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Schöps AM, Skinner TC, Fosgerau CF. Tele-health coaches' responses to clients' emotional cues and concerns and engagement with the Bump to Baby and Me Intervention. PATIENT EDUCATION AND COUNSELING 2024; 127:108370. [PMID: 38996574 DOI: 10.1016/j.pec.2024.108370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 06/14/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE To explore the relationship between health coaches' responses to emotional cues/concerns and women's subsequent engagement with the health coaching mHealth platform. METHODS 24 face-to-face video-mediated initial conversations between participants and their health coaches were coded using the VR-CoDES-P method. Women with high risk of developing Gestational Diabetes Mellitus were selected from the study, based on their engagement with the smartphone health coaching platform. 12 women with very low engagement and 12 women with high engagement were identified. RESULTS In interactions with women with high goal engagement, coaches had significantly more counseling codes with prior other codes and no instances of non-explicit response codes that reduce space for further disclosure. Analysis showed that interactions with women with high goal engagement were more frequently met by the coach with affect-acknowledging and empathic responses prior to the counseling speech act. CONCLUSION High goal engagement among women with Gestational Diabetes Mellitus may appear to be associated with coaches facilitating the frequent use of empathy. PRACTICE IMPLICATIONS Findings can draw coaches' attention to the impact that their counseling has on goal engagement, increasing the opportunity for intervention to be person-centered and effective.
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Affiliation(s)
- Antje Maria Schöps
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark.
| | - Timothy Charles Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark; Department of Psychology, La Trobe University, Bendigo, Australia; Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
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Jeon Y, Choi H, Lee U, Kim H. Technology-based interactive communication simulation addressing challenging communication situations for nursing students. J Prof Nurs 2024; 53:71-79. [PMID: 38997201 DOI: 10.1016/j.profnurs.2024.05.002] [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] [Received: 10/21/2023] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Simulation-based interventions for nursing students addressing challenging communication situations involving geriatric patients and end-of-life care are limited. PURPOSE This study evaluated the effects of technology-based interactive communication simulations on nursing students' communication knowledge, self-efficacy, skills, compassion, and program satisfaction. METHOD A randomized controlled repeated-measures design was used with third- and fourth-year nursing students enrolled in five nursing colleges located in five regions in Korea as participants. Participants were randomly assigned to either a technology-based interactive communication simulation or an attention control group. Changes in communication knowledge, self-efficacy, skills, compassion, and program satisfaction were assessed using three self-reported measures and communication skills were measured by the raters. Statistical analyses included descriptive analyses, chi-square tests, t-tests, and a generalized estimating equation model. RESULTS Eighty students participated in one of the two programs, and 77 in the four-week follow-up test. The intervention group indicated significant improvements in communication knowledge, self-efficacy, skills, and compassion, as well as higher program satisfaction compared with the attention control group. Communication skills as assessed by raters also showed significant change at all assessment time points. CONCLUSION The technology-based interactive communication simulation program is effective in improving communication skills among nursing students managing geriatric patients and end-of-life care.
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Affiliation(s)
- Yeseul Jeon
- College of Nursing, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Heeseung Choi
- College of Nursing, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea; Research Institute of Nursing Science, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Ujin Lee
- College of Nursing, Incheon Catholic University, Yeonsu-gu, Incheon 21987, Republic of Korea.
| | - Hannah Kim
- College of Nursing, Seoul National University, Jongno-gu, Seoul 03080, Republic of Korea.
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Solvang PK, Fougner M. Learning from clinical placement experience: how do undergraduate physiotherapy students approach person-centered practice? Physiother Theory Pract 2023; 39:2609-2624. [PMID: 35708964 DOI: 10.1080/09593985.2022.2089609] [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] [Received: 10/15/2021] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION It is now widely accepted in physiotherapy and in other health professions, that involving patients in the design, planning and implementation of services is best practice. Little is, however, known about how physiotherapy students perceive their professional development in applying person-centered practice. OBJECTIVE To analyze how undergraduate physiotherapy students experience the process of learning to work in a person-centered way in clinical practice. METHOD Five focus-group interviews of final-year physiotherapy students. RESULTS It is important that students communicate in ways that accommodate the sociocultural characteristics of their patients. Students, where they experience that mutual understanding is not possible to achieve, tend to resort to the biomedical model and take on an expert instructor role that is met with acceptance from the patients. Some practice contexts were also found to strongly promote person-centered practice, others tightly restricting it. CONCLUSION In the educational setting, attention should be paid to the practice learning context, to the improvement of the ability of students to grasp the lived world of patients, and to activate their own identities and experiences as a relational tool in practicing person-centered care.
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Affiliation(s)
- Per Koren Solvang
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Marit Fougner
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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Höglander J, Holmström IK, Gustafsson T, Lindberg E, Söderholm HM, Hedén L, von Heideken Wågert P, Sundler AJ. Implementing A person-centred CommunicaTION (ACTION) educational intervention for in-home nursing assistants - a study protocol. BMC Geriatr 2023; 23:112. [PMID: 36841761 PMCID: PMC9960173 DOI: 10.1186/s12877-023-03831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND In this study, the focus is on how to support the competence development needed for nursing assistants in home care. Home care services for older persons can be challenging concerning the nature of the interpersonal interaction and communication needed to care for and respond to the diverse needs of older people who seek to live well in our communities. This implies a need to offer more person-centred care (PCC) to older persons. However, there is a lack of knowledge on how to develop such competence. We, therefore, developed A Person-centred CommunicaTION (ACTION) programme, which is a web-based educational intervention aimed at supporting competence development for nursing assistants. The research objective is to evaluate the ACTION programme with respect to participants' responses to and the effect of the intervention. METHODS A multicentre case-control study with pre- and post-assessments was designed. The ACTION programme will be implemented at home care units, in two different geographic areas in Sweden. A total of 300 nursing assistants will be recruited: 150 for the intervention group and 150 for the control group. We will evaluate the impact measures and the process. Pre- and post-assessments will be performed with data collected via a) audio recordings of communication, b) a questionnaire on self-efficacy communication skills, PCC, empathy and job satisfaction, c) user data, evaluation forms, field notes and observations, and d) interviews. The data will be analysed with descriptive and analytic statistics and/or qualitative methods for meanings. DISCUSSION This study has the potential to contribute to the evidence supporting competence development required to offer person-centred and quality home care to older persons and to meet upcoming needs for flexible and easily accessible competence development. TRIAL REGISTRATION ISRCTN64890826. Registered 10 January 2022, https://www.isrctn.com/ISRCTN64890826.
