Aim
To conduct a review summarizing evidence concerning communication with mechanically ventilated patients in the intensive care unit (ICU).
Background
ICU patients undergoing mechanical ventilation ...are unable to communicate verbally, causing many negative emotions. Due to changes in sedation practice, a growing number of patients are conscious and experience communication difficulties.
Design
The umbrella review method guided by the Joanna Briggs Institute was applied.
Data Sources
A systematic search was done in the Cochrane Library, the Joanna Briggs Institute database, Cinahl, Pubmed, PsycINFO and Scopus between January ‐April 2019. Search terms were ‘nurse‐patient communication’, ‘mechanical ventilation’, ‘intensive care’, and ‘reviews as publication type’. Literature from 2009–2019 was included.
Review Methods
Following recommendations by the Joanna Briggs Institute, a quality appraisal, data extraction, and synthesis were done.
Results
Seven research syntheses were included. There were two main themes and six subthemes: (1) Characterization of the nurse–patient communication: (a) Patients' communication; (b) Nurses' communication; (2) Nursing interventions that facilitate communication: (a) Communication assessment and documentation; (b) Communication methods and approaches; (c) Education and training of nurses; and (d) Augmentative and alternative communication.
Conclusion
Nurse–patient communication was characterized by an unequal power relationship with a common experience – frustration. Four key interventions were identified and an integration of these may be key to designing and implementing future ICU communication packages.
Impact
Nurse–patient communication is characterized by an unequal power relationship with one joint experience – frustration. Four key interventions should be integrated when designing and implementing communication packages in the ICU. Findings are transferable to ICU practices where patients are conscious and experience communication difficulties.
摘要
目标
有关于与重症监护室(ICU)机械通气患者的沟通进行回顾性总结取证。
背景资料
重症监护室(ICU)内进行机械通气的患者无法进行言语交流,导致其产生诸多的负面情绪。由于镇静方法的改变,越来越多的患者意识清醒,并出现沟通困难。
设计
采用澳大利亚JBI循证护理中心指导的伞式回顾方法。
数据来源
对考克兰图书馆、澳大利亚JBI循证护理中心数据库、护理学数据库(CINAHL)、国际文献数据库(PubMed)、心理学文摘(PsycINFO)和Scopus电子数据库2019年1月至4月的内容进行系统性搜索。搜索词为“护患沟通”、“机械通气”、“重症监护”和“出版类回顾 ”。包括了2009年至2019年的文献。
评审方法
根据澳大利亚JBI循证护理中心的建议,进行了质量评估、数据提取和合成。
结果
包含了七篇研究合成。有两大主题和六个子主题:(1) 护患沟通的特点:(a) 患者的沟通;(b)护士的沟通;(2)促进沟通的护理干预措施:(a) 沟通评估和记录;(b)沟通方式和方法;(c)护士的教育和培训;以及(d)补充和替代沟通。
结论
护患沟通的特点是不平等的权力关系和共同的挫折体验。确定了四大关键干预措施,这些措施的整合可能是设计和实施未来重症监护室沟通方案的关键。
影响
护患沟通的特点是不平等的权力关系和共同的挫折体验。在设计和实施重症监护室的沟通方案时,应整合四大关键干预措施。研究发现可应用于重症监护室内患者意识清醒且沟通困难的实践。
Patient participation is a way for patients to engage in their nursing care. In view of the possible link between patient participation and safety, there is a need for an updated review to assess ...patient participation in nursing care.
To investigate patients’ and nurses’ perceptions of and behaviours towards patient participation in nursing care in the context of hospital medical wards.
Integrative review.
Three search strategies were employed in August 2013; a computerised database search of Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Medline and PsychINFO; reference lists were hand-searched; and forward citation searching was executed.
After reviewing the studies, extracting study data and completing summary tables the methodological quality was assessed using the Mixed-Methods Assessment Tool by two reviewers. Reviewers met then to discuss discrepancies as well as the overall strengths and limitations of the studies. Discrepancies were overcome through consensus or a third reviewer adjudicated the issue. Within and across study analysis and synthesis of the findings sections was undertaken using thematic synthesis.
