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Gregory J. Understanding the communication skills that support nurses to provide person-centred care. Nurs Stand 2024; 39:61-66. [PMID: 38164078 DOI: 10.7748/ns.2024.e12132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 01/03/2024]
Abstract
Communication is a process of sharing information and developing relationships through interaction. It is essential for nursing care, providing a basis for nurses to establish therapeutic relationships and trust with patients and their families. It is often assumed that nurses can intuitively communicate well; as a result, traditionally there has been a lack of formal training in this area. However, communication is a skill that can be developed and enhanced. This article explains the elements of communication and discusses the skills required by nurses to communicate effectively and provide compassionate, person-centred care. The author outlines two communication models to demonstrate how nurses can use these skills to deliver bad news and support people in distress.
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Affiliation(s)
- Julie Gregory
- Department of Education, Research and Innovation, East Lancashire Hospitals NHS Trust, Lancashire, England
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Powell R, Davies A, Rowlinson-Groves K, French DP, Moore J, Merchant Z. Impact of a prehabilitation and recovery programme on emotional well-being in individuals undergoing cancer surgery: a multi-perspective qualitative study. BMC Cancer 2023; 23:1232. [PMID: 38097972 PMCID: PMC10722769 DOI: 10.1186/s12885-023-11717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Prehabilitation and recovery programmes aim to optimise patients' physical fitness and mental well-being before, during and after cancer treatment. This paper aimed to understand the impact of such a programme on emotional well-being in individuals undergoing cancer surgery. The programme was multi-modal, containing physical activity, well-being and nutritional support. METHODS Qualitative interviews were conducted with 16 individuals who participated in a prehabilitation and recovery programme. Twenty-four health care staff involved in referral completed an online survey. An inductive, thematic analysis was conducted, integrating perspectives of patients and staff, structured with the Framework approach. RESULTS Patients seemed to experience emotional benefits from the programme, appearing less anxious and more confident in their ability to cope with treatment. They seemed to value having something positive to focus on and control over an aspect of treatment. Ongoing, implicit psychological support provided by Exercise Specialists, who were perceived as expert, available and caring, seemed valued. Some patients appeared to appreciate opportunities to talk about cancer with peers and professionals. Discomfort with talking about cancer with other people, outside of the programme, was expressed. CONCLUSIONS Participation in a prehabilitation and recovery programme appeared to yield valuable emotional well-being benefits, even without referral to specialist psychological support. STUDY REGISTRATION The study protocol was uploaded onto the Open Science Framework 24 September 2020 ( https://osf.io/347qj/ ).
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Affiliation(s)
- Rachael Powell
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK.
| | - Amy Davies
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | | | - David P French
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - John Moore
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Greater Manchester Cancer Alliance, The Christie NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Zoe Merchant
- Greater Manchester Cancer Alliance, The Christie NHS Foundation Trust, Manchester, UK
- North West Lung Centre, Lung Cancer and Thoracic Surgery Directorate, Wythenshawe hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Codjoe L, N'Danga-Koroma J, Henderson C, Lempp H, Thornicroft G. Pilot study of a manualised mental health awareness and stigma reduction intervention for Black faith communities in the UK: ON TRAC project. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1687-1697. [PMID: 37244878 PMCID: PMC10224758 DOI: 10.1007/s00127-023-02492-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/30/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Building partnerships between mental health services and Black faith communities to co-produce culturally tailored interventions is an essential step towards improving access to services and reducing stigma among the Black population. Given that Black faith organisations are considered a primary source of emotional and psychological support they are well positioned as 'gatekeepers' for services, to overcome barriers to engagement and build trusting relationships with the Black community. The aim of this paper is to pilot a manualised mental health awareness and stigma reduction intervention for Black faith communities in the UK, and to make an initial assessment of feasibility, acceptability and outcomes. METHODS This study employed a mixed methods pre-post-design, based upon the Medical Research Council Framework (MRC) for complex interventions, and the Implementation Science Research Development. RESULTS The qualitative assessments indicate that the intervention was found overall to be acceptable and feasible to the Black faith community population. This pilot study did not find statistically significant changes for the Mental Health Knowledge schedule (MAKS), Reported and Intended Behaviour Scale (RIBS), intended help-seeking or willingness to disclose (Attitudes to Mental Illness Survey) measures. However, the direction of all the non-significant changes in these measures suggests positive changes in mental health knowledge, a reduction in participants' desire for social distance, and greater willingness to disclose personal experiences of mental health problems. A statistically significant improvement in the Community Attitudes towards Mental Illness (CAMI) scale results indicated a lower level of stigmatising attitudes towards people with lived experience of mental health conditions (PWLE), and an increase in tolerance and support towards PWLE after the intervention. Significant improvement in the willingness to disclose measure suggests increased preparedness to seek help amongst participants, a lesser desire for social distance, and greater willingness to engage with PWLE after the intervention. Three key themes, including 9 subthemes were identified from the qualitative data analysis: (i) initial implementation and intention to adopt; (ii) perceived suitability and usefulness of intervention to address cultural issues relating to mental health in the Black community; and (iii) strengthening the capacity of faith leaders. CONCLUSIONS This ON TRAC pilot study shows that the intervention was feasible and acceptable, and that it has promising positive impacts and next requires larger scale evaluation. These results demonstrate that the intervention was a culturally acceptable way to potentially increase mental health awareness and reduce stigma in Black faith communities. TRIAL REGISTRATION ISRCTN12253092.
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Affiliation(s)
- Louisa Codjoe
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Joelyn N'Danga-Koroma
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Heidi Lempp
- Department of Inflammation Biology, Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, King's College London, Weston Education, 10, Cutcombe Rd, London, SE5 9RJ, UK
| | - Graham Thornicroft
- Centre for Implementation Science and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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Mahdiabadi FR, Mirzaei S, Entezari A, Nasiriani K. The effect of implementing the COMFORT communication model on communication skills of nursing students. Int J Palliat Nurs 2023; 29:412-420. [PMID: 37757811 DOI: 10.12968/ijpn.2023.29.9.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Effective communication as a key component of palliative care requires sufficient knowledge and experience to make nursing interventions successful. AIM This quasi-experimental study was conducted to determine the effectiveness of the COMFORT communication model as an intervention to improve student nurses' communication skills while they are under clinical training in specialist palliative care inpatient units. METHODS The population sample included 86 student nurses who were randomly assigned into two groups of 40. The intervention group received training on communication skills using the COMFORT communication model. Nine lectures were delivered online or offline; the lectures lasted between 25 to 60 minutes. The control group received the conventional educational programme about communication with patients and families, according to the curriculum of the bachelor's degree in nursing. Data were collected using the Communication Skills Questionnaire and Communication Skills Attitude Scale and analysed using IBM® SPSS® Statistics 22.0. RESULTS The findings showed that, after the implementation of COMFORT communication model, there was a statistically significant difference in communication skills between the intervention group (122.95±9.36) and the control group (110.1±8.92). There was also a significant difference in attitudes toward communication skills between the intervention group (90.25±8.86) and the control group (90.85±9.15) (P=0.0001). The findings of the study revealed that the COMFORT Communication model created significant statistical differences in the student's attitude, knowledge and communication skills. CONCLUSION Novice nurses sometimes struggle with the level of communication skills needed when caring for patients with an end-stage illness. The implementation of the COMFORT communication model significantly improved communication skills and attitudes toward communication. Due to the need to establish effective communication as the core of nursing practice, the implementation of this training programme is recommended for students and qualified nurses, particularly when providing palliative care.