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Affiliation(s)
- Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
| | - Inger K. Holmström
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden ,grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Gustafsson
- grid.412442.50000 0000 9477 7523Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Elisabeth Lindberg
- grid.412442.50000 0000 9477 7523Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Hanna Maurin Söderholm
- grid.412442.50000 0000 9477 7523Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Lena Hedén
- grid.412442.50000 0000 9477 7523Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Petra von Heideken Wågert
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Annelie J. Sundler
- grid.412442.50000 0000 9477 7523Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Wanko Keutchafo EL, Kerr J, Baloyi OB. A Model for Effective Nonverbal Communication between Nurses and Older Patients: A Grounded Theory Inquiry. Healthcare (Basel) 2022; 10:2119. [PMID: 36360461 PMCID: PMC9690069 DOI: 10.3390/healthcare10112119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 08/24/2023] Open
Abstract
Nonverbal communication is an inevitable art to be effectively mastered by nurses. Nurse nonverbal communication has many benefits when it is effective. For instance, nonverbal communication is important to convey affective and emotional information, and demonstrate respect for and build therapeutic relationships with older patients. As the older population is growing fast worldwide, effective nonverbal communication with older patients is an essential skill for nurses and will improve patients' satisfaction and the quality of care. Therefore, this article presents a model to guide effective nonverbal communication between nurses and older patients. A Grounded Theory approach guided the study. Data were collected between July 2018 and January 2020 through overt participant observations and individual interviews. Purposive and theoretical sampling were used to select 13 clinically experienced nurses, 4 nursing students, and 8 older adults. Data analysis encompassed open coding, axial coding, and selective coding. The results showed that effective nonverbal communication emerged as the co-phenomenon hinged within context and/or environment and is influenced by certain factors. This model, which is in support of person-centered communication and care, advocates for effective nonverbal communication between nurses and older patients.
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Affiliation(s)
- Esther L. Wanko Keutchafo
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
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Empathy and Attitude upon An Aged Body: Aged Simulation Suit Among Undergraduate Physiotherapy Students. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1106052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background and Purpose: When empathy and attitude levels of health professionals are high, patient compliance and satisfaction are increased. The purpose of this study was to assess the empathy and attitude levels of undergraduate physiotherapy students towards older people before and after wearing the aged simulation suit by performing pre-defined related scenarios.
Methods: The aged simulation suit was put on 63 students to complete the pre-defined scenarios, which included reading, eating, walking, and sitting to determine the experiences and emotions of students via semi-structured questions and interviews. The empathy and attitude levels were evaluated using the Jefferson Scale of Empathy-Health Professions Students (JSE-HPS) version and Kogan's Attitudes Towards Old People (KAOP) scales at baseline and immediately after performed scenarios.
Results: The scores of the JSE-HPS and its sub-scales, including "perspective-taking" (p=0.000) and "compassionate care" (p=0.008), were significantly improved, while "standing in patient's shoes" was significantly decreased after the intervention (p=0.005). KAOP positive items were found to be higher compared to the baseline results (p=0.040). Besides, 87.1% of the students stated that their behavior towards older people would change positively.
Conclusion: Using aged simulation suits may be an effective educational technique that positively contributes to undergraduate physiotherapy students' attitudes and empathy.
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Fernández-Gutiérrez M, Bas-Sarmiento P, del Pino-Chinchilla H, Poza-Méndez M, Marín-Paz AJ. Effectiveness of a multimodal intervention and the simulation flow to improve empathy and attitudes towards older adults in nursing students: A crossover randomised controlled trial. Nurse Educ Pract 2022; 64:103430. [DOI: 10.1016/j.nepr.2022.103430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022]
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Leyva-Moral JM, Aguayo-González M, San Rafael-Gutiérrez S, Gómez-Ibáñez R. Narrative photography with an expert patient as a method to improve empathy: a satisfaction study with health sciences students. Int J Nurs Educ Scholarsh 2022; 19:ijnes-2021-0124. [PMID: 35618500 DOI: 10.1515/ijnes-2021-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/20/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess health sciences students' satisfaction with narrative photography with an expert patient as an empathy-fostering teaching method. METHODS Nineteen students from a public medical sciences university in Barcelona (Spain) voluntarily completed six online training sessions using narrative photography and expert patient. Data were collected using an anonymous online satisfaction questionnaire verified by experts, including 29 quantitative and qualitative questions that were analyzed descriptively. RESULTS Eighteen valid questionnaires were obtained (90% response rate). All students evaluated the teaching method as highly satisfactory. The main positive aspects of the teaching method were being able to express one's emotions and reflections. Students felt the activity enhanced their empathy and helped them minimize their prejudices, specifically to patients living with HIV. Students also evaluated the online format as less optimal than if it were delivered in person. CONCLUSION The students found the teaching method to have a personal and professional impact, which facilitated the integration of empathy in their daily practice when caring for people living with HIV.
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Affiliation(s)
- Juan M Leyva-Moral
- Nursing Department, Faculty of Medicine. Universitat Autonoma de Barcelona (Spain)
| | | | | | - Rebeca Gómez-Ibáñez
- Nursing Department, Faculty of Medicine. Universitat Autonoma de Barcelona (Spain)
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Wanko Keutchafo EL, Kerr J. Older Adults’ Interpretation of Nurses’ Nonverbal Communication in Cameroon: A Grounded Theory Inquiry. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580211056194. [PMID: 35341354 PMCID: PMC8958709 DOI: 10.1177/00469580211056194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Communication is central to nursing care. Yet, the nonverbal aspect of communication tends to be neglected or underestimated in nursing studies. Research has shown that older patients interpret nurses’ communication messages during the clinical encounter. This article conceptualizes older adults’ interpretation of and need for nonverbal communication (NVC) to enhance patient-centered communication advocated by the World Health Organization. The Corbin and Strauss (2015) inductive Grounded Theory approach was used to collect data from 3 hospital units in Cameroon using in-depth interviews with eight older adults, thirteen nurses, and four student nurses between July 2018 and January 2020. Open coding, axial coding, and selective coding were used for analysis, which reveals that interpretations of NVC can be positive or negative. It means that older adults view nurses either as angels or as difficult persons, depending on the nurses’ positive or negative NVC and behaviors. These interpretations lead to consequences ranging from a preference for some nurses to noncompliance with care. The results further show that older adults need active listening, humor, and affection from nurses. Information regarding older adults’ interpretation of and need for NVC can be used to improve curriculum content and to develop skills in and awareness of NVC with older adults. It is recommended that further research expand on effective nonverbal techniques during COVID-19 times where the meaning of facial expressions and voice inflection can be disrupted.
