Evaluation of an integrated communication skills training program for nurses in cancer care in Beijing, China

An online intervention to improve oncology health professional self-efficacy in communicating with carers: Hybrid effectiveness-implementation evaluation of the eTRIO program

OBJECTIVES

Many oncology health professionals (HPs) report communicating with carers as complex; and receive limited carer-relevant training. We developed an online HP education program for supporting and managing carer involvement (eTRIO). We aimed to assess whether HPs' self-efficacy in carer communication, knowledge, and decision-making preferences improve following eTRIO. Satisfaction and implementation potential were assessed.

METHODS

This type 1 hybrid effectiveness-implementation study used a pre-post single arm intervention design. HPs completed baseline measures, the eTRIO online module, and measures at 1- and 12-weeks post-intervention. Measures included: self-efficacy in carer communication (13-items), applied knowledge (7-items), preference for carer involvement in decisions (1-item). Fifteen of participants completed feedback interviews which underwent thematic analysis. User analytics were collected and analysed.

RESULTS

Fifty-six HPs completed baseline measures, 42 completed post- and follow-up measures. At baseline mean self-efficacy score was 88. HPs showed a statistically significant increase in self-efficacy post-intervention (mean = 105.8, CI [12.99, 20.47]), maintained at 12-weeks (mean = 101.1, CI [8.00, 15.72]). There were no changes in knowledge or decision-making preferences. Program engagement and satisfaction were high, 86.7% participants rated eTRIO as very/extremely helpful.

CONCLUSIONS AND PRACTICE IMPLICATIONS

eTRIO provided HPs with confidence to effectively engage with carers and manage complex situations such as family dominance. These gains are noteworthy, as conflict with families/carers contributes to HP burnout.

The Effect of an Educational Intervention Based on the Health Action Process Approach on Nurses' Communication Skills

Objective

This study aimed to the effects of the Health Action Process Approach (HAPA) in promoting the quality of nurses' communication skills among nurses.

Methods

The present quasi-experimental research was conducted on 148 nurses (76 in the intervention and 72 in the control group) in Yazd province (Iran). In this study, the total number of nurses in one hospital was selected as the intervention group, while the nurses from another hospital were chosen as the control group. The participants were recruited from public hospitals in Ardakan and Meibod cities. The data collection instrument was a questionnaire based on the Health Action Process Approach (HAPA) Constructs and a communicative skill questionnaire. The data were collected from the two groups before, one month after, and four months after the intervention. The control group did not receive any educational training during the course of the study.

Results

In the pretest, no statistically significant difference was found between the intervention and control groups regarding the behavioral stages of effective communication with patients. In the posttest, the mean task self-efficacy score was significantly increased in the intervention group compared to the control (p<0.001). The mean coping self-efficacy score was also significantly higher in the intervention group than the control in the posttest (p<0.001). Moreover, the mean coping planning score was significantly increased in the post-test intervention group(p < 0.001). The mean communicative skill score was also significantly increased in the intervention group compared to the post-test control (p=0.03).

Conclusion

The intervention used in the present study based on the target model (HAPA) significantly affected nurses' self-efficacy and communicative skills in the experimental group.

Training in communication skills for self-efficacy of health professionals: a systematic review

BACKGROUND

Communication skills are essential for health professionals to establish a positive relationship with their patients, improving their health and quality of life. In this perspective, communication skills training can be effective strategies to improve the care provided by professionals in patient care and the quality of health services.

OBJECTIVE

To identify the best available evidence on training programs in communication skills to promote changes in attitude and behavior or self-efficacy of health professionals.

METHODS

Systematic searches were performed in eight databases, evaluating Randomized Controlled Trials and quasi-experimental studies with a control group, focusing on training communication skills for health professionals, who assessed self-efficacy or behaviors related to these skills. The phases of study selection and data extraction were carried out by two independent researchers, and the conflicts were resolved by a third. The risk of bias was assessed using the Cochrane method.

RESULTS

Eight studies were included in the review. Most programs lasted between 4½ h and 2 days, involved information about communication skills and the content was applied to the health professionals' context. Several teaching strategies were used, such as lectures, videos and dramatizations and the evaluation was carried out using different instruments. Improvements in the performance and in the self-efficacy of communication skills were observed in the trained groups. The RCT had a low risk of bias and the quasi-experimental studies had a moderate risk.