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Affiliation(s)
- Farzad Reisi Mahdiabadi
- Master Student, Critical Care Nursing, Research Centre for Nursing and Midwifery Care, Noncommunicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Iran
| | - Samaneh Mirzaei
- Assistant Professor, Department of Health in Emergencies and Disasters, School of Public Health, Shahid Sadoughi University of Medical Sciences, Iran
| | - Ahmad Entezari
- Instructor, Department of Anesthesia and Operation Room, School of Paramedical Sciences, Shahid Sadoughi University of Medical Sciences, Iran
| | - Khadijeh Nasiriani
- Professor, Spiritual Heath Research Center, Research Centre for Nursing and Midwifery Care, Noncommunicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Iran
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Fan JX, Hu YC, Chen X, Li Y. Nursing Dilemmas in Chemotherapy-Induced Peripheral Neuropathy: A Qualitative Study of a Tertiary Hospital in China. J Pain Res 2023; 16:2299-2308. [PMID: 37435154 PMCID: PMC10332414 DOI: 10.2147/jpr.s409580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
Purpose This study investigated the experience of oncology nurses caring for chemotherapy-induced peripheral neuritis patients. Patients and Methods Through phenomenological research method, 11 nurses in a tertiary hospital in Shanghai were interviewed using face-to-face semi-structured interviews. Data analysis was conducted with the thematic analysis approach. Results This analysis revealed the experiences of oncology nurses in caring for patients with CIPN and identified three themes: 1) stress in the nursing of CIPN (inadequate knowledge of CIPN among oncology nurses, oncology nurses' CIPN nursing skills need to be improved, negative emotions of oncology nurses at work); 2) environmental dilemmas in nursing of CIPN (lack of effective care norms, busy schedules, doctors pay little attention to CIPN); 3) oncology nurses' desire to improve their knowledge of CIPN to meet care needs. Conclusion Based on the perspective of oncology nurses, the care dilemma of CIPN is mainly influenced by individual and environmental factors. It is recommended to enhance the attention of oncology nurses to CIPN, set specific and feasible training courses, explore CIPN assessment tools that meet our clinical practice, and construct CIPN care programs to improve CIPN clinical care ability and reduce patient suffering.
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Affiliation(s)
- Jia Xin Fan
- School of Medicine, Tongji University, Shanghai, People’s Republic of China
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Ya Chen Hu
- School of Medicine, Tongji University, Shanghai, People’s Republic of China
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People’s Republic of China
| | - XinXin Chen
- School of Medicine, Tongji University, Shanghai, People’s Republic of China
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People’s Republic of China
| | - YuMei Li
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People’s Republic of China
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Etkind SN. Uncertainty in multimorbidity: a shared experience we should recognise, acknowledge and communicate. Br J Community Nurs 2022; 27:540-544. [PMID: 36327210 DOI: 10.12968/bjcn.2022.27.11.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Multimorbidity is increasingly common and inevitably results in uncertainties about health, care and the future. Such uncertainties may be experienced by patients, carers and health professionals. Given the ubiquitous presence of uncertainty, all professionals should be prepared to approach and address it in clinical practice. Uncertainty in multimorbidity can rarely be eliminated, and so, must be carefully addressed and communicated; however, there is little evidence on how to approach it. Key areas are: recognising the existence of uncertainty, acknowledging it, and communicating to achieve a shared understanding. Evaluation of what has been discussed, and preparedness to repeat such conversations are also important. Future research should explore optimal communication of uncertainty in multimorbidity.
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Affiliation(s)
- Simon Noah Etkind
- Academic Clinical Lecturer, Department of Public Health and Primary Care, University of Cambridge
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Coyle AC, Yen RW, Elwyn G. Interrupted opening statements in clinical encounters: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:2653-2663. [PMID: 35393229 DOI: 10.1016/j.pec.2022.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/31/2022] [Accepted: 03/27/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To conduct a scoping review of literature on the duration of patients' opening statements in clinical encounters, with or without an interruption. METHODS We conducted a scoping review to identify articles based on pre-specified inclusion and exclusion criteria. One reviewer extracted study details and outcomes related to the length of patients' opening statements. A second reviewer verified this data. RESULTS We included 14 studies from 1185 citations reviewed. Encounters were in primary care clinics, specialty clinics, and hospitals. Across six studies, the mean time to interruption was 18.2 s. The mean length of uninterrupted opening statements was 45.9 s across nine studies. CONCLUSION Clinicians interrupting their patients' opening statements, compared to not interrupting, takes away time from the patient to fully present their concerns. Research has not focused on the nature of clinician interruptions. For instance, an interruption encouraging expansion or more detail facilitates understanding. Therefore, the impact these interruptions have on the clinical encounter remains unknown. PRACTICE IMPLICATIONS Interrupting the average patient does not save time, so clinicians may benefit from allowing their patients to complete their opening statements.
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Affiliation(s)
- Amanda C Coyle
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, USA; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
| | - Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, USA
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Nixon J, Turner J, Gray L, Scaife J. Communicating Actively, Responding Empathically (CARE): Perceptions of Cancer Health Professionals Attending Communication Training Workshops. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:288-295. [PMID: 32592036 DOI: 10.1007/s13187-020-01809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Communication skills training is standardly offered to health professionals working in cancer; however, there is no consensus on the precise style or duration of training, which is most effective. This study aimed to examine the experiences of health professionals who had participated in either a 1-day communication skills training workshop focusing on experiential learning or a 2-h workshop in which participants discussed different communication styles demonstrated on purpose-designed videotapes. Twenty health professionals comprising ten from each workshop type participated in a semi-structured interview with an interpretative descriptive design. Participant characteristics were summarised using descriptive statistics. Thematic analysis was conducted. Consistent themes across both groups were the importance of good communication and perceived barriers. All participants strongly endorsed the value of their respective training experience and considered this was due in part to the skill of facilitators and the creation of a supportive learning environment. Role plays were reported to be helpful in promoting skill development, and some participants in the 2-h workshop indicated that they would have liked the opportunity to practice new skills through role play, which was not possible in the short workshop. Participants self-reported increased confidence following both workshops and perceived improvements in delivery of person-centred care. Both the 1-day and the 2-h communication workshops were a positive experience for the groups who attended. The 1-day communication workshop offered an opportunity for experiential learning, which the 2-h group felt would have been worthwhile; however, both groups found value in attending the workshops.
