Nonverbal communication between registered nurses and patients during chronic disease management consultations: Observations from general practice.
general practice
nonverbal communication
nurse
nurse-patient interaction
observational research
patient relations
primary care
Journal
Journal of clinical nursing
ISSN: 1365-2702
Titre abrégé: J Clin Nurs
Pays: England
ID NLM: 9207302
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
19
11
2019
revised:
06
02
2020
accepted:
13
03
2020
pubmed:
30
3
2020
medline:
7
10
2020
entrez:
30
3
2020
Statut:
ppublish
Résumé
This study explores nonverbal communication behaviours between general practice nurses and patients during chronic disease consultations. Nonverbal communication is an important aspect of nurse-patient lifestyle risk reduction conversations. Despite the growing role of general practice nurses in lifestyle risk modification when managing chronic disease, few studies have investigated how this communication occurs. Observational study within a concurrent mixed methods project. Thirty-six consultations by 14 general practice nurses were video-recorded between August 2017 and March 2018. Video analysis used the Nonverbal Accommodation Analysis System. The STROBE checklist was used to guide this paper. Joint convergence of nurse-patient behaviours such as laughing, smiling and eye contact was most common (44%; n = 157). Patient-nurse eye contact time decreased significantly across the consultation, while nurse gesturing increased significantly. No significant relationship between consultation length and convergent to divergent behaviour categorisation or nurse-computer use across the consultation was found. The high levels of convergent behaviours are promising for person-centred care. However, scope exists to enhance nonverbal interactions around lifestyle risk reduction. Supporting nurses with skills and improved environments for lifestyle risk communication has potential to improve therapeutic relationships and patient outcomes. These results indicate that nurses support patients through nonverbal interactions during conversations of lifestyle risk reduction. However, there are opportunities to improve this practice for future interventions.
Sections du résumé
AIMS AND OBJECTIVES
OBJECTIVE
This study explores nonverbal communication behaviours between general practice nurses and patients during chronic disease consultations.
BACKGROUND
BACKGROUND
Nonverbal communication is an important aspect of nurse-patient lifestyle risk reduction conversations. Despite the growing role of general practice nurses in lifestyle risk modification when managing chronic disease, few studies have investigated how this communication occurs.
DESIGN
METHODS
Observational study within a concurrent mixed methods project.
METHODS
METHODS
Thirty-six consultations by 14 general practice nurses were video-recorded between August 2017 and March 2018. Video analysis used the Nonverbal Accommodation Analysis System. The STROBE checklist was used to guide this paper.
RESULTS
RESULTS
Joint convergence of nurse-patient behaviours such as laughing, smiling and eye contact was most common (44%; n = 157). Patient-nurse eye contact time decreased significantly across the consultation, while nurse gesturing increased significantly. No significant relationship between consultation length and convergent to divergent behaviour categorisation or nurse-computer use across the consultation was found.
CONCLUSIONS
CONCLUSIONS
The high levels of convergent behaviours are promising for person-centred care. However, scope exists to enhance nonverbal interactions around lifestyle risk reduction. Supporting nurses with skills and improved environments for lifestyle risk communication has potential to improve therapeutic relationships and patient outcomes.
RELEVANCE TO CLINICAL PRACTICE
CONCLUSIONS
These results indicate that nurses support patients through nonverbal interactions during conversations of lifestyle risk reduction. However, there are opportunities to improve this practice for future interventions.
