Keys to Trust-Building with Patients

When clinicians and patients disagree on vaccination: what primary care clinicians can learn from COVID-19-vaccine-hesitant patients about communication, trust, and relationships in healthcare

BACKGROUND

In the United States, discourse on COVID-19 vaccination has become polarized, and the positions of public health officials are met with skepticism by many vaccine-hesitant Americans. This polarization may impact future vaccination efforts as well as clinician-patient relationships.

METHODS

We interviewed 77 vaccine-hesitant patients and 41 clinicians about COVID-19 vaccination communication in primary care as part of a Veterans Affairs (VA) trial evaluating a vaccine-communication intervention. This paper reports the findings of a qualitative analysis focused on one aspect of those interviews-the disconnect between primary care clinicians' and patients' perceptions about COVID-19 vaccination communication and decision-making.

RESULTS

Rapid qualitative analysis of semi-structured interviews revealed fundamental differences in how clinicians and patients understood and described the reasoning, values, and concerns underlying COVID-19 vaccine hesitancy. These differences were significant and value-laden; they included negative judgments that could undermine communication between clinicians and patients and, over time, erode trust and empathy.

CONCLUSION

We advocate for empathic listening and suggest communication strategies to bridge the divide between clinicians and vaccine-hesitant patients.

Internship and postgraduate entrance examination: A qualitative study on the psychological experience of undergraduate nursing students under dual pressure in China

Background

With the development of nursing positions and nursing disciplines in China's tertiary hospitals, the number of people applying for the master's degree in nursing is also increasing year by year. Postgraduate examinations are held during internship, so nursing students face the dual pressure of testing and internship, which brings varying degrees of negative experiences and emotional fluctuations.

Objective

To explore the psychological experiences and influencing factors of undergraduate nursing students under the dual pressures of clinical nursing internships and postgraduate examination preparations.

Design

Descriptive qualitative study.

Method

Purposeful sampling was used to recruit 18 participants from eight tertiary hospitals in China between October and December 2023. Semi-structured in-depth interviews were conducted, with interview recordings transcribed verbatim. Thematic analysis was then applied to the data.

Results

Four themes were identified: negative experiences under dual pressures, coping mechanisms for negative experiences, motivational effects under dual pressures, and evaluations of significant individuals. Nursing students improved their overall abilities through internships and exam preparations, gaining a clear understanding of themselves and certain hospital roles. However, at this stage, students also experienced adverse psychological experiences for various reasons. Thus, they employed several methods to alleviate their psychological stress, aiming for a better state to face internships and exam preparations.

Conclusion

Schools and hospitals should pay more attention to the needs of nursing students under dual pressures, monitoring their emotional states, and providing psychological support to enhance their stress-coping abilities. It is important to ensure the overall well-being of students while strengthening the motivational effects of internships and learning experiences.

CICARE communication model and hierarchical responsibility nursing coordination in the application research of elderly patients with chronic heart failure

The aim of this study was to evaluate the efficacy of implementing the CICARE communication model and hierarchical responsibility nursing coordination in managing chronic heart failure among elderly patients. From June 2021 to June 2023, 120 elderly patients diagnosed with chronic heart failure were admitted to our hospital. They were divided into 2 groups according to different treatment methods: the regular group and the observation group. Both groups of patients received nursing interventions for 3 months. Before and after the intervention, we assessed the levels of cardiac function indicators (left ventricular end-diastolic diameter, left ventricular ejection fraction, and B-type natriuretic peptide levels) and exercise tolerance (6-minute walk test) in both groups of patients. The time to clinical symptom relief, self-efficacy, and quality of life scores were compared between the 2 groups of patients. Before the intervention, there were no significant differences in cardiac function indicators between the 2 groups (P > .05). However, after the intervention, both groups exhibited improvements in left ventricular end-diastolic diameter and B-type natriuretic peptide levels, with the observation group demonstrating greater reductions compared to the control group. Furthermore, both groups showed increased left ventricular ejection fraction levels, with the observation group experiencing a significantly higher improvement. Although exercise tolerance did not differ significantly between the groups before the intervention, post-intervention analysis revealed a greater increase in 6-minute walk test distance in the observation group compared to the control group (P < .05). The time to relief of breathlessness and edema did not significantly differ between the groups (P > .05). Similarly, there were no significant differences in self-efficacy and quality of life scores between the groups before the intervention (P > .05); however, post-intervention analysis showed higher self-efficacy scores in the observation group. Application of the CICARE communication model and hierarchical responsibility nursing coordination in elderly patients with chronic heart failure can effectively improve the patients' cardiac function levels and significantly enhance their exercise tolerance, self-efficacy, and quality of life.

