Interaction Behaviors Effects on Nursing Care Quality of Older Adults in the ICU

[摘要] Background: Approximately 2.8 million people require mechanical ventilation (MV) in intensive care units (ICU) each year and, therefore, are unable to communicate using vocal speech. ICU nurses are positioned to mitigate the detrimental effects of communication difficulties during care interactions. Objectives: The specific aims included: 1a) identify and describe communication interaction behaviors that nurses and nonspeaking, critically ill older adults use during communication interactions; 1b) describe the frequency of augmentative and alternative communication (AAC) use with critically ill older adults; 1c) evaluate the relationship between individual interaction behaviors and individual AAC strategies; 2) explore the association between interaction behaviors and nursing care quality indicators (NCQI), and 3) psychometrically evaluate an interaction behavior instrument derived from prior observational research in ICU. Methods: The sample included patients > 60 years of age (N=38) and their nurses (N=24) who participated in the Study of Patient-Nurse Effectiveness with Communication Strategies (SPEACS) (R01-HD043988). Interaction behaviors were measured by rating videotaped interactions. Participant characteristics and NCQI were obtained from the SPEACS dataset and medical chart review. Descriptive statistics were used to describe the nurse and patient interaction behaviors and AAC use. Group comparative statistics were used to examine the differences between interaction behaviors and use of AAC. The association between interaction behaviors and NCQI was explored through repeated measures analysis. Reliability and validity of the instrument were determined by inter-rater agreement, and expert review. Results: All positive behaviors were observed, whereas negative behaviors were rare.Significant (p<.05) associations were observed between: 1) positive nurse and patient behaviors, 2) patient unaided communication strategies and positive nurse behaviors, 3) individual unaided strategies and individual nurse positive behaviors and 4) nurse and patient behaviors and pain management and sedation level, respectively. Using the revised instrument, percent agreements were better for nurse behaviors (73-100%) than patient behaviors (68-100%). Kappa coefficients ranged from 0.13-1.00; lower coefficients occurred for patient behaviors.Conclusion: Findings provide evidence that nurse behaviors affect communication tone and suggest an association between nurse-patient interaction behaviors and NCQI.Preliminary results suggest that the revised interaction behavior instrument has good reliability and face validity in MV, non-speaking older adult patients.

[发布机构] the University of Pittsburgh