Types de publication
Journal Article
Observational Study
Langues
eng
Pagination
2378-2387Subventions
Organisme : University of Wollongong Health Impacts Research Cluster
Organisme : Australian Government Research Training Program Scholarship
Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Althouse, A. (2016). Adjust for multiple comparisons? It's not that simple. The Annals of Thoracic Surgery, 101(5), 1644-1645. https://doi.org/10.1016/j.athoracsur.2015.11.024
Ambady, N., Koo, J., Rosenthal, R., & Winograd, C. H. (2002). Physical therapists' nonverbal communication predicts geriatric patients' health outcomes. Psychology and Aging, 17(3), 443-452. https://doi.org/10.1037/0882-7974.17.3.443
American Academy of Family Physicians. (2019). Family Medicine Specialty. https://www.aafp.org/about/the-aafp/family-medicine-specialty.html
Australian Medicare Local Alliance (2012). General Practice Nurse National Survey Report. http://healthypractices.apna.asn.au/wp-content/uploads/2015/03/General-Practice-Nurse-National-Workforce-Survey-2012.pdf
Australian Primary Health Care Nurses Association (2017). Definition of Primary Health Care Nursing. http://www.apna.asn.au/lib/pdf/DefinitionofPrimaryHealthCareNursing.pdf
Australian Primary Health Care Nurses Association (2017). General Practice Nursing. https://www.apna.asn.au/profession/what-is-primary-health-care-nursing/general-practice-nursing
Blanch-Hartigan, D., Ruben, M. A., Hall, J. A., & Schmid Mast, M. (2018). Measuring nonverbal behavior in clinical interactions: A pragmatic guide. Patient Education and Counseling, https://doi.org/10.1016/j.pec.2018.08.013
Britt, H., Miller, G., Henderson, J., Bayram, C., Harrison, C., Valenti, L., … Gordon, J. (2016). General Practice Activity in Australia 2015-2016 (General practice series no. 40). Sydney: Sydney University Press.
Bryant, J., Yoong, S. L., Sanson-Fisher, R., Mazza, D., Carey, M., Walsh, J., & Bisquera, A. (2015). Is identification of smoking, risky alcohol consumption and overweight and obesity by General Practitioner's improving? A comparison over time. Family Practice, 32(6), 664-671. https://doi.org/10.1093/fampra/cmv078
Carrard, V., Schmid Mast, M., & Cousin, G. (2016). Beyond “One Size Fits All”: Physician nonverbal adaptability to patients’ need for paternalism and its positive consultation outcomes. Health Communication, 31(11), 1327-1333. https://doi.org/10.1080/10410236.2015.1052871
Chambers, S. (2003). Use of non-verbal communication skills to improve nursing care. British Journal of Nursing, 12(14), 874-878. https://doi.org/10.12968/bjon.2003.12.14.11412
D'Agostino, T. A., & Bylund, C. L. (2011). The Nonverbal Accommodation Analysis System (NAAS): Initial application and evaluation. Patient Education and Counseling, 85(1), 33-39. https://doi.org/10.1016/j.pec.2010.07.043
D'Agostino, T. A., & Bylund, C. L. (2014). Nonverbal accommodation in health care communication. Health Communication, 29(6), 563-573. https://doi.org/10.1080/10410236.2013.783773
de Rezende, R. D., de Oliveira, R. M., de Araújo, S. T., Guimarães, T. C., do Espírito Santo F. H., & Porto, I. S. (2015). Body language in health care: A contribution to nursing communication. Revista Brasileira De Enfermagem, 68(3), 430-436. https://doi.org/10.1590/0034-7167.2015680316i
Department of Health (2018). Fact Sheet: Primary Health Networks, Australian Government. https://www1.health.gov.au/internet/main/publishing.nsf/Content/Fact-Sheet-Primary-Health-Networks+
Desborough, J., Phillips, C., Mills, J., Korda, R., Bagheri, N., & Banfield, M. (2018). Developing a positive patient experience with nurses in general practice: An integrated model of patient satisfaction and enablement. Journal of Advanced Nursing, 74(3), 564-578. https://doi.org/10.1111/jan.13461
Donovan, H., & Forster, E. (2015). Communication adaption in challenging simulations for student nurse midwives. Clinical Simulation in Nursing, 11(10), 450-457. https://doi.org/10.1016/j.ecns.2015.08.004
Dragojevic, M., Gasiorek, J., & Giles, H. (2016). Accommodative strategies as core of the theory. In H. Giles (Ed.), Communication Accommodation Theory: Negotiating Personal Relationships and Social Identities Across Contexts. Cambridge, UK: Cambridge University Press.