What can nurses learn from patient's needs and wishes when developing an evidence-based quality improvement learning culture? A qualitative study

BACKGROUND

Patient participation is fundamental in nursing care and has yielded benefits for patient outcomes. However, despite their compassionate care approach, nurses do not always incorporate patients' needs and wish into evidence-based practice, quality improvement or learning activities. Therefore, a shift to continuous quality improvement based on evidence-based practice is necessary to enhance the quality of care. The patient's opinion is an essential part of this process. To establish a more sustainable learning culture for evidence-based quality improvement, it is crucial that nurses learn alongside their patients. However, to promote this, nurses require a deeper understanding of patients' care preferences.

OBJECTIVE

To explore patients' needs and wishes towards being involved in care processes that nurses can use in developing an evidence-based quality improvement learning culture.

METHODS

A qualitative study was conducted in two hospital departments and one community care team. In total, 18 patients were purposefully selected for individual semi-structured interviews with an average of 15 min. A framework analysis based on the fundamental of care framework was utilised to analyse the data deductively. In addition, inductive codes were added to patients' experiences beyond the framework. For reporting this study, the SRQR guideline was used.

RESULTS

Participants needed a compassionate nurse who established and sustained a trusting relationship. They wanted nurses to be present and actively involved during the care delivery. Shared decision-making improved when nurses offered fair, clear and tailored information. Mistrust or a disrupted nurse-patient relationship was found to be time-consuming and challenging to restore.

CONCLUSIONS

Results confirmed the importance of a durable nurse-patient relationship and showed the consequences of nurses' communication on shared decision-making. Insights into patients' care preferences are essential to stimulate the development of an evidence-based quality improvement learning culture within nursing teams and for successful implementation processes.

Reducing Racial Disparities at End-of-life: Using Narratives to Build Trust and Promote advance Care Planning

Black Americans are less likely than White Americans to have advance directives, die while receiving hospice services, or have their end-of life wishes honored. The root causes of disparities include imbalance of resources, lack of trust in health care institutions, lack of adequate education regarding end-of-life options, communication differences of health care providers with black vs white patients, variable access to hospice services in different communities, and poorer pain management for Black patients compared to White patients. Because root causes are numerous, comprehensive solutions are required. When advance care planning is in place, people are more likely to choose care focused on priorities and comfort than on seeking aggressive, sometimes futile, interventions in the last weeks of life. One important component of the solution should include listening to narrative stories of Black people as they encounter life-limiting diagnoses. Gathering the stories about life events and how strength was found through adversities can be a tool for growing trusting relationships and engaging in shared decision-making. Health care professionals should invite Black patients with serious illnesses to explore the sources of their strengths and identify their core values to work toward developing directives for the nature and place of their end-of-life and help to mitigate disparities in high quality end-of-life care.

The impact of nurses' experiences of hospital violence on resilience: A mediated moderation model

AIMS

This study aims to investigate the impact of nurses' experiences of hospital violence on resilience, the mediating effect of trust in patients and the moderating effect of organizational trust.

BACKGROUND

Despite belonging to the central part of health care worldwide and being the leading provider of medical services, nurses are often subjected to hospital violence, which affects their physical and mental well-being. Trust is a high-order mechanism that encourages positive thinking and personal and professional development. However, research into the impact of trust on resilience concerning nurses' experiences of hospital violence is limited.