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Affiliation(s)
| | - Jane Kerr
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Wanko Keutchafo EL, Kerr J, Baloyi OB, Duma SE. Conditions Influencing Effective Nurse Nonverbal Communication With Hospitalized Older Adults in Cameroon. Glob Qual Nurs Res 2022; 9:23333936221098751. [PMID: 35647218 PMCID: PMC9131379 DOI: 10.1177/23333936221098751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
Effective communication between nurses and patients is an important factor to quality nursing care but ineffective nonverbal communication could take a toll on health care. Therefore, understanding the factors that influence nonverbal communication between nurses and hospitalized older adults could help solve communication problems, thus improve nursing care. A sample of 13 nurses and 4 student nurses from two hospitals in Cameroon participated in the study. Data were collected using participant observations and semi-structured interviews, and analyzed using open coding and constant comparative analysis. Three categories were identified as influencing factors: nurse views of hospitalized older adults, hospitalized older adult-related factors, and nurse intrinsic factors. Effective nurses' nonverbal communication with hospitalized older adults relies mostly on nurses' intrinsic factors. Identification and nurturing of the positive nurse intrinsic factors are important to develop effective nonverbal communication skills among nurses.
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Affiliation(s)
| | - Jane Kerr
- University of KwaZulu-Natal, Durban, South Africa
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Laranjeira C, Afonso C, Querido AI. Communicating Bad News: Using Role-Play to Teach Nursing Students. SAGE Open Nurs 2021; 7:23779608211044589. [PMID: 34632058 PMCID: PMC8495521 DOI: 10.1177/23779608211044589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022] Open
Abstract
Receiving bad news can have a profound impact on a patient's physical, psychological and social well-being. Therefore, communication of bad news is an essential skill required for health professionals. A good interpersonal relationship based on trust, empathy, and respect can help the psychological adjustment to end-of-life losses. This study presents a simulation-based learning experience designed to teach communication skills to nursing students who care for palliative patients and their family members. The authors suggest adopting Gibbs' reflective cycle during structured debriefing that enables the students to move logically through the reflective process. A student-centered learning approach can promote responsibility and success in achieving the expected learning outcomes.
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Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences of Polytechnic of Leiria, Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal
| | - Catarina Afonso
- School of Health Sciences of Polytechnic of Leiria, UCC Arnaldo Sampaio do ACES Pinhal Litoral, Leiria, Portugal
| | - Ana Isabel Querido
- School of Health Sciences of Polytechnic of Leiria, Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal
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Heyn LG, Brembo EA, Eide H, Hafskjold L, Sundling V. Older persons' expressed worries during nursing care at home: Do health complexity and nature of nursing care in the visit matter? PATIENT EDUCATION AND COUNSELING 2021; 104:2418-2424. [PMID: 34294490 DOI: 10.1016/j.pec.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Older persons receiving home care express more cues and concerns compared to other clinical contexts. Increased health condition complexity requires a corresponding increase in nursing competence. The aim of this study was to explore how complexity of older persons' health and nature of the visit influenced their expressed worries. METHODS In this cross-sectional explorative study, we analysed older persons' expressed worries (n = 508) identified by the Verona Coding Definitions of Emotional Sequences (VR-CoDES) in 129 audio-recorded home care visits with older persons (≥65 years), collected in 3 city districts and 1 rural area in Norway. RESULTS Expressed worries of 45 older persons were included in the analysis: 18 had low health complexity, 5 moderate and 22 high health complexity. The nature of the visit affected the number of expressed worries, health complexity did not. Most of the worries were expressed during basic nursing care visits and/or medication administration. CONCLUSION Findings suggest that home visit type may influence the older persons' expressed worries. The complexity of the older persons' health condition seems to have little impact on the expressed worries. PRACTICE IMPLICATIONS Knowledge about communication in different complexity of visits is important when planning care for older persons.
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Affiliation(s)
- Lena Günterberg Heyn
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Espen Andreas Brembo
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Hilde Eide
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Linda Hafskjold
- Faculty of Health and Social Sciences, Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Drammen, Norway.
| | - Vibeke Sundling
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway; National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway.
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Wolderslund M, Kofoed PE, Ammentorp J. The effectiveness of a person-centred communication skills training programme for the health care professionals of a large hospital in Denmark. PATIENT EDUCATION AND COUNSELING 2021; 104:1423-1430. [PMID: 33303282 DOI: 10.1016/j.pec.2020.11.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/20/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE As a part of an evaluation of a large-scale communication skills training (CST) programme, this study aimed to investigate the effect on health care professionals' (HCPs) self-efficacy (SE) and perceived importance (PI) of the skills taught. METHODS A pre-post intervention design was used, and 1647 HCPs responded to the SE-12 questionnaire. Changes in self-efficacy were examined at an item and scale level. RESULTS The responses of 74% of the HCPs who replied to at least two of the three questionnaires were analysed. A significant increase in the SE-12 scale scores by 12.45 points between Q1 (baseline) and Q2 (immediately after the intervention) across all professions was found. There was a small albeit statistically significant decrease in the SE-12 scale scores by 2.06 points between Q2 and Q3 (24 weeks after the intervention). CONCLUSION The implementation of the CST course significantly improved the self-efficacy of HCPs. The findings were supported by an increase in the number of HCPs who considered the skills that they had acquired to be very important. PRACTICE IMPLICATIONS The findings suggest that the large-scale implementation of evidence-based CST programmes can yield the same outcomes that have been observed in smaller and better controlled studies.
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Affiliation(s)
- Maiken Wolderslund
- Health Services Research Unit, Lillebaelt University Hospital, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Poul-Erik Kofoed
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Pediatrics, Lillebaelt University Hospital, Kolding, Denmark.
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt University Hospital, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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Gustafsson T, Sundler AJ, Lindberg E, Karlsson P, Söderholm HM. Process evaluation of the ACTION programme: a strategy for implementing person-centred communication in home care. BMC Nurs 2021; 20:56. [PMID: 33832468 PMCID: PMC8034062 DOI: 10.1186/s12912-021-00565-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is currently a strong emphasis on person-centred care (PCC) and communication; however, little research has been conducted on how to implement person-centred communication in home care settings. Therefore, the ACTION (A person-centred CommunicaTION) programme, which is a web-based education programme focusing on person-centred communication developed for nurse assistants (NAs) providing home care for older persons, was implemented. This paper reports on the process evaluation conducted with the aim to describe and evaluate the implementation of the ACTION programme. METHODS A descriptive design with a mixed method approach was used. Twenty-seven NAs from two units in Sweden were recruited, and 23 of them were offered the educational intervention. Quantitative and qualitative data were collected from multiple sources before, during and after the implementation. Quantitative data were used to analyse demographics, attendance and participation, while qualitative data were used to evaluate experiences of the implementation and contextual factors influencing the implementation. RESULTS The evaluation showed a high degree of NA participation in the first five education modules, and a decrease in the three remaining modules. Overall, the NAs perceived the web format to be easy to use and appreciated the flexibility and accessibility. The content was described as important. Challenges included time constraints; the heavy workload; and a lack of interaction, space and equipment to complete the programme. CONCLUSIONS The results suggest that web-based education seems to be an appropriate strategy in home care settings; however, areas for improvement were identified. Our findings show that participants appreciated the web-based learning format in terms of accessibility and flexibility, as well as the face-to-face group discussions. The critical importance of organizational support and available resources are highlighted, such as management involvement and local facilitation. In addition, the findings report on the implementation challenges specific to the dynamic home care context. TRIAL REGISTRATION This intervention was implemented with nursing assistants, and the evaluation only involved nursing staff. Patients were not part of this study. According to the ICMJE, registration was not necessary ().
