Communication skills of nurses during interactions with simulated cancer patients

Empathic Care Culture in Intensive Care Unit Nurses: A Focused Ethnographic Study

Empathy is one of the important components in the patient-nurse relationship. The aim of the study was to explain the culture of empathic care in intensive care unit (ICU) nurses. The present focused ethnographic study was conducted in the cardiac surgery ICU in Tehran. Three methods of observation, interview, and review of existing documents were used to collect data. From data analysis, three cultural models, "Predominance of task-based care over emotion-based care," "Empathy and lack of empathy, two ends of the spectrum of the nurse-patient relationship," and "Empathy, an interactive and reciprocal process," were extracted. The results showed that empathy creates a caring environment where nurses not only understand their patients but also relate to them, and both are affected by it. Policymakers should consider removing barriers as a means of empowering nurses to provide empathic care.

What is in the toolkit (and what are the tools)? How to approach the study of doctor-patient communication

Doctor-patient communication is important, but is challenging to study, in part because it is multifaceted. Communication can be considered in terms of both the aspects of the communication itself, and its measurable effects. These effects are themselves varied: they can be proximal or distal, and can focus on subjective measures (how patients feel about communication), or objective measures (exploring more concrete health outcomes or behaviours). The wide range of methodologies available has resulted in a heterogeneous literature which can be difficult to compare and analyse. Here, we provide a conceptual approach to studying doctor-patient communication, examining both variables which can controlled and different outcomes which can be measured. We present methodologies which can be used (questionnaires, semistructured interviews, vignette studies, simulated patient studies and observations of real interactions), with particular emphasis on their respective logistical advantages/disadvantages and scientific merits/limitations. To study doctor-patient communication more effectively, two or more different study designs could be used in combination. We have provided a concise and practically relevant review of the methodologies available to study doctor-patient communication to give researchers an objective view of the toolkit available to them: both to understand current research, and to conduct robust and relevant studies in the future.

Relational aspects of regulating clinical work: examining electronic and in-person compliance mechanisms

Background

Clinical documentation quality is an important way to facilitate clinical communication, improve patient safety metrics and optimise hospital coding and public reporting. However, the monitoring of clinicians by external individuals (ie, those outside the profession or emanating from outside clinical teams) raises difficult questions relating to the autonomy of clinicians and an organisation’s control over clinical work. Typically, documentation improvement initiatives have relied solely on electronic monitoring systems to vet clinician documentation. In such systems, quality personnel monitor clinical documentation and, on encountering potentially problematic content, use an electronic querying system to ask the clinicians to voluntarily clarify or modify the text if appropriate. Importantly, clinicians retain their professional autonomy and can choose to disagree with documentation requests. The current study empirically examines a clinical documentation improvement program which takes a different approach. This programme uses two modes of querying clinicians: (1) conventional electronic documentation clarification queries and (2) in-person verbal documentation clarification requests.

Methods

We conducted regression analyses using archival documentation query data (n=19 650) from an American teaching hospital to compare the efficacy of conventional electronic documentation clarification queries and in-person verbal documentation clarification requests. Our dependent variable is the length of time between the documentation clarification request and the resolution of the query (ie, the time until a clinician responds).

Findings

Our analyses demonstrate that in-person verbal documentation clarification requests are associated with a 30-hour reduction in the time it takes for a query to be resolved relative to electronic-only queries.

Practical implications

The results suggest that while electronic regulatory systems might afford hospitals with opportunities to scale quality initiatives in a cost-effective manner, organisational efforts to influence clinical work may yet benefit from the human touch of in-person regulator–clinician interaction. Furthermore, the replacement of in-person compliance interactions with digital compliance requests can potentially produce negative compliance outcomes.

Communication patterns in nurse-led chemotherapy clinics: A mixed-method study

OBJECTIVE

To determine patterns of nurse-patient communication in fulfilling patients' informational/psychosocial needs, effects of longer consultation/operational aspects on person-centred care experiences.

METHODS

Mixed-method design; secondary analysis of transcripts of nurse-patient communication within nurse-led chemotherapy clinics in UK [3]. Purposive sampling (13 nurses); non-participant observations (61 consultations). Qualitative content analysis of audio-recorded transcripts. Quantitative analysis using the Medical Interview Aural Rating Scale [14] to compare mean differences in the number of cues and level of responding using one-way ANOVA, and correlational analyses of discursive spaces.

RESULTS

Nurses responded positively to informational cues, but not psychosocial cues. Longer consultations associated with more informational and psychosocial cues (p <  .0001), but not nurses' cue-responding behaviours. Four main themes emerged: challenges/opportunities for person-centred communication in biomedical contexts; patients' "life world" versus the "medical world"; three-way communication: nurse, patient and family; implications of continuity of care.

CONCLUSIONS

The challenges/opportunities for cue-responding in nurse-led chemotherapy clinics were evident for informational and psychosocial support of patients. Shifting from a biomedical to biopsychosocial focus is difficult.

PRACTICE IMPLICATIONS

Further evaluation is needed to integrate biopsychosocial elements into communication education/training. Careful planning is required to ensure continuity and effective use of time for person-centred care.

The Patient's Narrative Agenda as an assessment tool: the story of Robert, suffering from osteosarcoma

Background and aim of the work.