CONCLUSION

Training in communication skills can improve the performance and self-efficacy of health professionals. Programs that approach the conceptual issues and promote the space for experiential learning could be effective in communication skills training for professionals.

PROSPERO

CRD42019129384.

Effectiveness of communication skill training on cancer truth-telling for advanced practice nurses in Taiwan: A pilot study

OBJECTIVE

Advanced practice nurses (APNs) can best support physicians in improving the quality of truth-telling. However, the effectiveness of communication skill training (CST), based on the Japanese SHARE model exclusive to APNs, has not been tested from APNs' and recipients' viewpoints, motivating the author to conduct the present study.

METHODS

A two-group before-after model design was adopted, and 61 APNs from two hospitals were randomly assigned to either an experimental group (EG; N = 28) or an control group (CG; N = 33). APNs in the EG received 6 h of CST under the guidance of qualified facilitators and simulated patients. This study used APNs' subjective assessment (N = 61) (self-confidence and perceptions on truth-telling) and recipients' opinions (N = 480) (cancer patients' and their caregivers' satisfaction with truth-telling and emotional status) to assess the effectiveness of the SHARE CST. Data were collected before CST (baseline, T0), immediately after (T1), and 2 weeks after (T2).

RESULTS

APNs in the EG had more confidence (p < 0.05) and better perceptions of cancer truth-telling (p < 0.01) than APNs in the CG at both T1 and T2. No group differences were found in patients' or their caregivers' satisfaction with truth-telling, emotional distress, and anxiety (p > 0.05). In addition, patients in the EG had higher depression than patients in the CG (β = 1.65, p = 0.01).

CONCLUSIONS

SHARE CST can improve APNs' confidence and perceptions of cancer truth-telling. However, more rigorous studies are required to test the effectiveness of CST from recipients' viewpoint.

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.

Communication interventions in adult and pediatric oncology: A scoping review and analysis of behavioral targets

BACKGROUND

Improving communication requires that clinicians and patients change their behaviors. Interventions might be more successful if they incorporate principles from behavioral change theories. We aimed to determine which behavioral domains are targeted by communication interventions in oncology.

METHODS

Systematic search of literature indexed in Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov (2000-October 2018) for intervention studies targeting communication behaviors of clinicians and/or patients in oncology. Two authors extracted the following information: population, number of participants, country, number of sites, intervention target, type and context, study design. All included studies were coded based on which behavioral domains were targeted, as defined by Theoretical Domains Framework.

FINDINGS

Eighty-eight studies met inclusion criteria. Interventions varied widely in which behavioral domains were engaged. Knowledge and skills were engaged most frequently (85%, 75/88 and 73%, 64/88, respectively). Fewer than 5% of studies engaged social influences (3%, 3/88) or environmental context/resources (5%, 4/88). No studies engaged reinforcement. Overall, 7/12 behavioral domains were engaged by fewer than 30% of included studies. We identified methodological concerns in many studies. These 88 studies reported 188 different outcome measures, of which 156 measures were reported by individual studies.

CONCLUSIONS

Most communication interventions target few behavioral domains. Increased engagement of behavioral domains in future studies could support communication needs in feasible, specific, and sustainable ways. This study is limited by only including interventions that directly facilitated communication interactions, which excluded stand-alone educational interventions and decision-aids. Also, we applied stringent coding criteria to allow for reproducible, consistent coding, potentially leading to underrepresentation of behavioral domains.

Outcomes and outcome measures used in evaluation of communication training in oncology - a systematic literature review, an expert workshop, and recommendations for future research

BACKGROUND

Communication between health care provider and patients in oncology presents challenges. Communication skills training have been frequently developed to address those. Given the complexity of communication training, the choice of outcomes and outcome measures to assess its effectiveness is important. The aim of this paper is to 1) perform a systematic review on outcomes and outcome measures used in evaluations of communication training, 2) discuss specific challenges and 3) provide recommendations for the selection of outcomes in future studies.