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Affiliation(s)
- Tanja Gustafsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allégatan 1, SE-501 90, Borås, Sweden.
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allégatan 1, SE-501 90, Borås, Sweden
| | - Elisabeth Lindberg
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allégatan 1, SE-501 90, Borås, Sweden
| | - Pernilla Karlsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allégatan 1, SE-501 90, Borås, Sweden
| | - Hanna Maurin Söderholm
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allégatan 1, SE-501 90, Borås, Sweden.,PreHospen Centre for Prehospital Research, University of Borås, Borås, Sweden
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Sanerma P, Miettinen S, Paavilainen E, Åstedt-Kurki P. A client-centered approach in home care for older persons - an integrative review. Scand J Prim Health Care 2020; 38:369-380. [PMID: 33201752 PMCID: PMC7781976 DOI: 10.1080/02813432.2020.1841517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe and synthesize client-centered care and service in home care for older persons. METHODS The study was an integrative review using the guidelines for literature reviews by the Joanna Briggs Institute. The research process followed the Whittemore and Knafl framework and PRISMA toolkit in the selection of eligible articles. The CINAHL, Medline, Scopus, Web of Science and Social Sciences abstracts were searched for articles published between January 2007 and May 2020 according to previously designed search strategies. In total, 24 articles were deemed relevant for an analysis using a thematic analysis. RESULTS The analysis resulted in four themes with sub-themes which revealed that client-centered care and service in home care consist of: 1) Clients' involvement in their own care; self-care, decision-making, satisfactory daily life, 2) Family members' and care partners' participation in care; family members' and care partners' commitment to care, family members' and care partners' competence in care, 3) Communication and co-operation; communication models, empowerment, partnership, and 4) Evidence-based service competence; delivery and organization of services, implementation of services, versatile clinical skills, quality outcomes and personnel wellbeing. CONCLUSIONS According to the results, achieving client-centered care and service in home care requires the realization of all of the above aspects. The practice of nursing must better identify all dimensions of client-centered care and take these into account in the delivery of home care services. KEY POINTS Client-centeredness is a fundamental value and the basis of nursing and care in home care provided for older persons This paper: deepens and structures the concept of client-centered care in the context of home care. assists professionals to understand the factors behind client-centered care within the home care environment. provides deeper understanding of the roles of the older person, family members, and the service system in developing client-centered services in home care for older persons.
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Affiliation(s)
- Päivi Sanerma
- Department of Health Sciences, Faculty of Social sciences, University of Tampere, Tampere, Finland
- Hamk Smart Reseach Unit, Hamk University of Applied Sciences, Hämeenlinna, Finland
- CONTACT Päivi Sanerma ; Department of Health Sciences, Faculty of Social Sciences, University of Tampere, 100, Tampere, PL, 33014, Finland; Hamk Smart Reseach Unit, Hamk University of Applied Sciences, 230, Hämeenlinna, PL, 13100, Finland
| | - Sari Miettinen
- Hamk Smart Reseach Unit, Hamk University of Applied Sciences, Hämeenlinna, Finland
- Information Services Unit, Research Unit, The Social Insurance Institution of Finland, Helsinki, Finland
| | - Eija Paavilainen
- Department of Health Sciences, Faculty of Social sciences, University of Tampere, Tampere, Finland
| | - Päivi Åstedt-Kurki
- Department of Health Sciences, Faculty of Social sciences, University of Tampere, Tampere, Finland
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Höglander J, Eklund JH, Spreeuwenberg P, Eide H, Sundler AJ, Roter D, Holmström IK. Exploring patient-centered aspects of home care communication: a cross-sectional study. BMC Nurs 2020; 19:91. [PMID: 33013200 PMCID: PMC7526395 DOI: 10.1186/s12912-020-00483-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Communication is a cornerstone in nursing and aims at both information exchange and relationship building. To date, little is known about the naturally occurring communication between older persons and nurses in home care. Communication might heal through different pathways and a patient- or person-centered communication could be important for health and well-being of older persons. However, the delivery of individualized home care is challenged by routines and organizational demands such as time constraints. Therefore, the aim of this study was to explore the patient-centered aspects of home care communication between older persons and registered nurses. Methods In total 37 older persons (aged 65 years or older) and eleven RNs participated in 50 audio-recorded home care visits. Roter Interaction Analysis System (RIAS) was used to code verbal communication. A ratio from these codes, establishing the degree of patient-centeredness, was analyzed using a Generalized Linear Mixed Model. Results The present home care communication contained more socio-emotional than task-oriented communication and the emotional tone was largely positive. The global affect ratings reflected an overall positive tone (m = 39.88, sd = 7.65), with higher ratings on dimensions of, for example, responsiveness/engagement and interactivity or interest were more frequent than those that may be considered as less-positive emotions (m = 15.56, sd = 3.91), e.g. hurried, dominance or anger. The ratio of the degree of patient-centered communication in the home care visits was an average of 1.53, revealing that the communication could be considered as patient-centered. The length of the visits was the only characteristic significantly associated with the degree of patient-centeredness in the communication, with a peak in patient-centeredness in visits 8–9 min long. Sex, age or procedural focus showed no significant effects on the degree of patient-centeredness. Conclusion Overall, the degree of patient-centeredness and a positive emotional tone, which might have a positive outcome on older persons’ health, was high. Longer visits provided a higher degree of patient-centeredness, but no linear increase in patient-centeredness due to length of visit could be observed. The findings can be used for education and training of nurses, and for providing individualized care, e.g. patient- or person-centered care.
