Nursing staff's responses to thematic content of patients' expressed worries: observing communication in home care visits

Tele-health coaches' responses to clients' emotional cues and concerns and engagement with the Bump to Baby and Me Intervention

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.

Emotional cues and concerns of patients with a life limiting, chronic illness during advance care planning conversations in general practice

OBJECTIVE

To explore a) to what extent patients with serious illness express emotional cues and concerns during advance care planning (ACP) conversations with their general practitioner (GP), b) the content of cues/concerns and c) GPs' responses to cues/concerns.

METHODS

Cues/concerns and GPs' responses in 20 conversations were coded using the Verona Codes (VR-CoDES and Verona Codes-P). A qualitative thematic analysis was used to identify overarching themes within the content of the cues/concerns.

RESULTS

A total of 216 cues/concerns were identified (range: 1-28; mean: 13) in 85% of conversations; with 85% of these being cues/implicit expressions of emotions. In 72% of responses, the GP provided space for the patient to elaborate on cues/concerns. The most common theme cues/concerns were expressed about was "the consequences of illness on quality of life and burdening others".

CONCLUSION

Emotions were mainly communicated implicitly as cues and the content varied greatly. The amount of cues/concerns expressed show that ACP can evoke many emotions.

PRACTICE IMPLICATIONS

GPs should be attentive to implicit expressions of emotions as these provide opportunities to engage patients in tailored ACP conversations. As patients expressed many cues/concerns, GPs are recommended to have recurrent conversations with patients and actively ask about diverse ACP topics.

Understanding the role of positive emotions in healthcare communication - A realist review

AIM

To explore how the expression of positive emotions during the interaction between patients and providers can cultivate the patient-provider relationship.

DESIGN

We conducted a realist review guided by the Realist and Meta-narrative Evidence Syntheses: Evolving Standards.

METHODS

We systematically searched CINAHL, MEDLINE, PsychINFO and Scopus from inception to March 2019. Study selection and data extraction were performed blinded in pairs. From 3146 abstracts blinded in pairs, 15 papers were included and analysed. From each included paper, we extracted contexts, mechanisms and outcomes that were relevant to answer our research questions, creating a configuration between these elements (CMO configuration).

RESULTS

Our findings suggest that in the contexts of person orientation and positive outlook, patient-provider relationships improve by communication conveying and eliciting positive emotions. We found six underlying mechanisms for this that form either direct or indirect pathways between the context and the outcome.

Coding the negative emotions of family members and patients among the high-risk preoperative conversations with the Chinese version of VR-CoDES

Background

Little is known about family members' and patients' expression of negative emotions among high‐risk preoperative conversations.

Objectives

This study aimed to identify the occurrence and patterns of the negative emotions of family members and patients in preoperative conversations, to investigate the conversation themes and to explore the correlation between the negative emotions and the conversation themes.

Methods

A retrospective study was conducted using the Chinese version of Verona Coding Definitions of Emotional Sequences (VR‐CoDES‐C) to code 297 conversations on high‐risk procedures. Inductive content analysis was used to analyse the topics in which negative emotions nested. The χ² Test was used to test the association between the cues and the conversation themes.

Results

The occurrence rate of family members' and patients' negative emotions was very high (85.9%), much higher when compared to most conversations under other medical settings. The negative emotions were mainly expressed by cues (96.4%), and cue‐b (67.4%) was the most frequent category. Cues and concerns were mostly elicited by family members and patients (71.6%). Negative emotions were observed among seven themes, in which ‘Psychological stress relating to illness severity, family's care and financial burden’ (30.3%) ranked the top. Cue‐b, cue‐c and cue‐d had a significant correlation (p < .001) with certain themes.

Conclusions

Family members and patients conveyed significantly more negative emotions in the high‐risk preoperative conversations than in other medical communications. Certain categories of cues were induced by specific emotional conversation contents.

Patient Contribution

Family members and patients contributed to data.

Older persons' expressed worries during nursing care at home: Do health complexity and nature of nursing care in the visit matter?

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.

Suffering in silence: a qualitative study of older adults' experiences of living with long-term musculoskeletal pain at home

Long-term musculoskeletal pain is a major, disabling, and often undertreated health problem among the increasing number of older adults worldwide. However, there is limited knowledge of community-dwelling older adults' experiences of living with this type of pain. The aim of the study was to deepen the understanding of the phenomenon: how older adults experience living with long-term musculoskeletal pain at home. The study design was an inductive qualitative Reflective Lifeworld Research approach grounded in phenomenological epistemology. Data were obtained from 20 community-dwelling older adults, aged 72-97 years. Data were collected through open-ended interviews and analyzed to understand the meanings of the phenomenon. The essence of the phenomenon entailed suffering in silence and encompassed the following constituents: loneliness and restrictions in daily living; ways to endure and distract from pain; not being taken seriously; fear of the future; and valuing joy and meaning in life. Living with long-term musculoskeletal pain restricts access to the world and leads to a suffering in silence. Finding ways to endure and distract from pain and to focus on issues that give joy and meaning in life is predominant in efforts to balance restraints from pain in life. Suffering is reinforced by loneliness, a sense of not being taken seriously by health care providers and fear of an uncertain future. It is necessary to foster increased attentiveness and sensitivity in meeting the needs of each older adult and provide a care that alleviates suffering and preserves and promotes health and well-being.

Loneliness Among Older Home-Dwelling Persons: A Challenge for Home Care Nurses

Aim

To explore how nurses working in the home care service sector perceived the loneliness experienced by older people living at home, and how they met these lonely individuals’ needs.

