Objective

The study attempts to examine the relationship between nurses’ religious beliefs and how nurses communicate with patients.

Method

An online census survey was administered to graduate students in the School of Nursing at a Midwestern university. The survey was designed to measure: relational control, as measured by the subscales of dominance and task orientation in Burgoon and Hale's scale of relational communication; clinician empathy, as measured by the Jefferson scale of clinician empathy; and intrinsic and extrinsic religiosity, whether religious views are held for deep personal reasons or social reasons, as measured by the Maltby and Lewis scale. Data were analyzed using multiple regressions and one-way ANOVAs.

Results

Intrinsic religiosity and empathy were both associated with the willingness to relinquish relational control in certain, specific contexts, such as end-of-life care.

Conclusion

Nurses who scored higher on a scale of intrinsic religious beliefs were more willing to let patients take control of conversations about end-of-life care.

Practice implications

A nurse's religious beliefs can enhance the clinical experience without the nurse trying to impose his or her beliefs on the patient, as the nurse works to make sure the patient's religious beliefs are upheld.

Design Communication quality indicator analysis.

Setting Standardized parent encounters performed in practicing physicians' clinics or during educational workshops for residents.

Participants Fifty-nine pediatrics residents, 53 pediatricians, and 31 family physicians.

Intervention Participants were asked to counsel standardized parents about a screening result; counseling was recorded, transcribed, and parsed into statements (each with 1 subject and 1 predicate). Pairs of abstractors independently compared statements with a data dictionary containing explicit-criteria definitions.

Outcome Measures Four groups of "precautionary empathy" behaviors (assessment of emotion, anticipation/validation of emotion, instruction about emotion, and caution about future emotion), with definitions developed for both "definite" and "partial" instances.

Results Only 38 of 143 transcripts (26.6%) met definite criteria for at least 1 of the precautionary empathy behaviors. When partial criteria were counted, this number increased to 80 of 143 transcripts (55.9%). The most common type of precautionary empathy was the "instruction about emotion" behavior (eg, "don't be worried"), which may sometimes be leading or premature.

Conclusions Precautionary empathy behaviors were rare in this analysis. Further study is needed, but this study should raise concerns about the quality of communication services after newborn screening.

Aim.  This paper is a report of a dimensional concept analysis of patient safety culture in nursing.

Background.  Patient safety is an important issue in healthcare organizations. As the release of Institute of Medicine reports in the United States of America, substantial interest has arisen in studying patient safety culture; however, the concept remains poorly defined.

Data sources.  Multiple databases, including CINAHL, MEDLINE, PsycINFO and Anthropological Index Online, were searched from 1970 to 2006. A keyword search method was employed followed by a combined key word search.

Review methods.  A concept analysis based on Caron and Bowers’ method was carried out using 45 papers, three books and three theses after examination of the abstracts to identify definitions, dimensions, perspectives and consequences needed for content and dimensional analyses.

Findings.  Nurses’ shared values, beliefs and behavioural norms towards patient safety were identified as the overarching dimensions of the patient safety culture. The four sub-dimensions of patient safety culture were synthesized as system, personal, task-associated and interaction. Two main philosophical perspectives, functional and interpretative, were added to the analysis and further clarification was provided.

Conclusion.  It is expected that understanding the nature, as well as the key elements of the concept, would assist with analysing the existing safety culture and help to determine the strategies to build or shape the safety culture.

Background

Objective

Participants

Measurements

Results

Conclusions

Objective

To introduce a method for quantifying clinicians’ use of assessment of understanding (AU) questions, and to examine medicine residents’ AU usage during counseling of standardized patients about prostate or breast cancer screening.

Methods

Explicit-criteria abstraction was done on 86 transcripts, using a data dictionary for 4 AU types. We also developed a procedure for estimating the “load” of informational content for which the clinician has not yet assessed understanding.

Results

Duplicate abstraction revealed reliability κ = 0.96. Definite criteria for at least one AU were found in 68/86 transcripts (79%). Of these, 2 transcripts contained a request for a teach-back (“what is your understanding of this?”), 2 contained an open-ended AU, 46 (54%) contained only a close-ended AU, and 18 (21%) only contained an “OK?” question. The load calculation identified long stretches of conversation without an AU.

Conclusion

Many residents’ transcripts lacked AUs, and included AUs were often ineffectively phrased or inefficiently timed. Many patients may not understand clinicians, and many clinicians may be unaware of patients’ confusion.

Practice implications

Effective AU usage is important enough to be encouraged by training programs and targeted by population-scale quality improvement programs. This quantitative method should be useful in population-scale measurement of AU usage.

METHODS. An explicit-criteria abstraction procedure was used to identify jargon usage and explanations in transcripts of encounters between residents and standardized parents of a fictitious infant found to carry cystic fibrosis or sickle cell hemoglobinopathy. Residents were recruited from a series of educational workshops on how to inform parents about positive newborn screening test results. The time lag from jargon words to explanations was measured by using “statements,” each of which contained 1 subject and 1 predicate.

RESULTS. Duplicate abstraction revealed reliability of 0.92. The average number of unique jargon words per transcript was 20; the total jargon count was 72.3 words. There was an average of 7.5 jargon explanations per transcript, but the explained/ total jargon ratio was only 0.17. When jargon was explained, the average time lag from the first usage to the explanation was 8.2 statements.

CONCLUSION. The large number of jargon words and the small number of explanations suggest that physicians’ counseling about newborn screening may be too complex for some parents. Pediatrics 2008;122:243–249

Method: An online census survey was administered to graduate students in the School of Nursing at a Midwestern university. The survey was designed to measure: relational control, as measured by the subscales of dominance and task orientation in Burgoon and Hale’s scale of relational communication; clinician empathy, as measured by the Jefferson scale of clinician empathy; and intrinsic and extrinsic religiosity, whether religious views are held for deep personal reasons or social reasons, as measured by the Maltby and Lewis scale. Data were analyzed using multiple regressions and one-way ANOVAs.

Results: Intrinsic religiosity and empathy were both associated with the willingness to relinquish relational control in certain, specific contexts, such as end-of-life care.

Conclusion: Nurses who scored higher on a scale of intrinsic religious beliefs were more willing to let patients take control of conversations about end-of-life care.

Practice implications: A nurse’s religious beliefs can enhance the clinical experience without the nurse trying to impose his or her beliefs on the patient, as the nurse works to make sure the patient’s religious beliefs are upheld.