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Affiliation(s)
- Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, SE-721 23 Västerås, Sweden
| | - Jakob Håkansson Eklund
- School of Health, Care and Social Welfare, Mälardalen University, SE-721 23 Västerås, Sweden
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Hilde Eide
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Debra Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, SE-721 23 Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Wanko Keutchafo EL, Kerr J, Jarvis MA. Evidence of nonverbal communication between nurses and older adults: a scoping review. BMC Nurs 2020; 19:53. [PMID: 32550824 PMCID: PMC7298765 DOI: 10.1186/s12912-020-00443-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/04/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Communication is an integral part of life and of nurse-patient relationships. Effective communication with patients can improve the quality of care. However, the specific communication needs of older adults can render communication between them and nurses as less effective with negative outcomes. METHODS This scoping review aims at describing the type of nonverbal communication used by nurses to communicate with older adults. It also describes the older adults' perceptions of nurses' nonverbal communication behaviors. It followed (Int J Soc Res 8: 19-32, 2005) framework. Grey literature and 11 databases were systematically searched for studies published in English and French, using search terms synonymous with nonverbal communication between nurses and older adults for the period 2000 to 2019. RESULTS The search revealed limited published research addressing nonverbal communication between older adults and nurses. The studies eligible for quality assessment were found to be of high quality. Twenty-two studies were included and highlighted haptics, kinesics, proxemics, and vocalics as most frequently used by nurses when communicating with older adults; while studies showed limited use of artefacts and chronemics. There was no mention of nurses' use of silence as a nonverbal communication strategy. Additionally, there were both older adults' positive and negative responses to nurses' nonverbal communication behaviors. CONCLUSION Nurses should be self-aware of their nonverbal communication behaviors with older adults as well as the way in which the meanings of the messages might be misinterpreted. In addition, nurses should identify their own style of nonverbal communication and understand its modification as necessary in accordance with patient's needs.
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Affiliation(s)
- Esther L. Wanko Keutchafo
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, 71 Manor Drive, Manor Gardens, Durban, 4001 South Africa
| | - Jane Kerr
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, 71 Manor Drive, Manor Gardens, Durban, 4001 South Africa
| | - Mary Ann Jarvis
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, 71 Manor Drive, Manor Gardens, Durban, 4001 South Africa
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18
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Sundling V, Stene HA, Eide H, Hugaas Ofstad E. Identifying decisions in optometry: A validation study of the decision identification and classification taxonomy for use in medicine (DICTUM) in optometric consultations. PATIENT EDUCATION AND COUNSELING 2019; 102:1288-1295. [PMID: 30826109 DOI: 10.1016/j.pec.2019.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The aim of this study was to assess the validity and reliability of the Decision Identification and Classification Taxonomy for Use in Medicine (DICTUM) applied to optometry, to compare decisions in medical and optometric consultations, and to describe decisions in optometry. METHODS The study had a cross-sectional design. Data was collected from January to August 2016. Forty video-recorded patient-optometrist consultations were analysed. Clinical decisions were categorised according to DICTUM by two independent coders. RESULTS The framework was applied without modification. The inter-rater reliability was moderate, Cohen's kappa 0.57. The mean duration of the consultations was 41 (±9) minutes. In all, 891 clinical decisions were identified, mean 22 (±13) per consultation. Types of decisions were significantly different between optometric and medical consultations (chi-square, p < 0.001). More frequently, optometrists conveyed interpreted test results (27.6% vs 16.7%) and gave advice (23.6% vs 8%), while doctors defined the problem (30.4% vs 24.6%) and decided on treatment (17.8% vs 13.4%). CONCLUSION DICTUM is applicable to optometry encounters and may provide valuable insight to different health care settings. PRACTICE IMPLICATIONS Descriptive studiesofdecisions in patient-provider consultations is a first step for normative and prescriptive exploration of decision-making processes in health care.
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Affiliation(s)
- Vibeke Sundling
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway; Science Center Health and Technology, Faculty of Health and Social Sciences, University of University of South-Eastern Norway, Drammen, Norway.
| | - Hege Anita Stene
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Hilde Eide
- Science Center Health and Technology, Faculty of Health and Social Sciences, University of University of South-Eastern Norway, Drammen, Norway
| | - Eirik Hugaas Ofstad
- Department of Medicine, Nordland Hospital Trust, Bodø, Norway; Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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19
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Höglander J, Sundler AJ, Spreeuwenberg P, Holmström IK, Eide H, van Dulmen S, Eklund JH. Emotional communication with older people: A cross-sectional study of home care. Nurs Health Sci 2019; 21:382-389. [PMID: 30957364 DOI: 10.1111/nhs.12611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/05/2019] [Accepted: 03/09/2019] [Indexed: 01/25/2023]
Abstract
The aim of this study was to explore the influence of characteristics of nurses and older people on emotional communication in home care settings. A generalized, linear, mixed model was used to analyze 188 audio-recorded home care visits coded with Verona Coding Definitions of Emotional Sequences. The results showed that most emotional distress was expressed by older females or with female nurses. The elicitation of an expression of emotional distress was influenced by the nurses' native language and profession. Older women aged 65-84 years were given the most space for emotional expression. We found that emotional communication was primarily influenced by sex for nurses and older people, with an impact on the frequency of expressions of and responses to emotional distress. Expressions of emotional distress by older males were less common and could risk being missed in communication. The results have implications for students' and health professionals' education in increasing their knowledge of and attentiveness to the impacts of their and others' characteristics and stereotypes on emotional communication with older people.
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Affiliation(s)
- Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Annelie J Sundler
- Department of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Hilde Eide
- Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
| | - Sandra van Dulmen
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway.,Department of Primary and Community Care, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Jakob H Eklund
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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20
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Gholamzadeh S, Khastavaneh M, Khademian Z, Ghadakpour S. The effects of empathy skills training on nursing students' empathy and attitudes toward elderly people. BMC MEDICAL EDUCATION 2018; 18:198. [PMID: 30111312 PMCID: PMC6094453 DOI: 10.1186/s12909-018-1297-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/27/2018] [Indexed: 05/10/2023]
Abstract
BACKGROUND Nursing students' empathy and positive attitudes toward elderly people could help provide improved elderly care in their future practice. This study aimed to investigate the effects of empathy skills training on nursing students' empathy and attitudes toward elderly people. METHODS This quasi-experimental study was conducted in Yasuj, Iran in 2014. The sample consisted of 63 students at Hazrat Zeinab Nursing and Midwifery School who were randomly divided into a control (n = 31) and an intervention group (n = 32). The intervention group attended an eight-hour workshop on empathy skills that was presented through lectures, demonstration, group discussions, scenarios, and questioning. The data were collected using the Persian versions of Kogan's Attitudes towards Old People Scale and Jefferson Scale of Physician Empathy-Health Professionals Version. Then, the data were entered into the SPSS software, version 19 and were analyzed using descriptive statistics, chi-square test, t-test, and repeated measures analysis of variance. RESULTS The results showed that the empathy skills training program had a significant impact on the students' mean scores of empathy and attitudes toward elderly people (p < 0.001). The intervention group's mean score of empathy increased from 77.8 (SD = 10.7) before the intervention to 86 (SD = 7.3) immediately after that and 85.2 (SD = 8.9) 2 months later. Their mean score of attitude also increased from 110.8 (SD = 10.9) before the intervention to 155.2 (SD = 23.4) immediately after the intervention and 158.6 (SD = 23.2) 2 months later. Additionally, the empathy and attitude scores of the intervention group were significantly higher than those for control group immediately and 2 months after the intervention. CONCLUSIONS Empathy skills training improved the nursing students' empathy and attitudes towards elderly people. Therefore, empathy training is recommended to be incorporated into the undergraduate nursing curriculum.
