Aims. To synthesize evidence and knowledge from published research about nurses' experiences of nurse-patient relationships with adult patients in general, acute inpatient hospital settings. Background. While primary research on nurses' experiences has been reported, it has not been previously synthesized. Design. Meta-ethnography. Data sources. Published literature from Australia, Europe, and North America, written in English between January 1999-October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO. Review methods. Qualitative studies describing nurses' experiences of the nursepatient relationship in acute hospital settings were reviewed and synthesized using the meta-ethnographic method. Results. Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients. Conclusion. The findings of this meta-ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.
Hope Early Intervention Program, USAAlthough the use of paraprofessionals in the education of young children with autism spectrum disorders (ASD) is a common practice, research on effective training procedures is scarce. The following study used a multiple-baseline design across settings replicated by five paraprofessionals to evaluate their use of behavioral strategies with young children with, or at risk for, autism spectrum disorder. A training package consisting of a workshop and performance feedback by their supervising special education teacher served as the intervention. Results revealed that even though the paraprofessionals demonstrated skills in the use of behavioral strategies at the workshop, there was either no transfer or generalization to the preschool or home environments where they worked, or their use of skills decreased over time. When performance feedback was provided to all participants, their correct use of strategies increased. The training model evaluated in this study provides an example of one that could be employed in a typical public school classroom or early intervention program.
Purpose: Although the importance of communication skills in anesthetic practice is increasingly recognized, formal communication skills training has hitherto dealt only with limited aspects of this professional activity. We aimed to document and analyze the informally-learned communication that takes place between anesthesia personnel and patients at induction of and emergence from general anesthesia.
Methods:We adopted an ethnographic approach based principally on observation of anesthesia personnel at work in the operating theatres with subsequent analysis of observation transcripts.
Results:We noted three main styles of communication on induction, commonly combined in a single induction. In order of frequency, these were: (1) descriptive, where the anesthesiologists explained to the patient what he/she might expect to feel; (2) functional, which seemed designed to help anesthesiologists maintain physiological stability or assess the changing depth of anesthesia and (3) evocative, which referred to images or metaphors. Although the talk we have described is nominally directed at the patient, it also signifies to other members of the anesthetic team how induction is progressing. The team may also contribute to the communication behaviour depending on the context. Communication on emergence usually focused on establishing that the patient was awake.
Conclusion
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