Höglander Jessica, Eklund Jakob Håkansson, Spreeuwenberg Peter, Eide Hilde, Sundler Annelie J, Roter Debra, Holmström Inger K
School of Health, Care and Social Welfare, Mälardalen University, SE-721 23 Västerås, Sweden.
NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands.
BMC Nurs. 2020 Sep 29;19:91. doi: 10.1186/s12912-020-00483-1. eCollection 2020.
Communication is a cornerstone in nursing and aims at both information exchange and relationship building. To date, little is known about the naturally occurring communication between older persons and nurses in home care. Communication might heal through different pathways and a patient- or person-centered communication could be important for health and well-being of older persons. However, the delivery of individualized home care is challenged by routines and organizational demands such as time constraints. Therefore, the aim of this study was to explore the patient-centered aspects of home care communication between older persons and registered nurses.
In total 37 older persons (aged 65 years or older) and eleven RNs participated in 50 audio-recorded home care visits. Roter Interaction Analysis System (RIAS) was used to code verbal communication. A ratio from these codes, establishing the degree of patient-centeredness, was analyzed using a Generalized Linear Mixed Model.
The present home care communication contained more socio-emotional than task-oriented communication and the emotional tone was largely positive. The global affect ratings reflected an overall positive tone ( = 39.88, = 7.65), with higher ratings on dimensions of, for example, responsiveness/engagement and interactivity or interest were more frequent than those that may be considered as less-positive emotions ( = 15.56, = 3.91), e.g. hurried, dominance or anger. The ratio of the degree of patient-centered communication in the home care visits was an average of 1.53, revealing that the communication could be considered as patient-centered. The length of the visits was the only characteristic significantly associated with the degree of patient-centeredness in the communication, with a peak in patient-centeredness in visits 8-9 min long. Sex, age or procedural focus showed no significant effects on the degree of patient-centeredness.
Overall, the degree of patient-centeredness and a positive emotional tone, which might have a positive outcome on older persons' health, was high. Longer visits provided a higher degree of patient-centeredness, but no linear increase in patient-centeredness due to length of visit could be observed. The findings can be used for education and training of nurses, and for providing individualized care, e.g. patient- or person-centered care.
沟通是护理工作的基石，旨在实现信息交流和关系建立。迄今为止，对于居家护理中老年人与护士之间自然发生的沟通了解甚少。沟通可能通过不同途径发挥治愈作用，以患者或个人为中心的沟通对于老年人的健康和福祉可能至关重要。然而，个性化居家护理的提供面临着诸如时间限制等常规和组织要求的挑战。因此，本研究的目的是探讨老年人与注册护士之间居家护理沟通中以患者为中心的方面。
共有37名65岁及以上的老年人和11名注册护士参与了50次居家护理访视的音频录制。使用罗特互动分析系统（RIAS）对言语沟通进行编码。利用广义线性混合模型分析这些编码得出的一个确定以患者为中心程度的比率。
目前的居家护理沟通中，社会情感沟通多于任务导向型沟通，且情感基调大多为积极。总体情感评分反映出整体积极的基调（均值 = 39.88，标准差 = 7.65），在例如反应性/参与度和互动性等维度上评分较高，积极情绪（均值 = 15.56，标准差 = 3.91）比那些可能被视为不太积极的情绪（如匆忙、主导或愤怒）更为频繁。居家护理访视中以患者为中心的沟通程度的比率平均为1.53，表明这种沟通可被视为以患者为中心。访视时长是与沟通中以患者为中心程度显著相关的唯一特征，在时长为8 - 9分钟的访视中以患者为中心程度达到峰值。性别、年龄或程序重点对以患者为中心程度无显著影响。
总体而言，以患者为中心的程度和积极的情感基调较高，这可能对老年人的健康产生积极影响。较长的访视提供了更高程度的以患者为中心，但未观察到因访视时长导致的以患者为中心程度的线性增加。这些发现可用于护士的教育和培训，以及提供个性化护理，如以患者或个人为中心的护理。