To activate the participation of the person in his/her care path, the literature highlights the impact of the professional’s ability to show a genuine interest in the problems brought by the patient and to recognize him/her as ‘competent’. In this sense the narrative patient’s agenda could be a useful relational tool, because is focused on the perception of patient experiences of his/her illness. Thus this study aims to analyze the usefulness of patient’s narrative agenda during the assessment phase.

Method.

A semi-structured interview has been adopted to explore the agenda of Robert, 21 years old, suffering from osteosarcoma. A first level analysis identified the four functional areas of the agenda: ideas and beliefs; expectations and desires and context in which he lives and interacts. A second level analysis assessed the main Robert’s problems.

Results.

The narrative agenda has highlighted many central problems of Robert (e.g. therapeutic adherence, quality of life, mood, body image, existential problems related to experiences, hopes and expectations). Of course these results could be integrated with other tools: qualitative, to Understand difficulties and to formulate hypotheses, and quantitative, to measure the level of severity of problems reported.

Discussion and conclusion.

The narrative agenda has not only proved to be a valid instrument of assessment, allowing an adequate insight on the patient’s problems, as we exemplified, but it can be also used for monitoring the dynamic situation of the person’s history, lending itself to the re-exploration of its functional areas over time.

Exploring person-centred fundamental nursing care in hospital wards: A multi-site ethnography

Objective

To explore how nurses in hospitals enact person‐centred fundamental care delivery.

Background

Effective person‐centred care is at the heart of fundamental nursing care, but it is deemed to be challenging in acute health care as there is a strong biomedical focus and most nurses are not trained in person‐centred fundamental care delivery. We therefore need to know if and how nurses currently incorporate a person‐centred approach during fundamental care.

Design

Focused ethnography approach.

Methods

Observations of 30 nurses on three different wards in two Dutch hospitals during their morning shift. Data were collected through passive observations and analysed using framework analysis based on the fundamentals of care framework. The COREQ guideline was used for reporting.

Results

Some nurses successfully integrate physical, psychosocial and relational elements of care in patient interactions. However, most nurses were observed to be mainly focused on physical care and did not take the time at their patients’ bedside to care for their psychosocial and relational needs. Many had a task‐focused way of working and communicating, seldom incorporating patients’ needs and experiences or discussing care planning, and often disturbing each other.

Conclusions

This study demonstrates that although some nurses manage to do so, person‐centred fundamental care delivery remains a challenge in hospitals, as most nurses have a task‐focused approach and therefore do not manage to integrate the physical, relational and physical elements of care. For further improvement, attention needs to be paid to integrated fundamental care and clinical reasoning skills.

Relevance to clinical practice

Although most nurses have a compassionate approach, this study shows that nurses do not incorporate psychosocial care or encourage patient participation when helping patients with their physical fundamental care needs, even though there seems to be sufficient opportunity for them to do so.

Effectiveness of problem-based learning on the professional communication competencies of nursing students and nurses: A systematic review

The objective of this systematic review was to estimate the effectiveness of problem-based learning (PBL) in developing the professional communication competences of nursing students and nurses. We have searched PubMed, EMBASE, MEDLINE, PsycINFO, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Database for Chinese Technical Periodicals to identify all the English and Chinese language studies that used PBL to determine the effectiveness of developing professional communication competences of nursing students and nurses. Then two reviewers independently assessed eligibility and extracted data. Quality assessment using the Cochrane Collaboration's risk of bias tool for randomized controlled trials and Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) for quasi-experimental studies. A total of 12 studies were included, all of which were inclined to low bias. Eleven articles showed that PBL developed the communication skills of nursing students or nurses, while only one article revealed no significant difference between PBL and the traditional method. Owing to differences in experimental design and the method and duration of intervention, some of these studies combined PBL with other methods, and the evaluation tools were different. This systematic review cautiously supports the outcomes of PBL compared with traditional learning.

The Influence of Feedback in the Simulated Patient Case-History Training among Audiology Students at the International Islamic University Malaysia

Background and Objectives

There is a scant evidence on the use of simulations in audiology (especially in Malaysia) for case-history taking, although this technique is widely used for training medical and nursing students. Feedback is one of the important components in simulations training; however, it is unknown if feedback by instructors could influence the simulated patient (SP) training outcome for case-history taking among audiology students. Aim of the present study is to determine whether the SP training with feedback in addition to the standard role-play and seminar training is an effective learning tool for audiology case-history taking.

Subjects and Methods

Twenty-six second-year undergraduate audiology students participated. A cross-over study design was used. All students initially attended two hours of seminar and role-play sessions. They were then divided into three types of training, 1) SP training (Group A), 2) SP with feedback (Group B), and 3) a non-additional training group (Group C). After two training sessions, the students changed their types of training to, 1) Group A and C: SP training with feedback, and 2) Group B: non-additional training. All the groups were assessed at three points: 1) pre-test, 2) intermediate, and 3) post-test. The normalized median score differences between and within the respective groups were analysed using non-parametric tests at 95% confidence intervals.

Results

Groups with additional SP trainings (with and without feedback) showed a significantly higher normalized gain score than no training group (p<0.05).

Conclusions

The SP training (with/ without feedback) is a beneficial learning tool for history taking to students in audiology major.

Simulation-based education to improve communication skills: a systematic review and identification of current best practice

Background

Good communication in healthcare between professionals and between professionals and patients is important in delivering high-quality care. Evidence of translation of technical skills taught through simulation into the clinical environment has been demonstrated, but the evidence for the impact of communication skills is less well known.

