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）：美国每年约有 280 万人需要在重症监护室 (ICU) 进行机械通气，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。可预防的不良事件更有可能发生在年龄较大和沟通困难的住院患者中。由于重症监护病房的大部分时间都用于照顾老年人，因此危重老年人尤其容易受到伤害。重症监护护士具有独特的优势，可以在与老年患者进行护理互动时减轻沟通障碍的不利影响。护士使用的互动行为，无论是积极的还是消极的，都可以设定互动的基调。拟议研究的目标是：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 ICU 中不会说话的危重老年人之间沟通的因素；2）探索护士和患者互动行为与护理之间的关联护理质量指标。具体目标是： 1a) 识别和描述护士和不会说话的危重老年人在 ICU 中沟通互动时使用的互动行为； 1b) 描述对危重老年人的增强性和替代性沟通（AAC）的使用，并描述性地比较与 AAC 使用相关的互动行为； 2）探索互动行为与护理质量指标（镇静剂的使用和水平、身体约束的使用、疼痛管理和意外设备中断）之间的关联； 3) 对源自 ICU 环境中先前观察研究的交互行为工具进行心理测量评估。样本将包括参加患者-护士沟通策略有效性研究 (SPEACS) (R01-HD043988) 的所有年龄 > 60 岁的成年患者 (N=38) 及其护士 (N=24)。互动行为将通过对护士和患者之间的互动录像进行评分来衡量。质量指标上的患者临床特征将从现有的 SPEACS 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以及 AAC 的使用。群体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联。最后，工具的信度和效度将通过评估者之间和内部的一致性、因素分析和专家评审来确定。这项研究将有助于更好地了解互动行为如何影响护理质量。此外，这项研究还将提供建立重症监护中护士敏感质量和安全指标科学所需的基本证据。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大问题。本研究的目的是提高对增强性和替代性沟通（AAC）的使用如何与护士和患者沟通互动行为相关的理解。此外，这项研究将为互动行为与护理质量之间的关联提供新的证据，这将有助于为重症监护中护士敏感的质量和安全指标提供证据。