds, contexts, experiences, and worldviews. Metaphors used in a health care setting can help achieve consensual communication in professional-patient relationships. Patients use metaphors to describe symptoms, or how disease affects them. Health professionals draw on shared understanding of such metaphors to better comprehend and meet patient needs, and to communicate information that patients can more easily integrate into their lives. This study incorporated a theoretical framework based on four worldviews, each with an underlying foundational metaphor (root metaphor). The use of these root metaphors (formism, mechanism, contextualism, and organicism) can have an explanatory function and serve to impart new meanings, as each type of metaphor can lead to a particular interpretation. The study aimed to extract and discuss the root metaphors, with a view to analyzing the communication between health professionals and patients.

METHODS

In a case study in Spain over a six-month period, we analyzed the content of recorded, transcribed interviews conducted by one nurse with 32 patients who had chronic illnesses. We inductively extracted five categories that emerged from the interviews: blood sugar, cholesterol, exercise, blood pressure, and diet. We then examined these categories from the standpoint of each of the four root metaphors using two approaches: A series (deductive) and an emergent (inductive) approach.

RESULTS

The results show that the nurse tended to primarily use two worldviews: mechanism and formism. In contrast, patients tended to favor mechanism when discussing cholesterol, blood pressure, and blood sugar levels, whereas contextualism was predominant when the category was diet or exercise.

CONCLUSIONS

This study adds to the existing literature on health professionals and patients' communication. It shows how the use of Pepper's root metaphors help to analyze the communication between the nurse and patients. Furthermore, it shows they are both using different root metaphors when they are talking about illness and treatments especially regarding blood sugar, cholesterol, exercise, blood pressure, and diet. Further qualitative and quantitative studies are needed to solidly these findings.

A thematic analysis of the experience of UK mental health nurses who have trained in Solution Focused Brief Therapy

WHAT IS KNOWN ON THE SUBJECT?: Solution Focused Brief Therapy (SFBT) is an effective model of brief psychotherapy. Evidence suggests that nurses can be trained to deliver SFBT with only a few days training. It has been argued that SFBT reflects the core values of nursing practice, but no empirical research has been undertaken to validate this assertion. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This is the first time the impact of such training on nurses' sense of professional and personal identity has been explored. Drawing upon data derived from twenty interviews, this paper explores the key themes reported by nurses in relation to their personal experience of training in SFBT. This paper extends our understanding of the lived experience of mental health nurses and facilitates discussion on the preparation and practice of their role. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Training in SFBT can provide a framework for nurses to empower their clients/patients to take control of their own recovery in a shared and trusting relationship. Training in SFBT can enhance nurses' sense of trust in their clients. Training in solution-focused interactions may provide a framework for many nurses to provide the type of collaborative, patient-led care they aspire to.

ABSTRACT

Introduction SFBT is a psychotherapeutic model that aims to 'build solutions' rather than 'solve problems'. It has evolved into a structured communication framework utilized across a range of disciplines, focusing on the future, as opposed to the past, and on participant's strengths and abilities, as opposed to their problems and deficits. There have been no studies exploring the experience of training in SFBT from the perspective of the nurses being trained. Aim This study sought to explore the experience of nurses who had completed a six-month training course in SFBT. Methods Using a qualitative methodology, 20 nurses who had undertaken SFBT training were interviewed at various locations across Scotland. Results Five main themes emerged from analysis of the 20 interviews. Many of the participants reported increased trust in their clients and enhanced role satisfaction. Implications for Practice Training in SFBT provides nurses with an alternative model of practice to the dominant 'medical' and 'psychological' models of contemporary practice. The experiences of the participants in this study suggest that SFBT can be a useful intervention in nursing practice and that nurses can easily incorporate SFBT into their practice.

Using trauma informed care as a nursing model of care in an acute inpatient mental health unit: A practice development process

Without agreeing on an explicit approach to care, mental health nurses may resort to problem focused, task oriented practice. Defining a model of care is important but there is also a need to consider the philosophical basis of any model. The use of Trauma Informed Care as a guiding philosophy provides a robust framework from which to review nursing practice. This paper describes a nursing workforce practice development process to implement Trauma Informed Care as an inpatient model of mental health nursing care. Trauma Informed Care is an evidence-based approach to care delivery that is applicable to mental health inpatient units; while there are differing strategies for implementation, there is scope for mental health nurses to take on Trauma Informed Care as a guiding philosophy, a model of care or a practice development project within all of their roles and settings in order to ensure that it has considered, relevant and meaningful implementation. The principles of Trauma Informed Care may also offer guidance for managing workforce stress and distress associated with practice change.

