Duke University School of Nursing, Durham, North Carolina, USA.
Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
Gerontologist. 2022 Sep 7;62(8):1112-1123. doi: 10.1093/geront/gnab193.
Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stakeholders develop and communicate fall-related injury prevention plans to enhance sustained implementation.
Descriptive qualitative study using framework analysis applied to open-ended semistructured interviews (n = 28) regarding experiences of communication regarding fall-related injury prevention, guided by the Patient and Family Engaged Care framework. Participants included residents at high risk of injury and their proxies, nursing assistants, nurses, and a nurse practitioner from 3 SNFs in the Eastern United States (Massachusetts and North Carolina).
Interdisciplinary teams were viewed as essential for injury prevention. However, the roles of the interdisciplinary team members were sometimes unclear. Communication structures were often hierarchical, which reduced engagement of nursing assistants and frustrated proxies. Practices that enhanced engagement included knowing the residents, active listening skills, and use of strategies for respecting autonomy. Engagement was inhibited by time constraints, lack of proactive communication among staff, and by challenges eliciting the perspectives of residents with dementia. Resident barriers included desire for autonomy, strong preferences, and language differences.
Strengthening team meeting processes and cultivating open communication and collaboration could facilitate staff, resident, and proxy engagement in injury prevention planning and implementation. Skill building and targeting resources to improve communication can address barriers related to staff practices, resident characteristics, and time constraints.
通过有效的沟通让居民、他们的代理人和熟练护理机构（SNF）的工作人员参与进来，有可能改善与跌倒相关的伤害预防。本研究的目的是了解多个利益相关者如何制定和沟通与跌倒相关的伤害预防计划，以增强持续实施。
采用框架分析法对来自美国东部 3 家 SNF（马萨诸塞州和北卡罗来纳州）的 28 名有受伤高风险的居民及其代理人、护理助理、护士和护士从业者进行了有关沟通预防与跌倒相关伤害经验的描述性定性研究，以患者和家庭参与护理框架为指导。
跨学科团队被认为是预防伤害的关键。然而，跨学科团队成员的角色有时并不明确。沟通结构通常是分层的，这降低了护理助理的参与度，并使代理人感到沮丧。增强参与度的做法包括了解居民、积极倾听技巧以及使用尊重自主权的策略。时间限制、员工之间缺乏主动沟通以及难以从痴呆症居民那里获取观点等因素都抑制了参与度。居民的障碍包括对自主权的渴望、强烈的偏好和语言差异。
加强团队会议流程，培养开放的沟通和协作，可以促进员工、居民和代理人参与伤害预防计划的制定和实施。技能培训和针对沟通的资源投入可以解决与员工行为、居民特征和时间限制相关的障碍。
