Bunyan M, Crowley J, Smedley N, Mutti M-F, Cashen A, Thompson T, Foster J
Oxleas NHS Foundation Trust, Dartford, UK.
Faculty of Education and Health, University of Greenwich, London, UK.
J Psychiatr Ment Health Nurs. 2017 May;24(4):221-231. doi: 10.1111/jpm.12382.
WHAT IS KNOWN ON THE SUBJECT?: Recently, concerns have been raised about how well United Kingdom National Health Service nurses care for their patients and their level of compassion. Motivational interviewing (MI) is an established approach to helping people make positive behaviour changes, through directive, person-centred counselling within a collaborative relationship between clinician and recipient. Based on evidence that MI may influence nursing practice positively, an investigation into the feasibility of training nurses on mental health inpatient rehabilitation wards ('rehabilitation') in MI to improve patient experience was reported. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This pilot study demonstrates that training rehabilitation nurses in MI is feasible and provides preliminary evidence suggesting that a larger study to examine efficacy is warranted, including a calculation of sample size required to draw robust statistical conclusions. Nurses evaluated the training as highly relevant to their work. Patients responded well to interviews and focus groups with support from experts-by-experience; they were generally fairly satisfied with the rehabilitation ward and slight improvements in their experience were found following MI training for nurses but not at 6-month follow-up. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Rehabilitation nurses may face conflicting demands between ensuring patients with severe difficulties meet their basic needs and working with them to develop greater independence. Qualitative findings question whether nurse-patient interactions are fully valued as nursing interventions in inpatient rehabilitation. Learning MI might be a useful way of helping nurses think in detail about their interactions with patients and how to improve communications with their patients. The principles of MI should be incorporated into pre-registration training.
Introduction There is limited research addressing the experiences of patients in inpatient rehabilitation (rehabilitation), who often spend long periods in hospital, and the nursing approaches utilized. Aim Based on evidence that motivational interviewing (MI) may improve nursing practice, this was a pilot study evaluating the feasibility of training rehabilitation nurses in MI and measuring patient experience. Method Nurses underwent training and supervision focusing on MI spirit. Quantitative and qualitative measures were taken pretraining, 2 months post-training and 8 months post-training. Expert-by-experience research assistants facilitated patients' participation in the study. Results This study showed that training rehabilitation nurses in MI was feasible and relevant to their work. Patients participated in interviews and focus groups with support and potential improvements that require further empirical investigation in patient experience were found following the MI training. Discussion This pilot study establishes the feasibility of a larger study addressing efficacy. Tentative qualitative findings question whether interactions between nurses and patients are valued in rehabilitation and support MI as a promising skill set for rehabilitation nurses. Implications for practice Bringing MI into inpatient rehabilitation provoked reflection on nursing practice. Dilemmas for nurses about balancing safety with promoting autonomy and communicating constructively with patients emerged as important.
关于该主题已知的信息有哪些？最近，人们对英国国民医疗服务体系护士照顾患者的情况及其同情心水平提出了担忧。动机性访谈（MI）是一种既定的方法，通过临床医生与接受者之间的合作关系，采用指导性的、以患者为中心的咨询方式，帮助人们做出积极的行为改变。基于MI可能对护理实践产生积极影响的证据，有报告对在心理健康住院康复病房（“康复病房”）培训护士掌握MI以改善患者体验的可行性进行了调查。
这项试点研究表明，对康复护士进行MI培训是可行的，并提供了初步证据，表明有必要进行一项更大规模的研究来检验其效果，包括计算得出有力统计结论所需的样本量。护士们认为该培训与他们的工作高度相关。在有经验的专家的支持下，患者对访谈和焦点小组的反馈良好；他们总体上对康复病房相当满意，并且在护士接受MI培训后，患者体验有了轻微改善，但在6个月的随访中未发现进一步改善。
康复护士可能在确保严重困难患者满足其基本需求与帮助他们实现更大程度的独立之间面临相互冲突的要求。定性研究结果质疑在住院康复中，护患互动作为一种护理干预措施是否得到充分重视。学习MI可能是帮助护士详细思考他们与患者的互动以及如何改善与患者沟通的一种有用方法。MI的原则应纳入预注册培训。
引言 针对住院康复患者（康复病房）的经历以及所采用的护理方法的研究有限，这些患者通常在医院停留较长时间。目的 基于动机性访谈（MI）可能改善护理实践的证据，这是一项试点研究，评估对康复护士进行MI培训的可行性并衡量患者体验。方法 护士接受以MI精神为重点的培训和监督。在培训前、培训后2个月和培训后8个月进行定量和定性测量。有经验的专家研究助理协助患者参与研究。结果 本研究表明，对康复护士进行MI培训是可行的且与他们的工作相关。患者在支持下参与了访谈和焦点小组，并发现MI培训后患者体验有潜在改善，需要进一步进行实证研究。讨论 这项试点研究确定了进行一项更大规模的疗效研究的可行性。初步定性研究结果质疑在康复中护士与患者之间的互动是否得到重视，并支持MI作为康复护士一项有前景的技能组合。对实践的启示 将MI引入住院康复引发了对护理实践的反思。护士在平衡安全与促进自主性以及与患者进行建设性沟通方面面临的困境成为重要问题。
