Ratings of the performances of practicing internists by hospital-based registered nurses

PURPOSE: To examine the feasibility and reliability of ratings completed by hospital-based registered nurses of the humanistic qualities, communication skills, and selected aspects of the clinical skills of practicing internists. METHOD: In 1988-1989, registered nurses who worked in the same 175 hospitals as 232 internists with admitting privileges at these hospitals rated the internists' performances. The nurses were selected from medicine floors, specialty floors, and intensive care units and/or critical care units, using lists provided by head nurses. A total of 1,877 rating questionnaires with 13 performance categories were collected (with a mean of 8.01 nurses per internist). The ratings were analyzed to determine measurement characteristics and the relationships of the nurses' demographic characteristics to the ratings. In addition, for each of ten performance categories for 152 of the internists, the average rating each internist received from nurses was compared with the average rating each internist received from peer physicians. Statistical analysis used Pearson correlations, canonical correlations, factor analyses, Student's t-tests, analysis of variance, and stepwise multiple regression. Finally, the internists themselves, including physicians who were not actually rated by the nurses, were asked to complete a brief questionnaire that included questions about their opinions of the use of nurses' ratings. RESULTS: The nurses' ratings correlated moderately strongly with the peer physicians' ratings and had a common structure. However, the nurses' ratings were lower for several humanistic qualities, including respect, integrity, and responsibility, and their ratings were higher for medical knowledge and verbal communications. Across the 13 performance categories, approximately 10-15 ratings from nurses were needed to obtain a reliable assessment of an internist's humanistic qualities and communication skills. Many internists felt that nurses' ratings should be used equally with, or at least as a lesser contribution to, ratings by peer physicians of humanistic qualities and communication skills. CONCLUSION: Nurses' ratings appear to provide a feasible and reliable method of evaluating the internists' communication skills and humanistic qualities, when used in conjunction with ratings by peer physicians.     

The application of participatory control to facilitate patient well-being: An experimental study of nursing impact on geriatric patients.

Evaluated a program to teach 20 nurses skills to increase their 20 patients' sense of participatory control (the process by which people increase control through reciprocal interactions with their environment). Seven nurse-pairs were in the skills training (intervention) group, 6 in an attention-control group, and 7 in a no treatment control group. Training program topics included sensitivity training, goal-setting, clarity of communication, problem-solving, and interpretation of behavior. According to the Ward Atmosphere Scale, patients in the skills training group showed increases in Autonomy and Spontaneity and decreases in Staff Control. Patient scores on a self-concept scale showed an increase in positive self-concept. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospital ethics committees and nurses' participation

The hospital ethics committee's mandates of patient care review, policy formation, and education make them central to nurses and healthcare delivery. In a study examining nurses' communication exchange frequency and perceived effectiveness as members of hospital ethics committees, nurses represented the largest proportion, were moderately active, and rated their participation effectiveness the highest: they are more involved in discussions regarding patients than policy formation and education. Nurse administrators can provide strategies and education for nurses that enhance nurses' participation in all three committee functions. Policies affect patient care; therefore, policy decisions, too, benefit from nurses' participation.     

Videoendoscopic diagnosis of esophageal motility disorders

PURPOSE: Looking for a valid, reliable, and feasible method to collect data on the performances of practicing family physicians, the authors compare the measurement characteristics of a multiple-station examination (MSE) using standardized patients with those of a video assessment of regular consultations in daily practice (practice video assessment, PVA). METHOD: In a cross-sectional study, consultations of 90 family physicians were videotaped both in an MSE and in their daily practices. Peer-observers used a validated instrument (MAAS-Global) to assess the physicians' communication with patients and their medical performances. The physicians were randomly divided into two groups, comparable for demographic characteristics, and half underwent the assessments in reverse order to test for time-order effects. Content validity, criterion validity, reliability, and feasibility of the two methods were compared. RESULTS: Content validity of the PVA was superior to that of the MSE, since the domain of general family practice care was better covered. Observed participants judged the videotaped practice consultations to be "natural," whereas hardly any family physician, after reviewing the videotaped consultations of the MSE, recognized his or her usual working style. Specific criteria made it possible to standardize real practice. Concerning criterion validity, only the medical-performance components of the two methods correlated. No correlation was found for the communication components. Real-practice performance proved to be less influenced by observation than was performance during the MSE. The reliabilities of the two methods, expected to be better in the controlled MSE, were comparable. The administration of the PVA was more flexible, less costly, and better accepted by the family physicians than was that of the MSE. CONCLUSION: Assessment for quality improvement of family physicians' practices by video observation in daily practice is superior to video assessment in a simulated setting using standardized patients.     