Objectives

To identify and critically appraise the evidence for the impact of communication taught through simulation-based education (SBE) and use this evidence to suggest a model for future SBE interventions for communication skills.

Study selection

MEDLINE, CINAHL, EMBASE and PsycINFO were searched for articles pertaining to communication skills taught through simulation. A content expert was consulted to suggest additional studies. 1754 studies were initially screened for eligibility, with 274 abstracts screened further. 147 full-text articles were further assessed for eligibility, with 79 of these excluded. The remaining 68 studies were reviewed and 18 studies were included in the qualitative synthesis as studies designed to show benefits beyond the simulation centre.

Findings

The 18 identified studies with an impact at a Kirkpatrick level of ≥3, are analysed; 4 looking specifically at communication between healthcare professionals and 14 looking at communication between health professionals and patients or relatives.

Conclusions

There is some evidence that the improvements in communication taught through simulation can be translated into benefits measurable beyond the simulation centre, but this evidence is limited due to the way that most of the studies are designed. We suggest a model for SBE aimed at teaching communication skills that is informed by the current evidence and takes into account the need to collect higher-level outcome data.

Receiving Bad News: A Thematic Analysis of Stroke Survivor Experiences

Background

Breaking bad news to patients may be required in service provision to stroke survivors. While challenging, it may be critical to the retention of optimism and participation in rehabilitation.

Objectives

To explore the experience of stroke survivors when receiving bad news (RBN) from medical practitioners.

Methods

Data were obtained via 1:1 interviews conducted at stroke support groups with survivors at least 12 months into recovery and subsequently transcribed for thematic analysis and coded using NVivo.

Results

Eight of 10 participants experienced RBN, and 2 participants did not. The themes of being "lucky to be alive" and waiting for "delayed information" were expressed by all participants early in the interviews. Three sub-themes emerged and were labelled alliance, dissent, and dissatisfaction, each with a further 3 contextual themes. The perception of RBN was marked amongst the dissent and dissatisfaction groups, with the latter reporting negative implications for their rehabilitation as well as negative emotions, such as anger and anxiety. The perception of a poor-quality relationship with medical practitioners was said to impede rehabilitation and recovery processes. The dissent group was characterized by initial disbelief after RBN and consequently poorer long-term outcomes, whilst the Alliance group experienced very good quality of care due to existing personal knowledge and therefore did not perceive RBN during their early medical meetings.

Conclusions

In the period soon after their stroke, survivors required their medical practitioners to not only communicate knowledge and information, but also needed validation of their hopes and fears for the future from an empathically attuned clinician.

The implementation and evaluation of a communication skills training program for oncology nurses

Many nurses express difficulty in communicating with their patients, especially in oncology settings where there are numerous challenges and high-stake decisions during the course of diagnosis and treatment. Providing specific training in communication skills is one way to enhance the communication between nurses and their patients. We developed and implemented a communication skills training program for nurses, consisting of three teaching modules: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging interactions with families. Training included didactic and experiential small group role plays. This paper presents results on program evaluation, self-efficacy, and behavioral demonstration of learned communication skills. Three hundred forty-two inpatient oncology nurses participated in a 1-day communication skills training program and completed course evaluations, self-reports, and pre- and post-standardized patient assessments. Participants rated the training favorably, and they reported significant gains in self-efficacy in their ability to communicate with patients in various contexts. Participants also demonstrated significant improvement in several empathic skills, as well as in clarifying skill. Our work demonstrates that implementation of a nurse communication skills training program at a major cancer center is feasible and acceptable and has a significant impact on participants' self-efficacy and uptake of communication skills.

Factors influencing the development of end-of-life communication skills: A focus group study of nursing and medical students

BACKGROUND

Poor communication between health care professionals and dying patients and their families results in complaints about end-of-life care. End-of-life communication skills should be a core part of nursing and medical education but research suggests that qualified doctors and nurses find this a challenging area of practice.

AIMS

The aim of this study was to explore factors influencing the development of end-of-life communication skills by nursing and medical students.

DESIGN

A qualitative study comprising five focus groups.

PARTICIPANTS

Second year undergraduate nursing (n=9 across 2 focus groups) and fourth year undergraduate medical students (n=10 across 3 focus groups) from a London University.

FINDINGS

Barriers and facilitators influenced nursing and medical students' experience of communication with dying patients and their families in clinical practice. Extrinsic barriers included gatekeeping by qualified staff and lack of opportunity to make sense of experiences through discussion. Intrinsic barriers included not knowing what to say, dealing with emotional responses, wasting patients' time, and concerns about their own ability to cope with distressing experiences. Facilitating factors included good role models, previous experience, and classroom input.

CONCLUSION

In addition to clinical placements, formal opportunities for reflective discussion are necessary to facilitate the development of students' confidence and skills in end-of-life communication. For students and mentors to view end-of-life communication as a legitimate part of their learning it needs to be specified written practice-learning outcome. Mentors and supervisors may require training to enable them to facilitate students to develop end-of-life communication skills.

The impact of the SAGE & THYME foundation level workshop on factors influencing communication skills in health care professionals

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.

