初级卫生保健中的执业护士会诊：社会互动与会诊结果的观察性互动分析
Nurse practitioner consultations in primary health care: an observational interaction analysis of social interactions and consultation outcomes.
作者信息
Barratt Julian, Thomas Nicola
机构信息
Head of Community Nursing and Workforce Development, Institute of Health, University of Wolverhampton, Wolverhampton, UK.
Professor of Kidney Care, School of Health and Social Care, London South Bank University, London, UK.
出版信息
Prim Health Care Res Dev. 2018 Jul 6;20:e37. doi: 10.1017/S1463423618000427.
OBJECTIVE
To determine the discrete nature of social interactions occurring in nurse practitioner consultations and investigate the relationship between consultation social interaction styles (biomedical and patient-centred) and the outcomes of patient satisfaction, patient enablement, and consultation time lengths.
METHODS
A case study-based observational interaction analysis of verbal social interactions, arising from 30 primary health care nurse practitioner consultations, linked with questionnaire measures of patient satisfaction and enablement.
RESULTS
A significant majority of observed social interactions used patient-centred communication styles (P=0.005), with neither nurse practitioners nor patients or carers being significantly more verbally dominant. Nurse practitioners guided the sequence of consultation interaction sequences, but patients actively participated through interactions such as asking questions. Usage of either patient-centred or biomedical interaction styles were not significantly associated with increased levels of patient satisfaction or patient enablement. The median consultation time length of 10.1 min (quartiles 8.2, 13.7) was not significantly extended by high levels of patient-centred interactions being used in the observed consultations.
CONCLUSION
High usage levels of patient-centred interaction styles are not necessarily contingent upon having longer consultation times available, and clinicians can encourage patients to use participatory interactions, whilst still then retaining overall guidance of the phased sequences of consultations, and not concurrently extending consultation time lengths. This study adds to the body of nurse practitioner consultation communication research by providing a more detailed understanding of the nature of social interactions occurring in nurse practitioner consultations, linked to the outcomes of patient satisfaction and enablement.
目的
确定执业护士会诊中发生的社交互动的离散性质，并调查会诊社交互动方式（生物医学式和以患者为中心式）与患者满意度、患者赋能及会诊时长结果之间的关系。
方法
基于案例研究的言语社交互动观察性分析，该分析源于30次初级卫生保健执业护士会诊，并与患者满意度和赋能的问卷调查测量结果相关联。
结果
绝大多数观察到的社交互动采用以患者为中心的沟通方式（P = 0.005），执业护士、患者或护理人员在言语上均未表现出明显的主导性。执业护士引导会诊互动顺序，但患者通过提问等互动积极参与。采用以患者为中心或生物医学互动方式与患者满意度或患者赋能水平的提高均无显著关联。观察到的会诊中，高水平的以患者为中心的互动并未显著延长会诊时长中位数10.1分钟（四分位数间距8.2，13.7）。
结论
高水平地采用以患者为中心的互动方式不一定取决于有更长的会诊时间，临床医生可以鼓励患者进行参与性互动，同时仍保留对会诊各阶段顺序的总体引导，且不会同时延长会诊时长。本研究通过更详细地了解执业护士会诊中发生的社交互动的性质，以及与患者满意度和赋能结果的关联，为执业护士会诊沟通研究增添了内容。
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