Positioning of stroke patients: evaluation of a teaching intervention with nurses

BACKGROUND AND PURPOSE: There is agreement, although little evidence, that consistently positioning stroke patients in allegedly reflex-inhibiting positions is therapeutic and will enhance functional recovery. The nursing staff, therefore, needs to know and implement these postures and understand their potential underlying value. We examined nurses' knowledge of and practice in positioning stroke patients before and after a formal teaching intervention. METHODS: In a quasi-experimental study, 38 stroke patients and 59 nursing staff members (44 trained nurses and 15 healthcare assistants) from 6 wards were studied. The wards were randomly allocated to experimental or control status. Patients were assessed on entry into the study by use of a range of measures to establish group equivalence. Nineteen aspects of their position were documented at intervals throughout their stay with a previously developed observational tool. One thousand sets of observations of patient position were made. Using 2 questionnaires, the nurses' knowledge of the terminology used to denote posture and of issues relating to the moving and positioning of stroke patients was assessed before, immediately after, and 3 months after a package of formal teaching was implemented on the experimental wards. Nurse knowledge and patient position were used as the main outcome measures. RESULTS: Immediately after teaching, nurses in the experimental group scored significantly higher than those in the control group on the terminology questionnaire (P < 0.05) and the moving and positioning questionnaire (P < 0.001). Three months later, the experimental group scored higher on the latter questionnaire only (P < 0.005). The positioning of patients in the experimental group was improved overall after the teaching (P < 0.0005), and improvements to specific parts of the body were noted. CONCLUSIONS: It was possible to effect a degree of change in the nurses' knowledge of and practice in the positioning of stroke patients. However, the quality of patient positioning remained variable. More effective ways of improving positioning need to be developed. Only then can the effects of recommended positioning be evaluated.     

Comparison of standardized patients and faculty in teaching medical interviewing

PURPOSE: This randomized controlled study compared the interviewing skills of first-year medical students receiving feedback primarily from standardized patients (SPs) with those of students receiving feedback primarily from faculty. METHOD: All 154 first-year students at the University of Oklahoma College of Medicine in 1993-94 were video-taped to assess baseline and post-instruction interviewing skills. All the students, randomized to one of three study groups, attended two four-hour workshops on interviewing skills. Instruction in the groups was as similar as possible except in the matter of who provided feedback. Two rating systems were used to rate the videotaped interviews for performances of targeted skills. RESULTS: Complete, usable data were available for 120 (78%) of the students. Skill ratings using the Arizona Clinical Interview Rating Scale were significantly higher for the "types of questions used" and "use of empathy" items in the SP-led feedback group. No significant difference in ratings was detected among the groups as measured by the Rotor Interactional Analysis System. CONCLUSION: The SPs were at least as effective as the faculty in effecting behavioral changes in the first-year medical students' interviewing skills.     

The future of clinical communication in an electronic environment

Computer technologies, particularly electronic computer networks, can enhance nurses' abilities to initiate, facilitate, and sustain interpersonal contact with patients. Computer networks are electronic links between remote sites and as such provide a pathway for communication between nurses and patients. In an innovative project known as the ComputerLink, a team of nurses used an electronic network to provide information, communication, and decision support to homebound persons and their caregivers. This experiment allowed exploration of the unspoken language of nursing and provides direction for considering how nursing therapeutics can capitalize on the benefits of the electronic network.     

Intracellular cations and hypertension in blacks

OBJECTIVE: To evaluate the effectiveness of a fetal monitoring education program in increasing nurses' knowledge and clinical skills. DESIGN: Multicenter randomized control trial. SETTING: Twelve hospitals in eastern Ontario, Canada. PARTICIPANTS: One hundred nine volunteer registered nurses randomly assigned, within each hospital, to an experimental (n = 47) or control (n = 62) group. Ninety-six nurses (40 in the experimental group and 56 in the control group) completed the 6-month follow-up (88% retention). INTERVENTIONS: The experimental group participated in a 1-day fetal monitoring workshop and a review session 6 months later. MAIN OUTCOME MEASURES: Performance on a 45-item knowledge test and a 25-item skills checklist. The passing score was at least 75% correct on each test. RESULTS: The percentage of nurses in the experimental group passing both the knowledge and the clinical skills tests after the workshop was significantly higher (p < 0.01) than that of the nurses in the control group: 68.1% versus 6.5%, respectively. A large difference between the groups remained at the 6-month follow-up (experimental, 45%; control, 6.5%). The performance of the nurses in the experimental group improved to an 85% pass rate after they attended the 6-month review session. CONCLUSION: This comprehensive, research-based program is effective in increasing fetal monitoring knowledge and clinical skills.     