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Affiliation(s)
- Sakineh Gholamzadeh
- Community-Based Psychiatric Care Research Center, Shiraz University of Medical Sciences , Shiraz, Iran
| | - Maryam Khastavaneh
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Khademian
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soraya Ghadakpour
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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21
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Nursing staff's responses to thematic content of patients' expressed worries: observing communication in home care visits. BMC Health Serv Res 2018; 18:597. [PMID: 30075767 PMCID: PMC6091070 DOI: 10.1186/s12913-018-3390-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the study was to explore the thematic content of older persons’ expressed worries in home care visits, and how nursing staff respond to different thematic contents. Methods The study had a descriptive, observational design, including 195 audio-recorded Norwegian home care visits with 33 nursing staff and 48 older persons. In all, 638 patient cues/concerns (worries) and subsequent nursing staff’s responses were identified using Verona Coding Definitions of Emotional Sequences. A novel thematic coding scheme was used to label the thematic content of the cues/concerns. The nursing staff’s responses were grouped based on communicative function as emotion-focused, content-focused or ignoring/blocking the cue/concern. Group difference was analysed using Pearson’s chi-squared test, Fisher’s exact test, and adjusted residuals. Results The theme of worries was associated with elicitation of the cue/concern, either elicited by the nursing staff or spontaneously expressed by the patient (Chi-square, p< 0.001). “Ageing and bodily impairment” was the most common theme (66%) and was equally elicited by patients and nursing staff. Worries about “Relationships with others” (9%), “Health care-related issues” (15%) and “Life narratives and value issues” (9%) were mainly elicited by nursing staff. The nursing staff response was associated with the theme of worries (p˂0.001). For the sub-themes of “Ageing and bodily impairment”, Coping with existential challenges received more frequently emotion-focused responses (adjusted residuals: 3.2) and Expression of pain felt in the moment were more frequently ignored/blocked (adjusted residuals: 4.0, Fisher’s exact test, p< 0.001). For the sub-themes of “Relationships with others”, Being a burden more frequently received a content-focused response (adjusted residuals: 2.8), while Losing social ties more frequently received an emotion-focused response (adjusted residuals: 3.1, Fisher’s exact test, p = 0.009). Conclusion “Ageing and bodily impairment” was the most common theme and more frequently elicited by the older persons than other themes. Emotionally focused nursing staff responses were most common when addressing existential challenges and fear of losing social ties. Whereas nursing staff showed a tendency to ignore patients’ spontaneous expressions of pain. Further research should explore the influence of nursing staff’s responses on quality of care and patient satisfaction.
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22
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Barnett NL, Leader I, Easthall C. Developing person-centred consultation skills within a UK hospital pharmacy service: evaluation of a pilot practice-based support package for pharmacy staff. Eur J Hosp Pharm 2017; 26:93-100. [PMID: 31157107 DOI: 10.1136/ejhpharm-2017-001416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/04/2022] Open
Abstract
A person-centred approach to care is central to NHS England's health policy agenda and a standard for pharmacy practice from the General Pharmaceutical Council. Health coaching is a method of delivering person-centred care. A pilot of a health coaching support package, including a 2-day course and practice-based follow-up, was delivered to 70 London North West Healthcare NHS Trust pharmacy staff between December 2015 and July 2017. Objectives To evaluate the support package, identifying key themes from course feedback, evaluating staff perception and evidence of application in practice. To identify key benefits of the support package. Methods Qualitative analysis of written course feedback was undertaken to identify staff learning themes about person-centred care. The themes were used to design a survey, administered to support package recipients (staff), exploring staff perception of the package. Qualitative review of written examples highlighted use of person-centred themes in practice. Results Twelve person-centred themes emerged from 49 course evaluations forms, describing what participants learnt about patient-centred care. Of 24 surveys completed, respondents reported increased awareness of themes; however, use in practice varied between themes. Overall, respondents valued the support package and rated practice-support more highly than the course for ongoing development. Patient examples described the use of themes in practice. Conclusions The support package increased awareness of person-centred themes, portrayed within the practice examples submitted. While the course provided a foundation for use of a person-centred approach, continuing practice-based support is desired by staff to embed learning into day-to-day practice.
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Affiliation(s)
- Nina L Barnett
- Department of Pharmacy, Northwick Park Hospital, Harrow, UK
| | - Ilana Leader
- Cognitive Behavioural Therapy, Central and North West London NHS Trust, London, UK
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23
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Piccolo LD, Finset A, Mellblom AV, Figueiredo-Braga M, Korsvold L, Zhou Y, Zimmermann C, Humphris G. Verona Coding Definitions of Emotional Sequences (VR-CoDES): Conceptual framework and future directions. PATIENT EDUCATION AND COUNSELING 2017; 100:2303-2311. [PMID: 28673489 DOI: 10.1016/j.pec.2017.06.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/01/2017] [Accepted: 06/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To discuss the theoretical and empirical framework of VR-CoDES and potential future direction in research based on the coding system. METHODS The paper is based on selective review of papers relevant to the construction and application of VR-CoDES. RESULTS VR-CoDES system is rooted in patient-centered and biopsychosocial model of healthcare consultations and on a functional approach to emotion theory. According to the VR-CoDES, emotional interaction is studied in terms of sequences consisting of an eliciting event, an emotional expression by the patient and the immediate response by the clinician. The rationale for the emphasis on sequences, on detailed classification of cues and concerns, and on the choices of explicit vs. non-explicit responses and providing vs. reducing room for further disclosure, as basic categories of the clinician responses, is described. CONCLUSIONS Results from research on VR-CoDES may help raise awareness of emotional sequences. Future directions in applying VR-CoDES in research may include studies on predicting patient and clinician behavior within the consultation, qualitative analyses of longer sequences including several VR-CoDES triads, and studies of effects of emotional communication on health outcomes. PRACTICE IMPLICATIONS VR-CoDES may be applied to develop interventions to promote good handling of patients' emotions in healthcare encounters.