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Affiliation(s)
- Jodie Nixon
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Jane Turner
- Faculty of Medicine, The University of Queensland, St Lucia, QLD, 4027, Australia
| | - Lyndal Gray
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Jessica Scaife
- Department of Palliative Care, Calvary Mater Newcastle, Edith Street, Waratah, 2299, Australia
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A Network Analysis of Research Topics and Trends in End-of-Life Care and Nursing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010313. [PMID: 33406715 PMCID: PMC7795048 DOI: 10.3390/ijerph18010313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/20/2020] [Accepted: 12/30/2020] [Indexed: 11/17/2022]
Abstract
This study identified the trends in end-of-life care and nursing through text network analysis. About 18,935 articles published until September 2019 were selected through searches on PubMed, Embase, Cochrane, Web of Science, and Cumulative Index to Nursing and Allied Health Literature. For topic modeling, Latent Dirichlet Allocation (K = 8) was applied. Most of the top ranked topic words for the degree and betweenness centralities were consistent with the top 1% through the semantic network diagram. Among the important keywords examined every five years, "care" was unrivaled. When analyzing the two- and three-word combinations, there were many themes representing places, roles, and actions. As a result of performing topic modeling, eight topics were derived as ethical issues of decision-making for treatment withdrawal, symptom management to improve the quality of life, development of end-of-life knowledge education programs, life-sustaining care plan for elderly patients, home-based hospice, communication experience, patient symptom investigation, and an analysis of considering patient preferences. This study is meaningful as it analyzed a large amount of existing literature and considered the main trends of end-of-life care and nursing research based on the core subject control and semantic structure.
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Wharrad H, Sarre S, Schneider J, Maben J, Aldus C, Argyle E, Arthur A. In-PREP: a new learning design framework and methodology applied to a relational care training intervention for healthcare assistants. BMC Health Serv Res 2020; 20:1010. [PMID: 33148232 PMCID: PMC7643258 DOI: 10.1186/s12913-020-05836-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 'Older People's Shoes' is a training intervention designed for healthcare assistants (HCAs) to improve the relational care of older people in hospital. The intervention formed part of a broader evaluation, in this paper we describe its development from a learning design and methodological perspective. METHODS Learning theory and an instructional design model were key components of the In-PREP (Input, Process, Review and Evaluation, Product) development methodology used in the design of the 'Older People's Shoes' training intervention to improve the delivery of relational care by front-line hospital staff. An expert panel, current evidence, and pedagogical theory were used to co-design a training programme tailored to a challenging work environment and taking account of trainees' diverse educational experience. Peer review and process evaluation were built into the development model. RESULTS In-PREP provided a methodological scaffold for producing evidence-based, peer-reviewed, co-designed training. The product, 'Older People's Shoes', involved a one-day Train the Trainers event, followed by delivery of a two-day, face-to-face training programme by the trainers, with accompanying handbooks underpinned by a range of digital resources. Evaluation found the approach met learner needs, was applicable in practice and won approval from trainers. DISCUSSION In-PREP enables high quality learning content, alignment with learner needs and a product that is relevant, practical and straightforward to implement.
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Affiliation(s)
- Heather Wharrad
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2HA, UK.
| | - Sophie Sarre
- School of Nursing, Midwifery and Palliative Care, King's College, London, UK
| | - Justine Schneider
- School of Law and Social Sciences, University of Nottingham, Nottingham, UK
| | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Clare Aldus
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Elaine Argyle
- School of Education, University of Nottingham, Nottingham, UK
| | - Anthony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
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Nixon J, Gray L, Turner J, Bernard A, Scaife J, Cartmill B. Communicating Actively Responding Empathically (CARE): Comparison of Communication Training Workshops for Health Professionals Working in Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:54-60. [PMID: 30386978 DOI: 10.1007/s13187-018-1439-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Accessing full-day communication skills training can be challenging for health professionals working in cancer care. This study aimed to examine the effectiveness of Communicating Actively, Responding Empathically (CARE Express), a modified 2-h communication skills training course, across measures of health professional confidence, skills and attitudes. Cancer care health professionals (n = 147) were recruited from allied health, nursing and medical disciplines, using a partial randomisation to allocate to three arms: control, two-hour training (CARE Express) and 1-day training (CARE). Perceived confidence and skills were measured by self-report using a purpose-built scale, and written responses to a challenging clinical encounter were obtained at baseline, post-training and three-months post-training. Attitudes toward psychosocial issues were evaluated with the Physician Belief Scale at baseline and 3 months post-training. No changes were observed in the control group (n = 50) from baseline to 3 months follow-up. Participants in the CARE Express (n = 48) and CARE (n = 49) groups had significant improvement in confidence in identifying/responding to emotions between baseline and 3 months post-training (p < 0.001), as well as their attitude toward psychosocial care (p < 0.001). A significant increase in "acknowledging" responses from baseline to 3 months was also observed for CARE Express and CARE (p < 0.001), with no difference between groups. CARE Express and CARE resulted in changes in confidence in emotional identification/response, psychosocial focus and communication skills maintained at 3 months post-training. Whilst the 1-day workshop has been regarded as gold standard, this study has revealed positive outcomes with a modified 2-h version, thus offering a potential alternate training model.
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Affiliation(s)
- Jodie Nixon
- Occupational Therapy Department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
| | - Lyndal Gray
- Occupational Therapy Department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
| | - Jane Turner
- Faculty of Medicine, The University of Queensland, St Lucia, QLD, 4027, Australia
| | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, 4027, Australia
| | - Jessica Scaife
- Cancer Services, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
| | - Bena Cartmill
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
- Centre for Functioning and Health Research, Princess Alexandra Hospital, Brisbane, Australia
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Riley VA, Gidlow C, Ellis NJ, Povey RJ, Barnes O, Clark-Carter D. Improving cardiovascular disease risk communication in the UK national health service health check programme. PATIENT EDUCATION AND COUNSELING 2019; 102:2016-2023. [PMID: 31130337 DOI: 10.1016/j.pec.2019.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/11/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To develop and test training to improve practitioners' confidence and perceived understanding when communicating cardiovascular disease (CVD) risk using novel tools and metrics. METHODS A CVD risk communication training workshop was developed through interviews with patients and practitioners delivering Health Checks, a literature review, NICE guidance and the UK Health Check competency framework. It was pilot-tested with practitioners delivering Health Checks in the UK. Perceived practitioner understanding and confidence were measured before and up to 10 weeks after the workshop, and changes were compared with those in a control group (who received no intervention). Perceived impact was also explored through semi-structured interviews. RESULTS Sixty-two practitioners (34 intervention, 28 control) took part. Perceived practitioner understanding (p = .030) and perceived patient understanding (p = .007) improved significantly for those delivering Health Checks in the training group compared with controls. Practitioner confidence also improved significantly more in practitioners who attended the training (p = .001). Findings were supported by interviews with a sub-sample of practitioners (n = 13). CONCLUSION The training workshop improved practitioners' confidence and perceived understanding of CVD risk in Health Checks. PRACTICE IMPLICATIONS The training is an important step to improving practitioner understanding of CVD risk in Health Checks and should be implemented on a wider scale.
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Affiliation(s)
- V A Riley
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - C Gidlow
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - N J Ellis
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - R J Povey
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - O Barnes
- Yorkshire & Humber Academic Health Science Network, Navigation Court Calder Park, Wakefield , WF2 7BJ, United Kingdom.
| | - D Clark-Carter
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
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Ang SHM. Promoting Effective Nurse-Patient Communication in Palliative Care Using the SAGE and THYME Model: Can it be Implemented Cross-Culturally? Open Nurs J 2019. [DOI: 10.2174/1874434601913010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Effective communication in palliative care is essential in making optimal health care decisions that align with the interests of the patients and empowering them to be involved in their care planning. However, many Asian nurses lacked the prerequisite communication skills required to assess and address the informational needs of advanced cancer patients. These nurses often adopt a routinized approach of giving information to patients to overcome their inadequacies in eliciting patients’ concerns. Thus, this opinion paper seeks to understand whether the SAGE and THYME model can be utilised widely by nurses across different cultural contexts to facilitate more effective communication and to develop therapeutic relationships with advanced cancer patients who are receiving palliative care.
