Kannampallil Thomas, Abraham Joanna
Department of Anesthesiology & Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
J Am Med Inform Assoc. 2020 Mar 6;3(1):87-93. doi: 10.1093/jamiaopen/ooz069.
To characterize interactivity during resident and nurse handoffs by investigating listening and question-asking behaviors during conversations.
Resident (n = 149) and nurse (n = 126) handoffs in an inpatient medicine unit were audio-recorded. Handoffs were coded based on listening behaviors (active and passive), question types (patient status, coordination of care, clinical reasoning, and framing and alignment), and question responses. Comparisons between residents and nurses for listening and question-asking behaviors were performed using the Wilcoxon rank-sum tests. A Poisson regression model was used to investigate differences in the question-asking behaviors between residents and nurses, and the association between listening and question-asking behaviors.
There were no significant differences between residents and nurses in their active (18% resident vs 39% nurse handoffs) or passive (88% resident vs 81% nurse handoffs) listening behaviors. Question-asking was common in resident and nurse handoffs (87% vs 98%) and focused primarily on patient status, co-ordination, and framing and alignment. Nurses asked significantly more questions than residents (Mresident = 2.06 and Mnurse = 5.52) by a factor of 1.76 (P < 0.001). Unit increase in listening behaviors was associated with an increase in the number of questions during resident and nurse handoffs by 7% and 12%, respectively.
As suggested by the Joint Commission, question-asking behaviors were common across resident and nurse handoffs, playing a critical role in supporting resilience in communication and collaborative cross-checks during conversations. The role of listening in initiating question-asking behaviors is discussed.
通过调查对话中的倾听和提问行为来描述住院医师与护士交接班期间的互动情况。
对内科住院部的住院医师（n = 149）和护士（n = 126）交接班过程进行录音。根据倾听行为（主动和被动）、问题类型（患者状态、护理协调、临床推理以及框架与协调）和问题回答对交接班进行编码。使用Wilcoxon秩和检验对住院医师和护士在倾听和提问行为方面进行比较。采用泊松回归模型研究住院医师和护士在提问行为上的差异以及倾听和提问行为之间的关联。
住院医师和护士在主动倾听行为（住院医师为18%，护士为39%）或被动倾听行为（住院医师为88%，护士为81%）方面无显著差异。提问在住院医师和护士交接班中很常见（分别为87%和98%），主要集中在患者状态、协调以及框架与协调方面。护士提问明显多于住院医师（住院医师平均为2.06个，护士平均为5.52个），多出1.76倍（P < 0.001）。倾听行为每增加一个单位，住院医师和护士交接班期间的问题数量分别增加7%和12%。
正如联合委员会所建议的，提问行为在住院医师和护士交接班中很常见，在支持对话中的沟通弹性和协作交叉核对方面发挥着关键作用。文中讨论了倾听在引发提问行为中的作用。
