Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK.
Northumbria University, Newcastle upon Tyne, UK.
Clin Rheumatol. 2022 Dec;41(12):3869-3877. doi: 10.1007/s10067-022-06336-3. Epub 2022 Aug 18.
Educating patients about methotrexate is a core role of rheumatology nurses. We have previously reported the scoring of videoed interviews of rheumatology nurses educating patients prior to commencing methotrexate in comparison with the Calgary-Cambridge consultation model, and the qualitative analysis of the transcripts (Robinson et al. Musculoskeletal Care 2021). We were interested to investigate what could be learned from a more quantitative analysis of utterances and movements in these consultations and how they related to the qualitative interpretations.
To investigate the frequency of utterances and body movements during interactions between rheumatology nurses and patients commencing methotrexate and to relate these to the qualitative interpretations of the interviews.
Video-recordings of ten patients receiving methotrexate education from four different rheumatology nurses were available from the previous study. They were analysed using the Medical Interaction Process System (MIPS). This involved coding all utterances and body movements minute-by-minute by multiple inspections of the recordings. The first 10 min of each consultation was coded. The utterances and movements of the nurses and patients were compared. The thematic analysis based on the structure and content of the Calgary-Cambridge (C-C) consultation model was available from the previous study. This enabled the results from the MIPS to be compared between the interviews that scored higher on the C-C model and those scoring lower.
The inter-rater reliability between 2 raters for one video was satisfactory (80-100% agreement). Numerically, giving information dominated the nurse contribution and assent by positive utterances and head nodding dominated for the patients. The results were consistent with the nurse agenda dominating the interaction with little opportunity for patient involvement. Nurses in high-scoring interviews made more illustrative gestures and fewer batonic movements while patients did the opposite. Nurses in high-scoring consultations asked more open questions, with more checking of understanding and summarising but fewer interruptions. Patients in low-scoring consultations were much more animated with head movements and illustrative gestures. Patients also checked and interrupted more.
In this pilot study, the MIPS was usable and demonstrated verbal and non-verbal behaviours consistent with the qualitative assessments. It also showed some behaviours that are not intuitive but may indicate how effectively the interview was progressing. Some nurse behaviours identified that were associated with the higher scoring interviews may be useful indictors for training including making illustrative rather than batonic gestures and checking understanding. Patient behaviours, such as greater animation, were exhibited in low-scoring consultations, and could indicate that the interview was not addressing the patient perspective. Quantification of utterances and movements can be done and may give insights into the consultation process.
向患者讲解甲氨蝶呤是风湿病护士的核心职责之一。我们之前曾报告过对接受甲氨蝶呤治疗的风湿病护士在开始治疗前对患者进行视频访谈的评分，以及对转录本的定性分析（Robinson 等人，《肌肉骨骼护理》，2021 年）。我们有兴趣从对这些咨询中的话语和动作的更定量分析中了解更多信息，以及它们与定性解释的关系。
调查风湿病护士与开始接受甲氨蝶呤治疗的患者之间互动过程中的话语和身体动作的频率，并将这些与访谈的定性解释联系起来。
从之前的研究中获得了来自四位不同风湿病护士的十名接受甲氨蝶呤教育的患者的视频记录。使用医疗互动过程系统（MIPS）对其进行分析。这涉及通过多次检查录音来逐分钟对所有话语和身体动作进行编码。对每次咨询的前 10 分钟进行了编码。比较了护士和患者的话语和动作。基于卡尔加里-剑桥（C-C）咨询模型的结构和内容的主题分析可从之前的研究中获得。这使得可以根据 C-C 模型评分较高和评分较低的访谈比较 MIPS 的结果。
两名评分者对一段视频的评分具有较高的组内一致性（80-100%的一致性）。从数值上看，提供信息主导了护士的贡献，而积极的话语和点头表示同意则主导了患者的贡献。结果与护士主导互动、患者参与机会较少的情况一致。在评分较高的访谈中，护士的手势更加生动，而敲击动作较少，而患者则相反。在评分较低的访谈中，患者的头部动作和手势更加生动，互动性更强。患者也会更多地检查和打断对话。
在这项试点研究中，MIPS 是可用的，并证明了与定性评估一致的言语和非言语行为。它还显示了一些不直观但可能表明访谈进展情况的行为。与评分较高的访谈相关的一些护士行为可能是有用的培训指标，包括进行生动的而非敲击的手势以及检查理解。在评分较低的访谈中，患者表现出更活跃的行为，这可能表明访谈没有涉及到患者的观点。可以对话语和动作进行定量分析，这可能会深入了解咨询过程。
