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

基本信息

批准号：
8265292
负责人：
MARCI LEE NILSEN
金额：
$ 2.78万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
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/8265292
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 public health relevance statistics

项目摘要

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）：大约280万要求在美国的重症监护病房（ICU）机械通气，因此无法使用自然语音进行交流。无法说话可以引起困扰，愤怒，恐惧，躁动和孤立的感觉。在年龄较大的患者和沟通困难的患者中，可预防的不良事件更有可能发生。由于大多数ICU时代都致力于照顾老年人，因此重病的老年人特别脆弱。重症监护护士在与老年患者相互作用期间的沟通障碍有害影响方面具有独特的位置。护士使用的正面和负面行为都可以设定相互作用的基调。拟议的研究的目标是：1）测量和描述护士和患者的互动行为以及可能影响护士与非重症监护病房（ICU）重病老年人之间的沟通的因素，以及2）探索护士与患者互动行为与护理护理质量指标之间的关联。具体目的是：1a）识别和描述护士和非宣传年轻人在ICU进行交流相互作用时使用的互动行为； 1b）描述与重症老年人的增强性和替代性交流（AAC）使用，并描述地比较了相对于AAC使用的相互作用行为； 2）探索相互作用行为与护理质量指标之间的关联（镇静使用和水平，身体约束使用，疼痛管理和计划外的设备破坏）； 3）心理计量法评估ICU环境中先前观察性研究得出的相互作用行为仪器。样本将包括所有> 60岁> 60岁的成年患者（n = 38）及其护士（n = 24），他们通过沟通策略（SPEAC）（R01-HD043988）研究了患者 - 尿素有效性。相互作用行为将通过对护士与患者之间的录像相互作用进行评估来衡量。质量指标的患者临床特征将从现有的SPEAC数据集和医疗图表审查中获得。描述性统计数据将用于描述护士和患者的互动行为和AAC使用。组比较统计将比较使用AAC之间的相互作用行为之间的差异。相互作用行为与护理质量指标之间的关联将通过重复措施分析探讨。最后，该工具的可靠性和有效性将由间和评估者协议，因素分析和专家审查确定。这项研究将对相互作用行为如何影响护理护理质量有更深入的了解。此外，这项研究将提供基本证据，以建立有关护士敏感质量和安全指标的科学。公共卫生相关性：护士与机械通风的老年人之间的沟通困难仍然是重大护理中的重要问题。这项研究的目的是提高对增强和替代交流（AAC）使用如何与护士和患者沟通互动行为有关的理解。此外，这项研究将为相互作用行为与护理质量之间的关联提供新的证据，这将有助于对重症监护中护士敏感质量和安全指标的证据。