Gould Lisa Jane, Griffiths Peter, Barker Hannah Ruth, Libberton Paula, Mesa-Eguiagaray Ines, Pickering Ruth M, Shipway Lisa Jane, Bridges Jackie
Faculty of Health Sciences, University of Southampton, Southampton, UK.
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, Southampton, UK.
BMJ Open. 2018 Feb 22;8(2):e018563. doi: 10.1136/bmjopen-2017-018563.
Compassionate care continues to be a focus for national and international attention, but the existing evidence base lacks the experimental methodology necessary to guide the selection of effective interventions for practice. This study aimed to evaluate the Creating Learning Environments for Compassionate Care (CLECC) intervention in improving compassionate care.
Ward nursing teams (clusters) in two English National Health Service hospitals randomised to intervention (n=4) or control (n=2). Intervention wards comprised two medicines for older people (MOPs) wards and two medical/surgical wards. Control wards were both MOPs.
Data collected from 627 patients and 178 staff.
reverse barrier nursed, critically ill, palliative or non-English speaking. All other patients and all nursing staff and Health Care Assistant HCAs were invited to participant, agency and bank staff were excluded.
CLECC, a workplace intervention focused on developing sustainable leadership and work-team practices to support the delivery of compassionate care.
No educational activity.
Primary-Quality of Interaction Schedule (QuIS) for observed staff-patient interactions. Secondary-patient-reported evaluations of emotional care in hospital (PEECH); nurse-reported empathy (Jefferson Scale of Empathy).
Trial proceeded as per protocol, randomisation was acceptable. Some but not all blinding strategies were successful. QuIS observations achieved 93% recruitment rate with 25% of patient sample cognitively impaired. At follow-up there were more total positive (78% vs 74%) and less total negative (8% vs 11%) QuIS ratings for intervention wards versus control wards. Sixty-three per cent of intervention ward patients scored lowest (ie, more negative) scores on PEECH connection subscale, versus 79% of control. This was not a statistically significant difference. No statistically significant differences in nursing empathy were observed.
Use of experimental methods is feasible. The use of structured observation of staff-patient interaction quality is a promising outcome measure inclusive of hard to reach groups.
ISRCTN16789770.
人文关怀一直是国内外关注的焦点,但现有的证据基础缺乏指导实践中有效干预措施选择所需的实验方法。本研究旨在评估创建人文关怀学习环境(CLECC)干预措施对改善人文关怀的效果。
英国两家国民健康服务医院的病房护理团队(群组)被随机分为干预组(n = 4)或对照组(n = 2)。干预病房包括两个老年用药病房和两个内科/外科病房。对照病房均为老年用药病房。
收集了627名患者和178名工作人员的数据。
反向屏障护理、重症、姑息治疗或非英语使用者。邀请了所有其他患者以及所有护理人员和医疗保健助理(HCA)参与,排除了代理和银行工作人员。
CLECC,一种工作场所干预措施,重点是培养可持续领导力和工作团队实践,以支持人文关怀的提供。
无教育活动。
主要指标——观察到的医护人员与患者互动的互动质量量表(QuIS)。次要指标——患者报告的医院情感护理评估(PEECH);护士报告的同理心(杰斐逊同理心量表)。
试验按方案进行,随机分组可接受。部分但并非所有的盲法策略成功。QuIS观察的招募率达到93%,患者样本中有25%存在认知障碍。随访时,干预病房的QuIS总积极评分(78%对74%)更多,总消极评分(8%对11%)更少。63%的干预病房患者在PEECH联系子量表上得分最低(即更消极),而对照病房为79%。这不是统计学上的显著差异。未观察到护理同理心方面的统计学显著差异。
使用实验方法是可行的。对医护人员与患者互动质量进行结构化观察是一种有前景的结局指标,包括难以接触到的群体。
ISRCTN16789770。