Duggan, A. P., & Parrott, R. L. (2001). Physicians' nonverbal rapport building and patients' talk about the subjective component of illness. Human Communication Research, 27(2), 299-311. https://doi.org/10.1093/hcr/27.2.299
Equator Network (2019). STROBE Statement-Checklist of Items That Should Be Included In Reports of Cross-Sectional Studies, UK EQUATOR Centre. https://www.equator-network.org/wp-content/uploads/2015/10/STROBE_checklist_v4_cross-sectional.pdf
Giles, H., Coupland, J., & Coupland, N. (1992). Accommodation theory: Communication, context, and consequence. In H. Giles, J. Coupland, & N. Coupland (Eds.), Contexts of Accommodation. Cambridge, UK: Cambridge University Press.
Halcomb, E., Ashley, C., James, S., & Smyth, E. (2018). Employment conditions of Australian primary health care nurses. Collegian, 25, 65-71. https://doi.org/10.1016/j.colegn.2017.03.008
Hall, J. A., Horgan, T. G., & Murphy, N. A. (2019). Nonverbal communication. Annual Review of Psychology, 70(1), 271-294. https://doi.org/10.1146/annurev-psych-010418-103145
Haskard, K. B., Dimatteo, M. R., & Heritage, J. (2009). Affective and instrumental communication in primary care interactions: Predicting the satisfaction of nursing staff and Patients. Health Communication, 24(1), 21-32. https://doi.org/10.1080/10410230802606968
Health Workforce New Zealand (2011). HWNZ Postgraduate Nursing Training Specification. https://www.health.govt.nz/system/files/documents/pages/1-b57-hwnz-postgraduate-nursing-training-spec.doc
IBM Corp. (2012a). Windows Movie Maker. United States: Microsoft, Corp.
IBM Corp. (2012b). IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp.
James, S., Desborough, J., McInnes, S., & Halcomb, E. (2019). Strategies for using non-participatory video research methods in general practice. Nurse Researcher, 27(2), 32-37. https://doi.org/10.7748/nr.2019.e1667
James, S., Halcomb, E., Desborough, J., & McInnes, S. (2019). Lifestyle risk communication by general practice nurses: An integrative literature review. Collegian, 26, 183-193. https://doi.org/10.1016/j.colegn.2018.03.006
James, S., McInnes, S., Halcomb, E., & Desborough, J. (2020). Lifestyle risk factor communication by nurses in general practice: Understanding the interactional elements. Journal of Advanced Nursing, 76(1), 234-242. https://doi.org/10.1111/jan.14221
Jewitt, C. (2012). An Introduction to Using Video for Research, National Centre for Research Methods. http://eprints.ncrm.ac.uk/2259/4/NCRM_workingpaper_0312.pdf
Kozłowska, L., & Doboszynska, A. (2012). Nurses' nonverbal methods of communicating with patients in the terminal phase. International Journal of Palliative Nursing, 18(1), 40-46. https://doi.org/10.12968/ijpn.2012.18.1.40
Mason, P., & Butler, C. (2010). Health Behavior Change: A Guide for Practitioners, 2nd ed. London, UK: Churchill Livingstone Elsevier.
