Supporting Persons With Dementia: Perspectives From Certified Nurse's Assistants

Background and Objectives

Many persons with Alzheimer's disease or related dementias (ADRD) receive care from paid staff in residential communities. The most common staff in these communities are certified nursing assistants (CNAs). Although CNAs have a high number of interactions with residents, and thus the possibility of engaging in social interactions, evidence suggests that they provide limited social support to persons with ADRD. Little is known about the attitudes of CNAs toward providing social support to persons with ADRD and their perception of components of quality social interactions with these individuals.

Research Design and Methods

We conducted a thematic analysis of semistructured interviews with 11 CNAs (91% female participants, mean age 23.6) to understand their perceptions about providing social support to persons with ADRD and the components of effective social interactions.

Results

Our results show that CNAs consider providing social support to be an important part of their role as CNAs. Additionally, participants emphasized the interplay of verbal communication, nonverbal communication, and internal beliefs and attitudes toward persons with ADRD in creating effective social interactions. Participants highlighted multiple barriers to providing residents with social support, including lack of time, lack of training, and the behavioral and psychological symptoms of dementia.

Discussion and Implications

We offer implications for expanding training for CNAs working with persons with dementia and improving policy based on our results.

Relationship between emotional intelligence and job well-being in Chinese Registered Nurses: Mediating effect of communication satisfaction

AIM

To explore the relationship between emotional intelligence and job well-being among Chinese Registered Nurses, and the mediating role of communication satisfaction in the relationship.

DESIGN

A descriptive cross-sectional study design was employed.

METHODS

Random sampling was adopted. The study was conducted from September to December 2019, and 1,475 Registered Nurses from a Chinese hospital provided responses to Wong and Law's emotional intelligence scale, communication satisfaction scale, job well-being scale and general information questionnaire. SPSS25.0 software was used to calculate means, standard deviations and correlations, and AMOS 21.0 software was used to establish the structural equation model.

RESULTS

The emotional intelligence, communication satisfaction and job well-being of Registered Nurses in China were related to positional rank, work department, monthly income, years of service, night shift work distribution and intensity of work. There were positive correlations among emotional intelligence, communication satisfaction and job well-being. Communication satisfaction partly mediated the relationship between emotional intelligence and job well-being. Improving the level of emotional intelligence and communication satisfaction should be an important strategy to improve nurses' job well-being. Therefore, nursing managers could carry out targeted training on emotional intelligence management and communication between nurses and patients and pay attention to the spiritual needs of nurses and provide psychological guidance on a regular basis.

Clinicians' accounts of communication with patients in end-of-life care contexts: A systematic review

OBJECTIVE

Communication between patients and end-of-life care providers requires sensitivity given the context and complexity involved. This systematic review uses a narrative approach to synthesise clinicians' understandings of communication in end-of-life care.

METHODS

A systematic, narrative synthesis approach was adopted given the heterogeneity across the 83 included studies. The review was registered prospectively on PROSPERO (ID: CRD42019125155). Medline was searched for all articles catalogued with the MeSH terms "palliative care," "terminal care" or "end-of-life care," and "communication". Articles were assessed for quality using a modified JQI-QARI tool.

RESULTS

The findings highlight the centrality and complexity of communication in end-of-life care. The challenges identified by clinicians in relation to such communication include the development of skills necessary, complexity of interpersonal interactions, and ways in which organisational factors impact upon communication. Clinicians are also aware of the need to develop strategies for interdisciplinary teams to improve communication.

CONCLUSION

Training needs for effective communication in end-of-life contexts are not currently being met.

PRACTICE IMPLICATIONS

Clinicians need more training to address the lack of skills to overcome interactional difficulties. Attention is also needed to address issues in the organisational contexts in which such communication occurs.