Delivery of telephone-based supportive care to people with cancer: An analysis of cancer helpline operator and cancer nurse communication

OBJECTIVES

Telephone-based supportive care presents a potentially highly accessible means of addressing unmet supportive care needs for people with cancer. Identification of behaviours that facilitate communication is essential for development of training for telephone-based supportive care. The aim of this study was to describe communication behaviours within supportive care telephone calls in two contexts (1) a telephone outreach intervention and (2) cancer helpline calls, to identify potential areas for further training.

METHODS

50 recorded calls were analysed using two standardised coding systems: the RIAS and Verona-CoDES-C.

RESULTS

Mean call length was 21 min (304 utterances) for nurse-outreach calls and 23 min (355 utterances) for helpline calls. Closed questioning, verbal attentiveness and giving information/counselling were the most common communication behaviours identified. Emotional cues were most commonly responded to through non-explicit back-channelling, exploration of content or provision of reassurance or advice.

CONCLUSIONS

This study confirmed the need to address the manner in which questions are framed to maximise patient disclosure. Responding to patent emotional cues was highlighted as an area for future training focus.

PRACTICE IMPLICATIONS

Communication skills training that addresses each of these tasks is likely to improve the effectiveness of telephone-based delivery of supportive care.

What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients

AIM

To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients.

BACKGROUND

The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. To support the development of effective nursing communication in clinical practice, a good understanding of what constitutes effective communication is helpful.

DESIGN

An exploratory design was used involving individual interviews, focus groups and written notes from participants and field notes from researchers to investigate perspectives on nurse-patient communication.

METHODS

Focus groups and individual interviews were held between August 2010-September 2011 with a purposive sample of 15 nurse educators and clinicians who observed videos of interactions between nurses and simulated patients. These participants were asked to give oral feedback on the quality and content of these interactions. Verbatim transcriptions were undertaken of all data collected. All written notes and field notes were also transcribed. Thematic analysis of the data was undertaken.

FINDINGS

Four major themes related to nurse-patient communication were derived from the educators' and clinicians' feedback: approach to patients and patient care, manner towards patients, techniques used for interacting with patients and generic aspects of communication.

CONCLUSION

This study has added to previous research by contributing grounded evidence from a group of nurse educators and clinicians on the aspects of communication that are relevant for effective nurse-patient interactions in clinical practice.

Transformation of admission interview to documentation for nursing practice

The admission interview is usually the first structured meeting between patient and nurse. The interview serves as the basis for personalised nursing and care planning and is the starting point for the clinic's documentation of the patient and his course of treatment. In this way, admission interviews constitute a basis for reporting by each nurse on the patient to nursing colleagues. This study examined how, by means of the admission interview, nurses constructed written documentation of the patient and his course of treatment for use by fellow nurses. A qualitative case study inspired by Ricoeur was conducted and consisted of five taped admission interviews, along with the written patient documentation subsequently worked out by the nurse. The findings were presented in four constructed themes: Admission interviews are the nurse's room rather than the patient's; Information on a surgical object; The insignificant but necessary contact; and Abnormalities must be medicated. It is shown how the nurse's documentation was based on the admission interview, the medical record details on the patient (facts that are essential to know in relation to disease and treatment), as well as the nurse's preconception of how to live a good life, with or without disease. Often, the patient tended to become an object in the nurse's report. It is concluded that in practice, the applied documentation system, VIPS, comes to act as the framework for what is important to the nurse to document rather than a tool that enables her to document what is important to the individual patient and his special circumstances and encounter with the health system.

Emotional congruence in learning and health encounters in medicine: addressing an aspect of the hidden curriculum

This paper aims to draw attention to and provide insights into an area that is of educational significance for clinical teachers, namely the need to acknowledge and respond appropriately to the emotional context of both learning and health encounters in order to improve the outcomes of both. This need has been highlighted by recent calls for more attention to be paid to the role of emotion within medical education and within health care provision. What is already known about the role of emotion in learner-teacher encounters and in patient-doctor encounters will be used to develop the concept of emotional congruence within these two types of encounter as a challenge to clinical teachers to examine their own practice. The reasons why emotional congruence is not always apparent in the learning environment of the teaching hospital will be discussed using the model of the 'hidden curriculum'. It will be suggested that explicit strategies to counteract the hidden curriculum in relation to emotion can bring about transformative change in individual practice and the health care environment that has the potential to improve both learning and health outcomes.

Dr. Tulp attends the soft machine: patient simulators, user involvement and intellectual disability

Simulation as a way to teach clinical skills attracts much critical attention. Its benefits, however, might be significantly reduced when the simulation model used relies exclusively on patient simulators. This is particularly true if the intended patient population for students taught is characterized by intellectual disability. Learning to care for people with intellectual disability might be better supplemented when the simulation model used incorporates input from 'real' people. If these people themselves have intellectual disabilities then the verisimilitude of the simulation will be higher and the outcomes for learners and potential patients will also be improved.

Cancer patients' evaluation of communication: a report from the population-based study 'The Cancer Patient's World'

PURPOSE

The aims of this study were to assess how communication with health care staff is perceived by Danish cancer patients and to characterise those patients who report problems in communication.

METHODS

In a cross-sectional survey, a nationally representative sample of 2,202 cancer patients who had been in contact with a hospital department during the past year was invited to respond to a questionnaire. Communication with doctors and nurses was assessed separately as were their abilities as listeners, doctors' use of an understandable language, timing of the information, duration of consultations, and whether doctors criticised other doctors.

