Authors (including presenting author) :
Poon ST(1), Chu NW(1), Chan CK(1)
Affiliation :
(1) Intensive Care UNit, Prince of Wales Hospital
Introduction :
ICU nurses are sometimes criticized as “high tech. & low touch” in the medical literature, which may create patient and nurse dissatisfaction patient but also to nurses. A 2 phrase training program is conducted to evaluate it's effectiveness in improve patient's satisfactory & nurse's knowledge in improving communication. Stayt (2007) studied ICU nurse’s emotional experiences and reflected ICU nurses face a fundamental conflict both between the role expectations of patient care, professional ideals and being a human which may contribute to occupational stress.
Objectives :
1. To test a “Therapeutic Nurse Relationship Program” designed to improve nursing communication skill with patients and relatives in ICU
2. To evaluate any improvement in nurse’s perception on communication after conduct a staff education program
Methodology :
Phrase 1
From Nov.2018, a pre-survey was conducted to explore nurse communication within established therapeutic relationships with patients/families. Inclusion criteria: patient ICU stay > 72 hours, either patient or relatives were recruited by convenience sampling.
The survey questions included 6 questions used an anonymous 5-item questionnaire with a 5-point Likert response scale (1=poor to 5=excellent).
It focused on nursing communication with patient / relatives regarding:
1. Explanation before performing a procedure (such as suction/turning)
2. Care about patient’s comfort
3. Proactively updating the condition
4. Providing psychological / mental support
5. Offering religion support / referral
6. Overall satisfaction to nursing care
3 qualitative questions were also used to explore the subject’s views of nursing communication.
A teaching program was conducted at Dec., 2018 & focused on:
- Different skills on communication - including verbal & non-verbal
- Promotion of various referral service from hospital
79 (70%) of nurses attended the program and a post survey was conducted from Jan.- Feb.,2019 for comparison.
Phrase 2
Base on the result of the survey, an educational program is also conducted to improve nurse’s perception in therapeutic communication skill.
Using a video training program to teach nurses in handling various scenarios which is depressed, angry, fearful and communication with patient on mechanical ventilator (MV).
68 (60%) of nurses attended the program with knowledge test is conducted before & after the program.
Result & Outcome :
Phrase 1: Data shows that there was a substantial increase in positive response in three areas: 1. Providing explanation to patient / relatives before perform procedure (from 65% to 90%). 2. Providing psychological / mental support (from 55% to 70%). 3. Offer religion support / referral (from 15% to 25%). There was no substantial increase in the other domains, although overall baseline responses in the remaining domains were already good (>70%). Overall satisfaction baseline responses (excellent & very good) was already 80%, and increased to 90%. Phrase 2: The result shown that most of the staff’s self-perceived competency is increased (mostly 50%) after attended the training program. Knowledge test is used to measure staff knowledge on therapeutic relationship after attended the program. Pro-test also shown the staff’s knowledge has also been improved after attend the program. In knowledge-based questions (Q2-10), over 80% of correct answers were obtained in the post-test in most questions. It shown that there is a markedly increase in the following aspects: i. Handling of unresolved anger ii. Fear iii. Use of non-verbal communication tools The post-survey both demonstrated a more positive feedback from patient’s relatives and nurse’s knowledge on therapeutic relationship than the pre-survey. This positive trend was confirmed in the in qualitative descriptions. It suggests the program may enhance nursing communication to improve the therapeutic relationship between nurses to patient & patient’s relatives.
