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Objectives

Early parental support, provided by nurses within child health services, aims to strengthen parents in their parenthood. The aim of this integrative review is to describe communication in parental support in encounters between child health nurses and parents in child health services.

Methods

An integrative review was conducted. The databases Cinahl+ , MedLine, Psych Info, and Scopus were searched, 312 articles were screened, and 16 articles were found to be eligible.

Results

The studies included qualitative and quantitative methods, using interviews, focus group interviews, and observations. The findings show an overarching theme: The significance of mutuality in communication in a professional-parental relationship, further described in the following categories, 1) Authoritarian approach: a controlling manner, a neglecting manner, and a teaching manner; 2. Guiding approach: a counselling manner and a compliant manner.

Conclusions

The communication between nurses and parents can be understood as having several layers; the organisational context, the professional skills, knowledge, and experiences, and parents’ knowledge, expectations, and needs. There is a lack of studies of authentic communication between nurses and parents; thus, future research is warranted.

Practice implications:

The authoritarian and guiding approaches in parental support show the required skills a nurse is expected to have, but sufficient organizational prerequisites are also crucial.

Background: In this study, the focus is on how to support the competence development needed for nursing assistants in home care. Home care services for older persons can be challenging concerning the nature of the interpersonal interaction and communication needed to care for and respond to the diverse needs of older people who seek to live well in our communities. This implies a need to offer more person-centred care (PCC) to older persons. However, there is a lack of knowledge on how to develop such competence. We, therefore, developed A Person-centred CommunicaTION (ACTION) programme, which is a web-based educational intervention aimed at supporting competence development for nursing assistants. The research objective is to evaluate the ACTION programme with respect to participants’ responses to and the effect of the intervention. Methods: A multicentre case–control study with pre- and post-assessments was designed. The ACTION programme will be implemented at home care units, in two different geographic areas in Sweden. A total of 300 nursing assistants will be recruited: 150 for the intervention group and 150 for the control group. We will evaluate the impact measures and the process. Pre- and post-assessments will be performed with data collected via a) audio recordings of communication, b) a questionnaire on self-efficacy communication skills, PCC, empathy and job satisfaction, c) user data, evaluation forms, field notes and observations, and d) interviews. The data will be analysed with descriptive and analytic statistics and/or qualitative methods for meanings. Discussion: This study has the potential to contribute to the evidence supporting competence development required to offer person-centred and quality home care to older persons and to meet upcoming needs for flexible and easily accessible competence development. Trial registration: ISRCTN64890826. Registered 10 January 2022, https://www.isrctn.com/ISRCTN64890826

AimTo explore communication research in nursing by investigating the theoretical approaches, methods, content and perspectives in research on real-time registered nurse (RN)-patient communication. DesignAn integrative review of real-time communication between RNs and patients. Data SourcesEmpirical research papers were searched in PubMed, CINAHL Plus and Medline. The results from the database searches were supplemented with results from manual searches in reference lists. Review MethodsA total of 1369 articles published between January 1996 and December 2021 were screened, which resulted in the inclusion of 52 articles. ResultsThe integration of various theories, such as nursing or communication theories, is weak in most of the included studies. RN-patient communication appears to influence relationship building. Even when nurses strive to meet patients' needs, they often focus primarily on nursing routines and physical care. The topic of the communication varies depending on the situation and different communication styles are used. When a patient-centred approach is adopted, the interpersonal communication becomes quite symmetrical, with complementary roles of nurses and patients. Within a more asymmetric communication context, nurses dominate communication, choose topics and function as instructors. How the nurses communicated subsequently influenced the patients' communication styles and strategies. ConclusionCommunication is multifaceted, contains different strategies and is important for building trust and facilitating patient-centred care. The importance of RNs' communication for interaction and relationship-building seems to be well established within research, but few studies focused on patients' communication with RNs. ImpactThis integrative review gives an overview of the width and depth of observational studies on RN-patient communication research. The variety of studies indicates that this area is a less well-grounded field of research. Future research is warranted to support nurses in their communication, especially regarding the exploration of patients' communication and desired communication skills in nurse-patient interactions. Patient or Public ContributionNo patient or public contribution was included in this integrative review.

