School of Nursing and Midwifery, The University of Newcastle, Member of the University of Newcastle Centre for Evidence Based Healthcare Informing Research (CEBHIR): A Joanna Briggs Institute Centre of Excellence, University Drive, Callaghan, NSW, 2308, Australia.
Faculty of Health, University of Technology Sydney, 235 Jones St, Ultimo, NSW, 2007, Australia.
Int J Nurs Stud. 2017 Nov;76:120-128. doi: 10.1016/j.ijnurstu.2017.09.001. Epub 2017 Sep 5.
Communication errors have a negative impact on patient safety. It is therefore essential that healthcare professionals have the skills and confidence to speak up assertively when patient safety is at risk. Although the facilitators to and barriers of assertive communication have been the subject of previous reviews, evidence regarding the effectiveness of interventions designed to enhance assertive communication is lacking. Thus, this paper reports the findings from a systematic review of the effectiveness of assertiveness communication training programs for healthcare professionals and students.
The objective of this review is to identify, appraise and synthesise the best available quantitative evidence in relation to the effectiveness of assertiveness communication training programs for healthcare professionals and students on levels of assertiveness, communication competence and impact on clinicians' behaviours and patient safety.
The databases included: CINAHL, Cochrane library, EMBASE, Informit health collection, MEDLINE, ProQuest nursing and allied health, PsycINFO, Scopus and Web of Science. The search for unpublished studies included: MedNar, ProQuest Dissertations & Theses A&I. Studies published in English from 2001 until 2016 inclusive were considered.
The review included original quantitative research that evaluated (a) any type of independent assertiveness communication training program; and (b) programs with assertiveness training included as a core component of team skills or communication training for healthcare professionals and students, regardless of healthcare setting and level of qualification of participants.
Studies selected based on eligibility criteria were assessed for methodological quality and the data were extracted by two independent researchers using the Joanna Briggs Institute critical appraisal and data extraction tools.
Eleven papers were critically appraised using the Joanna Briggs Institute critical appraisal checklists. Eight papers from the USA, Australia, Ireland, and Taiwan were included in the review.
Interventions to improve assertive communication were reported to be effective to some degree with all targeted groups except experienced anaesthesiologists. Face-to-face and multimethod programs, support from leaders, teamwork skills training and communication techniques adapted from the aviation industry were identified as appropriate approaches for optimising the effectiveness of assertiveness communication training programs. Behavioural change as the result of assertiveness interventions was evaluated by observer-based rating scales during simulation, whilst self-perceived knowledge and attitudes were evaluated using validated scales. Future research should consider evaluation of sustained effect on behaviour change and patient safety.
沟通错误会对患者安全产生负面影响。因此，医疗保健专业人员必须具备在患者安全受到威胁时自信地表达意见的技能和信心。尽管之前的综述已经探讨了促进自信沟通的促进因素和障碍，但缺乏旨在增强自信沟通的干预措施的有效性证据。因此，本文报告了对医疗保健专业人员和学生的自信沟通培训计划的有效性进行系统评价的结果。
本综述的目的是确定、评估和综合与医疗保健专业人员和学生的自信沟通培训计划在自信水平、沟通能力以及对临床医生行为和患者安全的影响方面的最佳现有定量证据。
包括以下数据库：CINAHL、Cochrane 图书馆、EMBASE、Informit 健康收藏、MEDLINE、ProQuest 护理和联合健康、PsycINFO、Scopus 和 Web of Science。对未发表研究的搜索包括：MedNar、ProQuest 论文与专题 A&I。考虑了 2001 年至 2016 年期间发表的英语研究。
综述纳入了原始定量研究，评估了 (a) 任何类型的独立自信沟通培训计划；以及 (b) 将自信培训作为医疗保健专业人员和学生团队技能或沟通培训的核心组成部分的计划，无论医疗保健环境和参与者的资格水平如何。
根据入选标准选择的研究进行了方法学质量评估，两名独立研究人员使用 Joanna Briggs 研究所的批判性评估和数据提取工具提取数据。
使用 Joanna Briggs 研究所的批判性评估清单对 11 篇论文进行了批判性评估。综述纳入了来自美国、澳大利亚、爱尔兰和中国台湾的 8 篇论文。
除了经验丰富的麻醉师外，所有目标群体都报告称，改善自信沟通的干预措施在某种程度上是有效的。面对面和多方法的计划、领导的支持、团队技能培训和从航空业借鉴的沟通技巧被确定为优化自信沟通培训计划有效性的适当方法。在模拟过程中，观察者基于行为的评分量表评估自信干预的行为变化，而自我感知的知识和态度则使用经过验证的量表进行评估。未来的研究应考虑对行为改变和患者安全的持续影响进行评估。
