Doodlesack Amanda, Dubosh Nicole, Grossestreuer Anne, de Oliveira Lorian, Bilello Leslie
Dept. of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center Harvard Affiliated Emergency Medicine Residency, One Deaconess Road, W/CC2, Boston, MA, 02215, USA.
Lahey Medical Center, Burlington, MA, USA.
Int J Emerg Med. 2024 Oct 23;17(1):163. doi: 10.1186/s12245-024-00740-z.
Communication between nurses and physicians is essential to providing patient care in the emergency department. The American College of Graduate Medical Education includes interpersonal and communication skills as one of six core competencies for residents. There is a known correlation between poor communication and negative patient outcomes. Yet, formalized training programs in doctor-nurse communication are lacking and literature reports that physicians may view collaboration as less important than nurses. To address this gap, we developed and implemented a novel, pilot "Nurse-InteRN Mentorship Program". The program aimed to improve trainees' communication with nurses and enhance emergency department collaboration. We then evaluated the impact of this program on participant perception of nurse-physician communication, efficacy and overall benefit.
We used Kern's Six-step approach to develop and implement this program. We then evaluated the program's impact with a pre-program and post-program 12-question survey to evaluate participation, perceived benefit, and efficacy of the program using a 1-5 Likert scale. Nurse vs. intern responses were compared using Fisher's exact and Wilcoxon rank sum tests. Pre- and post- intervention responses were paired by respondent and compared using marginal homogeneity tests.
13 interns and 22 nurses participated in the program. All 13 interns and 19 of 22 nurses completed the pre-program survey. 10 of 13 interns and 11 of 22 nurse mentors completed the post-program survey. Nurses showed greater interest in providing feedback on communication skills than interns showed in receiving feedback (p < 0.001). Interns rated themselves higher in communication skills with patients than nurses rated them (p = 0.004). Perceived benefit among nurses and interns decreased after completion of the program.
We were able to successfully implement a one-year nurse-intern mentorship program aiming to promote communication, collaboration and professional development. Our results show differing attitudes between nurses and interns around interns' communication skills. There was some perceived benefit, but unfortunately this decreased over the course of the program. Further studies are needed to determine how this program impacts communication, teamwork, and patient care. We hope that given the novelty of such a nurse-intern mentorship program, this study may serve as a pilot for future programs.
护士与医生之间的沟通对于在急诊科提供患者护理至关重要。美国研究生医学教育学院将人际沟通技能列为住院医师六项核心能力之一。已知沟通不良与负面患者结果之间存在关联。然而，缺乏正式的医护沟通培训项目，且文献报道医生可能认为协作不如护士重要。为了弥补这一差距，我们开发并实施了一个新颖的试点“护士 - 住院医师导师计划”。该计划旨在改善实习生与护士的沟通，并加强急诊科的协作。然后，我们评估了该计划对参与者对医护沟通、效能和整体益处认知的影响。
我们采用克恩六步法来开发和实施该计划。然后，我们通过一项在项目前后进行的包含12个问题的调查来评估该计划的影响，该调查使用1 - 5李克特量表来评估参与度、感知到的益处和计划的效能。使用费舍尔精确检验和威尔科克森秩和检验比较护士与实习生的回答。干预前后的回答按受访者配对，并使用边际同质性检验进行比较。
13名实习生和22名护士参与了该计划。13名实习生和22名护士中的19名完成了项目前的调查。13名实习生中的10名和22名护士导师中的11名完成了项目后的调查。护士对提供沟通技能反馈的兴趣高于实习生对接收反馈表现出的兴趣（p < 0.001）。实习生对自己与患者沟通技能的评分高于护士对他们的评分（p = 0.004）。项目完成后，护士和实习生感知到的益处有所下降。
我们成功实施了一项为期一年的护士 - 实习生导师计划，旨在促进沟通、协作和专业发展。我们的结果显示护士和实习生对实习生沟通技能的态度存在差异。有一些感知到的益处，但不幸的是，在计划实施过程中这种益处有所下降。需要进一步研究来确定该计划如何影响沟通、团队合作和患者护理。鉴于这样一个护士 - 实习生导师计划的新颖性，我们希望这项研究可以作为未来项目的试点。
