McMaster University, School of Nursing, HSC 3N28H, 1280 Main St. W., Hamilton, ON L8S 4K1, Canada.
University of British Columbia, Nursing, Centre for Health Services and Policy Research & BC Centre for Palliative Care, T275 - 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
Appl Nurs Res. 2018 Apr;40:26-33. doi: 10.1016/j.apnr.2017.12.014. Epub 2017 Dec 18.
Nurses in acute medical units are uniquely positioned to support goals of care communication. Further understanding of nurse and physician perceptions about hospital nurses' actual and possible roles was required to improve goals of care communication.
To critically examine nurse and physician perceptions of the nurse's role in communication with seriously ill patients and their families.
We focus on the qualitative component of a mixed method study. We employed an interpretive descriptive approach informed by Flanagan's critical incident technique.
Participants were recruited from the acute medical units at three tertiary care hospitals in three Canadian provinces.
Thirty participants provided interviews (10 from each site): 12 nurses, 9 staff physicians and 9 medical resident physicians.
Participants' described "critical incidents" they considered as "excellent" or "poor" or "usual" practice. Interviews, were audiotaped and transcribed. Team-based analysis used constant comparison and triangulation to identify healthcare team members' roles in goals of care communication.
We identified two major themes from 120 critical incidents: 1) the ambiguous nature of the nurse's role in formal, physician-led, decision-making communication, and 2) embedded in care serious illness communication. Physicians understood nurses' supportive role in relation to their own communication practices that culminated in decisions about care; nurses' reported their roles were determined by unit routines, physician practices and preferences, and their self-confidence in supporting decision-making. Nurses described their unique role in facilitating informal and spontaneous communication with patients and families that was critical background work to physician-led goals of care communication.
Nurses and physicians had different understandings, practices and beliefs about goals of care communication The value of nurses embedded in care work is key to supporting the interprofessional team's work during formal goals of care communication.
急症医学科的护士在支持治疗目标沟通方面具有独特的地位。为了改善治疗目标沟通，需要进一步了解护士和医生对医院护士实际和可能角色的看法。
批判性地审视护士和医生对护士在与重病患者及其家属沟通中的角色的看法。
我们专注于混合方法研究的定性部分。我们采用了由 Flanagan 的关键事件技术提供信息的解释性描述方法。
参与者是从加拿大三个省的三家三级保健医院的急症医学科招募的。
30 名参与者提供了访谈（每个地点 10 名）：12 名护士、9 名工作人员医生和 9 名住院医生。
参与者描述了他们认为是“优秀”、“差”或“通常”实践的“关键事件”。访谈被录音并转录。基于团队的分析使用恒定比较和三角测量来确定医疗保健团队成员在治疗目标沟通中的角色。
我们从 120 个关键事件中确定了两个主要主题：1）护士在正式的、以医生为主导的决策沟通中的角色具有模糊性，2）嵌入在关怀重病患者的沟通中。医生理解护士在与他们自己的沟通实践相关的支持性角色，这些实践最终决定了护理决策；护士报告说，他们的角色取决于单位常规、医生的实践和偏好，以及他们在支持决策方面的自信。护士描述了他们在促进与患者和家属进行非正式和自发沟通方面的独特角色，这是医生主导的治疗目标沟通的关键背景工作。
护士和医生对治疗目标沟通有不同的理解、实践和信念。护士在护理工作中的价值是支持正式治疗目标沟通期间跨专业团队工作的关键。
