Quantity and quality of interaction between staff and older patients in UK hospital wards: A descriptive study

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• 作者：Hannah Ruth Barker ; M.Sc BN RN^a ; ^{h.r.barker@soton.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; Peter Griffiths ; PhD BA RN FEANS FHEA^a ; ^{Peter.griffiths@soton.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; Ines Mesa-Eguiagaray ; MSc BSc^b ; ^{I.Mesa-Eguiagaray@soton.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; Ruth Pickering ; PhD MSc^b ; ^{rmp@soton.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; Lisa Gould ; MSc BSc^a ; ^{l.j.gould@soton.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; Jackie Bridges ; PhD MSN B. Nurs (Hons) RN PG Cert^a ; ^{Jackie.bridges@soton.ac.uk" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Staff-patient interactions ; Patient experience ; Older people ; Communication ; Quality of interactions schedule
• 刊名：International Journal of Nursing Studies
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：62
• 期：Complete
• 页码：100-107
• 全文大小：342 K

文摘

The quality of staff-patient interactions underpins the overall quality of patient experience and can affect other important outcomes. However no studies have been identified that comprehensively explore both the quality and quantity of interactions in general hospital settings.

Aims & objectives

To quantify and characterise the quality of staff-patient interactions and to identify factors associated with negative interaction ratings.

Setting

Data were gathered at two acute English NHS hospitals between March and April 2015. Six wards for adult patients participated including medicine for older people (n = 4), urology (n = 1) and orthopaedics (n = 1).

Methods

Eligible patients on participating wards were randomly selected for observation. Staff-patient interactions were observed using the Quality of Interactions Schedule. 120 h of care were observed with each 2 h observation session determined from a balanced random schedule (Monday-Friday, 08:00-22:00 h). Multilevel logistic regression models were used to determine factors associated with negative interactions.

Results

1554 interactions involving 133 patients were observed. The median length of interaction was 36 s with a mean of 6 interactions per patient per hour. Seventy three percent of interactions were categorized as positive, 17% neutral and 10% negative. Forty percent of patients had at least one negative interaction (95% confidence interval 32% to 49%). Interactions initiated by the patient (adjusted Odds Ratio [OR] 5.30), one way communication (adjusted OR 10.70), involving two or more staff (adjusted OR 5.86 for 2 staff, 6.46 for 3+ staff), having a higher total number of interactions (adjusted OR 1.09 per unit increase), and specific types of interaction content were associated with increased odds of negative interaction (p < 0.05). In the full multivariable model there was no significant association with staff characteristics, skill mix or staffing levels. Patient agitation at the outset of interaction was associated with increased odds of negative interaction in a reduced model. There was no significant association with gender, age or cognitive impairment. There was substantially more variation at ward level (variance component 1.76) and observation session level (3.49) than at patient level (0.09).

Conclusion

These findings present a unique insight into the quality and quantity of staff-patient interactions in acute care. While a high proportion of interactions were positive, findings indicate that there is scope for improvement. Future research should focus on further exploring factors associated with negative interactions, such as workload and ward culture.