Uitterhoeve Ruud, De Leeuw Jacqueline, Bensing Jozien, Heaven Cathy, Borm George, DeMulder Pieter, Van Achterberg Theo
Ruud Uitterhoeve MScN RN Researcher Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJacqueline de Leeuw MScN RN Researcher Neurosensoric Cluster, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJozien Bensing PhD Professor of Clinical and Health Psychology Department of Health Psychology, Utrecht University and Netherlands Institute for Health Services Research, Utrecht, The NetherlandsCathy Heaven PhD RN Researcher and Communication Skills Tutor Maguire Communication Skills Training Unit, Christie Hospital, Manchester, UKGeorge Borm PhD Associate Professor in Statistics Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsPieter deMulder (deceased) MD PhD Professor Medical Oncology Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsTheo van Achterberg PhD RN Professor Nursing Science Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Adv Nurs. 2008 Jan;61(1):71-80. doi: 10.1111/j.1365-2648.2007.04467.x. Epub 2007 Nov 22.
This paper is a report of a study to describe nurse-patient interactions, i.e. nurses' cue-responding behaviour in encounters with actors playing the role of patients.
Patients with cancer seldom express their concerns directly but express cues instead. Few studies empirically investigated nurses' cue-responding behaviour and the subsequent influence of disclosure of cues and concerns.
In this descriptive observational study, conducted from April to June 2004, five oncology nurses interviewed an actor playing the role of a patient with cancer. Each nurse performed seven different interviews (n = 35); these were videotaped and subsequently rated for cue-responding using the Medical Interview Aural Rating Scale. Mixed model analysis was used to investigate the relation between cues and cue-responding.
Half of the patients' cues were responded to with distancing behaviours. The other half of the cues were either explored (33%) or acknowledged (17%). In 16% of these responses, nurses used open directive questions. One out of four open directive questions were used as a distancing response, suggesting that open directive questions are not used to explore or acknowledge cues of patients. Cue-responding influenced subsequent expression of concerns and emotions, i.e. disclosure of a concern is two times higher after exploration or acknowledging of a preceding cue than after a distancing response.
Cue-responding is a valuable concept which can contribute to our understanding of optimal ways of communicating. Cue-responding behaviour facilitates the disclosure of worries and concerns of patients. Further research is needed to assess the clinical relevancy of cue-responding.
本文报告一项旨在描述护士与患者互动情况的研究，即护士在与扮演患者角色的演员交流时对线索的反应行为。
癌症患者很少直接表达他们的担忧，而是给出线索。很少有研究实证调查护士对线索的反应行为以及线索和担忧披露后的后续影响。
在这项于2004年4月至6月进行的描述性观察研究中，五名肿瘤护理人员对一名扮演癌症患者的演员进行了访谈。每位护理人员进行了七次不同的访谈（n = 35）；这些访谈被录像，随后使用医学访谈听觉评定量表对线索反应进行评分。采用混合模型分析来研究线索与线索反应之间的关系。
患者一半的线索得到的回应是保持距离的行为。另一半线索要么被探究（33%），要么被认可（17%）。在这些回应中，16%的情况下护士使用了开放式指导性问题。四分之一的开放式指导性问题被用作保持距离的回应，这表明开放式指导性问题并非用于探究或认可患者的线索。线索反应影响了后续担忧和情绪的表达，即与保持距离的回应相比，在前一个线索被探究或认可后，担忧的披露要高出两倍。
线索反应是一个有价值的概念，有助于我们理解最佳的沟通方式。线索反应行为有助于患者披露担忧。需要进一步研究以评估线索反应的临床相关性。