METHODS

To identify studies and reviews reporting on the evaluation of communication training for health care professionals in oncology, we searched seven databases (Ovid MEDLINE, CENTRAL, CINAHL, EMBASE, PsychINFO, PsychARTICLES and Web of Science). We extracted outcomes assessed and the respective assessment methods. We held a two-day workshop with experts (n = 16) in communication theory, development and evaluation of generic or cancer-specific communication training and/or outcome measure development to identify and address challenges in the evaluation of communication training in oncology. After the workshop, participants contributed to the development of recommendations addressing those challenges.

RESULTS

Out of 2181 references, we included 96 publications (33 RCTs, 2 RCT protocols, 4 controlled trials, 36 uncontrolled studies, 21 reviews) in the review. Most frequently used outcomes were participants' training evaluation, their communication confidence, observed communication skills and patients' overall satisfaction and anxiety. Outcomes were assessed using questionnaires for participants (57.3%), patients (36.0%) and observations of real (34.7%) and simulated (30.7%) patient encounters. Outcomes and outcome measures varied widely across studies. Experts agreed that outcomes need to be precisely defined and linked with explicit learning objectives of the training. Furthermore, outcomes should be assessed as broadly as possible on different levels (health care professional, patient and interaction level).

CONCLUSIONS

Measuring the effects of training programmes aimed at improving health care professionals' communication skills presents considerable challenges. Outcomes as well as outcome measures differ widely across studies. We recommended to link outcome assessment to specific learning objectives and to assess outcomes as broadly as possible.

Care staff's self-efficacy regarding end-of-life communication in the long-term care setting: Results of the PACE cross-sectional study in six European countries

BACKGROUND

An important part of palliative care is discussing preferences at end of life, however such conversations may not often occur. Care staff with greater self-efficacy towards end-of-life communication are probably more likely to have such discussions, however, there is a lack of research on self-efficacy towards end-of-life discussions among long-term care staff in Europe and related factors.

OBJECTIVES

Firstly, to describe and compare the self-efficacy level of long-term care staff regarding end-of-life communication across six countries; secondly, to analyse characteristics of staff and facilities which are associated to self-efficacy towards end-of-life communication.

DESIGN

Cross-sectional survey.

SETTINGS

Long-term care facilities in Belgium, England, Finland, Italy, the Netherlands and Poland (n = 290).

PARTICIPANTS

Nurses and care assistants (n = 1680) completed a self-efficacy scale and were included in the analyses.

METHODS

Care staff rated their self-efficacy (confidence in their own ability) on a scale of 0 (cannot do at all) to 7 -(certain can do) of the 8-item communication subscale of the Self-efficacy in End-of-Life Care survey. Staff characteristics included age, gender, professional role, education level, training in palliative care and years working in direct care. Facility characteristics included facility type and availability of palliative care guidelines, palliative care team and palliative care advice. Analyses were conducted using Generalized Estimating Equations, to account for clustering of data at facility level.

RESULTS

Thde proportion of staff with a mean self-efficacy score >5 was highest in the Netherlands (76.4%), ranged between 55.9% and 60.0% in Belgium, Poland, England and Finland and was lowest in Italy (29.6%). Higher levels of self-efficacy (>5) were associated with: staff over 50 years of age (OR 1.86 95% CI[1.30-2.65]); nurses (compared to care assistants) (1.75 [1.20-2.54]); completion of higher secondary or tertiary education (respectively 2.22 [1.53-3.21] and 3.11 [2.05-4.71]; formal palliative care training (1.71 [1.32-2.21]); working in direct care for over 10 years (1.53 [1.14-2.05]); working in a facility with care provided by onsite nurses and care assistants and offsite physicians (1.86 [1.30-2.65]); and working in a facility where guidelines for palliative care were available (1.39 [1.03-1.88]).

CONCLUSION

Self-efficacy towards end-of-life communication was most often low in Italy and most often high in the Netherlands. In all countries, low self-efficacy was found relatively often for discussion of prognosis. Palliative care education and guidelines for palliative care could improve the self-efficacy of care staff.

Communication skills training for healthcare professionals working with people who have cancer

BACKGROUND

This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective.

OBJECTIVES

To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction.

SEARCH METHODS

For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies.

SELECTION CRITERIA

The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs).

MAIN RESULTS

We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias.

