Majerovitz S Deborah, Mollott Richard J, Rudder Cynthia
Department of Behavioral Sciences, York College, City University of New York, New York, NY 11451, USA.
Health Commun. 2009 Jan;24(1):12-20. doi: 10.1080/10410230802606950.
Good communication between families and care providers is central to quality care, providing valuable insight into medical history and preferences, increasing family involvement and satisfaction, and reducing complaints. Two studies offer insight into sources of family-staff miscommunication and conflict. The Nursing Home Family Study (Study 1) interviewed 103 family caregivers to nursing home residents. The Long Term Care Community Coalition (Study 2) conducted focus groups and surveys with staff in six facilities: 323 certified nurse's assistants, 52 licensed practical nurses, and 71 registered nurses. Qualitative and quantitative data from both studies identified multiple barriers to good communication associated with both nursing homes and family caregivers. Institutional barriers include understaffing, turnover, inadequate training, policies based in a medical model, rigid routines, poor intrastaff communication, and work schedules that do not coincide with family visits. Psychosocial factors that hinder family communication include guilt, role confusion, clashes of culture and values, unrealistic expectations, and conflicting responsibilities. Specific communication problems identified by families were: making them feel guilty, criticism of their involvement, lack of information, changes made without consultation, staff have too little time to talk, high turnover, rotating shifts, and poor intrastaff communication. Similar issues were raised by nursing staff, who valued trusting, respectful relationships with supervisors and families, being consulted prior to changes, support in addressing racist or abusive comments, adequate staffing, and teamwork. Certified nursing assistants noted that family members are quick to complain but seldom offer praise, and that their intimate knowledge of the resident is rarely acknowledged. These data are applied to develop educational interventions to improve family-staff communication.
家庭与护理提供者之间的良好沟通是优质护理的核心，它能提供有关病史和偏好的宝贵见解，增加家庭参与度和满意度，并减少投诉。两项研究深入探讨了家庭与工作人员之间沟通不畅和冲突的根源。养老院家庭研究（研究1）采访了103位养老院居民的家庭护理人员。长期护理社区联盟（研究2）对六个机构的工作人员进行了焦点小组讨论和调查：323名注册护士助理、52名执业护士和71名注册护士。两项研究的定性和定量数据都确定了与养老院和家庭护理人员相关的良好沟通的多重障碍。机构障碍包括人员不足、人员流动、培训不足、基于医疗模式的政策、僵化的日常安排、工作人员内部沟通不畅以及与家庭探访时间不一致的工作时间表。阻碍家庭沟通的社会心理因素包括内疚、角色混乱、文化和价值观冲突、不切实际的期望以及相互冲突的责任。家庭指出的具体沟通问题有：让他们感到内疚、对他们的参与进行批评、缺乏信息、未经协商就做出改变、工作人员交谈时间太少、人员流动率高、轮班制以及工作人员内部沟通不畅。护理人员也提出了类似问题，他们重视与主管和家庭建立信任、尊重的关系，在做出改变之前得到咨询，在处理种族主义或辱骂性言论方面得到支持，充足的人员配备以及团队合作。注册护士助理指出，家庭成员很快就会抱怨，但很少给予赞扬，而且他们对居民的深入了解很少得到认可。这些数据被用于制定教育干预措施，以改善家庭与工作人员之间的沟通。