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Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
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Henderson S, Barker M. Developing nurses' intercultural/intraprofessional communication skills using the EXCELLence in Cultural Experiential Learning and Leadership Social Interaction Maps. J Clin Nurs 2017; 27:3276-3286. [PMID: 28960547 DOI: 10.1111/jocn.14089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 01/06/2023]
Abstract
AIMS AND OBJECTIVES To examine how the use of Social Interaction Maps, a tool in the EXCELLence in Cultural Experiential Learning and Leadership Program, can enhance the development of nurses' intercultural/intraprofessional communication skills. BACKGROUND Nurses face communication challenges when interacting with others from similar background as well as those from a culturally and linguistically diverse background. We used the EXCELLence in Cultural Experiential Learning and Leadership Program's Social Interaction Maps tool to foster intercultural/intraprofessional communication skills in nurses. Social Interaction Maps describe verbal and nonverbal communication behaviours that model ways of communicating in a culturally appropriate manner. The maps include four stages of an interaction, namely Approach, Bridging, Communicating and Departing using the acronym ABCD. DESIGN Qualitative approach was used with a purposeful sample of nurses enrolled in a postgraduate course. METHODS Fifteen participants were recruited. The Social Interaction Map tool was taught to participants in a workshop where they engaged in sociocultural communication activities using scenarios. Participants were asked to apply Social Interaction Maps in their workplaces. Six weeks later, participants completed a semistructured open-ended questionnaire and participated in a discussion forum on their experience of using Social Interaction Maps. Data were content-analysed. RESULTS Four themes identified in the use of the Social Interaction Maps were (i) enhancing self-awareness of communication skills; (ii) promoting skills in being nonconfrontational during difficult interactions; (iii) highlighting the importance of A (Approach) and B (Bridging) in interaction with others; and (iv) awareness of how others interpret what is said C (Communicating) and discussing to resolve issues before closure D (Departing). CONCLUSIONS Application of the EXCELLence in Cultural Experiential Learning and Leadership Social Interaction Mapping tool was shown to be useful in developing intercultural/intraprofessional communication skills in nurses. RELEVANCE TO CLINICAL PRACTICE Professional development programmes that incorporate EXCELLence in Cultural Experiential Learning and Leadership Social Interaction Maps can enhance nurses' intercultural/intraprofessional communication competencies when engaging with others from culturally and linguistically diverse backgrounds and improve the way nurses communicate with each other.
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Affiliation(s)
- Saras Henderson
- School of Nursing and Midwifery, Griffith University, Southport, Qld, Australia.,The Hopkins Centre Research for Rehabilitation and Resilience, Griffith University, Southport, Qld, Australia.,Women's Wellness Research Group, Menzies Health Institute Queensland, Griffith University, Southport, Qld, Australia
| | - Michelle Barker
- Department of International Business and Asian Studies, Griffith Business School, Griffith University, Nathan, Qld, Australia
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Griffiths J. Person-centred communication for emotional support in district nursing: SAGE and THYME model. Br J Community Nurs 2017; 22:593-597. [PMID: 29189053 DOI: 10.12968/bjcn.2017.22.12.593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients on district nursing caseloads have multiple physical morbidities, and related emotional concerns. District nurses are ideally placed to assess and meet patients' emotional needs but in increasingly stretched workplaces, it is difficult to find time. There is also evidence that district nurses sometimes believe they lack skills to address patients' concerns. Traditional communication skills training is useful for encouraging patients to open up about their concerns, but less helpful at finding workable solutions. District nurses can be afraid to open a 'can of worms' of concerns that they are unable to deal with. SAGE and THYME is a person-centred, evidence-based communication skills model that addresses district nurses' concerns about time and skills. It provides a structure for conversations about concerns, and empowers patients to work with district nurses to find solutions. Research suggests that it is a promising model for district nursing practice.
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Affiliation(s)
- Jane Griffiths
- Senior Lecturer, School of Health Sciences, Division of Nursing Midwifery and Social Work, University of Manchester
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Austin L, Ewing G, Grande G. Factors influencing practitioner adoption of carer-led assessment in palliative homecare: A qualitative study of the use of the Carer Support Needs Assessment Tool (CSNAT). PLoS One 2017. [PMID: 28622348 PMCID: PMC5473540 DOI: 10.1371/journal.pone.0179287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Informal caregivers play a pivotal role in supporting patients approaching the end of life. The Carer Support Needs Assessment Tool (CSNAT) is designed to facilitate person-centred assessment and support through a process that is practitioner-facilitated, but carer-led. This study explored practitioners' experiences of implementing the CSNAT in palliative homecare. METHODS We conducted qualitative interviews/focus groups with 20 practitioners in one UK hospice homecare service (18 nurses, two healthcare assistants) before and after the implementation of the CSNAT. Thematic analysis of the data was underpinned by framework analysis. RESULTS Not all practitioners appreciated that using the CSNAT required a shift towards a more person-centred approach to assessment; consequently they tagged the tool onto their existing practitioner-led practice. Practitioners who did use the CSNAT as intended were able to act as role models and support their colleagues in making this transition. Practitioners' comments revealed a number of contradictions: 1) Most felt that they 'already do' identify carer support needs, but feared using the CSNAT could increase their workload; 2) some worried about introducing the CSNAT 'too soon', but recognised that it was 'too late' once patients were close to the end of life; 3) whilst practitioners stated 'they were there for the family as well as the patient', care provision was overtly centred around patients. CONCLUSION This study provides vital insights into barriers and facilitators to implementing the CSNAT as part of a person-centred approach to assessment. The findings identified the training and support required to help practitioners make this transition to this new way of working.
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Affiliation(s)
- Lynn Austin
- Centre for Primary Care, Faculty of Biological, Medical and Health Sciences, The University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Martin ASH, Costello J, Griffiths J. Communication in palliative care: the applicability of the SAGE and THYME model in Singapore. Int J Palliat Nurs 2017. [PMID: 28648130 DOI: 10.12968/ijpn.2017.23.6.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Majority of the progress and development in palliative care in the last decade has been improvements in physical aspects of treatment, namely pain and symptom management. Psychosocial aspects of care have improved, although not enough to meet the needs of many patients and family members. This is evident in many parts of the world and notably in Singapore, where palliative care is seen as an emerging medical and nursing specialty. AIM To discuss the implementation of the SAGE and THYME communication model in a palliative care context. The article examines the use of the model and how its implementation can improve communication between patients and nurses. The model works by reviewing contemporary developments made in relation to improving communication in palliative care. These include, highlighting the importance of meeting individual needs, therapeutic relationship building, and advanced communication training within a Singaporean context. RESULTS The implementation of the SAGE and THYME model can be a useful way of enabling nurses to improve and maintain effective communication in a medically dominated health care system. The challenges and constraints in educating and training nurses with limited skills in palliative care, forms part of the review, including the cultural and attitude constraints specific to Singaporean palliative care.