Eight studies met inclusion criteria. Four themes were identified – enacting participation, challenges to participation, promoting participation and types of participation. Most studies included were conducted in Europe. The majority of studies used qualitative methodologies, with all studies sampling patients; nurses were included in three studies. Data were largely collected using self-reported perceptions; two studies included observational data. Methodological issues included a lack of reflexivity, un-validated data collection tools, sampling issues and low response rates.
On medical wards, patients and nurses desire, perceive or enact patient participation passively. Challenging factors for patient participation include patients’ willingness, nurses’ approach and confusion around expectations and roles. Information-sharing was identified as an activity that promotes patient participation, suggesting nurses encourage active communication with patients in practice. Involving patients in assessment and care planning may also enhance patient participation. For education, enhancing nurses' understanding of the attributes of patient participation, as well as patient-centred care approaches may be beneficial for medical ward nurses. From here, researchers need to examine ways to overcome the barriers to patient participation; further nurse participants and observational data is required on medical wards.
The Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for nursing homes, where staff have faced rapidly evolving circumstances to care for a vulnerable resident population. ...Our objective was to document the experiences of these front-line health care professionals during the pandemic.
Electronic survey of long-term care staff. This report summarizes qualitative data from open-ended questions for the subset of respondents working in nursing homes.
A total of 152 nursing home staff from 32 states, including direct-care staff and administrators.
From May 11 through June 4, 2020, we used social media and professional networks to disseminate an electronic survey with closed- and open-ended questions to a convenience sample of long-term care staff. Four investigators identified themes from qualitative responses for staff working in nursing homes.
Respondents described ongoing constraints on testing and continued reliance on crisis standards for extended use and reuse of personal protective equipment. Administrators discussed the burden of tracking and implementing sometimes confusing or contradictory guidance from numerous agencies. Direct-care staff expressed fears of infecting themselves and their families, and expressed sincere empathy and concern for their residents. They described experiencing burnout due to increased workloads, staffing shortages, and the emotional burden of caring for residents facing significant isolation, illness, and death. Respondents cited the presence or lack of organizational communication and teamwork as important factors influencing their ability to work under challenging circumstances. They also described the demoralizing impact of negative media coverage of nursing homes, contrasting this with the heroic public recognition given to hospital staff.
Nursing home staff described working under complex and stressful circumstances during the COVID-19 pandemic. These challenges have added significant burden to an already strained and vulnerable workforce and are likely to contribute to increased burnout, turnover, and staff shortages in the long term.
Aim
To describe the lived experiences of nurses caring for patients and families in the context of COVID‐19 in Brazil and United States.
Design
A phenomenological philosophical approach following the ...van Manen analysis method.
Methods
Participants were recruited in Brazil and the United States, including nurses working in health care settings caring for COVID‐19 patients. Recruitment used purposive and snowball sampling. Participants completed a demographic survey and semi‐structured interviews that were audio‐recorded and transcribed for analysis. A cross‐cultural examination occurred among researchers from each country.
Results
The result was described (n = 35) by the themes, representing the essences of each lifeworld (relationship, time, space and body). The nurses' lived experience was one of reframing care while enduring repeated trauma of witnessing disrupted patient‐family‐nurse relationships. Themes were as follows: (a) Living a silent and lonely experience; (b) Providing connectedness for disrupted patient and family relationships; (c) Feeling the burden of the demands; (d) Being a helping connector; (e) Reshaping spaces amidst evolving interventions and policies; (f) Creating safe spaces, surrounded by turmoil, threat, and distress within an unsafe environment; (g) Reorganizing care and reframing time; (h) Reconciling losses, regrets, victories and lessons.
Conclusion
The nurses' lived experience of caring for patients and families during the COVID‐19 pandemic prompted the need to respond to repeated traumas and distress posed by interrupted patient‐family and nurse‐own family relationships, vulnerable bodies, threatened space and dynamic and volatile time.
Impact
Cultural nuances were discovered depending on the practice setting, political discourse and the autonomy of the nurse. Innovative models of care that create structures and processes to support nurses in caring for patients in threatening environments and the commitment to connecting family members have potential to contribute to the ongoing health of the nursing profession.
Elderspeak communication is typically viewed as patronizing and infantilizing by older adults and can lead to resistive behaviors in persons living with dementia. Little is known about the presence ...of elderspeak communication in hospitals in the United States. Understanding this phenomenon in the hospital setting is needed in order to improve hospital dementia care.
