Training in the 21st century: Using Virtual Role-Plays to Improve Nurse Communication for Medication Adherence

项目摘要：尽管在过去的三十年里，高血压（HTN）的治疗取得了进展， 在美国，控制不好的血压（BP）仍然是一个重要的公共卫生问题。 对不受控制的HTN患者的循证护理需要医疗保健提供者、患者 以及进行护理的医疗保健系统，以便患者充分了解 他们的疾病，并坚持药物治疗，需要降低血压升高。虽然研究 一致地记录了合作的患者-医生关系的有益影响， 改善慢性乙型肝炎患者的药物依从性和疾病控制 HTN等疾病，40%的初级保健访问不包括关于药物依从性的讨论， 无论患者的疾病控制状况如何。当这些对话发生时，初级保健医生 平均花费5%的互动时间讨论药物。作为医疗保健的最大部分， 护士是护理团队不可或缺的成员，因此，随时准备协助完成关键任务， 作为药物依从性的咨询。虽然干预措施有针对性的护士的沟通技巧， 患者的依从性，他们并没有始终如一地导致护士或患者水平的结果的改善。一个主要 局限性一直是使用简短的讲习班为基础的干预措施，包括有限的机会，护士， 练习新学到的技能，以及未能将新角色融入日常工作。拟议 这项研究提供了一个机会，以解决这一差距的文献，是一个合乎逻辑的延伸博士。 Schooner出色的研究轨迹专注于患者与提供者的沟通和药物治疗 坚持，并建立在来自博士Schooner的K23职业发展奖的试点数据。根据她 调查结果，目前的应用程序将与临床护士作为主要目标的沟通 干预，以支持初级保健医生评估和解决药物治疗障碍 坚持。具体而言，该提案将采用一种由理论驱动的三阶段方法， 实施框架：1）进行需求分析，以确定个人、卫生保健团队 在安全网初级保健中进行依从性咨询的实践水平障碍和促进因素 实践; 2）开发旨在提高依从性质量的虚拟通信模拟 通过允许护士重复练习讨论药物依从性的机会， 3）进行试点研究，以评估可行性，可接受性和初步疗效， 模拟变化：a）护士的协作沟通技能，B）药物依从性，以及c） 在20例不依从药物治疗的不受控制的HTN患者的样本中降低血压。

Project Summary: Despite advances in treatments for hypertension (HTN) over the past three decades, poorly controlled blood pressure (BP) remains a significant public health problem in the United States. Evidence-based care of patients with uncontrolled HTN requires collaboration of healthcare providers, patients, and the healthcare system within which the care occurs—in order for patients to achieve a full understanding of their disease, and to be adherent to medications that are needed to reduce elevated BP. While studies have consistently documented the beneficial effects of collaborative patient–physician relationships on improvements in medication adherence and attainment of disease control among patients with chronic diseases such as HTN, 40% of primary care visits do not include discussions about medication adherence, irrespective of patients' disease control status. When these conversations do occur, primary care physicians spend an average of 5% of the interaction discussing medications. As the largest segment of the healthcare workforce, nurses are integral members of the care team and thus, well poised to assist with critical tasks such as counseling for medication adherence. While interventions have targeted nurses' communication skills for patient adherence, they have not consistently led to improvements in nurse or patient-level outcomes. A major limitation has been the use of brief workshop-based interventions that include limited opportunity for nurses to practice the newly learned skills and the failure to integrate the new role into their daily work. The proposed study provides an opportunity to address this gap in the literature, and is a logical extension of Dr. Schoenthaler's excellent research trajectory focused on patient-provider communication and medication adherence, and builds on pilot data from Dr. Schoenthaler's K23 Career Development Award. Based on her findings, the current application will partner with clinic nurses as the primary target for a communication intervention in order to support primary care physicians in assessing and addressing barriers to medication adherence. Specifically, this proposal will utilize a three-phase approach that is informed by a theory-driven implementation framework to: 1) conduct a needs analysis in order to identify individual-, health care team-, and practice-level barriers and facilitators to conducting adherence counseling in safety-net primary care practices; 2) develop a virtual communication simulation designed to improve the quality of adherence counseling by allowing nurses repeated opportunities to practice discussing medication adherence with virtual patients; and 3) conduct a pilot study to evaluate the feasibility, acceptability and preliminary efficacy of the simulation on changes in: a) nurses' collaborative communication skills, b) medication adherence, and c) reduction in BP in a sample of 20 patients with uncontrolled HTN who are non-adherent to their medications.