METHODS

The participants were 2331 nurses working in general hospitals in China. A cross-sectional survey was conducted, and data were collected via questionnaires from July to October 2022 and analysed using SPSS 25.0 and SPSS PROCESS 3.3 macros. This study was prepared and reported according to the STROBE checklist.

RESULTS

Mean trust in patients was 48.00 ± 10.86 (12-60), mean organizational trust was 56.19 ± 8.90 (13-65) and mean resilience was 78.63 ± 19.26 (0-100). Nurses' experience of hospital violence had a direct negative effect on resilience (β = -.096, p = .871), a significant adverse effect on trust in patients (β = -3.022, p < .001) and a significant positive effect on trust in patients on resilience (β = 1.464, p < .001). Trusting patients played a mediating role. The significant moderating effect of organizational trust between experience of hospital violence and trust in patients was moderated by a mediating effect index of -0.1867 (95% CI = [-0.3408, -0.0345]).

CONCLUSIONS

Nurses' experience of hospital violence exerted a negative effect on resilience, trust in patients had a fully mediated effect and organizational trust had a significant moderating influence in the pathway from nurses' experience of hospital violence to patients' trust-mediated resilience.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study highlights the impact of nurses' experiences of hospital violence on resilience and explores the importance of trust from the nurses' perspective. Measures taken by managers to provide nurses with a safe, trusting and positive work environment can be highly beneficial in enhancing nurse resilience.

Trust as a dyadic mechanism of action: a call to explore patient-provider relationships in the twenty-first century

Background: There is general agreement that trust between patients and providers influences patient knowledge, behaviors, and adherence to provider-recommendations--with subsequent impacts on patient health-related outcomes and provider practices. There is less academic agreement on the processes by which trust is formulated and changed over time and how trust with ongoing healthcare providers can influence health-related outcomes over time.Methods: This opinion draws on social constructionism and symbolic interactionism to posit the possibility that trust can emanate through the communication process, during which a patient and provider transmit and attend to words, images, and paralanguage to convey their states of being and to induce responses, usually acknowledgement, suasion, or physical behaviors, from one another.Results: Theoretical bases for this construct are provided as are qualitative, quantitative, and mixed measurement approaches for multiple healthcare settings.Conclusions: A mechanistic approach to understand how trust is established through patient-provider communication and how trust informs patient health-related outcomes can contribute over time to improve communication in healthcare encounters.

Analysis of Nursing Students' Nonverbal Communication Patterns during Simulation Practice: A Pilot Study

Therapeutic communication, of which nonverbal communication is a vital component, is an essential skill for professional nurses. The aim of this study is to assess the possibility of incorporating computer analysis programs into nursing education programs to improve the nonverbal communication skills of those preparing to become professional nurses. In this pilot observational study, the research team developed a computer program for nonverbal communication analysis including facial expressions and poses. The video clip data captured during nursing simulation practice by 10 3rd- and 4th-grade nursing students at a university in South Korea involved two scenarios of communication with a child's mother regarding the child's pre- and post-catheterization care. The dominant facial expressions varied, with sadness (30.73%), surprise (30.14%), and fear (24.11%) being the most prevalent, while happiness (7.96%) and disgust (6.79%) were less common. The participants generally made eye contact with the mother, but there were no instances of light touch by hand and the physical distance for nonverbal communication situations was outside the typical range. These results confirm the potential use of facial expression and pose analysis programs for communication education in nursing practice.

Construction of a nurses' interpersonal communication knowledge system: A Delphi study

BACKGROUND

Effective communication is essential for nursing students to provide safe patient care. Many communication consensuses focus on physician-associated communication rather than nurses' interpersonal communication. However, studies on developing a systematic and comprehensive communication knowledge system for nursing students are scarce.

OBJECTIVES

To explore the teaching content and teaching framework of nurses' interpersonal communication, construct a systematic and scientific knowledge system for interpersonal communication among nursing students and provide a theoretical basis for the training of nurses on interpersonal communication.