AUTHORS' CONCLUSIONS

Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.

Evaluation of nursing students' communication abilities in clinical courses in hospitals

Background:

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has established, improving communication as a priority for improving patient safety since 2006. Therefore, the present study aimed to evaluate nursing students’ communication abilities to recognize their strengths and weaknesses in communication skills.

Method:

This cross-sectional study was carried out in 2014. The study participants included all the nursing students who passed two semesters in Fatemeh School of Nursing and Midwifery in Shiraz, Iran. The students’ communication skills were assessed using a self-administered questionnaire. Then, the data were entered into the SPSS statistical software (v. 16) and analyzed using both descriptive (mean and percentage) and inferential statistics (Pearson correlation and ANOVA).

Results:

Among the 200 students who completed the questionnaires, 58% were female and 42% were male with the mean age of 21.79 years (SD=2.14). The results of Pearson correlation analysis demonstrated a significant correlation between the nursing students’ clinical communication behavior scores and treatment communication ability scores (P<0.001). The findings demonstrated that most nursing students required improvement in their communication skills in both clinical communication behavior and treatment communication ability. Besides, a significant difference was observed among the students of different terms regarding clinical communication behaviors (P≤0.05), but not concerning communication abilities. Nursing students in higher semesters had better communication skills.

Conclusions:

The results showed that nursing students in this university had a moderate ability in clinical and treatment communication. Thus, paying attention to standard education, curriculum revision, and adding some specific theoretical lessons for improving communication skills are mandatory during the bachelor’s degree.

Process evaluation of workplace interventions with physical exercise to reduce musculoskeletal disorders

Process evaluation is important to explain success or failure of workplace interventions. This study performs a summative process evaluation of workplace interventions with physical exercise. As part of a randomized controlled trial 132 office workers with neck and shoulder pain were to participate in 10 weeks of elastic resistance training five times a week at the workplace; the 2 min group performed a single set of lateral raise to failure, and the 12 min group performed 5-6 sets with 8–12 repetitions. Participants received a single instructional session together with a training diary and manual at baseline (100% dose delivered and 100% dose received), and 59 and 57 participants, respectively, replied to the process evaluation questionnaire at 10-week follow-up. Results showed that in the 2 and 12 min groups, respectively, 82% and 81% of the participants completed more than 30 training sessions. However, two-thirds of the participants would have preferred more than a single exercise to vary between. In the 12 versus 2 min group more participants experienced the training sessions as too long (30% versus 5%). Most participants (67–92%) found the training diary and manual helpful, adequacy in a single instructional session, and satisfaction with the type of training. Among those with low adherence, lack of time (51%) and difficulties in starting exercising after illness (26%) were common barriers for regular training. Among those with low adherence, 52% felt that five training sessions per week were too much, and 29% would rather have trained a completely different kind of exercise. In conclusion, resistance training at the workplace is generally well received among office workers with neck-shoulder pain, but a one-size-fits-all approach is not feasible for all employees.

Personal cancer knowledge and information seeking through PRISM: the planned risk information seeking model

This study retested PRISM, a model of risk information seeking, and found that it is applicable to the context of cancer risk communication. The study, which used an online sample of 928 U.S. adults, also tested the effect of additional variables on that model and found that the original model better fit the data. Among the strongest predictors of cancer information seeking were seeking-related subjective norms, attitude toward seeking, perceived knowledge insufficiency, and affective risk response. Furthermore, risk perception was a strong predictor of an affective risk response. The authors suggest that, given the robustness across studies, the path between seeking-related subjective norms and seeking intention is ready to be implemented in communication practice.

Development and evaluation of a learner-centered training course on communication skills for baccalaureate nursing students

BACKGROUND

There is no standardized or formal communication skills training in the current nursing curriculum in Macao, China.

OBJECTIVES

To develop and evaluate a learner-centered communication skills training course.

DESIGN

Both qualitative and quantitative designs were used in two separate stages.

SETTINGS AND PARTICIPANTS

A randomized sample and a convenience sample were taken from students on a four-year bachelor's degree program at a public institute in Macao.