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Affiliation(s)
- Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Arnstein Finset
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anneli V Mellblom
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Pediatric Medicine, Women and Children's Unit, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Margarida Figueiredo-Braga
- Faculty of Medicine, University of Porto, Portugal; I3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Live Korsvold
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yuefang Zhou
- University of St Andrews, Medical School, North Haugh, St Andrews, UK
| | - Christa Zimmermann
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gerald Humphris
- University of St Andrews, Medical School, North Haugh, St Andrews, UK
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24
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Gorawara-Bhat R, Hafskjold L, Gulbrandsen P, Eide H. Exploring physicians' verbal and nonverbal responses to cues/concerns: Learning from incongruent communication. PATIENT EDUCATION AND COUNSELING 2017; 100:1979-1989. [PMID: 28698034 DOI: 10.1016/j.pec.2017.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/22/2017] [Accepted: 06/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Explore physicians' verbal and nonverbal responses to cues/concerns in consultations with older-patients. METHODS Two teams independently coded a sample of Norwegian consultations (n=24) on verbal and nonverbal dimensions of communication using VR-CoDES and NDEPT instruments. Consultations exploring older-patients' verbal emotional expressions were labeled 'Acknowledging of patients' emotional expressions', and 'Distancing from patients' emotional expressions.' Based on type and extent of nonverbal expressiveness, consultations were labeled 'Affective' and 'Prescriptive.' Congruency of verbal and nonverbal communication was assessed and categorized into four types. Incongruent consultations were qualitatively analyzed. RESULTS Types 1 and 2 consultations were described as 'Congruent,' i.e. both verbal and nonverbal behaviors facilitate or inhibit emotional expressions. Types 3 and 4 were considered 'Incongruent,' i.e. verbal inhibits, but nonverbal facilitates emotional expressions or vice versa. Type 3 incongruent encounters occurred most often when it was challenging to meet patients' needs. CONCLUSIONS Frequently physicians' display incongruent behavior in challenging situations. Older patients' may perceive this as either alleviating or increasing distress, depending on their needs. PRACTICE IMPLICATIONS Type 3 consultations may shed light on reasons for physicians' incongruent behavior; therefore, independent measurement and analyses of verbal and nonverbal communication are recommended. Older-patients' perceptions of incongruent communication should be further explored.
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Affiliation(s)
| | - L Hafskjold
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University College of Southeast-Norway, Drammen, Norway
| | - P Gulbrandsen
- University of Oslo, Oslo, Norway; Akershus University Hospital, Norway
| | - H Eide
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University College of Southeast-Norway, Drammen, Norway
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Sundling V, Sundler AJ, Holmström IK, Kristensen DV, Eide H. Mindfulness predicts student nurses' communication self-efficacy: A cross-national comparative study. PATIENT EDUCATION AND COUNSELING 2017; 100:1558-1563. [PMID: 28342674 DOI: 10.1016/j.pec.2017.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to compare student nurses' communication self-efficacy, empathy, and mindfulness across two countries, and to analyse the relationship between these qualities. METHODS The study had a cross-sectional design. Data was collected from final year student nurses in Norway and Sweden. Communication self-efficacy, empathy, and mindfulness were reported by questionnaires; Clear-cut communication with patients, Jefferson Scale of Empathy, and Langer 14 items mindfulness scale. RESULTS The study included 156 student nurses, 94 (60%) were Swedish. The mean communication self-efficacy score was 119 (95% CI 116-122), empathy score 115 (95% CI 113-117) and mindfulness score 79 (95% CI 78-81). A Mann-Whitney test showed that Swedish students scored significantly higher on communication self-efficacy, empathy, and mindfulness than Norwegian students did. When adjusted for age, gender, and country in a multiple linear regression, mindfulness was the only independent predictor of communication self-efficacy. CONCLUSION The Swedish student nurses in this study scored higher on communication self-efficacy, empathy, and mindfulness than Norwegian students did. Student nurses scoring high on mindfulness rated their communication self-efficacy higher. PRACTICE IMPLICATIONS A mindful learning approach may improve communication self-efficacy and possibly the effect of communication skills training.
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Affiliation(s)
- Vibeke Sundling
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University College of Southeast Norway, Kongsberg, Norway; Department of Nursing Science, Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen Norway; Science Center Health and Technology, Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway.
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Dorte Vesterager Kristensen
- Department of Nursing Science, Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen Norway
| | - Hilde Eide
- Science Center Health and Technology, Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway; Department of Nursing Science, Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen Norway
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Kristensen DV, Sundler AJ, Eide H, Hafskjold L, Ruud I, Holmström IK. Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits. J Clin Nurs 2017; 26:4613-4621. [PMID: 28301068 DOI: 10.1111/jocn.13807] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 02/03/2023]
Abstract
AIMS AND OBJECTIVES To describe the characteristics of communication practice in home care visits between older people (over 65 years old) and nurse assistants and to discuss the findings from a person-centered perspective. BACKGROUND The older population is increasing worldwide, along with the need for healthcare services in the person's home. To achieve a high-quality care, person-centered communication is crucial. DESIGN A descriptive design with a qualitative inductive approach was used. METHOD Fifteen audio recordings of naturally occurring conversations between 12 nurse assistants and 13 older people in Norway were analysed by qualitative content analysis. RESULTS Four categories were revealed through analysis: (i) supporting older people's connection to everyday life; (ii) supporting older people's involvement in their own care; (iii) attention to older people's bodily and existential needs; and (iv) the impact of continuity and predictability on older people's well-being. CONCLUSIONS The communication between the older people and the nurse assistants during home care visits was mainly task-oriented, but also related to the person. The older people were involved in the tasks to be carried out and humour was part of the communication. Greater attention was paid to bodily than existential needs. The communication was connected with the older people's everyday life in several ways. Time frames and interruptions concern the older people; hearing and speech impairments were a challenge to communication. To enhance person-centred communication, further studies are needed, especially intervention studies for healthcare professionals and students. RELEVANCE TO CLINICAL PRACTICE Being responsive to older people's subjective experiences is important in meeting their needs in home care. Communication that addresses the need for trust and predictability is important for older people. Responding to existential needs require more attention. The home care setting has an impact on communication.
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Affiliation(s)
- Dorte V Kristensen
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Hilde Eide
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Linda Hafskjold
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Iren Ruud
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Hafskjold L, Sundling V, van Dulmen S, Eide H. The use of supportive communication when responding to older people's emotional distress in home care - An observational study. BMC Nurs 2017; 16:24. [PMID: 28522923 PMCID: PMC5434581 DOI: 10.1186/s12912-017-0220-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Responding to older people’s distress by acknowledging or encouraging further discussion of emotions is central to supportive, person-centred communication, and may enhance home care outcomes and thereby promote healthy aging. This observational study describes nursing staff’s responses to older people’s emotional distress, and identify factors that encourage further emotional disclosure. Methods Audio-recorded home care visits in Norway (n = 196), including 48 older people and 33 nursing staff, were analysed with the Verona Coding Definitions of Emotional Sequences, identifying expressions of emotional distress and subsequent provider responses. The inter-rater reliability (two coders), Cohen’s kappa, was >0.6. Sum categories of emotional distress were constructed: a) verbal and non-verbal expressions referring to emotion, b) references to unpleasant states/circumstances, and c) contextual hints of emotion. A binary variable was constructed based on the VR response codes, differentiating between emotion-focused responses and responses that distanced emotion. Fisher’s exact test was used to analyse group differences and determined variables included in a multivariate logistic regression analysis to identify factors promoting emotion-focused responses. Results Older people’s expressions of emotional distress (n = 635) comprised 63 explicit concerns and 572 cues. Forty-eight per cent of nursing staff responses (n = 638) were emotion-focused. Emotion-focused responses were observed more frequently when nursing staff elicited the expression of emotional distress from the patients (54%) than when patients expressed their emotional distress on their own initiative (39%). Expressions with reference to emotion most often received emotion-focused responses (60%), whereas references to unpleasant states or circumstances and contextual hints of emotion most often received non-emotion-focused responses (59%). In a multivariate logistic model, nursing staff’s elicitation of the emotional expression (vs patients initiating it) and patients’ expression with a reference to an emotion (vs reference to unpleasant states or contextual hints) were both explanatory variables for emotion-focused responses. Conclusions Emotion-focused responses were promoted when nursing staff elicited the emotional expression, and when the patient expression referred to an emotion. Staff responded most often by acknowledging the distress and using moderately person-centred supportive communication. More research is needed to establish generalizability of the findings and whether older people deem such responses supportive.