METHODS

Based on the literature review and comparative research, this study explored the theoretical basis and basic principles of constructing an interpersonal communication knowledge system for nurses. Moreover, a correspondence questionnaire on nurses' interpersonal communication knowledge systems was initially constructed to clarify the related teaching content and structure. Finally, the Delphi method was used to establish the index of the nurses' interpersonal communication knowledge system according to the principle of expert selection and inclusion criteria.

RESULTS

The Delphi method included 26 experts from nursing education, clinical nursing, nursing management and other fields for consultation. The effective response rate of the letter inquiry was 96.3 % in the first round and 100 % in the second round. The judgment basis, familiarity and authority coefficient of expert consultation were 0.907, 0.862 and 0.884, respectively. In the two rounds of inquiry, the coordination coefficients of the total questionnaire were 0.228 and 0.302, which was statistically significant (P < 0.001). Thereafter, a wheeled model of nurses' interpersonal communication knowledge system with 3 primary indicators, 13 secondary indicators and 58 tertiary indicators was constructed, which included professional ethics and attitude, communication knowledge and communication skills.

CONCLUSION

Literature and comparative research methods along with Delphi expert consultation were used to construct a scientific and systematic knowledge system of nurses' interpersonal communication. The research methods were feasible, and the results were scientific and reliable, thereby providing a basis for the education of nurses' interpersonal communication among nurses and the compilation of related teaching materials in China and globally. Furthermore, special attention should be paid to the comprehensive cultivation of nursing students' professional ethics and attitude, communication knowledge and communication skills.

COVID-19 risk perception framework of the public: an infodemic tool for future pandemics and epidemics

Understanding the risk perceptions of the public is central for risk communications and infodemic management during emergency and preparedness planning as people's behavior depends on how they perceive the related risks. This qualitative study aimed to identify and describe factors related to COVID-19 risk perceptions of the public in Finland and to make this information readily available to those who communicate with the public during crises. The study is part of a larger project exploring crisis narratives through a mixed-methods approach. The study was based on a dataset of over 10,000 comments on the Facebook and Twitter posts of the Finnish Institute of Health and Welfare (THL) between March-May 2021. The data were analyzed qualitatively using thematic analysis. The study identified concepts linked with the pandemic risk perception that included knowledge, perceptions, personal experiences, trust, attitudes, and cultural values. The findings resulted in a framework of risk perceptions that can be used as taxonomy and a set of key concepts and keywords in social listening to monitor risk perception during future epidemics and pandemics.

Public health nurses' professional dignity: An interview study in Finland

BACKGROUND

Dignity is a central human value supported by nurses' professional ethics. In previous studies, nurses in clinical practice have experienced that dignity increased their work well-being and pride of work. Dignity is also strictly interweaved to professional identity in the different nursing' roles, but little is known about dignity among public health nurses and primary care settings.

PURPOSE

This study aimed to describe the perceptions of nursing's professional dignity of public health nurses in primary care in Finland.

RESEARCH DESIGN

An inductive qualitative descriptive approach with semi-structured focus group interviews was utilised.

PARTICIPANTS AND RESEARCH CONTEXT

Twenty-seven Finnish public health nurses were interviewed via eight semi-structured focus group interviews in primary health care settings.

ETHICAL CONSIDERATIONS

Before data collection, research permissions were obtained from participating health care centres. This type of research in Finland, with competent adult participants, does not require ethical pre-assessment but written and oral informed consent obtained before the interviews.

FINDINGS

Based on our findings, public health nurses perceived that professional dignity was (1) part of their self-respect, an observed daily value based on their acknowledged competence. Besides, they perceived that (2) service users' trust in public health nurses was a strong expression of professional dignity, and it could be uncovered when recipients of care utilised their services. In addition, public health nurses experienced that (3) professional dignity was an expression of different intertwined interprofessional and social factors.

DISCUSSION AND CONCLUSION

Professional dignity is simultaneously an essential prerequisite and an outcome of public health nurses' work. In future, more information would be needed to implement strategies in primary health care to foster nurses' professional dignity also in international public health arenas.