METHODS

Stage I consisted of developing a learner-centered communication skills training course using four focus groups (n=32). Stage II evaluated the training's efficacy by comparing communication skills, clinical interaction, interpersonal dysfunction, and social problem-solving abilities using a quasi-experimental longitudinal pre-post design among 62 nursing students. A course evaluation form was also used.

RESULTS

Content analysis was used to evaluate the essential themes in order to develop the specific content and teaching strategies of the course. Paired t-tests and Wilcoxon signed-rank tests showed significant improvement in all post-training scores for communication ability, content of communication, and handling of communication barriers. According to the mean scores of the course evaluation form, students were generally very satisfied with the course: 6.11 to 6.74 on a scale of 1 to 7.

CONCLUSIONS

This study showed that the course was effective in improving communication skills, especially in terms of the content and the handling of communication barriers. The course filled an important gap in the training needs of nursing students in Macao. The importance of these findings and their implications for nursing education are discussed.

An evaluation of nursing students' communication ability during practical clinical training

OBJECTIVES

To investigate communication abilities and other influential factors on nursing students at the beginning of clinical practical session.

METHODS

A cluster sample of 312 nursing students from 22 nursing colleges or universities was recruited. Communication ability of these participants was evaluated by 4 questionnaires for demographic data, clinical communication behavior, treatment communication skills and interpersonal communication skills at the beginning of clinical practical session.

RESULTS

The stability and accuracy of the questionnaires were established with an overall content validity index of 0.78, the Cronbach's Alpha index ranged from 0.872 to 0.951, and the letter index fluctuates from 0.85 to 0.89. Results demonstrated that 88.1% of the nursing students require extra training in clinical communication behavior, treatment communication skills, and interpersonal communication skills. The Pearson analysis revealed significantly positive correlations between communication abilities and the students' educational level, clinical training experience, living circumstances and number of siblings.

CONCLUSION

Most nursing students need communication skill training. Multiple factors, including educational level, living circumstances, number of siblings, and training experience significantly affect nursing students' communication abilities. Our study suggested a need to widely establish a communication course or clinical communication training program to improve nursing students' communication skills.

Communication skills training for healthcare professionals working with people who have cancer

BACKGROUND

This is an updated version of a review that was originally published in the Cochrane Database of Systematic Reviews in 2004, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses have been proposed and are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective.

OBJECTIVES

To assess whether CST is effective in improving the communication skills of HCPs involved in cancer care, and in improving patient health status and satisfaction.

SEARCH METHODS

We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2012, MEDLINE, EMBASE, PsycInfo and CINAHL to February 2012. The original search was conducted in November 2001. In addition, we handsearched the reference lists of relevant articles and relevant conference proceedings for additional studies.

SELECTION CRITERIA

The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In this updated version, we limited our criteria to RCTs evaluating 'CST' compared with 'no CST' or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real and/or simulated patients with cancer, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects model and, for continuous data, we used standardised mean differences (SMDs).

MAIN RESULTS

We included 15 RCTs (42 records), conducted mainly in outpatient settings. Eleven studies compared CST with no CST intervention, three studies compared the effect of a follow-up CST intervention after initial CST training, and one study compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists (six studies), residents (one study) other doctors (one study), nurses (six studies) and a mixed team of HCPs (one study). Overall, 1147 HCPs participated (536 doctors, 522 nurses and 80 mixed HCPs).Ten studies contributed data to the meta-analyses. HCPs in the CST group were statistically significantly more likely to use open questions in the post-intervention interviews than the control group (five studies, 679 participant interviews; P = 0.04, I² = 65%) and more likely to show empathy towards patients (six studies, 727 participant interviews; P = 0.004, I² = 0%); we considered this evidence to be of moderate and high quality, respectively. Doctors and nurses did not perform statistically significantly differently for any HCP outcomes.There were no statistically significant differences in the other HCP communication skills except for the subgroup of participant interviews with simulated patients, where the intervention group was significantly less likely to present 'facts only' compared with the control group (four studies, 344 participant interviews; P = 0.01, I² = 70%).There were no significant differences between the groups with regard to outcomes assessing HCP 'burnout', patient satisfaction or patient perception of the HCPs communication skills. Patients in the control group experienced a greater reduction in mean anxiety scores in a meta-analyses of two studies (169 participant interviews; P = 0.02; I² = 8%); we considered this evidence to be of a very low quality.