Decrease of insulin resistance after splenectomy in a diabetic patient with liver cirrhosis and portal hypertension. Physiopathologic evaluation

OBJECTIVE: To evaluate the effects of a course in physical diagnosis on the knowledge, skills, and attitudes of internal medicine trainees. DESIGN: A controlled, prospective assignment of housestaff to a year-long curricular program, linked to a set of pre- and posttests. Houseofficers who could not attend the teaching sessions functioned as control subjects. SETTING: An internal medicine training program at an urban medical school. SUBJECTS: 56 (86.1%) of 65 eligible internal medicine housestaff (post-graduate years 1 through 3) participated in the intervention and assessment. A comparison group of 14 senior medical students participated in the pretest. INTERVENTION: 12 monthly lectures emphasizing skills useful in emergencies or validated by the literature. MEASUREMENTS: The pre- and posttests included: 1) a multiple-choice questionnaire to assess knowledge; 2) professional standardized patients to assess selected skills; and 3) Likert-type questionnaires to assess self-motivated learning and attitude toward diagnosis not based on technology. MAIN RESULTS: The residents expressed interest in the program and on a six-point scale rated the usefulness of lectures and standardized patients as 3.5 +/- 1.3 and 4.3 +/- 1, respectively. For no system tested, however, did they achieve more than 55.2% correct answers (range: 24.2%-55.2%, median = 41.04), and their performance did not differ from that of the fourth-year medical students. There was no significant difference in pre/posttest improvement between the control and intervention groups. CONCLUSIONS: These data confirm the deficiencies of physical diagnostic skills and knowledge among physicians in training. These deficiencies were not corrected by the classroom lecture series. Improvement in these skills may require a more intense experiential program made part of residency requirements.     

Nurse coaching and cartoon distraction: an effective and practical intervention to reduce child, parent, and nurse distress during immunizations

Evaluated a low cost and practical intervention designed to decrease children's, parents', and nurses' distress during children's immunizations. The intervention consisted of children viewing a popular cartoon movie and being coached by nurses and parents to attend to the movie. Ninety-two children, 4-6 years of age, and their parents were alternatively assigned to either a nurse coach intervention, a nurse coach plus train parent and child intervention, or a standard medical care condition. Based on previous findings of generalization of adult behaviors during medical procedures, it was hypothesized that training only the nurses to coach the children would cost-effectively reduce all participants levels of distress. Observational measures and subjective ratings were used to assess the following dependent variables: children's coping, distress, pain, and need for restraint; nurses' and parents' coaching behavior; and parents' and nurses' distress. Results indicate that, in the two intervention conditions, children coped more and were less distressed, nurses and parents exhibited more coping promoting behavior and less distress promoting behavior, and parents and nurses were less distressed than in the control condition. Although neither intervention was superior on any of the variables assessed in the study, nurse coach was markedly more practical and cost-effective. Therefore, nurses' coaching of children to watch cartoon movies has great potential for dissemination in pediatric settings.     

The cat vertebral column: stance configuration and range of motion

PURPOSE: To evaluate whether clinical-teaching skills could be improved by providing teachers with augmented student feedback. METHOD: A randomized, controlled trial in 1994 included 42 attending physicians and 39 residents from the Department of Medicine at the Indiana University School of Medicine who taught 110 students on medicine ward rotations for one-month periods. Before teaching rotations, intervention group teachers received norm-referenced, graphic summaries of their teaching performances as rated by students. At mid-month, intervention group teachers received students' ratings augmented by individualized teaching-effectiveness guidelines based on the Stanford Faculty Development Program framework. Linear models were used to analyze the students' mean ratings of teaching behaviors at mid-month and end-of-month. Independent variables included performance ratings, intervention status, teacher status, teaching experience, and interactions with baseline ratings. RESULTS: Complex interactions with baseline performance were found for most teaching categories at mid-month and end-of-month. The intervention-group teachers who had high baseline performance scores had higher student ratings than did the control group teachers with similar baseline scores; the intervention group teachers who had low baseline performance scores were rated lower than were the control group teachers with comparable baseline scores. The residents who had medium or high baseline scores were rated higher than were the attending physicians with comparable baseline scores; the performance of the residents who had low baseline scores was similar to that of the attending physicians with comparable baseline scores. CONCLUSION: Baseline performance is important for targeting those teachers most likely to benefit from augmented student feedback. Potential deterioration in teaching performance warrants a reconsideration of distributing students' ratings to teachers with low baseline performance scores.     