Can We Help Care Providers Communicate More Effectively With Persons Having Dementia Living in Long-Term Care Homes?

Background:

Effective communication between residents with dementia and care providers in long-term care homes (LTCHs) is essential to resident-centered care.

Purpose:

To determine the effects of a communication intervention on residents’ quality of life (QOL) and care, as well as care providers’ perceived knowledge, mood, and burden.

Method:

The intervention included (1) individualized communication plans, (2) a dementia care workshop, and (3) a care provider support system. Pre- and postintervention scores were compared to evaluate the effects of the intervention. A total of 12 residents and 20 care providers in an LTCH participated in the feasibility study.

Results:

The rate of care providers’ adherence to the communication plans was 91%. Postintervention, residents experienced a significant increase in overall QOL. Care providers had significant improvement in mood and perceived reduced burden.

Conclusion:

The results suggest that the communication intervention demonstrates preliminary evidence of positive effects on residents’ QOL and care providers’ mood and burden.

Effect of Communication Skills Training on the Burnout of Nurses: A Cross-Sectional Study

INTRODUCTION

One of the factors influencing the burnout of nurses is their difficult and complicated relations with patients and other members of the medical team. Therefore, it is necessary that nurses to be trained on communication skills.

AIM

The present research aims to study the effect of communication skills training on the burnout of nurses.

MATERIALS AND METHODS

The present research was an experimental study using pretest-posttest method. The subjects included 60 nurses working in Khatamolanbia Hospital in Iranshahr, Sistan and Baluchestan Province, Iran. The subjects were randomly divided into two groups. The required data and information were collected using Jackson and Maslach Burnout Inventory which was filled out by subjects in three steps including before the intervention, at the end of the second session, and one month after the intervention. The intervention included training on communication skills which was carried out for the intervention group as a 2-day workshop for 8 hours within a week.

RESULTS

The findings showed that the mean score of frequency and intensity of burnout in the intervention group before the intervention, at the end of the intervention, and one month after the intervention was 39.3±6.2 and 61.1±8.0, 37.5±4.6 and 58.8±7.6, and 34.2±4.4 and 54.6±7.0, respectively. These changes suggest a significant decreasing trend (p=0.01). On the other hand, mean scores of burnout in the control group showed no significant difference in three steps (p<0.05).

CONCLUSION

Since communication skills training is an effective and inexpensive way for reducing the burnout among nurses, it is recommended that this approach to be taken into account by managers in order to reduce the burnout among nurses and improve the quality of healthcare services provided by them.

Investigating the efficacy of a whole team, psychologically informed, acute mental health service approach

BACKGROUND

Service user demand and service changes, from hospital based, to community and hospital mix, within acute adult mental health services, focus the need for psychologically informed, holistic, approaches.

AIMS

(1) Describe and report feasibility of a psychologically led Intensive Support Programme (ISP) to meet this need. (2) Present results of a pilot evaluation of this programme.

METHOD

ISP was implemented in four acute mental health services of the Southern Health NHS Trust, available to both inpatient and outpatient acute services. Evaluation of the service one month after data collection, illustrates operation and level of uptake across different professional roles. The programme was evaluated by assessing psychological distress (CORE-10) and confidence in self-management (Mental Health Confidence Scale) of participating service users before and after intervention.

RESULTS

The service evaluation demonstrated extensive roll out of this programme across acute services of an extensive NHS Trust. Repeated measure t-tests demonstrated significant decrease in distress (p < 0.0005) and significant increase in confidence in self-management of mental health (p < 0.0005).

CONCLUSION

Evaluation shows that ISP can be delivered in routine care in an acute mental health service and results in improvement in self management skills and facilitation of recovery.

Predictors of nurses' intention and behavior in using health literacy strategies in patient education based on the theory of planned behavior

BACKGROUND

Health literacy is one of the most important priorities for improving health care quality through enhancing patient-provider communication. Implementing health literacy strategies enable nurses to provide information and instructions for patients in a manner that is more commensurate and understandable. The purpose of this study was to investigate the factors affecting nurses' intention to implement health literacy strategies in patient education based on theory of planned behavior.