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Affiliation(s)
| | - John Costello
- Associate Professor, University of Manchester, United Kingdom
| | - Jane Griffiths
- Senior Lecturer, University of Manchester, United Kingdom
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Arthur A, Aldus C, Sarre S, Maben J, Wharrad H, Schneider J, Barton G, Argyle E, Clark A, Nouri F, Nicholson C. Can Health-care Assistant Training improve the relational care of older people? (CHAT) A development and feasibility study of a complex intervention. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundOlder people account for an increasing proportion of those receiving NHS acute care. The quality of health care delivered to older people has come under increased scrutiny. Health-care assistants (HCAs) provide much of the direct care of older people in hospital. Patients’ experience of care tends to be based on the relational aspects of that care including dignity, empathy and emotional support.Objective(s)We aimed to understand the relational care training needs of HCAs caring for older people, design a relational care training intervention for HCAs and assess the feasibility of a cluster randomised controlled trial to test the new intervention against HCA training as usual (TAU).Design(1) A telephone survey of all NHS hospital trusts in England to assess current HCA training provision, (2) focus groups of older people and carers, (3) semistructured interviews with HCAs and other care staff to establish training needs and inform intervention development and (4) a feasibility cluster randomised controlled trial.Setting(1) All acute NHS hospital trusts in England, and (2–4) three acute NHS hospital trusts in England and the populations they serve.Participants(1) Representatives of 113 out of the total of 161 (70.2%) NHS trusts in England took part in the telephone survey, (2) 29 older people or carer participants in three focus groups, (3) 30 HCA and 24 ‘other staff’ interviewees and (4) 12 wards (four per trust), 112 HCAs, 92 patients during the prerandomisation period and 67 patients during the postrandomisation period.InterventionsFor the feasibility trial, a training intervention (Older People’s Shoes™) for HCAs developed as part of the study was compared with HCA TAU.Main outcome measuresPatient-level outcomes were the experience of emotional care and quality of life during patients’ hospital stay, as measured by the Patient Evaluation of Emotional Care during Hospitalisation and the EuroQol-5 Dimensions questionnaires. HCA outcomes were empathy, as measured by the Toronto Empathy Questionnaire, and attitudes towards older people, as measured by the Age Group Evaluation and Description Inventory. Ward-level outcomes were the quality of HCA–patient interaction, as measured by the Quality of Interaction Scale.Results(1) One-third of trust telephone survey participants reported HCA training content that we considered to be ‘relational care’. Training for HCAs is variable across trusts and is focused on new recruits. The biggest challenge for HCA training is getting HCAs released from ward duties. (2) Older people and carers are aware of the pressures that ward staff are under but good relationships with care staff determine whether or not their experience of hospital is positive. (3) HCAs have training needs related to ‘difficult conversations’ with patients and relatives; they have particular preferences for learning styles that are not always reflected in available training. (4) In the feasibility trial, 187 of the 192 planned ward observation sessions were completed; the response to HCA questionnaires at baseline and at 8 and 12 weeks post randomisation was 64.2%, 46.4% and 35.7%, respectively, and 57.2% of eligible patients returned completed questionnaires.LimitationsThis was an intervention development and feasibility study so no conclusions can be drawn about the clinical effectiveness or cost-effectiveness of the intervention.ConclusionsThe intervention had high acceptability among nurse trainers and HCA learners. Viability of a definitive trial is conditional on overcoming specific methodological (patient recruitment processes) and contextual (involvement of wider ward team) challenges.Future workMethods to ease the burden of questionnaire completion without compromising ethics or methodological rigour need to be explored.Trial registrationCurrent Controlled Trials ISRCTN10385799.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 5, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Antony Arthur
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Norwich Clinical Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Clare Aldus
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Norwich Clinical Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sophie Sarre
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Jill Maben
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Heather Wharrad
- School of Health Sciences, Queen’s Medical Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Garry Barton
- Norwich Clinical Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Elaine Argyle
- School of Health Sciences, Queen’s Medical Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Allan Clark
- Norwich Clinical Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona Nouri
- School of Health Sciences, Queen’s Medical Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Caroline Nicholson
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
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Taylor F, Taylor C, Baharani J, Nicholas J, Combes G. Integrating emotional and psychological support into the end-stage renal disease pathway: a protocol for mixed methods research to identify patients' lower-level support needs and how these can most effectively be addressed. BMC Nephrol 2016; 17:111. [PMID: 27484760 PMCID: PMC4971672 DOI: 10.1186/s12882-016-0327-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/28/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As a result of difficulties related to their illness, diagnosis and treatment, patients with end-stage renal disease experience significant emotional and psychological problems, which untreated can have considerable negative impact on their health and wellbeing. Despite evidence that patients desire improved support, management of their psychosocial problems, particularly at the lower-level, remains sub-optimal. There is limited understanding of the specific support that patients need and want, from whom, and when, and also a lack of data on what helps and hinders renal staff in identifying and responding to their patients' support needs, and how barriers to doing so might be overcome. Through this research we therefore seek to determine what, when, and how, support for patients with lower-level emotional and psychological problems should be integrated into the end-stage renal disease pathway. METHODS/DESIGN The research will involve two linked, multicentre studies, designed to identify and consider the perspectives of patients at five different stages of the end-stage renal disease pathway (Study 1), and renal staff working with them (Study 2). A convergent, parallel mixed methods design will be employed for both studies, with quantitative and qualitative data collected separately. For each study, the data sets will be analysed separately and the results then compared or combined using interpretive analysis. A further stage of synthesis will employ data-driven thematic analysis to identify: triangulation and frequency of themes across pathway stages; patterns and plausible explanations of effects. DISCUSSION There is an important need for this research given the high frequency of lower-level distress experienced by end-stage renal disease patients and lack of progress to date in integrating support for their lower-level psychosocial needs into the care pathway. Use of a mixed methods design across the two studies will generate a holistic patient and healthcare professional perspective that is more likely to identify viable solutions to enable implementation of timely and integrated care. Based on the research outputs, appropriate support interventions will be developed, implemented and evaluated in a linked follow-on study.
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Affiliation(s)
- Francesca Taylor
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Celia Taylor
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS UK
| | - Johann Nicholas
- Renal Unit, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP UK
| | - Gill Combes
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
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Brighton LJ, Bristowe K. Communication in palliative care: talking about the end of life, before the end of life. Postgrad Med J 2016; 92:466-70. [DOI: 10.1136/postgradmedj-2015-133368] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 04/17/2016] [Indexed: 01/22/2023]
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Etkind SN, Koffman J. Approaches to managing uncertainty in people with life-limiting conditions: role of communication and palliative care. Postgrad Med J 2016; 92:412-7. [PMID: 27129911 DOI: 10.1136/postgradmedj-2015-133371] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/12/2016] [Indexed: 12/21/2022]
Abstract
Patients with any major illness can expect to experience uncertainty about the nature of their illness, its treatment and their prognosis. Prognostic uncertainty is a particular source of patient distress among those living with life-limiting disease. Uncertainty also affects professionals and it has been argued that the level of professional tolerance of uncertainty can affect levels of investigation as well as healthcare resource use. We know that the way in which uncertainty is recognised, managed and communicated can have important impacts on patients' treatment and quality of life. Current approaches to uncertainty in life-limiting illness include the use of care bundles and approaches that focus on communication and education. The experience in communicating in difficult situations that specialist palliative care professionals can provide may also be of benefit for patients with life-limiting illness in the context of uncertainty. While there are a number of promising approaches to uncertainty, as yet few interventions targeted at recognising and addressing uncertainty have been fully evaluated and further research is needed in this area.