RESULTS

A total of 1,490 cancer patients responded to the questionnaire. Of these, 24 % reported one or more problems with the areas of communication measured. The problem most frequently reported (by 12 %) was not having sufficient time for consultations. More patients reported problems with doctors' communication and abilities as listeners than with nurses' skills in these areas. There was a general pattern that younger patients and those sampled in Copenhagen reported the highest degree of dissatisfaction with the communication. Those exposed to a high number of different treatment modalities were at especially high risk of experiencing problems.

CONCLUSIONS

A high proportion of patients reported one or more problems in the communication. However, the number reporting each of the specific problems was remarkably low. Special focus should be given to patients exposed to several treatment modalities and their communicative needs.

Existential issues among nurses in surgical care--a hermeneutical study of critical incidents

AIMS

To report a qualitative study conducted to gain a deeper understanding of surgical nurses' experiences of existential care situations. Background.  Existential issues are common for all humans irrespective of culture or religion and constitute man's ultimate concerns of life. Nurses often lack the strategies to deal with patients' existential issues even if they are aware of them.

DESIGN

This is a qualitative study where critical incidents were collected and analysed hermeneutically.

METHODS

During June 2010, ten surgical nurses presented 41 critical incidents, which were collected for the study. The nurses were first asked to describe existential care incidents in writing, including their own emotions, thoughts, and reactions. After 1-2 weeks, individual interviews were conducted with the same nurses, in which they reflected on their written incidents. A hermeneutic analysis was used.

FINDINGS

The majority of incidents concerned nurses' experiences of caring for patients' dying of cancer. In the analysis, three themes were identified, emphasizing the impact of integration between nurses' personal self and professional role in existential care situations: inner dialogues for meaningful caring, searching for the right path in caring, and barriers in accompanying patients beyond medical care.

CONCLUSION

Findings are interpreted and discussed in the framework of Buber's philosophy of the relationships I-Thou and I-It, emphasizing nurses' different relationships with patients during the process of caring. Some nurses integrate their personal self into caring whereas others do not. The most important finding and new knowledge are that some nurses felt insecure and were caught somewhere in between I-Thou and I-It.

A systematic review of the associations between empathy measures and patient outcomes in cancer care

OBJECTIVE

Despite a call for empathy in medical settings, little is known about the effects of the empathy of health care professionals on patient outcomes. This review investigates the links between physicians' or nurses' empathy and patient outcomes in oncology.

METHOD

With the use of multiple databases, a systematic search was performed using a combination of terms and subject headings of empathy or perspective taking or clinician-patient communication, oncology or end-of-life setting and physicians or nurses. Among the 394 hits returned, 39 studies met the inclusion criteria of a quantitative measure of empathy or empathy-related constructs linked to patient outcomes.

RESULTS

Empathy was mainly evaluated using patient self-reports and verbal interaction coding. Investigated outcomes were mainly proximal patient satisfaction and psychological adjustment. Clinicians' empathy was related to higher patient satisfaction and lower distress in retrospective studies and when the measure was patient-reported. Coding systems yielded divergent conclusions. Empathy was not related to patient empowerment (e.g. medical knowledge, coping).

CONCLUSION

Overall, clinicians' empathy has beneficial effects according to patient perceptions. However, in order to disentangle components of the benefits of empathy and provide professionals with concrete advice, future research should apply different empathy assessment approaches simultaneously, including a perspective-taking task on patients' expectations and needs at precise moments. Indeed, clinicians' understanding of patients' perspectives is the core component of medical empathy, but it is often assessed only from the patient's point of view. Clinicians' evaluations of patients' perspectives should be studied and compared with patients' reports so that problematic gaps between the two perspectives can be addressed.

Nonverbal Communication Behaviors of Internationally Educated Nurses and Patient Care

Background: Because of language barriers and cultural differences, internationally educated nurses (IENs) face documented communication challenges in health care delivery. Yet, it is unknown how and to what extent nonverbal behaviors affect patient care because of research gap in the existing nursing literature. Methods: This is an exploratory study evaluating nonverbal communication behaviors of IENs interacting with standardized patients (SPs) in a controlled clinical setting through videotape analysis. Participants included 52 IENs from two community hospitals in the same hospital system in a southwestern metropolitan area in the United States. Twelve nonverbal behaviors were rated using a 4-point Likert scale with 4 indicating the best performance by the research team after watching videos of SP–IEN interactions. The global communication performance was also ranked in four areas: genuineness, spontaneity, appropriateness, and effectiveness. The relationships between these four areas and the nonverbal behaviors were explored. Finally, a qualitative analysis of two extreme cases was conducted and supplemented the quantitative findings. Results: The IENs received average scores under 2 in 5 out of the 12 nonverbal behaviors. They were “hugging” (1.06), “lowering body position to patient’s level” (1.07), “leaning forward” (1.26), “shaking hands” (1.64), and “therapeutic touch” (1.66). The top three scores were for “no distractive movement,” “eye contact,” and “smile” (3.80, 3.73, and 3.57, respectively). The average overall global impression score was 2.98. The average score for spontaneity was 2.80, which was significantly lower than the scores for genuineness (3.15), appropriateness (3.11), but comparable to the average score for effectiveness (2.85). Finally, therapeutic touch, interpersonal space, eye contact, smiling, and hugging were all significantly correlated with one or more of the global impression scores, with therapeutic touch showing moderate correlations with all of the scores as well as the overall global impression score. Implications: The IENs’ nonverbal behaviors in areas such as hugging, lowering body position to patient’s level, leaning forward, shaking hands, and therapeutic touch have room for improvement. Targeted interventions focusing on norms and expectations of nonverbal behaviors in the U.S. health care setting are called for to improve quality of care.