Palliative Care Nursing Communication: An Evaluation of the COMFORT Model

Despite the frequency, complexity, and intensity of communication that occurs between nurses, patients, and families, palliative care nurses often struggle with end-of-life communication. The primary goal of this quality improvement project was to increase nurse confidence and satisfaction engaging in end-of-life communication following the implementation of the COMFORT model; the secondary goal was to improve patient-family satisfaction with care provided in the palliative care unit. Fourteen palliative care nurses attended a 4-hour course to learn the tenets of the COMFORT model and practice through role-play exercises. A repeated-measures design was used to measure nurse confidence and satisfaction precourse, postcourse, and 3 months postcourse. A between-subjects pre-post design was used to compare family satisfaction survey scores in the 3-month period before versus the 3 months after implementation. Analysis revealed a statistically significant increase in all measures of nurse confidence and satisfaction from precourse to postcourse and from precourse to 3 months postcourse. There was no statistical difference between the family satisfaction survey scores before versus after training, although survey results were generally high at baseline and most respondents rated palliative services with the best possible response. This project demonstrates that COMFORT model training increased confidence and satisfaction of palliative care nurses engaged in end-of-life communication and demonstrates potential for use in other clinical areas that do not specialize in end-of-life nursing (eg, critical care) but find themselves in need of the communications skills to address end-of-life care.

Compassionate communication in acute healthcare: establishing the face and content validity of a questionnaire

The National Health Service is committed to measuring the quality of nursing care through adopting a number of indicators which are not nationally standardised. Compassionate communication is one indicator, but it is unclear how this is assessed or demonstrated in practice. This is primarily a methodological paper which aims to establish the face and content validity of a questionnaire to measure nurses’ non-verbal methods of compassionate communication with patients in acute healthcare. An existing questionnaire was amended to meet the study’s requirements. A ‘lay expert sample’ was used to rate the face validity and a ‘research expert sample’ to rate the content validity of the instrument. Modification of one response and adding instructions on how to complete the questionnaire meant that Version 2 potentially has high face validity. The questionnaire demonstrated excellent content validity (Scale-Content Validity Index = 0.85). Recommendations include pilot testing to further investigate the construct of non-verbal compassionate communication in an acute healthcare context. This research can be used to inform the measurement of compassionate communication and promote standardisation nationally.

Enhancing person-centred care through the development of a therapeutic relationship

More than ever, district nurses require highly developed communication and interpersonal skills to enable and nurture a therapeutic relationship. The 'shift left'-whereby patients are being assessed and cared for in the community at a much earlier stage of their illness or recovery-has significant implications. The complexity of patient care and the need for collaborative working and shared decision making necessitates a focus on fostering person-centred care and improving the patient experience in practice. District nurses are adept communicators with a specialist body of knowledge and skills. In Northern Ireland, the single assessment tool (NISAT) is used by health professionals and follows a person-centred framework. This case study reflects on the assessment process used by a district nursing student in clinical practice and demonstrates how a therapeutic relationship is developed, thereby supporting person centredness.

Novice Nurses’ Experiences With Palliative and End-of-Life Communication

Health care providers recognize that delivery of effective communication with family members of children with life-threatening illnesses is essential to palliative and end-of-life care (PC/EOL). Parents value the presence of nurses during PC/EOL of their dying child. It is vital that nurses, regardless of their years of work experience, are competent and feel comfortable engaging family members of dying children in PC/EOL discussions. This qualitative-descriptive study used focus groups to explore the PC/EOL communication perspectives of 14 novice pediatric oncology nurses (eg, with less than 1 year of experience). Audio-taped focus group discussions were reviewed to develop the following 6 theme categories: ( a) Sacred Trust to Care for the Child and Family, ( b) An Elephant in the Room, ( c) Struggling with Emotional Unknowns, ( d) Kaleidoscope of Death: Patterns and Complexity, ( e) Training Wheels for Connectedness: Critical Mentors during PC/EOL of Children, and ( f) Being Present with an Open Heart: Ways to Maintain Hope and Minimize Emotional Distress. To date, this is the first study to focus on PC/EOL communication perspectives of novice pediatric oncology nurses.