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Affiliation(s)
- S N Etkind
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - J Koffman
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
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Griffiths J, Wilson C, Ewing G, Connolly M, Grande G. Improving communication with palliative care cancer patients at home - A pilot study of SAGE & THYME communication skills model. Eur J Oncol Nurs 2015; 19:465-72. [PMID: 25782722 DOI: 10.1016/j.ejon.2015.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To pilot an evidence-based communication skills model (SAGE & THYME) with UK District Nurses (DNs) who visit patients with advanced cancer early in the dying trajectory. Evidence suggests that DNs lack confidence in communication skills and in assessing cancer patients' psycho-social needs; also that they lack time. SAGE & THYME is a highly structured model for teaching patient centred interactions. It addresses concerns about confidence and time. METHOD Mixed methods. 33 DNs were trained in SAGE & THYME in a three hour workshop and interviewed in focus groups on three occasions: pre-training, immediately post-training and two months post-training. Questionnaires measuring perceived outcomes of communication, confidence in communication and motivation to use SAGE & THYME were administered at the focus groups. RESULTS SAGE & THYME provided a structure for conversations and facilitated opening and closing of interactions. The main principle of patient centeredness was reportedly used by all. Knowledge about communication behaviours helpful to patients improved and was sustained two months after training. Increased confidence in communication skills was also sustained. Motivation to use SAGE & THYME was high and remained so at two months, and some said the model saved them time. Challenges with using the model included controlling the home environment and a change in style of communication which was so marked some DNs preferred to use it with new patients. CONCLUSION Training DNs in SAGE & THYME in a three hour workshop appears to be a promising model for improving communication skills when working with cancer patients.
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Affiliation(s)
- Jane Griffiths
- University of Manchester, School of Nursing Midwifery and Social Work, Jean McFarlane Building, Manchester, United Kingdom.
| | - Charlotte Wilson
- Barts & The London School of Medicine, Centre for Primary Care and Public Health, Yvonne Carter Building, 58 Turnser Street, London, United Kingdom
| | - Gail Ewing
- University of Cambridge, Centre for Family Research, Free School Lane, Cambridge, United Kingdom
| | - Michael Connolly
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Lane, Wythenshawe, Manchester, United Kingdom
| | - Gunn Grande
- University of Manchester, School of Nursing Midwifery and Social Work, Jean McFarlane Building, Manchester, United Kingdom
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McLeod J, McLeod J. Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology. COUNSELLING PSYCHOLOGY QUARTERLY 2014. [DOI: 10.1080/09515070.2014.942774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Huang SH, Tang FI, Liu CY, Chen MB, Liang TH, Sheu SJ. Truth-telling to patients' terminal illness: what makes oncology nurses act individually? Eur J Oncol Nurs 2014; 18:492-8. [PMID: 24907230 DOI: 10.1016/j.ejon.2014.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 04/10/2014] [Accepted: 04/19/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Nurses encounter the challenge of truth-telling to patients' terminal illness (TTPTI) in their daily care activities, particularly for nurses working in the pervasive culture of family protectiveness and medical paternalism. This study aims to investigate oncology nurses' major responses to handling this issue and to explore what factors might explain oncology nurses' various actions. METHODS A pilot quantitative study was designed to describe full-time nurses' (n = 70) truth-telling experiences at an oncology centre in Taipei. The potential influencing factors of nurses' demographic data, clinical characteristics, and truth-telling attitudes were also explored. RESULTS Most nurses expressed that truth-telling was a physician's responsibility. Nevertheless, 70.6% of nurses responded that they had performed truth-telling, and 20 nurses (29.4%) reported no experience. The reasons for inaction were "Truth-telling is not my duty", "Families required me to conceal the truth", and "Truth-telling is difficult for me". Based on a stepwise regression analysis, nurses' truth-telling acts can be predicted based on less perceived difficulty of talking about "Do not resuscitate" with patients, a higher perceived authorisation from the unit, and more oncology work experience (adjusted R² = 24.1%). CONCLUSIONS Oncology care experience, perceived comfort in communication with terminal patients, and unit authorisation are important factors for cultivating nurses' professional accountability in truth-telling. Nursing leaders and educators should consider reducing nursing barriers for truth-telling, improving oncology nurses' professional accountability, and facilitating better quality care environments for terminal patients.
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Affiliation(s)
- Shu-He Huang
- School of Nursing, National Yang Ming University, Taipei, Taiwan; Department of Nursing, National Yang-Ming University Hospital, Taipei, Taiwan.
| | - Fu-In Tang
- School of Nursing, National Yang Ming University, Taipei, Taiwan.
| | - Chang-Yi Liu
- Oncology Unit of O'Connor Hospital, San Jose, CA, USA.
| | - Mei-Bih Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Te-Hsin Liang
- Department of Statistics of Information Science, Center for Statistical Consultation, Fu Jen Catholic University, Taipei, Taiwan.
| | - Shuh-Jen Sheu
- School of Nursing, National Yang Ming University, Taipei, Taiwan.
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Ethical behaviour in clinical practice: a multidimensional Rasch analysis from a survey of primary health care professionals of Barcelona (Catalonia, Spain). Qual Life Res 2014; 23:2681-91. [PMID: 24859160 DOI: 10.1007/s11136-014-0720-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Normative ethics includes ethical behaviour health care professionals should uphold in daily practice. This study assessed the degree to which primary health care (PHC) professionals endorse a set of ethical standards from these norms. METHODS Health care professionals from an urban area participated in a cross-sectional study. Data were collected using an anonymous, self-administered questionnaire. We examined the level of ethical endorsement of the items and the ethical performance of health care professionals using a Rasch multidimensional model. We analysed differences in ethical performance between groups according to sex, profession and knowledge of ethical norms. RESULTS A total of 452 Professionals from 56 PHC centres participated. The level of ethical performance was lower in items related to patient autonomy and respecting patient choices. The item estimate across all dimensions showed that professionals found it most difficult to endorse avoiding interruptions when seeing patients. We found significant differences in two groups: nurses had greater ethical performance than family physicians (p < 0.05), and professionals who reported having effective knowledge of ethical norms had a higher level of ethical performance (p < 0.01). CONCLUSIONS Paternalistic behaviour persists in PHC. Lesser endorsement of items suggests that patient-centred care and patient autonomy are not fully considered by professionals. Ethical sensitivity could improve if patients are cared for by multidisciplinary teams.