Evaluating pharmacists' ability to counsel on tobacco cessation using two standardized patient scenarios

OBJECTIVES

To evaluate the impact that role-playing two pre/post standardized patient scenarios within a tobacco cessation training program had on pharmacists' counseling skills. Second, to analyze the validity of the observation coding tool used to evaluate pharmacist's role-play performance.

METHODS

Pharmacists performed two role-playing scenarios which incorporated national guidelines, the 5A's counseling process, and the "preparation" and "action" phases of the transtheoretical model. Pharmacists' performance was evaluated with an observation coding tool.

RESULTS

Pharmacists' (n=25) counseling performance improved significantly post-training (p<0.02: Action Scenario; p<0.004: Preparation Scenario). More than 50% of pharmacists provided patient-directed tobacco consultation services in the one year following training. The observation tool score for the "action phase" scenario was highly associated with pharmacists' subsequent delivery of tobacco cessation services in community practice.

CONCLUSION

Role-playing facilitated pharmacists' skill development. The evaluation tool and Action Scenario may be powerful for predicting pharmacists' delivery of tobacco cessation services.

PRACTICE IMPLICATIONS

Incorporating role-playing and structured tools for performance evaluation can help enhance pharmacist performance during training and predict service delivery in community practice. Together they could facilitate tailored feedback to help pharmacists struggling with the difficult task of extending cognitive service roles in practice.

[Nurse-patient interaction patterns and patient satisfaction in the emergency department]

PURPOSE

The purpose of this study was to identify effective nurse interaction patterns with patients in the emergency department.

METHODS

For this study, video technology was used to record complete conversations between the nurse and patient. The participants were 28 nurses and 63 patients in the emergency department at one university hospital located in Seoul. The data were collected from November, 2002 to April, 2003. The video recordings were observed for 4 hr for each case and coded using an adapted version of Roter's Interaction Analysis System (RIAS). The data were analyzed using cluster analysis to identify the patterns of nurse-patient interaction.

RESULTS

Cluster analysis revealed 4 distinct nurse interaction patterns; 1) "closed" characterized by orientation and negative talk, 2) "positive" characterized by positive affective talk, 3) "informative and directing" characterized by task-focused behavior including data gathering, and giving information about medical condition and treatment, 4) "facilitative" characterized by balance of psychosocial and biomedical topics. Patient satisfaction was highest in the facilitative interaction pattern.

CONCLUSION

The patient centered interaction pattern, balancing information exchange and psychosocial exchange are the most effective interactions in the emergency department, suggesting that effective interaction skill is a core clinical nursing intervention in acute care.

The impact of high fidelity human simulation on self-efficacy of communication skills

Communication is a critical component of nursing education as well as a necessity in maintaining patient safety. Psychiatric nursing is a specialty that emphasizes utilization of communication skills to develop therapeutic relationships. Nursing students are frequently concerned and anxious about entering the mental health setting for their first clinical placement. High fidelity human simulation (HFHS) is one method that can be used to allow students to practice and become proficient with communication skills. The purpose of this study was to compare the effectiveness of two educational delivery methods, traditional lecture and HFHS, on senior level nursing student's self-efficacy with respect to communicating with patients experiencing mental illness. The results of this study support the use of HFHS to assist in enhancing undergraduate students' self-efficacy in communicating with patients who are experiencing mental illness.

Effective communication and information provision in radiotherapy—the role of radiation therapists

Introduction: Health professionals have a duty of care to radiotherapy patients in providing them with adequate information before treatment. There is a lack of research that describes the roles of radiation therapists and radiation oncology nurses in providing information to patients. This study aimed to: (1) explore how radiation therapists communicate with breast cancer patients during a radiotherapy planning appointment; (2) determine what information is provided during this appointment and (3) explore radiation therapists’ perspectives on their role in providing patient information and support.

Methods: The following methodologies were used: self-report questionnaires; simulated radiotherapy planning sessions and joint interpretive forums. Statistical analysis was used to analyse the questionnaires and the simulated planning sessions and forums were analysed qualitatively.

Results: A total of 110 radiation therapists participated in the survey. We simulated two radiotherapy planning appointments and held two forums. Four themes emerged: role definitions, reducing patient anxiety and distress, barriers and strategies for effective communication and confidence in patient communication.

Conclusion: Radiation therapists play an important role in communicating with patients and providing information, particularly if patients exhibit anxiety and distress. Further research is required to determine whether patients’ information needs can be met with additional information provided by radiation therapists.

A systematic review on the factors affecting effective communication between registered nurses and oncology adult patients in an inpatient setting

BACKGROUND

Effective nurse-patient communication is essential in the development of therapeutic relationships and meeting the cognitive and affective needs of oncology patients. However, the emotional load in cancer nursing has made communication additionally challenging.

OBJECTIVE

This review aimed to establish the best available evidence regarding the factors affecting effective communication between registered nurses and adult oncology patients in inpatient setting.