Ministry of Health (2003). Primary Health Care and Community Nursing Workforce Survey 2001, Ministry of Health New Zealand. http://www.moh.govt.nz/notebook/nbbooks.nsf/0/C621693E7803A9C3CC257837007CF433/$file/Primary%20Health%20Care%20and%20Community%20Nursing.pdf
Noordman, J., van der Weijden, T., & van Dulmen, S. (2012). Communication-related behavior change techniques used in face-to-face lifestyle interventions in primary care: A systematic review of the literature. Patient Education and Counseling, 89(2), 227-244. https://doi.org/10.1016/j.pec.2012.07.006
Noordman, J., Verhaak, P., van Beljouw, I., & van Dulmen, S. (2010). Consulting room computers and their effect on general practitioner-patient communication. Family Practice, 27(6), 644-651. https://doi.org/10.1093/fampra/cmq058
Pearce, C., Hall, S., Phillips, C., Dwan, K., Yates, R., & Sibbald, B. (2012). A spatial analysis of the expanding roles of nurses in general practice. BMC Nursing, 11(1), 13-20. https://doi.org/10.1186/1472-6955-11-13
Pounds, K. G. (2010). Client-nurse interaction with individuals with schizophrenia: A descriptive pilot study. Issues in Mental Health Nursing, 31(12), 770-774. https://doi.org/10.3109/01612840.2010.518337
Primary Care Workforce Commission (2015). The Future of Primary Care; Creating Teams for Tomorrow. https://www.hee.nhs.uk/sites/default/files/documents/The%20Future%20of%20Primary%20Care%20report.pdf
Robinson, J. (2006). Nonverbal communication and physician-patient interaction: review and new directions. In V. Manusov & M.L. Patterson (Eds.), The SAGE Handbook of Nonverbal Communication. Thousand Oaks, CA: SAGE Publications, Inc. https://doi.org/10.4135/9781412976152
Rollnick, S., & Miller, W. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23(4), 325-334.
Rusu, O., & Chiriță, M. (2017). Verbal, non-verbal and paraverbal skills in the patient-kinetotherapist relationship. Timisoara Physical Education & Rehabilitation Journal, 10(19), 39-45. https://doi.org/10.1515/tperj-2017-0014
Siouta, E., Farrell, C., Chan, E. A., Walshe, C., & Molassiotis, A. (2019). Communicative constructions of person-centred and non-person-centred caring in nurse-led consultations. European Journal of Oncology Nursing, 40, 10-21. https://doi.org/10.1016/j.ejon.2019.02.008
Sobral, D., Rosenbaum, M., & Figueiredo-Braga, M. (2015). Computer use in primary care and patient-physician communication. Patient Education and Counseling, 98(12), 1568-1576. https://doi.org/10.1016/j.pec.2015.07.002
Street, R. L., Liu, L., Farber, N. J., Chen, Y., Calvitti, A., Zuest, D., … Agha, Z. (2014). Provider interaction with the electronic health record: The effects on patient-centered communication in medical encounters. Patient Education and Counseling, 96(3), 315-319. https://doi.org/10.1016/j.pec.2014.05.004
Street, R. L. , Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counseling, 74(3), 295-301. https://doi.org/10.1016/j.pec.2008.11.015
The Royal Australian College of General Practitioners (2018). The Role of a GP. https://www.racgp.org.au/education/students/a-career-in-general-practice/what-is-general-practice
Timmermann, C., Uhrenfeldt, L., & Birkelund, R. (2017). Ethics in the communicative encounter: Seriously ill patients' experiences of health professionals' nonverbal communication. Scandinavian Journal of Caring Sciences, 31(1), 63-71. https://doi.org/10.1111/scs.12316
United Nations (2015). Goal 3: Ensure Healthy Lives and Promote Well-being For All At All Ages. https://www.un.org/sustainabledevelopment/health/
Varndell, W., Fry, M., & Elliott, D. (2017). A systematic review of observational pain assessment instruments for use with nonverbal intubated critically ill adult patients in the emergency department: An assessment of their suitability and psychometric properties. Journal of Clinical Nursing, 26(1-2), 7-32. https://doi.org/10.1111/jocn.13594
World Health Organization (2015). Noncommunicable diseases, World Health Organization. http://www.who.int/gho/publications/mdgs-sdgs/en/
World Health Organization (2017). Global Health Observatory (GHO) data; Noncommunicable Diseases. http://www.who.int/gho/ncd/en/
World Health Organization (2019). Nursing. https://www.who.int/topics/nursing/en/
Young, J., Eley, D., Patterson, E., & Turner, C. (2016). A nurse-led model of chronic disease management in general practice: Patients' perspectives. Australian Family Physician, 45(12), 912-916.