METHODS

A cross-sectional study was done on 148 nurse practitioners of AL-Zahra educational hospital in Isfahan, Iran, using a descriptive-analytic method. Data collected via a standardized questionnaire based on theory of planned behavior constructed and analyzed by SPSS v.17 using ANOVA, Independent T-test, Pearson correlation and linear regression.

RESULTS

There was statistically significant correlation between using health literacy strategies and marriage status, attending in retraining courses, employment type, job history, and job status. Perceived behavioral control was the most powerful predictor of intention (β=0.417) and use health literacy strategies in patient education and behavior of nurses (β=0.33).

CONCLUSION

According to the findings of this study, perceived behavioral control is a powerful determinant of nurses' intention and behavior of using health literacy strategies in patient education. Hence we recommend nurse educators to pay special attention to the constructs of this theory mainly perceived behavioral control in retrain courses about patient education and health literacy strategies.

Factors affecting the nurse-patients' family communication in intensive care unit of kerman: a qualitative study

INTRODUCTION

The communication between nurses and patients' families impacts patient well-being as well as the quality and outcome of nursing care, this study aimed to demonstrated the facilitators and barriers which influence the role of communication among Iranian nurses and families member in ICU.

METHODS

This study is a qualitative study with content analysis. Participants were eight registered nurses and ten of patients' families. Patients were admitted to the ICU of two large university hospitals in Kerman, Iran. We used non-structured interviews for data collection. All interviews were transcribed verbatim with a simultaneous, constant comparative analysis of the audio tapes.

RESULTS

According to data analysis, facilitative factors between nurses and families' communication consisted of spiritual care, emotional support, Participation, notification and consultation and barriers that were misunderstandings regarding treatment, job and patient difficulties.

CONCLUSION

The findings led into the recognition of the important barriers and facilitators in communication between ICU team and the family of the patients. By identification of the barriers and facilitators of communication, establishing new rules and using creative methods in education and establishing the communication of ICU team especially using patient-based approach we can have effective communication.

Solution-focused approach therapy for mental health nursing students

Solution-focused therapy is a model of therapy that builds on the client's strengths, is future-focused and can be generally offered as a brief intervention. It can be used across multiple clinical settings and is not limited to being useful for clients accessing mental health services. Learning the underlying principles and developing a foundation level of skill in the approach was found to be achievable in an undergraduate nursing course, with students reporting an increase in their knowledge of the model and confidence in basic therapeutic skills in just one day of training. In this paper, we introduce the solution-focused approach in relation to nursing practice. We describe the template used for the training day offered to undergraduate mental health nurses. Students reported that this method of learning a therapeutic approach was helpful and increased both their knowledge and skill base.

Respect in final-year student nurse-patient encounters - an interpretative phenomenological analysis

Very little is known regarding health-care professionals' understanding and experiences of respect towards patients. The study aimed to explore student nurses' understanding and experiences of respect in their encounters with patients. Semi-structured interviews were conducted with eight final-year student nurses with practice placements across different health-care trusts in the UK. Transcripts were analysed using interpretative phenomenological analysis (IPA). Three super-ordinate themes were identified: understanding of what it means to show respect, negotiating role expectations and personal attitudes in practice, and barriers related to the performance of the nursing role. The factors identified should be investigated further and addressed as they are likely to influence patients' experiences of feeling respected in nurse–patient interactions and subsequently their well-being and health-related behaviours.

The Role of Occupational Therapists in Supporting Psychological Wellbeing after Stroke Using a Solution-Focused Psychological Approach to Mood Assessment

This practice analysis describes a solution-focused approach to mood assessment and care with stroke survivors. A brief introduction to a solution-focused approach is detailed, together with the rationale for its use in stroke rehabilitation settings. The mood assessment procedure is described, with reflections from occupational therapists using the approach. Implications for how this can enhance patient-centred care in line with current United Kingdom Department of Health principles are outlined.

What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients

AIM

To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients.

BACKGROUND

The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. To support the development of effective nursing communication in clinical practice, a good understanding of what constitutes effective communication is helpful.

DESIGN

An exploratory design was used involving individual interviews, focus groups and written notes from participants and field notes from researchers to investigate perspectives on nurse-patient communication.

METHODS

Focus groups and individual interviews were held between August 2010-September 2011 with a purposive sample of 15 nurse educators and clinicians who observed videos of interactions between nurses and simulated patients. These participants were asked to give oral feedback on the quality and content of these interactions. Verbatim transcriptions were undertaken of all data collected. All written notes and field notes were also transcribed. Thematic analysis of the data was undertaken.