INCLUSION CRITERIA

Types of participants This review considered studies that included registered nurses and inpatient oncology adults who were more than 21 years of age. This review considered studies carried out in inpatient settings, regardless of ward specialty, whilst active or palliative cancer treatments were administered.Phenomena of interest This review considered the factors affecting effective communication between registered nurses and inpatient oncology adults.Types of studies This review considered both quantitative (randomized controlled trials, non-randomized controlled trials, before and after studies, cohort observational, descriptive survey and mixed method studies) and qualitative (including, but not limited to, phenomenology, grounded theory and ethnography) research studies on the factors affecting effective communication between registered nurses and inpatient oncology adults.Search strategy The search strategy aimed to find studies published in English language and not limited by year of publication. A three-step search strategy was utilized in each component of this review. The grey literature was not included in this review.

DATA EXTRACTION

Quantitative data were extracted using standardized data extraction tools adapted from the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Qualitative data were extracted using the standardized data extraction tool from the Joanna Briggs Institute-Qualitative Assessment and Review Instrument (JBI-QARI).

DATA ANALYSIS

Quantitative data were presented in a narrative summary. Qualitative findings were categorised using JBI-QARI tool to generate synthesised findings.

RESULTS

One quantitative, two mixed method and four qualitative studies were included in this review. Combined findings of the narrative summary and meta-synthesis identified promoting and inhibiting factors in the characteristics of nurses, patients, and the environment. Promoting factors in nurses included genuineness, competency and supportive facilitation skills. However, the role of post-basic training in improving communication remained inconsistent. In patients, active participation in their own care and information-seeking behaviour promoted nurse-patient communication. Conversely, inhibiting factors in nurses included task orientation, fear of own death and low self-awareness of own verbal behaviours. Nurses also communicated less effectively during psychological assessments and emotionally-charged situations. For patients, their unwillingness to discuss the disease/feelings, their preference to seek emotional support from family and friends and the use of implicit cues inhibited effective communication. Environmentally, a supportive ward environment increased the use of facilitative behaviour in nurses, whereas the existence of conflict among staff increased the use of blocking behaviours. Cultural norms in the Chinese society also inhibited nurse-patient communication.

CONCLUSION

Within the constraints of the study and the few quality papers available, it appears that personal characteristics of patients and nurses are the key influencing factors of effective nurse-patient communication in the oncology setting. Very little evidence exists on the role of environment in effective nurse-patient communication, particularly within an Asian setting.

IMPLICATIONS FOR PRACTICE

Using evidence from the quantitative component of the review, nurses need to focus on the mental health status of patients admitted with a recurrence of cancer. Education programs can be implemented to inform nurses about the challenges in communication and develop strategies to counter these obstacles. Using evidence from the qualitative component of the review, nurses should build rapport and encourage active patient participation in their care in order to enhance patient disclosure. Nurses should also be mindful of patients' psychological readiness to communicate and respect their preference as to whom they wish to share their thoughts/emotions with. Institutions need to design ward structures (ward culture and nurses' workload) that support and/or encourage nurses to be person-oriented and take responsibility for providing holistic care to patients. Both the quantitative and qualitative components of the review indicated the need to improve nurses' communication skills and their receptivity to patient cues.

IMPLICATIONS FOR RESEARCH

An explorative descriptive study on the effect of the Asian culture on the effective communication in the oncology setting is required to add to the small amount of knowledge in this area. Descriptive or mixed method studies to ascertain the effect of the patient's age and place within the oncology treatment cycle are also warranted. The lack of evidence on the effectiveness of post-basic communication courses would be best gathered by a descriptive study, followed by a before-and-after randomised controlled trial to test different education programs.

Communication and human patient simulation in psychiatric nursing

Communication is an integral component of nursing education and has been shown to improve health outcomes, patient compliance, and patient satisfaction. Psychiatric nursing emphasizes knowledge and utilization of communication skills. Nursing students often express anxiety and lack of confidence regarding communicating with patients diagnosed with psychiatric illnesses. Human patient simulation is one method that may be used for students to practice and become proficient with communication skills in a simulated environment. The authors of this article provide an overview of communication and psychiatric nursing as well as review of the current research related to the use of human patient simulation in nursing education.

Nurse responsiveness to cancer patient expressions of emotion

OBJECTIVE

This theoretically based study examined nurse responses to cancer patient expressions of emotion using a videotaped, simulated cancer patient.

METHODS

This study used an experimental crossover design with a videotaped patient expressing anger, sadness, and neutral emotion to elicit nurse responses. Seventy-four nurses from eight sites participated. Responses were coded using Roter interaction analysis system. Correlations explored relationships between variables that impact communication (age, gender, work experience, trait anxiety, work stress, self-efficacy). Regression models explored the effect of variables on nurse affective responsiveness.

RESULTS

Patient expressions of sadness elicited more affective responses than anger. Expressions of anger or neutral emotion elicited more instrumental behaviors than sadness. Variables such as age, work stress and work experience were significantly correlated. No variables predicted affective responsiveness to patient expressions of anger or sadness.

CONCLUSION

Nurse communication showed significant variation in response to patient emotional expressions. Understanding the relationships between demographic, personality, and work variables, and identification of new variables that influence nurse-patient communication, has implications for interventional studies.

PRACTICE IMPLICATIONS

Over 90% of the participants indicated that the videotape simulation would be a useful method for teaching and practicing communication skills with patients expressing emotions.