The purpose of the Nurse Talk study was to (1) describe attributes of elderspeak use in hospital dementia care and to (2) determine what characteristics are associated with nursing staff use of elderspeak communication with hospitalized patients with dementia.
A cross-sectional observational study design was used to collect and analyze audio-recordings of nursing staff during care for hospitalized patients with dementia.
Three hospital units in one Midwestern university hospital in the United States.
A convenience sample of 53 staff nurses and nursing assistants that provided direct care to 16 patients with mild or more severe dementia recruited from October 2019 through mid-March 2020.
Eighty-eight care encounters were audio-recorded and coded for elderspeak communication using the Iowa Coding of Elderspeak scheme to determine the frequency and characteristics of elderspeak communication. A linear mixed effects model was used to determine what characteristics were associated with elderspeak and the frequency of elderspeak use by nursing staff to hospitalized patients with dementia.
Over a quarter (28.7%) of all nursing staff speech directed towards patients with dementia constituted elderspeak and nearly all (96.6%) care encounters included some elderspeak. Particularly common attributes of elderspeak were minimizing words and mitigating expressions, childish terms and phrases, and collective pronoun substitution. A statistically significant interaction was identified between staff role and age (95% CI: −0.02, −0.00, p = .008) in predicting the frequency of elderspeak use, indicating that elderspeak was used more often by older staff nurses, whereas the age of nursing assistants remained constant across elderspeak use. Statically significant effects for delirium and length of stay were also demonstrated. Elderspeak use was 12.5% higher with patients with delirium (95% CI: 0.02, 0.23, p = .025) and increased 1.5% for each additional day the patient with dementia was hospitalized (95% CI: 0.00, 0.03, p = .035).
Elderspeak is present and pervasive in the acute care setting. Interventions targeted towards older staff nurses and nursing staff from hospital units that care for patients with delirium and longer lengths of stay are needed.
This study identified that nursing staff are frequently using elderspeak (infantilizing speech) with hospitalized patients with dementia. @claireshaw_phd @IowaNursing.
Aims
To explore nurses' views of patient participation in nursing care on medical wards.
Background
Nurses have frequent contact with patients, highlighting their potential role in enabling patient ...participation. However, some nurses' actions and attitudes act as barriers, failing to achieve core requirements of patient participation. Discovering nurses' views may assist in developing strategies to encourage patient participation in hospitals.
Design
Interpretive study.
Methods
Twenty nurses were recruited from four medical wards, located in two Australian hospitals. In‐depth semi‐structured interviews were conducted between November 2013–March 2014 and analysed using content analysis.
Findings
Five categories emerged from the nurses' views. The first category, acknowledging patients as partners, showed nurses respected patients as legitimate participants. In the second category, managing risk, nurses emphasized the need to monitor participation to ensure rules and patient safety were maintained. Enabling participation was the third category, which demonstrated nurses' strategies that enhanced patients' participation. The fourth category was hindering participation; encapsulating nurses' difficulty in engaging patients with certain characteristics. In the final category, realizing participation, nurses believed patients could be involved in physical activities or clinical communication.
Conclusion
Nurses have a crucial role in promoting patient participation. Through acknowledging and enabling participation, nurses may facilitate patient participation in a range of nursing activities. The nurse's role in enacting participation is complex, having to accommodate each patient's risks and characteristics, highlighting the need for good assessment skills. Education, policy and research strategies are essential to foster nurses' pivotal role in patient participation.
Aim and objectives
The study aimed to investigate whether the patients’ education level affected the mediation effect of self‐efficacy on the relationship between the autonomy‐supportive healthcare ...climate and health behaviour among patients with cardiovascular risk factors.
Background
Autonomy and self‐efficacy are identified as influential factors related to the behaviours of individuals with health problems. However, it is unclear whether autonomy support from healthcare providers affects health behaviour through self‐efficacy and if patients’ education level affects the association.
Design
A cross‐sectional study.
Methods
A convenience sample of 207 individuals with one or more cardiovascular diseases completed self‐administered surveys including the healthcare climate questionnaire, self‐efficacy scale and the engagement in health behaviour scale. Data were analysed using descriptive statistics, t test, Pearson's correlation coefficients and hierarchical regression analysis. All procedures of the study adhered to the STROBE guidelines.