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Affiliation(s)
- Linda Hafskjold
- Faculty of Health and Social Sciences, University College of Southeast Norway, PoBox 7053, N-3007 Drammen, Norway
| | - Vibeke Sundling
- Faculty of Health and Social Sciences, University College of Southeast Norway, PoBox 7053, N-3007 Drammen, Norway
| | - Sandra van Dulmen
- Faculty of Health and Social Sciences, University College of Southeast Norway, PoBox 7053, N-3007 Drammen, Norway.,NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilde Eide
- Faculty of Health and Social Sciences, University College of Southeast Norway, PoBox 7053, N-3007 Drammen, Norway
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Sundler AJ, Höglander J, Eklund JH, Eide H, Holmström IK. Older persons' expressions of emotional cues and concerns during home care visits. Application of the Verona coding definitions of emotional sequences (VR-CoDES) in home care. PATIENT EDUCATION AND COUNSELING 2017; 100:276-282. [PMID: 27692492 DOI: 10.1016/j.pec.2016.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study aims to a) explore to what extent older persons express emotional cues and concerns during home care visits; b) describe what cues and concerns these older persons expressed, and c) explore who initiated these cues and concerns. METHODS A descriptive and cross-sectional study was conducted. Data consisted of 188 audio recorded home care visits with older persons and registered nurses or nurse assistants, coded with the Verona coding definitions on emotional sequences (VR-CoDES). RESULTS Emotional expressions of cues and concerns occurred in 95 (51%) of the 188 recorded home care visits. Most frequent were implicit expressions of cues (n=292) rather than explicit concerns (n=24). Utterances with hints to hidden concerns (63,9%, n=202) were most prevalent, followed by vague or unspecific expressions of emotional worries (15,8%, n=50). Most of these were elicited by the nursing staff (63%, n=200). CONCLUSION Emotional needs expressed by the older persons receiving home care were mainly communicated implicitly. To be attentive to such vaguely expressed emotions may demand nursing staff to be sensitive and open. PRACTICE IMPLICATIONS The VR-CoDES can be applied on audio recorded home care visits to analyse verbal and emotional communication, and may allow comparative research.
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Affiliation(s)
- Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-50190 Borås, Sweden.
| | - Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123 Västerås, Sweden.
| | - Jakob Håkansson Eklund
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123 Västerås, Sweden.
| | - Hilde Eide
- Faculty of Health Sciences, University College of Southeast Norway, Postbox 7053, N-3007 Drammen, Norway,.
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123 Västerås, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Sweden.
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Hafskjold L, Eide T, Holmström IK, Sundling V, van Dulmen S, Eide H. Older persons' worries expressed during home care visits: Exploring the content of cues and concerns identified by the Verona coding definitions of emotional sequences. PATIENT EDUCATION AND COUNSELING 2016; 99:1955-1963. [PMID: 27439669 DOI: 10.1016/j.pec.2016.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 07/01/2016] [Accepted: 07/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Little is known about how older persons in home care express their concerns. Emotional cues and concerns can be identified by the Verona coding definitions of emotional sequences (VR-CoDES), but the method gives no insight into what causes the distress and the emotions involved. The aims of this study are to explore (1) older persons' worries and (2) the content of these expressions. METHODS An observational exploratory two-step approach was used to investigate audiotaped recordings from 38 Norwegian home care visits with older persons and nurse assistants. First, 206 cues and concerns were identified using VR-CoDES. Second, the content and context of these expressions were analysed inductively. RESULTS Four main categories emerged: worries about relationships with others, worries about health care-related issues, worries about aging and bodily impairment, and life narratives and value issues, with several subcategories showing the causes of worry and emotions involved. CONCLUSION The two-step approach provides an in-depth knowledge of older persons' worries, causes of worries, and their related emotions. PRACTICE IMPLICATIONS The subcategories described in a language close to the experience can be useful in practice development and communication training for students and health care providers.
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Affiliation(s)
- Linda Hafskjold
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway.
| | - Tom Eide
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University and Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Vibeke Sundling
- Department of Optometry and Visual Science, Faculty of Health Sciences, University College of Southeast Norway, Kongsberg, Norway
| | - Sandra van Dulmen
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilde Eide
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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Sundler AJ, Eide H, van Dulmen S, Holmström IK. Communicative challenges in the home care of older persons - a qualitative exploration. J Adv Nurs 2016; 72:2435-44. [PMID: 27144778 DOI: 10.1111/jan.12996] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 02/06/2023]
Abstract
AIM To explore communicative challenges in encounters between nurse assistants and older persons during home care visits. BACKGROUND The older population is increasing worldwide. Currently, there is a shift in care for older people from institutional care to home care. Providing home care in a person's home involves several challenges, including the complexity of communication. DESIGN A descriptive observational design with a qualitative approach was used. METHODS The data consisted of audio recordings of real-life encounters during home care visits between nurse assistants and older persons, collected in 2014. A hermeneutic phenomenological analysis was conducted. RESULTS Communicative challenges were identified: (a) in situations where the older persons had a different view than the nurse assistants on the care task and its content; and (b) when unexpected actions or turns occurred in the communication. Challenges included older person's existential issues, fragility and worries and concerns, which often appeared to be only vaguely expressed and difficult to verbally detect and tackle. This engendered a risk of misinterpretation or ignorance of these challenges. CONCLUSION The findings point to the importance of communication as the key to facilitate person-centred home care. Communication training should focus more on addressing needs and existential issues in older persons. Person-centred home care for older persons needs to be addressed at both an individual and an organizational level.
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Affiliation(s)
- Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Hilde Eide
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Sandra van Dulmen
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway.,NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalens University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Sweden
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