[Evaluation of the patient centered clinical relationship: analysis of psychometric properties using the CICAA scale]

Improving simulation performance through Self-Learning Methodology in Simulated Environments (MAES©)

BACKGROUND

One of the main challenges faced by nursing educator is using the best strategy for students to learn. In MAES© (Self-learning methodology in simulated environments), the students are guided by a facilitator, and perform their simulations in a knowledge-specific area in a self-directed learning manner.

METHOD

The performance by the students in the MAES© simulation was compared to traditional Simulation-based learning (SBL). With this aim in mind, a study was conducted which quantitatively analyzed and compared the scores in SBL and MAES© scenarios from 274 students enrolled in the 4th year of the nursing degree. The students were assessed with the Clinical Simulation in Nursing Assessment Questionnaire (CLISINAQ) and the Knowledge Management Scale (KMS).

RESULTS

The students received a higher score in the scenarios with the MAES© methodology in clinical and non-technical skills.

CONCLUSIONS

When compared to SBL, MAES© granted students a better degree of performance in learning with simulation.

The development and psychometric validation of an instrument to evaluate nurses' attitudes towards communication with the patient (ACO)

BACKGROUND

Patient communication is a key skill for nurses involved in clinical care. Its measurement is a complex phenomenon that can be addressed through attitude evaluation.

OBJECTIVES

To develop and psychometrically test a measure of nurses' attitudes towards communication with patients (ACO), to study the relationship between these dimensions, and to analyse nursing attitudes.

DESIGN

To develop and psychometrically test the ACO questionnaire.

SETTINGS

All hospitals in the province of Valencia were invited by e-mail to distribute the ACO instrument. Ten hospitals took part in the study.

PARTICIPANTS

The study population was composed of a convenience sample of 400 hospital nurses on general or special services. The inclusion criteria were nurses at the selected centres who had previously provided an informed consent to participate.

METHODS

A literature review and expert consultation (N = 10) was used to develop the content of the questionnaire. The 62-item version of the instrument was applied to a convenience sample of 400 nurses between May 2015 and March 2016. Factor structure was evaluated with exploratory and confirmatory factor analysis (EFA, CFA), and reliability was evaluated with Cronbach's alpha, composite reliability (CR), and average variance extracted (AVE).

RESULTS

The final instrument (ACO), composed of 25 items grouped into three attitude dimensions (cognitive, affective and behavioural), had good psychometric properties. In the study sample, nurses had a favourable attitude towards communication. The cognitive and affective dimensions of the ACO should be able to predict the behaviour dimension.

CONCLUSION

The ACO is useful for evaluating current clinical practices, identifying educational needs and assessing the effectiveness of communication training or other interventions intended to improve communication.

Communication with patients and the duration of family medicine consultations

OBJECTIVE

To determine the distribution of consultation times, the factors that determine their length, and their relationship with a more participative, patient-centred consulting style.

DESIGN

Cross-sectional multicentre study.

LOCATION

Primary Healthcare Centres in Andalusia, Spain.

PARTICIPANTS

A total of 119 tutors and family medicine physician residents.

PRINCIPAL MEASUREMENTS

Consultation length and communication with the patient were analysed using the CICCAA scale (Connect, Identify, Understand, Consent, Help) during 436 interviews in Primary Care.

RESULTS

The mean duration of consultations was 8.8min (sd: 3.6). The consultation tended to be longer when the physician had a patient-centred approach (10.37±4.19min vs 7.54±2.98min; p=0.001), and when there was joint decision-making (9.79±3.96min vs 7.73±3.42min: p=0.001). In the multivariable model, longer consultations were associated with obtaining higher scores on the CICAA scale, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and a smaller number of daily visits (r²=0.32). There was no correlation between physician or patient gender, or problem type.

CONCLUSION

A more patient centred medical profile, increased shared decision-making, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and less professional pressure all seem to be associated with a longer consultation.

Ensuring relational competency in critical care: Importance of nursing students' communication skills

OBJECTIVES

The aim of this study was to analyse the communication skills of students in interactions with simulated critically-ill patients using a new assessment tool to study the relationships between communication skills, teamwork and clinical skills and to analyse the psychometric properties of the tool.

METHODS

A cross-sectional study was conducted to assess the communications skills of 52 students with critically-ill patients through the use of a new measurement tool to score video recordings of simulated clinical scenarios.

RESULTS

The 52 students obtained low scores on their skills in communicating with patients. The reliability of the measuring instrument showed good inter-observer agreement (ICC between 0.71 and 0.90) and the validity yielded a positive correlation (p<0.01).

CONCLUSIONS

The results provide evidence that nursing students lack skills when communicating with critically ill patients in simulated scenarios. The measuring instrument used is therefore deemed valid and reliable for assessing nursing students through a clinical simulation.

