Quality issues: 33% of patient complaints involve communication and ... BN Fully Integrative Teaching Model (The FIT Curriculum) ... Professional Studies. V e.
Patient-centred clinical communication for first year nursing students: an integrative approach A/Prof Debra Kiegaldie Steven Goldsmith Elizabeth Pryor
Dr John Elias Jennifer Jennings Bob Ribbons
“If you can’t communicate it doesn’t matter what you know…” (Kurtz, Silverman & Draper, 2013)
The problem… Quality issues: 33% of patient complaints involve communication and interactions (Reader et at., 2014)
Safety issues: Communication failures leading to adverse events (Kennedy, 2001; Thompson & Tilden, 2009; Kohn et al, 2001)
The nature of nurse communication: – 40% of nurse talk with patients about nursing/medical content – 60% constitutes friendly, social talk about non-medical issues
(Holmes
and Major, 2002)
No specific nursing model/framework of communication Poor evidence-base for nursing communication (Grant & Jenkins, 2014)
Background… BN Fully Integrative Teaching Model (The FIT Curriculum) Nursing Theory and Concepts
Integrated Clinical Practice
Professional Studies
Vertical Integration
CAPSTONE SUBJECTS Capstone subjects facilitate application and assessment of integrated knowledge and skills from across the curriculum.
Horizontal
Integration
What did we do? Curriculum Review Specialist advice
Curriculum framework and planning – von Fragstein et al., - Curriculum wheel (2008) – Stein-Parbury - Nursing text (2014) – Silverman, Kurtz & Draper (2013)
Cross functional teaching team Common themes ‘Core Communication Skills – foundation course’ Integrative teaching methods
Focus for Year 1
The curriculum-core skills (Stein-Parbury/Calgary-Cambridge) Communication with patients 1. Encourage interaction – Introductions, building rapport (The 6 steps of an introduction) – Active listening skills (SOLER)
2. Building meaning: understanding and responding – Paraphrasing for building empathy
3. Collecting information: exploring – Prompting and probing
4. Intervening: comforting, supporting and enabling – Sharing information
5. Additional skills – Providing structure: ‘signposting’ and summarising; Closing the interaction – Communicating in specific contexts: Patients from CALD backgrounds, elderly [hearing impaired], children
The curriculum-core skills (Stein-Parbury/Calgary-Cambridge) Communication with other health professionals
Handover (ISBAR)
Integrative teaching methods Semester 1, Year 1 - Core communication skills
Staged curriculum - 6 weeks of teaching Interactive lectures
Small group tutorials Clinical skills laboratories
3 Immersive simulations with simulated patients
Research questions Does an integrative, patient-centred clinical skills communication curriculum develop: – students’ knowledge of patient centred clinical communication? – students’ perceived confidence in performing patient centred clinical communication tasks?
What are the perceptions of students and clinical supervisors on the application of clinical communication skills in the clinical placement setting?
Methods Longitudinal – Mixed Methods
3 time points – Pre-teaching (Pre-test) – End of semester (Post-test 1) – End of clinical placement (Post-test 2)
Participants: – First year/First Semester Bachelor of Nursing students – Clinical Supervisors
Instruments 1. Knowledge questions (9 items, 6 point Likert Scale)
2. Confidence questions (22 items, 10 point Rating Scale) 3. Views and comparisons of the teaching approaches (8 items, 6 point Likert Scale)
4. Views on preparation for clinical placement (1 item, 6 point Likert Scale)
5. Perceptions of the learning experience (3 open-ended Qs)
6. Applying skills on clinical placement (10 items, 6 point Likert Scale)
7. Perceptions of applying skills on clinical placement (3 open ended Qs)
8. Supervisor questions (3 open-ended Qs)
Study Design
Post-test 1 (end of semester)
Pre-test (before the teaching) 1. General communication 2. Confidence in performing communication tasks
1. General communication 2. Confidence in performing communication tasks 3. Views and comparisons of teaching approaches 4. Preparation for clinical placement 5. Perceptions of the learning experience
Post-test 2 (end of clinical placement) 1. General communication 2. Confidence in performing communication tasks 6. Applying skills on clinical placement 7. Perceptions of applying skills on clinical placement
Clinical Placement (end of clinical placement)
8. Supervisor questions
Results - demographics Response rates – Pre-test
(73.3%, n=44/60)
– Post-test 1
(89.3%, n=50/56)
– Post-test 2
(69.8%, n=37/53)
Age: Majority 18-29 years (86.4%, n=38/44) Gender: Majority female (72.7%, n=32/44) Other post secondary qualifications: (43.2%, n=19/44) – Cert III/IV, Dip Nursing, Other
1. Knowledge Questions (n=9 items) Pooled responses between 3 surveys
Increased mean score from Pre-test to Post-test 1 (p < 0.05) Increased mean score from Pre-test to Post-test 2 (p < 0.01) No difference from Post-test 1 to Post-test 2
1. Knowledge Qs One Way ANOVA contrast testing (n=9 items)
All items increased from pre-test to post-test 1
All items increased from pre-test to post-test 2 5 items increased from post-test 1 to post-test 2 Significant increases were for 3 items: “Clinical communication increases the therapeutic effectiveness of nursing activities” (pre-test - post test 1 p