FINDINGS

Four major themes related to nurse-patient communication were derived from the educators' and clinicians' feedback: approach to patients and patient care, manner towards patients, techniques used for interacting with patients and generic aspects of communication.

CONCLUSION

This study has added to previous research by contributing grounded evidence from a group of nurse educators and clinicians on the aspects of communication that are relevant for effective nurse-patient interactions in clinical practice.

Evidence-based solution-focused care for school-age children experiencing cyberbullying: using the Omaha System to guide and document psychiatric nursing interventions

Cyberbullying is a global phenomenon. The experiences of bullied children are the same across cultures and languages, and psychiatric nursing interventions are known to be effective. It is critical to widely disseminate effective interventions to identify and address cyberbullying. Therefore, evidence-based care plans addressing cyberbullying at the individual and community levels were developed using the Omaha System, a terminology that is used internationally to guide and document care. This article presents a case study in which an evidence-based intervention was used to help a bullied child arrive at a solution, and demonstrates the use of the Omaha System to document evidence-based cyberbullying interventions with individuals and communities.

Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care

BACKGROUND

Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient's needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1) examining the effects of the intervention on patients' quality of life, depression, satisfaction with care, and agitation; and (2) examining the extent to which the intervention improves staff's attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study.

METHODS/DESIGN

A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1) development of an individualized patient communication care plan; (2) a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3) a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient.

DISCUSSION

The Patient-Centred Communication Intervention will provide staff with strategies to facilitate interactions with patients and to minimize agitation associated with considerable stress. The improvement of these interactions will lead to a reduction of agitation, which has the additional significance of increasing patients' well-being, quality of life, and satisfaction with care.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT01654029.

Existential issues among nurses in surgical care--a hermeneutical study of critical incidents

AIMS

To report a qualitative study conducted to gain a deeper understanding of surgical nurses' experiences of existential care situations. Background.  Existential issues are common for all humans irrespective of culture or religion and constitute man's ultimate concerns of life. Nurses often lack the strategies to deal with patients' existential issues even if they are aware of them.

DESIGN

This is a qualitative study where critical incidents were collected and analysed hermeneutically.

METHODS

During June 2010, ten surgical nurses presented 41 critical incidents, which were collected for the study. The nurses were first asked to describe existential care incidents in writing, including their own emotions, thoughts, and reactions. After 1-2 weeks, individual interviews were conducted with the same nurses, in which they reflected on their written incidents. A hermeneutic analysis was used.

FINDINGS

The majority of incidents concerned nurses' experiences of caring for patients' dying of cancer. In the analysis, three themes were identified, emphasizing the impact of integration between nurses' personal self and professional role in existential care situations: inner dialogues for meaningful caring, searching for the right path in caring, and barriers in accompanying patients beyond medical care.

CONCLUSION

Findings are interpreted and discussed in the framework of Buber's philosophy of the relationships I-Thou and I-It, emphasizing nurses' different relationships with patients during the process of caring. Some nurses integrate their personal self into caring whereas others do not. The most important finding and new knowledge are that some nurses felt insecure and were caught somewhere in between I-Thou and I-It.

Is training in solution-focused working useful to community matrons?

This article evaluates the usefulness of a small initiative to train community matrons (CMs) in solution-focused (SF) approaches, from the perspective of the CMs. A SF approach is a psychologically sophisticated, yet relatively easy-to-use psychological model for enhancing care and wellbeing which can help to empower patients and promote self-care. Data from questionnaires completed by CMs immediately post training and from qualitative interviews conducted 12 months later suggest that training in SF approaches is considered useful, useable and relevant by the nurses themselves. More specifically, CMs reported that SF approaches allowed them to work alongside patients to investigate and amplify patients' own expertise in 'living well' despite their difficulties, contributing to improved patient self-management, less reliance on the CM, and greater job satisfaction for the CM. SF approaches seem to resonate with the current NHS drive for greater efficiency and better patient-centred care.

A qualitative investigation into the effects of brief training in solution-focused therapy in a social work team

OBJECTIVES

Previous research into the effectiveness of brief training in psychological therapies for non-therapist health and social services workers has found mixed results regarding transferring learning into practice. Very few published studies have assessed the impact of such training in Solution-Focused Brief Therapy (SFBT), despite such training being popular. This study explored the impact of brief SFBT training for a group of community-based social workers.

DESIGN

A qualitative interview-based design was used, with the researcher adopting an ethnographic stance to obtain a rich, detailed and focused account of events.