Results
The influence of autonomy support from healthcare providers on self‐efficacy differed by individuals’ education level. Self‐efficacy in less educated, but not highly educated individuals, tended to depend on the autonomy‐supportive climate. Additionally, the autonomy‐supportive healthcare climate affected health behaviour through self‐efficacy only in less educated individuals.
Conclusion
The relationship between autonomy support from healthcare providers and self‐efficacy was more evident in the relatively less educated individuals. The associations among autonomy support, self‐efficacy and health behaviour differed by patient education level, and the mediating role of self‐efficacy on the relationship between autonomy‐supportive climate and health behaviour was found only in those less educated.
Relevance to clinical practice
Healthcare providers should recognise the importance of supporting patients’ need for autonomy to improve self‐efficacy and healthy behaviour, particularly in less educated patients. Additionally, healthcare providers’ support tailored to patients’ needs and educational status should be highlighted.
Background
Patient participation benefits the patient and is a core concept of patient‐centred care. Patients believe in their ability to prevent errors; thus, they may play a vital role in combating ...adverse event rates in hospitals.
Aims and objectives
To explore hospitalised medical patients’ perceptions of participating in nursing care, including the barriers and facilitators for this activity.
Research methods
This interpretive study was conducted on four medical wards, in two hospitals. Purposeful maximum variation sampling was operationalised to recruit patients that differed in areas such as age, gender and mobility status. In‐depth semi‐structured audiotaped interviews were undertaken and analysed using inductive content analysis.
Results
Twenty patients participated in the study. Four categories were uncovered in the data. First, valuing participation showed patients’ willingness to participate, viewing it as a worthwhile task. Second, exchanging intelligence was a way of participating where patients’ knowledge was built and shared with health professionals. Third, on the lookout was a type of participation where patients monitored their care, showing an attentive approach towards their own safety. Fourth, power imbalance was characterised by patients feeling their opportunities for participation were restricted.
Conclusions
Patients were motivated to participate and valued participation. Cultivating this motivation may be crucial to patient empowerment and practices of safety monitoring, a fundamental strategy to addressing patient safety issues in hospitals. Engaging nurse–patient relationships, inclusive of knowledge sharing, is required in practice to empower patients to participate. Educating patients on the consequences of non‐participation may motivate them, while nurses may benefit from training on patient‐centred approaches. Future research should address ways to increase patient motivation and opportunities to participate.
High profile safety failures have demonstrated that recognising early warning signs of clinical and physiological deterioration can prevent or reduce harm resulting from serious adverse events. Early ...warning scoring systems are now routinely used in many places to detect and escalate deteriorating patients. Timely and accurate vital signs monitoring are critical for ensuring patient safety through providing data for early warning scoring systems, but little is known about current monitoring practices.
To establish a profile of nurses’ vital signs monitoring practices, related dialogue, and adherence to health service protocol in New South Wales, Australia.
Direct observations of nurses’ working practices were conducted in two wards. The observations focused on times of the day when vital signs were generally measured. Patient interactions were recorded if occurring any time during the observation periods. Participants (n=42) included nursing staff on one chronic disease medical and one acute surgical ward in a large urban teaching hospital in New South Wales.
We observed 441 patient interactions. Measurement of vital signs occurred in 52% of interactions. The minimum five vital signs measures required by New South Wales Health policy were taken in only 6–21% of instances of vital signs monitoring. Vital signs were documented immediately on 93% of vitals-taking occasions and documented according to the policy in the patient's chart on 89% of these occasions. Nurse–patient interactions were initiated for the purpose of taking vital signs in 49% of interactions, with nurse–patient discourse observed during 88% of all interactions. Nurse–patient dialogue led to additional care being provided to patients in 12% of interactions.
The selection of appropriate vital signs measured and responses to these appears to rely on nurses’ clinical judgement or time availability rather than on policy-mandated frequency. The prevalence of incomplete sets of vital signs may limit identification of deteriorating patients. The findings from this study present an important baseline profile against which to evaluate the impact of introducing continuous monitoring approaches on current hospital practice.
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