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Bristowe K, Shepherd K, Bryan L, Brown H, Carey I, Matthews B, O'Donoghue D, Vinen K, Murtagh FEM. The development and piloting of the REnal specific Advanced Communication Training (REACT) programme to improve Advance Care Planning for renal patients. Palliat Med 2014; 28:360-6. [PMID: 24201135 DOI: 10.1177/0269216313510342] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In recent years, the End-Stage Kidney Disease population has increased and is ever more frail, elderly and co-morbid. A care-focused approach needs to be incorporated alongside the disease focus, to identify those who are deteriorating and improve communication about preferences and future care. Yet many renal professionals feel unprepared for such discussions. AIM To develop and pilot a REnal specific Advanced Communication Training (REACT) programme to address the needs of End-Stage Kidney Disease patients and renal professionals. DESIGN Two-part study: (1) development of the REnal specific Advanced Communication Training programme informed by multi-professional focus group and patient survey and (2) piloting of the programme. SETTING/PARTICIPANTS The REnal specific Advanced Communication Training programme was piloted with 16 participants (9 renal nurses/health-care assistants and 7 renal consultants) in two UK teaching hospitals. RESULTS The focus group identified the need for better information about end-of-life phase, improved awareness of patient perspectives, skills to manage challenging discussions, 'hands on' practice in a safe environment and follow-up to discuss experiences. The patient survey demonstrated a need to improve communication about concerns, treatment plans and decisions. The developed REnal specific Advanced Communication Training programme was acceptable and feasible and was associated with a non-significant increase in confidence in communicating about end-of-life issues (pre-training: 6.6/10, 95% confidence interval: 5.7-7.4; post-training: 6.9/10, 95% confidence interval: 6.1-7.7, unpaired t-test - p = 0.56), maintained at 3 months. CONCLUSION There is a need to improve end-of-life care for End-Stage Kidney Disease patients, to enable them to make informed decisions about future care. Challenges include prioritising communication training among service providers.
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Affiliation(s)
- Katherine Bristowe
- 1King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
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Connolly M, Thomas JM, Orford JA, Schofield N, Whiteside S, Morris J, Heaven C. The impact of the SAGE & THYME foundation level workshop on factors influencing communication skills in health care professionals. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2014; 34:37-46. [PMID: 24648362 DOI: 10.1002/chp.21214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION The "SAGE & THYME Foundation Level Workshop" delivers evidence-based communication skills training to 30 health care workers in 3 hours. It teaches a structured approach (the SAGE & THYME model) to discuss patient/carer concerns. The aim of this study was to determine whether the workshop had a positive outcome on factors that influence communication skills. METHODS The study had a pragmatic, mixed methods design. Workshops were run in an acute hospital. One hundred seventy health care workers completed questionnaires pre- and post-workshop; 141 were sent follow-up questionnaires at 2 weeks and 2 months; and 9 were filmed talking to a simulated patient pre- and post-workshop. RESULTS From pre- to post-workshop, there was a significant increase in knowledge (p < 0.001), self-efficacy (p < 0.001), and outcome expectancy (p < 0.001). An expert's rating of behavior with the simulated patient also significantly increased after the training (p = 0.011). Motivation to use the training, and the perceived usefulness of the SAGE & THYME model, were high post-workshop. There was a poor response rate in the follow-up period; hence, the quantitative data are not reported. The qualitative data are described, however, as they give an insight into the impact of the training on staff and their patients. DISCUSSION The SAGE & THYME Foundation Level Workshop significantly increases communication skills knowledge, self-efficacy, and outcome expectancy of hospital health care workers who are predominantly white, female, nursing, or nonclinical staff. This suggests that the workshop may have a positive impact on some factors influencing communication skills in this group.
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Jack BA, O'Brien MR, Kirton JA, Marley K, Whelan A, Baldry CR, Groves KE. Enhancing communication with distressed patients, families and colleagues: the value of the Simple Skills Secrets model of communication for the nursing and healthcare workforce. NURSE EDUCATION TODAY 2013; 33:1550-1556. [PMID: 23398914 DOI: 10.1016/j.nedt.2013.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/03/2013] [Accepted: 01/10/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND Good communication skills in healthcare professionals are acknowledged as a core competency. The consequences of poor communication are well-recognised with far reaching costs including; reduced treatment compliance, higher psychological morbidity, incorrect or delayed diagnoses, and increased complaints. The Simple Skills Secrets is a visual, easily memorised, model of communication for healthcare staff to respond to the distress or unanswerable questions of patients, families and colleagues. OBJECTIVES To explore the impact of the Simple Skills Secrets model of communication training on the general healthcare workforce. DESIGN AND METHODS An evaluation methodology encompassing a quantitative pre- and post-course testing of confidence and willingness to have conversations with distressed patients, carers and colleagues and qualitative semi-structured telephone interviews with participants 6-8 weeks post course. PARTICIPANTS During the evaluation, 153 staff undertook the training of which 149 completed the pre- and post-training questionnaire. A purposive sampling approach was adopted for the follow up qualitative interviews and 14 agreed to participate. RESULTS There is a statistically significant improvement in both willingness and confidence for all categories; (overall confidence score, t(148)=-15.607, p=<0.05 overall willingness score, t(148)=-10.878, p=<0.05) with the greatest improvement in confidence in communicating with carers (pre-course mean 6.171 to post course mean 8.171). There is no statistical significant difference between the registered and support staff. Several themes were obtained from the qualitative data, including: a method of communicating differently, a structured approach, thinking differently and additional skills. The value of the model in clinical practice was reported. CONCLUSION This model can be suggested as increasing the confidence of staff, in dealing with a myriad of situations which, if handled appropriately can lead to increased patient and carers' satisfaction. Empowering staff appears to have increased their willingness to undertake these conversations, which could lead to earlier intervention and minimise distress.
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Affiliation(s)
- Barbara A Jack
- Evidence-based Practice Research Centre, Faculty of Health and Social Care Edge Hill University, Ormskirk, Lancs., L39 4QP, UK.
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Eggenberger E, Myllymäki J, Kolb C, Martschin R, Bollheimer LC, Sieber C. [We cannot care alone: volunteers in dementia care at Nürnberg General Hospital]. Z Gerontol Geriatr 2013; 46:226-32. [PMID: 23463157 DOI: 10.1007/s00391-013-0480-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND People with dementia have specific care needs especially in an acute care setting. Professionals in clinical routine have limited capacities in meeting the needs of dementia patients as far as communication, interaction and orientation are concerned. AIMS For 2 years, the Department of Internal Medicine and Geriatrics at Nürnberg General Hospital has hosted volunteers in dementia care who accompany and visit people with dementia during their acute care stay. We present the organization of the volunteer training program, training content, and preliminary evaluation results. METHODS We chose a mixed methods approach for research and evaluation. Baseline data, motivational profile of volunteers, paper and pencil data on attitudes, skills and knowledge before and after training were assessed. RESULTS Preliminary results show a positive effect on attitudes, skills, and knowledge after volunteer training. Volunteers and professionals need continual support and education to enable volunteers to act as an integrative part of the acute geriatric care team. CONCLUSION The admission to an acute care setting is often frightening and confusing for dementia patients. Trained volunteers have the potential to make the hospital stay more pleasant for people with dementia.
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Affiliation(s)
- E Eggenberger
- Medizinische Klinik für Innere Medizin und Geriatrie, Klinikum Nürnberg, Prof.- Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
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Moore PM, Rivera Mercado S, Grez Artigues M, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2013; 2013:CD003751. [PMID: 23543521 PMCID: PMC6457800 DOI: 10.1002/14651858.cd003751.pub3] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Philippa M Moore
- Family Medicine, P. Universidad Catolica de Chile, Lira 44, Santiago, Chile.