Background Communication is a cornerstone in nursing and aims at both information exchange and relationship building. To date, little is known about the naturally occurring communication between older persons and nurses in home care. Communication might heal through different pathways and a patient- or person-centered communication could be important for health and well-being of older persons. However, the delivery of individualized home care is challenged by routines and organizational demands such as time constraints. Therefore, the aim of this study was to explore the patient-centered aspects of home care communication between older persons and registered nurses. Methods In total 37 older persons (aged 65 years or older) and eleven RNs participated in 50 audio-recorded home care visits. Roter Interaction Analysis System (RIAS) was used to code verbal communication. A ratio from these codes, establishing the degree of patient-centeredness, was analyzed using a Generalized Linear Mixed Model. Results The present home care communication contained more socio-emotional than task-oriented communication and the emotional tone was largely positive. The global affect ratings reflected an overall positive tone (m = 39.88,sd = 7.65), with higher ratings on dimensions of, for example, responsiveness/engagement and interactivity or interest were more frequent than those that may be considered as less-positive emotions (m = 15.56,sd = 3.91), e.g. hurried, dominance or anger. The ratio of the degree of patient-centered communication in the home care visits was an average of 1.53, revealing that the communication could be considered as patient-centered. The length of the visits was the only characteristic significantly associated with the degree of patient-centeredness in the communication, with a peak in patient-centeredness in visits 8-9 min long. Sex, age or procedural focus showed no significant effects on the degree of patient-centeredness. Conclusion Overall, the degree of patient-centeredness and a positive emotional tone, which might have a positive outcome on older persons' health, was high. Longer visits provided a higher degree of patient-centeredness, but no linear increase in patient-centeredness due to length of visit could be observed. The findings can be used for education and training of nurses, and for providing individualized care, e.g. patient- or person-centered care.

Communication is an essential part of care and human interaction. While communication within care entails both task-focused and socio-emotional elements, nurses are sometimes perceived as too task-focused. When in need of care, older persons want to be perceived and treated as individuals – to feel involved. However, nurses might lack the prerequisites for establishing individualised home care, which is often based on daily tasks rather than on older persons’ needs and wishes. Despite the importance of communication in nurse-patient interactions, knowledge about daily communication within home care is scarce. Therefore, the overall aim of this thesis was to explore the naturally occurring communication between nursing staff and older persons during home care visits, with a focus on emotional distress and from a person-centred perspective.

This thesis is an observational, cross-sectional study of the communication in 188 audio-recorded home care visits, and is part of the international COMHOME project. In Study I, older persons’ expressions of emotional distress were coded and analysed using the Verona Coding Definitions of Emotional Sequences [VR-CoDES]. The results showed that older persons often express emotional distress in the form of hints at emotional concerns, which were defined as cues. Explicit expressions of emotional distress, which were defined as concerns, were uncommon. The responses of nursing staff to older persons’ cues and concerns were coded and analysed in Study II using VR-CoDES. Nursing staff often responded by providing space rather than reducing it for further disclosure of older persons’ emotional distress. In Study III, the communication of emotional distress and participants’ characteristics were analysed using generalised linear mixed model [GLMM]. The results revealed that most cues and concerns were expressed by older females and to female nursing staff. Furthermore, elicitations of expressions of emotional distress were influenced by native language and profession, and responses that provided space were more often given to older females and to older persons aged 65-84 years. Home care communication between registered nurses and older persons was coded and analysed in Study IV using the Roter Interaction Analysis System [RIAS]. The results revealed a high degree of person-centred communication, especially during visits lasting 8-9 minutes, and that socio-emotional communication was more frequent than task-oriented communication.

Home care communication contains important aspects of person-centred communication, with nursing staff providing space for the older person’s narrative; however, there are also challenges in the form of vague and implicit expressions of emotional distress.

Keywords: communication; home care services; nursing staff; older persons; person-centred care; RIAS; VR-CoDES