多层面干预对重症监护病房护患沟通的影响：SPEACS 试验结果。
Effect of a multi-level intervention on nurse-patient communication in the intensive care unit: results of the SPEACS trial.
机构信息
University of Pittsburgh School of Nursing, Pittsburgh, PA, USA; University of Pittsburgh Department of Critical Care Medicine, Pittsburgh, PA, USA; The Ohio State University College of Nursing.
Alternative Communication, LLC.
出版信息
Heart Lung. 2014 Mar-Apr;43(2):89-98. doi: 10.1016/j.hrtlng.2013.11.010. Epub 2014 Feb 1.
OBJECTIVE
To test the impact of two levels of intervention on communication frequency, quality, success, and ease between nurses and intubated intensive care unit (ICU) patients.
DESIGN
Quasi-experimental, 3-phase sequential cohort study: (1) usual care, (2) basic communication skills training (BCST) for nurses, (3) additional training in augmentative and alternative communication devices and speech language pathologist consultation (AAC + SLP). Trained observers rated four 3-min video-recordings for each nurse-patient dyad for communication frequency, quality and success. Patients self-rated communication ease.
SETTING
Two ICUs in a university-affiliated medical center.
PARTICIPANTS
89 intubated patients awake, responsive and unable to speak and 30 ICU nurses.
MAIN RESULTS
Communication frequency (mean number of communication acts within a communication exchange) and positive nurse communication behaviors increased significantly in one ICU only. Percentage of successful communication exchanges about pain were greater for the two intervention groups than the usual care/control group across both ICUs (p = .03) with more successful sessions about pain and other symptoms in the AAC + SLP group (p = .07). Patients in the AAC + SLP intervention group used significantly more AAC methods (p = .002) and rated communication at high difficulty less often (p < .01).
CONCLUSIONS
This study provides support for the feasibility, utility and efficacy of a multi-level communication skills training, materials and SLP consultation intervention in the ICU.
目的
测试两种干预水平对护士与气管插管重症监护病房（ICU）患者之间沟通频率、质量、成功率和舒适度的影响。
设计
准实验、3 阶段顺序队列研究：（1）常规护理，（2）护士基本沟通技巧培训（BCST），（3）辅助和替代沟通设备以及言语语言病理学家咨询（AAC+SLP）的额外培训。经过培训的观察员为每对护士-患者对进行了 4 次 3 分钟的视频记录，以评估沟通频率、质量和成功率。患者自我评估沟通的舒适度。
设置
一所大学附属医院的 2 个 ICU。
参与者
89 名清醒、有反应且无法说话的气管插管患者和 30 名 ICU 护士。
主要结果
仅在一个 ICU 中，沟通频率（每次沟通交流中的沟通行为平均数）和积极的护士沟通行为显著增加。在两个 ICU 中，与常规护理/对照组相比，两个干预组关于疼痛的沟通成功率更高（p=0.03），AAC+SLP 组关于疼痛和其他症状的成功沟通次数更多（p=0.07）。接受 AAC+SLP 干预组的患者明显更多地使用 AAC 方法（p=0.002），并更少地将沟通评为高难度（p<0.01）。
结论
本研究为 ICU 中多层次沟通技巧培训、材料和 SLP 咨询干预的可行性、实用性和有效性提供了支持。
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