Measuring the quality of motivational interviewing in primary health care encounters: The development and validation of the motivational interviewing assessment scale (MIAS)

BACKGROUND

Motivational interviewing (MI) is a collaborative, goal-oriented method to help patients change behaviour. Tools that are often used to measure MI are the motivational interviewing skills code' (MISC), the 'motivational interviewing treatment integrity' (MITI) and the 'behaviour change counselling index' (BECCI). The first two instruments have not been designed to be used in primary healthcare (PHC) settings. The BECCI actually is time-consuming. The motivational interviewing assessment scale (MIAS, 'EVEM' in Spanish) was developed to measure MI in PHC encounters as an alternative to the previous instruments.

OBJECTIVES

To validate MIAS as an instrument to assess the quality of MI in PHC settings.

METHODS

(a)

DEVELOPMENT

Sixteen experts in MI participated in the design, face and consensus validity, using a Delphi-type methodology. (b)

VALIDATION

SETTING

27 PHC centres located in Spain.

SUBJECTS

four experts in MI tested its psychometric properties with 332 video recordings coming from the Dislip-EM study (consultations provided by 37 practitioners).

MEASUREMENTS

dimensionality, internal consistency, reliability (intra-class correlation coefficient-ICC), sensitivity to change and convergent validity with the BECCI scale.

RESULTS

A 14-item scale was obtained after the validation process. Factor analysis: two factors explained 76.6% of the total variance. Internal consistency, α = 0.99. Reliability: intra-rater ICC = 0.96; inter-rater ICC = 0.97. Sensitivity to change: means before and after training were 23.63 versus 38.57 (P < 0.001). Spearman's coefficient between the MIAS and the BECCI scale was 0.98 (P < 0.001).

CONCLUSION

The MIAS is a consistent and reliable instrument to assess the use of MI in PHC settings. [Box: see text].

Communication skills of tutors and family medicine physician residents in Primary Care clinics

Aim

To determine the communicative profiles of family physicians and the characteristics associated with an improved level of communication with the patient.

Design

A descriptive multicentre study.

Location

Primary Healthcare Centres in Almeria, Granada, Jaen and Huelva.

Participants

119 family physicians (tutors and 4th year resident physicians) filmed and observed with patients.

Principal measurements: Demographic and professional characteristics. Analysis of the communication between physicians and patients, using a CICAA (Connect, Identify, Understand, Agree and Assist, in English) scale. A descriptive, bivariate, multiple linear regression analysis was performed.

Results

There were 436 valid interviews. Almost 100% of physicians were polite and friendly, facilitating a dialogue with the patient and allowing them to express their doubts. However, few physicians attempted to explore the state of mind of the patient, or enquire about their family situation or any important stressful events, nor did they ask open questions. Furthermore, few physicians summarised the information gathered. The mean score was 21.43 ± 5.91 points (maximum 58). There were no differences in the total score between gender, city, or type of centre. The linear regression verified that the highest scores were obtained from tutors (B: 2.98), from the duration of the consultations (B: 0.63), and from the age of the professionals (B: −0.1).

Conclusion

Physicians excel in terms of creating a friendly environment, possessing good listening skills, and providing the patient with information. However the ability to empathise, exploring the psychosocial sphere, carrying out shared decision-making, and asking open questions must be improved. Being a tutor, devoting more time to consultations, and being younger, results in a significant improvement in communication with the patient.

Psychometric Properties of the Spanish Adaptation of the Health Care Communication Questionnaire (HCCQ)

This study’s aim is to adapt the Health Care Communication Questionnaire in a Spanish sample, and then test the psychometric properties of the adapted instrument. To do so, the questionnaire was adapted for the Spanish context and then applied in a pilot study as well as a final study. The final sample consisted of 200 patients at Morales Meseguer Hospital in Murcia, Spain. The results show that this adaptation’s psychometric properties were similar to those of the original questionnaire. As for item analysis, all items obtained discriminant indices > .30. Confirmatory factor analysis revealed the same structure as that of the original questionnaire (χ2/df = 1.345; CFI = .983; IFI = .983; TLI = .977; RMSEA = .042), with indices reflecting adequate goodness of fit. Also, results from the analysis of each dimension’s internal consistency had coefficients between .71 and .86. We conclude that the Spanish version of the HCCQ has adequate psychometric properties, is useful, and will serve its purpose in the context in which it will be used.

[Efficacy of motivational interviewing for reducing medication errors in chronic patients over 65 years with polypharmacy: Results of a cluster randomized trial]

BACKGROUND AND OBJECTIVE

To evaluate the effectiveness of an intervention based on motivational interviewing to reduce medication errors in chronic patients over 65 with polypharmacy.

PATIENTS AND METHOD

Cluster randomized trial that included doctors and nurses of 16 Primary Care centers and chronic patients with polypharmacy over 65 years. The professionals were assigned to the experimental or the control group using stratified randomization. Interventions consisted of training of professionals and revision of patient treatments, application of motivational interviewing in the experimental group and also the usual approach in the control group. The primary endpoint (medication error) was analyzed at individual level, and was estimated with the absolute risk reduction (ARR), relative risk reduction (RRR), number of subjects to treat (NNT) and by multiple logistic regression analysis.

