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

交互行为对ICU老年人护理质量的影响

• 批准号: 8121783
• 负责人: MARCI LEE NILSEN
• 金额: $ 2.74万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-05-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8121783
• 关键词: Acute; Adult; Adverse event; Age-Years; Agitation; Agreement; Anger; Attention; Behavior; Caring; Characteristics; Clinical; Communication; Communication impairment; Confusion; Critical Care; Critical Illness; Data Set; Decision Making; Device Removal; Devices; Effectiveness; Elderly; Emotions; Factor Analysis; Family; Frequencies; Fright; Frustration; Gestures; Goals; Intensive Care Units; Interpersonal Relations; Lipreading; Measures; Mechanical ventilation; Medical; Medical Care Team; Nurses; Pain management; Patients; Physical Restraint; Play; Positioning Attribute; Quality Indicator; Reporting; Research; Risk; Role; Safety; Sampling; Science; Sedation procedure; Speech; Symptoms; Time; United States; Validity and Reliability; Videotape; alternative communication; behavior influence; communication behavior; comparative; critical care nursing; emotional distress; experience; health care quality; improved; instrument; meetings; member; novel; nursing care quality; statistics

DESCRIPTION (provided by applicant): Approximately 2.8 million require mechanical ventilation in intensive care units (ICU) in the USA each year and, as a consequence, are unable to communicate using natural speech. The inability to speak can elicit feelings of distress, anger, fear, agitation and isolation. Preventable adverse events are more likely to occur among hospitalized patients who are older and those with communication difficulties. Since the majority of ICU days are devoted to the caring for older adults, critically ill older adults are particularly vulnerable. Critical care nurses are uniquely positioned to mitigate the detrimental effects of communication impairment during caring interactions with their older adult patients. Interaction behaviors, both positive and negative, used by the nurse can set the tone of the interaction. The goals of the proposed study are to: 1) measure and describe nurse and patient interaction behaviors and factors that may impact communication between nurses and nonspeaking critically ill older adults in the ICU and 2) explore the association between nurse and patient interaction behaviors and nursing care quality indicators. The specific aims are to: 1a) identify and describe interaction behaviors that nurses and nonspeaking critically ill older adults use during communication interactions in the ICU; 1b) describe augmentative and alternative communication (AAC) use with critically ill older adults and descriptively compare the interaction behaviors with respect to AAC use; 2) explore the association between interaction behaviors and nursing care quality indicators (sedation use and level, physical restraint use, pain management, and unplanned device disruption); 3) psychometrically evaluate an interaction behavior instrument derived from prior observational research in ICU setting. The sample will include all adult 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 will be measured by rating videotaped interactions between nurses and patients. Patient clinical characteristics on quality indicators will be obtained from the existing SPEACS data set and medical chart review. Descriptive statistics will be used to describe the nurse and patient interaction behaviors and AAC use. Group comparative statistics will compare the differences between interaction behaviors with the use of AAC. The association between interaction behaviors and nursing care quality indicators will be explored through repeated measures analysis. Finally, reliability and validity of the instrument will be determined by inter and intra-rater agreement, factor analysis, and expert review. This study will provide a greater understanding of how interaction behaviors influence nursing care quality. In addition, this study will provide essential evidence needed to build the science on nurse sensitive quality and safety indicators in critical care. PUBLIC HEALTH RELEVANCE: Communication difficulties between nurses and mechanically ventilated older adults remain a significant problem in critical care. The purpose of this study is to improve the understanding of how augmentative and alternative communication (AAC) use is related to nurse and patient communication interaction behaviors. In addition, this study will provide novel evidence on the association between interaction behaviors and nursing care quality, which will contribute to the body of evidence on nurse sensitive quality and safety indicators in critical care.

描述（由申请人提供）：在美国，每年约有280万人在重症监护室（ICU）需要机械通气，因此无法使用自然语言进行交流。无法说话会引起痛苦、愤怒、恐惧、激动和孤立的感觉。年龄较大和有沟通困难的住院患者更容易发生可排除的不良事件。由于ICU的大部分时间都用于照顾老年人，因此重症老年人特别脆弱。重症监护护士的独特定位，以减轻沟通障碍的不利影响，在照顾互动与老年患者。护士所使用的积极和消极的互动行为可以设定互动的基调。本研究的目的是：1）测量和描述护士和病人的互动行为和可能影响护士和重症监护室中不说话的危重老年人之间的沟通的因素; 2）探索护士和病人的互动行为和护理质量指标之间的关联。具体目标是：1a）识别并描述ICU中护士和不说话的重症老年人在交流互动过程中使用的互动行为; 1b）描述重症老年人使用的辅助和替代交流（AAC），并将互动行为与AAC使用进行连续比较; 2）探讨互动行为与护理质量指标的关系（镇静剂的使用和水平、身体约束的使用、疼痛管理和计划外的设备中断）; 3）从心理测量学上评估来自先前在ICU环境中的观察性研究的交互行为工具。样本将包括所有参加沟通策略患者-护士有效性研究（SPEACS）（R 01-HD 043988）的60岁以上成年患者（N=38）及其护士（N=24）。互动行为将通过评估护士和患者之间的互动录像来衡量。将从现有SPEACS数据集和病历审查中获得关于质量指标的患者临床特征。描述性统计将用于描述护士和患者的互动行为和AAC的使用。分组比较统计将比较使用AAC的交互行为之间的差异。透过重复测量分析，探讨互动行为与护理品质指标间之关联。最后，该工具的信度和效度将通过评分者间和评分者内的一致性、因素分析和专家评审来确定。本研究将提供一个更深入的了解如何互动行为影响护理服务质量。此外，这项研究将提供必要的证据，需要建立科学的护士敏感的质量和安全指标，在重症监护。 公共卫生相关性：护士和机械通气老年人之间的沟通困难仍然是重症监护中的一个重要问题。本研究的目的是提高对辅助和替代沟通（AAC）的使用是如何与护士和病人的沟通互动行为的理解。此外，这项研究将提供新的证据之间的关联互动行为和护理质量，这将有助于身体的证据，护士敏感的质量和安全指标在重症监护。