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

描述（由申请人提供）：在美国，每年约有280万人在重症监护病房（ICU）需要机械通气，因此，他们无法使用自然语言进行交流。不能说话会引起痛苦、愤怒、恐惧、激动和孤立的感觉。可预防的不良事件更可能发生在年龄较大和有沟通困难的住院患者中。由于ICU的大部分时间用于照顾老年人，危重老年人特别脆弱。重症护理护士在与老年患者的护理互动中具有独特的地位，可以减轻沟通障碍的有害影响。护士使用的互动行为，无论是积极的还是消极的，都可以为互动定下基调。本研究的目的是：1)测量和描述护患互动行为和可能影响ICU护士与非言语危重老年人沟通的因素；2)探讨护患互动行为与护理质量指标之间的关系。具体目的是：1a)识别和描述护士和不能说话的危重老年人在ICU的交流互动中使用的互动行为；1b)描述危重老年人的辅助和替代沟通（AAC）使用情况，并描述性地比较有关AAC使用的互动行为；2)探讨交互行为与护理质量指标（镇静使用和水平、肢体约束使用、疼痛管理和意外器械中断）之间的关系；3)心理测量学评估来自ICU环境中先前观察研究的互动行为工具。样本将包括所有参与患者-护士沟通策略有效性研究（SPEACS） （R01-HD043988）的60岁以上的成年患者（N=38）及其护士（N=24）。互动行为将通过评估护士和病人之间的互动录像来衡量。从现有的SPEACS数据集和病历回顾中获得患者临床特征的质量指标。描述性统计将用于描述护患互动行为和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。通过重复测量分析，探讨互动行为与护理质量指标之间的关系。最后，仪器的可靠性和有效性将通过内部和内部的协议，因素分析和专家评审来确定。本研究将有助于了解互动行为如何影响护理质量。此外，本研究将为建立护士敏感的重症监护质量和安全指标科学提供必要的证据。

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.