Collaborative communication: learning from advanced clinical practice patient consultations

Development and validation of the questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication

OBJECTIVE

The purpose of this study was to develop and analyze the psychometric properties of an instrument that could analyze the communication of nursing professionals in nurse-patient therapeutic communication.

METHODS

A literature review and a panel of experts were used (N = 10) to develop the questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication. The final version of the questionnaire was composed of 49 items and applied to a convenience sample of 370 nurses.

RESULTS

The construct validity was assessed by an exploratory factor analysis (EFA) and the reliability using Cronbach's Alpha. Three dimensions were identified that determine therapeutic communication: professional, contextual and/or situational and patient. The Cronbach's α total coefficient was 0.90, ranging from 0.71 to 0.81 for the dimensions.

CONCLUSION

The questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication represents a valid and reliable questionnaire to measure nurses' communication with patients in the clinical setting.

IMPLICATIONS FOR PRACTICE

The use of the questionnaire enables the analysis of elements that interfere with effective communication. This can assist in developing interventions to improve nurses' therapeutic communication with patients.

Communication Styles Inventory-Brief: Adaptation and validation for Spanish nursing

Healthcare attention is sometimes considered purely technical, but communication has proven to be closely related to clinical results and patient satisfaction. Therefore, evaluation of communication in the scope of healthcare is a priority. The purpose of this study was to validate and adapt the Spanish version of the Communication Styles Inventory in a sample of nursing professionals. The sample was made up of 2313 nursing professionals selected at random from various medical centres in Spain, and is therefore a sample actively employed at the time data were acquired. We started out from the Communication Style Inventory, a questionnaire for evaluating the predominance of certain individual communication behaviours on six scales (expressiveness, preciseness, verbal aggressiveness, questioningness, emotionality and impression manipulativeness). Confirmatory Factor Analysis of the model proposed showed god fit indices. The reliability of the model shown by the Cronbach's alpha of α = 0.81 was adequate, and so was single-level and aggregate consistency. Finally, in the analysis of variance by type of contract, configural, metric and scalar invariance was acceptable, but not strict invariance. This instrument progresses in measuring non-technical attributes, such as communication styles, in nursing personnel.

Developing clinical reasoning and effective communication skills in advanced practice

Clinical reasoning and effective communication are fundamental skills for nurses working at an advanced level of practice. Clinical reasoning processes are designed to enable the nurse to establish the nature of a patient's presenting condition before focusing on problem-solving techniques that can guide the appropriate course of treatment. This article explores the concept of clinical reasoning in advanced practice and outlines the various approaches that nurses can take. It also details the role of effective communication in advanced practice. A case study is used to demonstrate the specific stages involved in clinical reasoning.

Nurse practitioner consultations in primary health care: patient, carer, and nurse practitioner qualitative interpretations of communication processes

Aim

To advance understanding of the discrete nature of the communication processes and social interactions occurring in nurse practitioner consultations.

Background

Preceding qualitative investigations of nurse practitioner consultations have, when conducting interviews with participants, often exclusively sampled either nurse practitioners or patients. Furthermore, previous qualitative studies of the nature of nurse practitioner consultations have not typically also sampled carers attending with patients for nurse practitioner consultations. Accordingly this study was developed, in part, to address this exclusivity of sampling in qualitative research of nurse practitioner consultations by developing an inclusive sample of patient, carer and nurse practitioner participants of nurse practitioner consultations, so as to conjointly develop an understanding of the multiple perceptions of those participants of communication processes occurring in nurse practitioner consultations.

Methods

Qualitative component of a larger mixed methods case study of communication processes and social interactions in nurse practitioner consultations, utilising individual semi-structured interviews with the patient (n = 9), carer (n = 2) and nurse practitioner (n = 3) participants of video-recorded consultations derived from a nurse practitioner-led general practice clinic. Interview transcripts were initially analysed via an emergent thematic analysis, followed up by computer-assisted qualitative data analysis with NVivo 9.

Findings

The participants’ perceptions of nurse practitioner consultation communication processes and social interactions were represented through six themes: Consulting style of nurse practitioners; Nurse practitioner – GP comparisons; Lifeworld content or lifeworld style; Nurse practitioner role ambiguity; Creating the impression of time and Expectations for safety netting. The findings identify a need for policy makers to address a perceived ambiguity of the nature of the nurse practitioner role amongst patients and carers. The benefits of nurse practitioners using personable, everyday lifeworld styles of communication for optimising interactions, sharing clinical reasoning and conveying a sense of having time for patients and carers in consultations are also identified.

Nurse practitioner consultations in primary health care: a case study-based survey of patients' pre-consultation expectations, and post-consultation satisfaction and enablement

Background

Research has not yet fully investigated links to consultation duration, patient expectations, satisfaction, and enablement in nurse practitioner consultations. This study was developed to address some of these research gaps in nurse practitioner consultations, particularly with a focus on expectations, satisfaction, and enablement.

Aim

To explore the influence of pre-consultation expectations, and consultation time length durations on patient satisfaction and enablement in nurse practitioner consultations in primary health care.

Design

Survey component of a larger convergent parallel mixed methods case study designed to conjointly investigate the communication processes, social interactions, and measured outcomes of nurse practitioner consultations. The survey element of the case study focusses on investigating patients’ pre-consultation expectations and post-consultation patient satisfaction and enablement.

Methods

A questionnaire measuring pre-consultation expectations, and post-consultation satisfaction and enablement, completed by a convenience sample of 71 adults consulting with nurse practitioners at a general practice clinic. Initial fieldwork took place in September 2011 to November 2012, with subsequent follow-up fieldwork in October 2016.

Results

Respondents were highly satisfied with their consultations and expressed significantly higher levels of enablement than have been seen in previous studies of enablement with other types of clinicians (P=0.003). A significant, small to moderate, positive correlation of 0.427 (P=0.005) between general satisfaction and enablement was noted. No significant correlation was seen between consultation time lengths and satisfaction or enablement.

Conclusion

Higher levels of patient enablement and satisfaction are not necessarily determined by the time lengths of consultations, and how consultations are conducted may be more important than their time lengths for optimising patient satisfaction and enablement.