Abraham Joanna, Kannampallil Thomas, Brenner Corinne, Lopez Karen D, Almoosa Khalid F, Patel Bela, Patel Vimla L
Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States.
Department of Family Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.
J Biomed Inform. 2016 Feb;59:76-88. doi: 10.1016/j.jbi.2015.11.009. Epub 2015 Nov 26.
Effective communication during nurse handoffs is instrumental in ensuring safe and quality patient care. Much of the prior research on nurse handoffs has utilized retrospective methods such as interviews, surveys and questionnaires. While extremely useful, an in-depth understanding of the structure and content of conversations, and the inherent relationships within the content is paramount to designing effective nurse handoff interventions. In this paper, we present a methodological framework-Sequential Conversational Analysis (SCA)-a mixed-method approach that integrates qualitative conversational analysis with quantitative sequential pattern analysis. We describe the SCA approach and provide a detailed example as a proof of concept of its use for the analysis of nurse handoff communication in a medical intensive care unit. This novel approach allows us to characterize the conversational structure, clinical content, disruptions in the conversation, and the inherently phasic nature of nurse handoff communication. The characterization of communication patterns highlights the relationships underlying the verbal content of nurse handoffs with specific emphasis on: the interactive nature of conversation, relevance of role-based (incoming, outgoing) communication requirements, clinical content focus on critical patient-related events, and discussion of pending patient management tasks. We also discuss the applicability of the SCA approach as a method for providing in-depth understanding of the dynamics of communication in other settings and domains.
护士交接班期间的有效沟通对于确保患者获得安全且优质的护理至关重要。此前关于护士交接班的许多研究都采用了回顾性方法，如访谈、调查和问卷调查。虽然这些方法非常有用，但要深入理解对话的结构和内容以及内容中固有的关系，对于设计有效的护士交接班干预措施至关重要。在本文中，我们提出了一种方法框架——顺序对话分析（SCA），这是一种将定性对话分析与定量顺序模式分析相结合的混合方法。我们描述了SCA方法，并提供了一个详细示例，作为其用于分析医疗重症监护病房护士交接班沟通的概念验证。这种新颖的方法使我们能够描述对话结构、临床内容、对话中的干扰以及护士交接班沟通固有的阶段性特征。对沟通模式的描述突出了护士交接班言语内容背后的关系，特别强调：对话的互动性质、基于角色（ incoming, outgoing）的沟通要求的相关性、临床内容对关键患者相关事件的关注以及对未决患者管理任务的讨论。我们还讨论了SCA方法作为一种深入理解其他环境和领域沟通动态的方法的适用性。