AUTHORS' CONCLUSIONS

Various CST courses appear to be effective in improving some types of HCP communication skills related to information gathering and supportive skills. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', patients' mental or physical health, and patient satisfaction.

Effects of a stress management program for hospital staffs on their coping strategies and interpersonal behaviors

The present study examined effects of a 3-h stress management program for Japanese hospital staffs that included relaxation and assertion training. Twenty-seven hospital staffs (mean age: 29.4 yr) in a stress management group and 28 hospital staffs (mean age: 29.5 yr) in a wait-list group answered evaluation surveys at both pre- and post-intervention. Self-administered questionnaires including items on job stress, coping strategies, and interpersonal behaviors were evaluated. The stress management program was given six different participant groups: 3 groups were the stress management group and 3 groups were the wait-list group. The program increased active coping and decreased dependent behavior scores significantly in the stress management group, while decreasing assertive behavior scores in the wait-list group. A comparison of the education sub-groups showed that the first group had significantly increased assertiveness and decreased dependency scores. The second group had significantly decreased depression-anxiety scores. The data analyzed for men and women separately showed the stress management intervention significantly improved active coping and assertive behavior in men and dependent behavior in women. A brief one-time stress management program can be effective in improving active coping and assertive behaviors as well as reducing dependent behavior in hospital staffs. Sex differences were noteworthy.

Conhecimento sobre hipotermia dos profissionais de Enfermagem do Centro Cirúrgico

Objetivou-se identificar a diferença no conhecimento sobre hipotermia do auxiliar de enfermagem após a intervenção educativa. A base conceitual de educação fundamenta-se na perspectiva da aprendizagem significativa, aliada à construção de mapa conceitual e à realização de estudo de caso. Os dados foram coletados por meio de um questionário validado por especialistas. A média do conhecimento após a intervenção educativa teve aumento de 3,49 pontos. Não se verificou diferença significativa do conhecimento quando foi relacionado às variáveis sociais e de formação estudadas. Conclui-se que a intervenção educativa foi satisfatória na medida em que as informações sobre hipotermia foram ancoradas e modificadas na estrutura cognitiva dos auxiliares de enfermagem.

Intervenção educativa sobre hipotermia: uma estratégia de ensino para aprendizagem em centro cirúrgico

Este trabalho trata-se de um estudo quase experimental aplicado em uma intervenção educativa de curta duração aos auxiliares de enfermagem do Centro Cirúrgico, cujos objetivos foram conhecer as características sociais e de formação dos auxiliares de enfermagem; identificar a diferença no conhecimento sobre hipotermia no auxiliar de enfermagem após a intervenção educativa e relacionar as ações de enfermagem às variáveis estudadas. A intervenção educativa foi efetiva, uma vez que a diferença na média das ações de enfermagem foi de 5,35 após a intervenção educativa. Entretanto, não se verificou diferença significativa das ações de enfermagem quando relacionadas às variáveis estudadas. Recomenda-se realizar estudos sobre educação nos profissionais de Enfermagem, baseado na aprendizagem significativa nas diferentes unidades.

Translating theory into practice: using Action Research to introduce a coordinated approach to emotional care

OBJECTIVE

This paper describes a translational project that explored the feasibility and effect of introducing a coordinated approach to emotional care.

METHODS

The project was undertaken using Action Research on one ward at St John of God Hospital Subiaco, Western Australia. A senior Registered Nurse was appointed to provide the leadership and direction to staff regarding emotional care and an education program for staff was provided. The project was evaluated using both quantitative and qualitative data.

RESULTS

Data demonstrated an increase in the patient's evaluation of emotional care, although levels were found to fluctuate throughout the project. Factors such as the emotional distress of the staff were hypothesised as impacting on the delivery of emotional care.

CONCLUSION

The approach used in this project was found to be a useful method of improving emotional care. However, the data collected in this study revealed the complexity of emotional care delivery and the possible impact of a number of factors within the environment.

PRACTICE IMPLICATIONS

Emotional care delivery can be improved by using a coordinated research-based educational approach led by a clinical champion. However, the impact of other factors within the hospital environment needs to be considered and more research is required.