The concept of confidence - the nurse's perception

The purpose of this paper is to investigate a nurse's understanding of the concept of confidence and what a nurse thinks affects the experience of confidence in the patient relationship. The project has a hermeneutic design using a research interview method. Nine nurses were interviewed. A hermeneutic approach was used in the analysis of the data. Interpretation of the data was linked to Segesten's model for confidence. Analysis of the data generated two major themes in relationship to the comprehension a nurse has of confidence. One theme was 'to feel comfortable, be relaxed'; the other was: 'feeling secure'. The result shows that nurses' definition of confidence is dependent on two security-creating factors: the significance of a professional network of co-workers and the importance of confirmation of professional role and competence.

Teaching nurses how to teach: an evaluation of a workshop on patient education

OBJECTIVE

To evaluate the effects of a patient education workshop on nurses: (1) communication skills; (2) Knowledge of patient-centered model, patient education process, and sense of preparedness to provide patient education.

METHODS

Fourteen nurses attended a 2-day workshop on patient education based on a patient-centered model. Data on communication skills were collected by means of pre-/post-written dialogues and analyzed with the Roter Interaction Analysis System (RIAS). Data of nurses' knowledge and sense of preparedness were collected through a post questionnaire comprised of 5-point Likert scale items.

RESULTS

Post-dialogues showed an increase in patient talking (P<0.001) and in patient-centered communication as indicated by the increase in Psychosocial exchanges (P=0.003) and Process exchanges (P=0.001). Nurses reported that the workshop increased "very much" their knowledge of the patient-centered model (mean=4.19) and patient education process (mean=4.69), and their sense of preparedness to provide patient education (P=0.001).

CONCLUSIONS

Data suggest the efficacy of the workshop in developing patient-centered communication skills and improving nurses' knowledge and preparedness to deliver patient education.

PRACTICE IMPLICATIONS

Training based on a patient-centered model and interactive learning methods should be implemented for nurses to improve their ability to deliver effective patient education.

Communication skills of health-care professionals working in oncology--can they be improved?

Communication skills' training has been placed high on the agenda by the National Institute of Clinical Excellence guidelines and the National Health Service in the UK. The paper reviews the importance of good communication skills in cancer care for the patient and describes research that has identified ways in which health-care professionals (HCP) can improve their communication with patients. The evidence as to why there is a lack of facilitative skills is reviewed along with what skills are required in order to improve communication with patients. The paper describes evidence of increased facilitative skills post-training, discusses whether there is evidence of transfer of these skills into clinical practice and how this might be best achieved. To conclude, research evidence would support the fact that training in communication skills needs to provide the best possible outcomes for HCP and their patients. Patient concerns, needs and preferences need to be elicited and the impact of concerns identified, so that the HCP can appropriately tailor their information giving, advice, treatment and plan of care.

Nurse and patient communication profiles in a home-based telehealth intervention for heart failure management

OBJECTIVE

This study compared differences in nurse and patient communication profiles between two telehealth modes: telephone and videophone, and evaluated longitudinal changes in communication, nurse perceptions, and patient satisfaction.

METHODS

Subjects were enrolled in a randomized controlled clinical trial evaluating a 90-day home-based intervention for heart failure. Telephone (n=14) and videophone (n=14) interactions were audio taped and analyzed using the Roter Interaction Analysis System.

RESULTS

Nurses were more likely to use open-ended questions, back-channel responses, friendly jokes, and checks for understanding on the telephone compared to videophone. Compliments given and partnership were more common on the videophone. Patients were more likely to give lifestyle information and approval comments on the telephone, and used more closed-ended questions on the videophone. Nurses perceptions of the interactions were not different between the telephone and videophone, nor did their perceptions change significantly over the course of the intervention. There were no significant differences in patient satisfaction between the telephone and videophone.

CONCLUSIONS

The results of this study did not support use of a videophone over the telephone.

PRACTICE IMPLICATIONS

It is critical to match technologies to patient needs and use the least complex technology possible. When considering use a videophone, health care providers should critically examine the trade-offs between additional complexities with the added value of the visual interaction.

Emotional toil: psychosocial care in rural settings for patients with cancer

AIM

This paper is a report of a study to identify experienced rural nurses' perceptions of key issues related to the provision of effective psychosocial care for people with cancer in rural settings.

BACKGROUND

A cancer diagnosis has a major impact on psychological and emotional wellbeing, and psychosocial support provided by nurses is an integral part of ensuring that people with cancer have positive outcomes. Although, ideally, people with cancer should be managed in specialist settings, significant numbers are cared for in rural areas.

METHODS

Using a qualitative descriptive approach, three focus groups were conducted in 2005 with 19 nurses in three hospitals in rural Victoria, Australia.

FINDINGS

Participants indicated that a key issue in providing psychosocial care to patients with cancer in the rural setting was their own 'emotional toil'. This Global Theme encapsulated three Organizing Themes- task vs. care, dual relationships and supportive networks--reflective of the unique nature of the rural environment. Nurses in rural Australia are multi-skilled generalists and they provide care to patients with cancer without necessarily having specialist knowledge or skill. The fatigue and emotional exhaustion that the nurses described often has a major impact on their own well-being.

CONCLUSION

In the rural context, it is proposed that clinical supervision may be an important strategy to support clinicians who face emotional exhaustion as part of their cancer nursing role.