Communication by Nurses in the Intensive Care Unit: Qualitative Analysis of Domains of Patient-Centered Care

Abstract

Background High quality communication is a key determinant and facilitator of patient-centered care. Nurses engage in the vast majority of communication with patients and families in the intensive care unit (ICU). Objective To perform a qualitative analysis of nurses' communication. Methods The study was conducted in a 26-bed cardiac/medical ICU in an academic hospital and a 26-bed general ICU in a Veterans Affairs hospital in Portland, OR. We reviewed 315 hours of ICU interactions and 53 interviews with 33 nurses to categorize communication interactions into five patient-centered care domains. Interviews were analyzed to identify major themes regarding nurses’ roles and preferences for communicating with patients and families within the domains. Results Most nursing communication occurred in the biopsychosocial information exchange, “patient-as-person”, and “clinician-as-person” domains. Nurses endorsed the importance of the shared power and responsibility and therapeutic alliance domains but had relatively few communication interactions in these areas. Communication behaviors were strongly influenced by the nurses’ roles as translators of information between physicians with patients and families and what they were and were not willing to communicate to patients and families. Conclusions Critical care, including communication, is a collaborative effort. Understanding how nurses engage in patient-centered communication in the ICU can guide future interventions to improve patient-centered care.

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

“…Our program, IMPACT-ICU, was designed to address identified barriers to integration of palliative care into the ICU and to increase bedside nurses' engagement in palliative care. 3,17,18,21,[25][26][27][28][29] A combination of learner-centered communication training workshops and bedside coaching rounds led by advanced practice palliative care nurses and nurse educators helped bedside nurses to feel more skilled to engage in palliative care communication, as well as to be more involved in identifying and addressing palliative care needs.…”

“…26 We organized factors found in previous work to influence bedside nurses' involvement in palliative care 17,18,21,25,[27][28][29] on the basis of whether they predisposed, enabled, or reinforced bedside nurses to perform daily palliative care assessments and develop plans to address identified needs (Table 1). An overview of the initiative follows.…”

“…Our program, IMPACT-ICU, was designed to address identified barriers to integration of palliative care into the ICU and to increase bedside nurses' engagement in palliative care. 3,17,18,21,[25][26][27][28][29] A combination of learner-centered communication training workshops and bedside coaching rounds led by advanced practice palliative care nurses and nurse educators helped bedside nurses to feel more skilled to engage in palliative care communication, as well as to be more involved in identifying and addressing palliative care needs.The initiative was focused on nurses, to address the gap between their actual and potential involvement in palliative care communication. [15][16][17][18][19]21,24 Our findings indicate that IMPACT-ICU prepared nurses As a result of the training received through the IMPACT-ICU program, a nurse in one of our ICUs facilitated a family meeting that allowed a patient to make a decision to go home instead of continuing therapy in the ICU.…”

Construcción Colectiva De Un Concepto De Cuidado Humanizado en Enfermería

“…La importancia de la "sensibilidad" para el cuidado humanizado que destacan los participantes se puede relacionar con Watson, quien en los 10 factores de cuidado resalta la importancia del cultivo de la sensibilidad hacia sí mismo y hacia los demás como un componente estructural del fundamento filosófico para la ciencia del cuidado (8,32).…”

“…En consonancia con la literatura que ha resaltado la relevancia de la comunicación en la satisfacción y seguridad del paciente, la adherencia de éste al tratamiento y la promoción del autocuidado (32,33).…”