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Barnes S, Gardiner C, Gott M, Payne S, Chady B, Small N, Seamark D, Halpin D. Enhancing patient-professional communication about end-of-life issues in life-limiting conditions: a critical review of the literature. J Pain Symptom Manage 2012; 44:866-79. [PMID: 22819438 DOI: 10.1016/j.jpainsymman.2011.11.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/09/2011] [Accepted: 11/13/2011] [Indexed: 01/29/2023]
Abstract
CONTEXT The End of Life Care Strategy for England highlights effective communication between patients and professionals as key to facilitating patient involvement in advance care planning. The strategy emphasizes that, currently, communication in patients with noncancer life-limiting conditions is likely to be inadequate, and research has identified that patients with chronic obstructive pulmonary disease and heart failure have a poor understanding of their condition. OBJECTIVES To identify existing interventions of patient-professional communication developed for life-limiting conditions and explore the applicability of interventions developed within a cancer framework to other diagnostic groups. METHODS A comprehensive literature review of studies describing communication interventions for patients receiving end-of-life care was undertaken. Ten electronic databases were searched. Inclusion criteria were all English language studies relating to patient-professional communication interventions for patients with life-limiting conditions receiving end-of-life care. RESULTS Of the 755 articles initially identified, 16 met the inclusion criteria. Three core themes emerged from the synthesis of the literature: using education to enhance professional communication skills, using communication to improve patient understanding, and using communication skills to facilitate advance care planning. CONCLUSION Although limited, evidence relating to the development and evaluation of communication interventions for patients with life-limiting illnesses would suggest that a successful intervention should include combined components of training, patient discussion, and education. In a context of limited resources and an increasing number of patients living and dying with chronic life-limiting conditions, the need for appropriate and effective communication strategies should be seen as a priority for both research and policy.
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Affiliation(s)
- Sarah Barnes
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
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Körner M, Ehrhardt H, Steger AK. Designing an interprofessional training program for shared decision making. J Interprof Care 2012; 27:146-54. [PMID: 23151149 DOI: 10.3109/13561820.2012.711786] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
For implementation of patient-centered treatment in interprofessional health care units, such as rehabilitation teams, external participation (interaction between patient and health care professionals) and internal participation (communication, coordination and cooperation in the interprofessional team) need to be considered. The aim of this study is to identify the preferences of patients and health care professionals concerning internal and external participation in rehabilitation clinics, in order to develop an interprofessional shared decision-making (SDM) training program for health care professionals to enhance both types of participation. Therefore, a cross-sectional mixed-methods study was implemented in four rehabilitation clinics. The study consists of two parts: focus groups with patients and a survey of experts (senior health care professionals from medicine, psychotherapy, physical therapy and nursing). More time, more respect from the health care professionals and the desire for more participation in decision-making processes were mentioned most frequently by patients (n = 36) in the focus groups. The health care professionals (n = 32) saw most deficits in internal participation, e.g. management of feedback, talking with difficult team members and moderate conflict discussion. The results of both assessments have been used to develop an interprofessional SDM training program for implementing internal and external participation in interprofessional teams in medical rehabilitation.
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Affiliation(s)
- Mirjam Körner
- Department of Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Germany.
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Körner M, Ehrhardt H, Steger AK, Bengel J. Interprofessional SDM train-the-trainer program "Fit for SDM": provider satisfaction and impact on participation. PATIENT EDUCATION AND COUNSELING 2012; 89:122-128. [PMID: 22647558 DOI: 10.1016/j.pec.2012.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 04/03/2012] [Accepted: 04/09/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the interprofessional SDM training program "Fit for SDM" in medical rehabilitation, which was implemented in two steps: (1) university staff trained providers in executive positions as trainers and (2) the providers trained their staff. METHODS For the evaluation of the first step a questionnaire for shared decision-making (SDM) skills and satisfaction with the training was completed by the providers in executive positions. A staff survey was used in a cluster-randomized controlled study to determine the overall impact of the train-the-trainer program on internal and external participation in the team. RESULTS The providers in the six clinics evaluated their SDM competences and satisfaction very positively after training (step 1). External participation was enhanced by application of the training content, with significant changes recorded for females and nurses in particular. However, it had no direct influence on internal participation. CONCLUSIONS This is the first interprofessional SDM train-the-trainer program in Germany to bridge interprofessionalism (internal participation) and SDM (external participation); it was implemented successfully and evaluated positively. PRACTICE IMPLICATIONS Establishing interprofessional SDM training programs should be encouraged for all health care professionals. Implementation in the interprofessional setting should consider interprofessional team factors.
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Affiliation(s)
- Mirjam Körner
- Department of Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany.
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Griffiths J, Speed S, Horne M, Keeley P. 'A caring professional attitude': What service users and carers seek in graduate nurses and the challenge for educators. NURSE EDUCATION TODAY 2012; 32:121-127. [PMID: 21737189 DOI: 10.1016/j.nedt.2011.06.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 03/24/2011] [Accepted: 06/14/2011] [Indexed: 05/31/2023]
Abstract
With the publication of the new NMC standards for pre-registration nursing education, undergraduate curricula are being written in universities across England. There are many drivers for the curricula but one that has until recently received scant attention is the service user's and carer's voice. This paper discusses the findings of a qualitative study that asked 52 service users and carers about the qualities they sought in nurses and their views on nurse education. Eight focus groups were conducted with a broad range of service users and carers from primary and secondary care, and voluntary organisations. Data were analysed using the framework approach facilitated by a qualitative analysis software programme. The sample was diverse, but there were similarities in the qualities they valued in nurses. They sought technical competence, knowledge and willingness to seek information, but overwhelmingly prioritised 'a caring professional attitude'. This was articulated as empathy, communication skills and non-judgmental patient centred care: major themes in the new NMC standards. Our participants also expressed concern about whether the educational preparation of nurses can develop these caring qualities. We discuss this concern, the challenges for nurse educators it presents and how we can engage service users and carers in shaping and delivering our new curricula.
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Affiliation(s)
- Jane Griffiths
- School of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
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Dale MJ, Johnston B. An exploration of the concerns of patients with inoperable lung cancer. Int J Palliat Nurs 2011; 17:285-90. [PMID: 21727886 DOI: 10.12968/ijpn.2011.17.6.285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Appraisal of the literature suggests that patients with lung cancer report more unmet supportive care needs and greater psychological distress than patients with other cancers. This study aimed to explore the concerns of patients with inoperable lung cancer and to interpret those concerns to inform specialist palliative care nursing practice. A descriptive qualitative study was undertaken using semi-structured interviews with six participants on a single site. Three main themes were identified: steadfastly living life, family support and separation, and trust in professionals. The latter is crucial for enabling patients to express their concerns, which in turn allows support to be directed appropriately and from a patient-centred perspective.
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Affiliation(s)
- Moira J Dale
- Community Dumfries and Galloway Royal Infirmary, Bankend Road, Dumfries, Scotland.
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Stevens AM. Book Reviews. Int J Palliat Nurs 2010. [DOI: 10.12968/ijpn.2010.16.7.49065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
I was keen to review this book as I am in the process of undertaking a clinical doctorate, and research is very much at the forefront of my mind. This book offers information exactly as the title suggests in that it addresses the research process in nursing. Being the 6th edition, the book begins by acknowledging what is different from previous editions. The editors comment that the 6th edition incorporates ten new chapters including narrative research, mixed methods and how to apply research into clinical practice.
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