RESULTS

Thirty-two professionals were randomized (19 doctors and 13 nurses), 27 of them recruited 154 patients consecutively (13 professionals in the experimental group recruited 70 patients and 14 professionals recruited 84 patients in the control group) and completed 6 months of follow-up. The mean age of patients was 76 years (68.8% women). A decrease in the average of medication errors was observed along the period. The reduction was greater in the experimental than in the control group (F=5.109, P=.035). RRA 29% (95% confidence interval [95% CI] 15.0-43.0%), RRR 0.59 (95% CI:0.31-0.76), and NNT 3.5 (95% CI 2.3-6.8).

CONCLUSION

Motivational interviewing is more efficient than the usual approach to reduce medication errors in patients over 65 with polypharmacy.

Is the Scale for Measuring Motivational Interviewing Skills a valid and reliable instrument for measuring the primary care professionals motivational skills?: EVEM study protocol

Background

Lifestyle is one of the main determinants of people’s health. It is essential to find the most effective prevention strategies to be used to encourage behavioral changes in their patients. Many theories are available that explain change or adherence to specific health behaviors in subjects. In this sense the named Motivational Interviewing has increasingly gained relevance. Few well-validated instruments are available for measuring doctors’ communication skills, and more specifically the Motivational Interviewing.

Methods/Design

The hypothesis of this study is that the Scale for Measuring Motivational Interviewing Skills (EVEM questionnaire) is a valid and reliable instrument for measuring the primary care professionals skills to get behavior change in patients. To test the hypothesis we have designed a prospective, observational, multi-center study to validate a measuring instrument. –Scope: Thirty-two primary care centers in Spain. -Sampling and Size: a) face and consensual validity: A group composed of 15 experts in Motivational Interviewing. b) Assessment of the psychometric properties of the scale; 50 physician- patient encounters will be videoed; a total of 162 interviews will be conducted with six standardized patients, and another 200 interviews will be conducted with 50 real patients (n=362). Four physicians will be specially trained to assess 30 interviews randomly selected to test the scale reproducibility. -Measurements for to test the hypothesis: a) Face validity: development of a draft questionnaire based on a theoretical model, by using Delphi-type methodology with experts. b) Scale psychometric properties: intraobservers will evaluate video recorded interviews: content-scalability validity (Exploratory Factor Analysis), internal consistency (Cronbach alpha), intra-/inter-observer reliability (Kappa index, intraclass correlation coefficient, Bland & Altman methodology), generalizability, construct validity and sensitivity to change (Pearson product–moment correlation coefficient).

Discussion

The verification of the hypothesis that EVEM is a valid and reliable tool for assessing motivational interviewing would be a major breakthrough in the current theoretical and practical knowledge, as it could be used to assess if the providers put into practice a patient centered communication style and can be used both for training or researching purposes.

Trials registration Dislip-EM study

NCT01282190 (ClinicalTrials.gov)

[Doctor-patient communication: one of the basic competencies, but different]

Effective communication skills form part of being a good doctor. Today there is solid evidence to support the teaching of effective communication skills in all medical schools. This article describes how communication is different from the other skills that medical students and residents need to learn, how this affects teaching and learning, and the application of these ideas in a Chilean medical school. We describe the premises that need to be taken into consideration when planning teaching communication in medicine and illustrate how these affected the development of our teaching of communication in our undergraduate curriculum. All medical education programmes should include formal teaching on the doctor-patient relationship, but must take into consideration the aspects of communication teaching that make it different from teaching other aspects of medicine.

Patient participation in the discussions of options in Spanish primary care consultations

OBJECTIVES

To determine patients' participation in the discussion of options in primary care consultations. Identify the patients' wish to participate and their perceptions of their participation and explore the potential factors that may influence these.

DESIGN

Cross-sectional study. Setting. Ninety-seven general practices. Participants. six hundred and fifty-eight patients who went to their doctors for unselected reasons. Measurements. All the encounters were videoed, patient participation in decision making (DM) was assessed with two tools. After the consultation, GPs completed a questionnaire about biomedical and relational information. Patients' preferences and perception of participation was explored with different type of questions.

RESULTS

Encounters successfully videoed: 638. Of these, only 90 interviews clearly showed patient participation. In 161 other interviews, patient participation was considered possible. Questionnaires collected: 645. In 60% of the situations (390 encounters), patients wished they could have stated their views about the proposed option(s), but they perceived this did not happen. The degree of participation at the consultation did not relate significantly with the physician's ideas about the type of problem, evolution and treatment. Neither did any of the considered variables influence either the patients' wish to participate in the discussion of the suggested option or their perception of this.

CONCLUSIONS

GPs ask patients for their opinion and promote discussion about the suggested plan in few encounters. Patients perceive this, including many patients that previously had declared not to be interested in being involved in decisions. These results revealed an important mismatch between what patients wish and what they perceive.