METHODS

Six social workers working with adults with intellectual disabilities took part in the study. All had attended a 2-day workshop in SFBT 9 months previously. The interviews were transcribed and subjected to thematic analysis.

RESULTS AND CONCLUSIONS

Factors affecting skill transfer included being able to practise, peer and organizational support, and perceived conflicts between SFBT and work role. Whilst specific trained techniques were not consistently adopted, most workers changed the style of their interaction with clients in simple ways which they reported resulted in benefits including improved communication, collaboration, and increased feelings of control and self-efficacy for clients and workers. The findings suggest that in addition to peer and organizational support, trainees' perceptions of the fit of the training with their work role may be a key factor in determining transfer. Recommendations are made for developing training for non-therapists that focuses on helping change the style of their interactions rather than on learning to implement specific psychological therapy techniques.

Provider verbal responses to patient distress cues during ambulatory oncology visits

PURPOSE/OBJECTIVES

To explore healthcare provider cue-responding behaviors to patient cues of distress and socioemotional concerns during ambulatory, on-treatment oncology visits.

DESIGN

Descriptive secondary analysis of a data set of audio recordings of oncology visits and reports of symptoms and quality of life recorded with an electronic self-report assessment-cancer (ESRA-C) tool.

SETTING

Comprehensive cancer center, ambulatory care.

SAMPLE

31 randomly selected cases from an existing data set (with one used as a training tool) of 590 audio recordings of patient-provider communication.

METHODS

Patients were placed in Group 1 (n = 20) and Group 2 (n = 10) to explore differences in patient-provider communication and decrease coder bias. Both groups completed the ESRA-C questionnaire prior to the visit. Providers in Group 2 received a printed ESRA-C summary report for use during the visit. Audio files of the visit were coded using the Medical Interview Aural Rating System (MIARS).

MAIN RESEARCH VARIABLES

Patient cues of distress and provider cue-responding behaviors.

FINDINGS

Patient cues of distress and socioemotional concerns ranged from 0-13 cues per visit, with a mean of 4.6 cues per visit. Providers acknowledged 57% of patient cues, but only acknowledged and explored 22% of all patient cues. Providers in Group 2 acknowledged patient concerns more often but explored the concerns less frequently. The number of patient cues distanced from by providers was lower in Group 2 and the overall provider score for responsiveness to patient cues of distress was higher, indicating more responsiveness than from Group 1.

CONCLUSIONS

The use of a summary report of patient concerns may have enhanced provider responsiveness, in general. Distancing behaviors by providers in response to patient verbal cues may indicate a lack of knowledge, time limitations, or a lack of confidence.

IMPLICATIONS FOR NURSING

To effectively support patients with cancer through active therapy, a greater level of acknowledgment, exploration, and responsive action by providers is indicated. These findings have implications for provider education, with regard to appropriate responses, and for researchers to test methods that best prompt and support effective provider behaviors, ultimately improving patient outcomes.

Conversations in end-of-life care: communication tools for critical care practitioners

BACKGROUND

Communication skills are the key for quality end-of-life care including in the critical care setting. While learning general, transferable communication skills, such as therapeutic listening, has been common in nursing education, learning specific communication tools, such as breaking bad news, has been the norm for medical education. Critical care nurses may also benefit from learning communication tools that are more specific to end-of-life care.

STRATEGY

We conducted a 90-min interactive workshop at a national conference for a group of 78 experienced critical care nurses where we presented three communication tools using short didactics. We utilized theatre style and paired role play simulation. The Ask-Tell-Ask, Tell Me More and Situation-Background-Assessment-Recommendation (SBAR) tools were demonstrated or practiced using a case of a family member who feels that treatment is being withdrawn prematurely for the patient. The audience actively participated in debriefing the role play to maximize learning. The final communication tool, SBAR, was practiced using an approach of pairing with another member of the audience. At the end of the session, a brief evaluation was completed by 59 nurses (80%) of the audience.

SUMMARY

These communication tools offer nurses new strategies for approaching potentially difficult and emotionally charged conversations. A case example illustrated strategies for applying these skills to clinical situations. The three tools assist critical care nurses to move beyond compassionate listening to knowing what to say. Ask-Tell-Ask reminds nurses to carefully assess concerns before imparting information. Tell Me More provides a tool for encouraging dialogue in challenging situations. Finally, SBAR can assist nurses to distill complex and often long conversations into concise and informative reports for colleagues.