Wilma M.C.M. Caris-Verhallen

Nurse-elderly patient communication in home care and institutional care: an explorative study

This study explores communication patterns between nurses and elderly patients in two different care settings. In a sample of 181 video-taped nursing encounters, involving 47 nurses and 109 patients, a study was made of nurse-patient communication. The video recordings were observed using an adapted version of Roters Interaction Analysis System, which yields frequencies of 23 types of verbal behaviours. These data were analyzed using correspondence analysis, to reduce them to a smaller number of verbal categories, in which two socio-emotional categories and three categories with task-related communication, could be distinguished. For each encounter five summary statistics corresponding to these categories were calculated. Using analysis of variance, it was shown that the amount of socio-emotional interaction in both settings appeared to be higher than was reported in previous studies into nurse-patient communication. Compared with the home for the elderly, communication was more task-related in home care.

DOING THE RIGHT THING AND DOING IT RIGHT: TOWARD A FRAMEWORK FOR ASSESSING THE POLICY RELEVANCE OF HEALTH SERVICES RESEARCH

OBJECTIVES Health services research is atypical instance of applied research, meaning that its research findings should contribute to a more evidence-based health policy. A basic assumption for the usefulness of policy research is that it is of good scientific quality, but evaluation of health services research would be incomplete without an assessment of its societal relevance. However, there is no generally accepted framework in which criteria to assess societal relevance are defined. METHODS In this study, we made an effort to specify criteria and indicators for policy relevance. RESULTS AND CONCLUSIONS In general, we concluded that it is important to define from the start of a research project, what kind of answers are being sought to the questions at hand, who the intended users of these answers will be, and how they can be reached. Furthermore, a productive dialogue between researchers and policy makers is indispensable for remaining in tune with policy thinking. In addition, we specified domains and a list of potential criteria for assessing policy relevance. For the purpose of quality assurance, these criteria have to be integrated into a quality improvement cycle. This means that the societal output of health services research should be related to the aims and missions at the level of projects, programs, and institutes. Furthermore, it is important that consensus is reached about (the weighting of) relevant indicators and that routines are developed for collecting information on these indicators.

Doctors' responses to patients' concerns: testing the use of sequential analysis.

AIMS The aim of this small scale study was to explore interaction sequences during the medical consultation. Specific attention was paid to how doctors responded to patients concerns and worries. Empathic behaviours (e.g. concern, partnership, legitimizing) and facilitating behaviours (e.g. paraphrasing, agreement) were considered as an adequate response to a patients concern. METHODS Nine consultations of nine different GPs were randomly selected from a sample of 1600 videotaped doctor-patient consultations, that were all rated with the Roter Interaction Analysis System. Each consultation contained at least 9 utterances of patients concern. It was investigated how doctors respond within five lags of utterances after a patients concern. RESULTS The results showed that doctors more often responded to a patients concern in a facilitative way than in an empathic way. When an empathic response was given, it appeared mostly during the first utterance after the patient expressed a concern. CONCLUSIONS The findings indicate that sequential analysis is appropriate to investigate a health care providers specific style of responding. Based on the problems emerged during the sequential analysis, further exploration of the method is recommended.

Nurse-elderly patient communication in home care and institutional care

This study explores communication patterns between nurses and elderly patients in two different care settings. In a sample of 181 video-taped nursing encounters, involving 47 nurses and 109 patients, a study was made of nurse-patient communication. The video recordings were observed using an adapted version of Roters Interaction Analysis System, which yields frequencies of 23 types of verbal behaviours. These data were analyzed using correspondence analysis, to reduce them to a smaller number of verbal categories, in which two socio-emotional categories and three categories with task-related communication, could be distinguished. For each encounter five summary statistics corresponding to these categories were calculated. Using analysis of variance, it was shown that the amount of socio-emotional interaction in both settings appeared to be higher than was reported in previous studies into nurse-patient communication. Compared with the home for the elderly, communication was more task-related in home care.