Background

Loneliness is a well-known phenomenon among groups of older home-dwelling people and has been shown to be a health-related problem. Health care professionals working in the primary care sector, such as home care nurses, may be in the position to identify loneliness among at-home seniors. Identifying and addressing loneliness must become important issues in home care nursing.

Design

A qualitative study.

Methods

Focus group interviews were performed with 11 home care nurses in Norway. The interviews were analyzed in accordance with manifest and latent content analysis. The Coreq checklist was followed.

Findings

Home care nurses identified loneliness among older people as being a complex and sensitive phenomenon that activated conflicted thoughts, feelings and solutions in a system where older people’s loneliness was generally not considered as a need requiring nursing care.

Conclusion

Loneliness among older people challenged the nurses with regard to communicating older people’s feelings of loneliness and meeting their social needs. Organizational structures were perceived as being the main barriers to meeting these needs. Older people’s feelings of loneliness stimulated nurses’ reflections about the purpose of their nursing role. It is important to address loneliness among older home-dwelling people and include the issue in home care nursing in order to meet their need for social contact. Home nursing leaders must pay attention to the nurses’ experiences, promote the nurses’ acquisition of knowledge about this kind of loneliness and learn how to meet an older individual’s needs. There should be a special focus on communicating with lonely older people in order to address their feelings loneliness.

A client-centered approach in home care for older persons - an integrative review

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.

Emotional communication in home care: A comparison between Norway and Sweden

OBJECTIVE

Given the free movement of workers across countries, knowledge regarding communication differences between countries is imperative. In this study, we explored and compared the supportive responses of nursing staff to older persons' emotions in home care in Norway and Sweden.

METHODS

The study had an observational, cross-sectional, comparative design, which included 383 audio-recorded home-care visits. Communication was coded using Verona Coding Definitions of Emotional Sequences. Worries and responses were categorised with regard to reference, communicative function and level of person-centredness. Standard statistical tests were used to analyse the data.

RESULTS

The Swedish nursing staff provided space for further disclosure of worry more frequently than the Norwegian nursing staff (75.0 % versus 60.2 %, χ2 = 20.758, p < 0.01). In all, 65 % of the responses were supportive. Multiple logistic regression analyses showed that highly person-centred responses were independently associated with worries phrasing an emotion, OR (95 % CI) 3.282 (1.524-7.067).

CONCLUSION

The level of person-centredness was associated with the way in which older persons expressed their distress. The Swedish nursing staff provided opportunities for further disclosure of worries more frequently than the Norwegian nursing staff.

PRACTICE IMPLICATIONS

Findings of intercultural differences should be incorporated into the training of nursing staff.

Pharmacists' responses to cues and concerns of polypharmacy patients during clinical medication reviews-A video observation study

OBJECTIVE

The research questions of this study are 1) How do pharmacists respond to negative emotions of patients during a clinical medication review (CMR)? 2) How do patients express negative emotions during a CMR? 3) Who (pharmacist or patient) initiates a negative emotion to be discussed during a CMR?

METHODS

We used video-recordings to observe 132 CMR interviews of 49 pharmacists. Videos were coded with the Verona coding definitions on emotional sequences(-provider responses) (VR-CoDES(-P)).

RESULTS

In total 2538 negative emotions were identified, mainly expressed as cues (95.0 %). Often cues were expressed as verbal hints to hidden concerns (33.2 %) or were related to cognitive or physical causes (28.3 %).Three-quarters of the negative emotions were elicited by patients. 2670 pharmacists' responses were coded. The most common response was non-explicit providing space (77.6 %) and the least common response was explicit reducing space (5.8 %).

CONCLUSION

Pharmacists are mainly non-explicitly providing space in their responses. While this hinders their ability to capture patients' problems it also may enable patients to initiate topics.

PRACTICE IMPLICATIONS

Pharmacists are able to respond to patients' negative emotions. Training should focus on developing pharmacist's skills to be more explicit in their responses to get more in-depth knowledge of patients' problems.

Educare : interactions soignantes à domicile. Un outil d’observation pour évaluer la centration sur la personne

Contexte : Cet article s’inscrit dans une étude longitudinale contrôlée à travers laquelle nous avons émis l’hypothèse selon laquelle une éducation thérapeutique centrée sur la personne donnait plus de satisfaction aux professionnels de la santé qu’une éducation thérapeutique biomédicale centrée sur la maladie ou le traitement. Pour tester l’hypothèse, nous avions besoin d’un outil d’observation des interactions soignantes à domicile. Objectifs : Construire et valider un nouvel outil d’observation des interactions soignantes à domicile. Méthodes : Nous nous sommes inspirés du Roter Interaction Analysis System (RIAS) initié par Debra Roter, pour élaborer cet outil dont nous avons ensuite testé la fidélité à travers l’analyse de sa concordance interne. Résultats : Nous avons observé 25 soignants, 72 patients et 223 soins. La fidélité varie entre un α de Cronbach de 0,23 à 0,81 en fonction des dimensions analysées, avec une moyenne de 0,58. L’analyse de la régression entre les réactions des clients et les interventions des soignants corrobore une certaine validité de construit. Discussion : Bien que partiellement fidèle, cet outil nous semble un instrument pertinent pour analyser les interactions des soignants centrés sur la personne dans le cadre des soins à domicile. Son contenu doit encore être amélioré afin d’augmenter sa fidélité. Conclusion : Cet outil contribue à la mise en évidence d’interactions soignantes réellement centrées sur la personne à domicile tout en identifiant les méthodes et les éléments qui les favorisent.