Gene expression of syndecans and betaglycan in isolated rat liver cells

Competence as communication skills and as skilled practice of asepsis were studied by observing four nurses while interacting with patients and performing intravenous procedures. Nurses were observed using sterile equipment for methods of intravenous therapy. Asepsis is performed frequently, but through misunderstanding in the learning of asepsis or improper model learning the nurses may establish incorrect routines. When performing procedures, unexpected factors can distract both the expert and the inexperienced, resulting in a failure to apply basic aseptic techniques. The nurses showed an interest in the patient by listening and giving responses. Nurses may control interactions with the patient by using undesirable communication skills which include incomplete sentences, incomplete explanations and closed questions. Asked to evaluate their own behavior, the nurses did not estimate whether or not the appropriate skills were applied in observed situations. To improve the quality of nursing care performance it is recommended to further develop and apply skill training programs.     

Communication and socialisation (1): An exploratory study and explanation for nurse-patient communication in an ITU

This exploratory study was designed to determine the state of communication between conscious, intubated and orientated patients, and nurses in an intensive therapy unit (ITU) and the factors that influence this communication. The aim was to determine whether nurses are able to identify the needs and problems of their patients. This was done by examining characteristics of nurse-patient interactions through participant observation, and exploring nurses' attitudes and knowledge of communication and the nursing process. Dissatisfaction with the nursing process and continual difficulty in communicating with conscious intubated patients by ITU colleagues was the stimulus to investigate the state of nurse-patient communication in the unit where the researcher works. In this paper critical evaluation of previous studies of nurse-patient communication in ITUs is followed by presentation of results of the observations and interviews in this study. The discussion that follows focuses on the socialisation of nurses in 'becoming' ITU nurses related to Bradby's (1990) interpretation of status passage, and the effect that this has on the way in which they communicate.     

Fundamentals and basic principles of tissue transfer

BACKGROUND AND PURPOSE: Physical therapists strive to promote children's motor function and the parents' abilities to interact with their children, thus aiming to positively influence the parent-child relationship. This study examined a model for provision of home-based physical therapy within the context of motor play on mother-child interactions and motor behaviors of children. SUBJECTS: The subjects were 38 mothers and their children with motor delay, aged 6 to 34 months (mean = 18.8, SD = 7.2), who were receiving center-based early intervention. METHOD: Children were ranked by motor development, using the Bayley Motor Scale, and assigned to either an experimental or control group. The experimental group received five home-based sessions of physical therapy. Conventional physical therapy strategies were incorporated into interactive play activities between mothers and their children. Both groups continued to receive their centered-based services. Mother-child interactions were videotaped before and after intervention and were analyzed using a modification of the response-class matrix. RESULTS: The mothers in the experimental group demonstrated an increase in appropriate holding of their children, whereas mothers in the control group demonstrated a decrease. The mothers in the experimental group became more directive, thus controlling their children's behavior, but they were not less positive or more negative when interacting with their children. CONCLUSION AND DISCUSSION: The integration of conventional physical therapy within the context of interactive play was well received and may promote generalization of motor skills during play without interfering with positive mother-child interactions.     

“Physician and patient communication training in primary care: Effects on participation and satisfaction”: Correction.

Reports an error in "Physician and patient communication training in primary care: Effects on participation and satisfaction" by Kelly B. Haskard, Summer L. Williams, M. Robin DiMatteo, Robert Rosenthal, Maysel Kemp White and Michael G. Goldstein (Health Psychology, 2008[Sep], Vol 27[5], 513-522). There was a typographical error in the text on page 521, in the first sentence of the first full paragraph. The corrected sentence is provided in the erratum. (The following abstract of the original article appeared in record 2008-13168-002.) Objective: To assess the effects of a communication skills training program for physicians and patients. Design: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). Main Outcome Measures: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. Results: The following significant (p     

Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom

PURPOSE: To determine the communication difficulties experienced by clinicians in cancer medicine and to develop, implement, and evaluate communication skills training courses. METHODS: One hundred seventy-eight senior clinicians attended 1 1/2- or 3-day residential courses designed to enhance skills development, knowledge acquisition, and personal awareness. Course content included structured feedback, video review of interviews, interactive group demonstrations, and discussion in groups of four led by trained facilitators. The main outcomes were self-rated confidence in key aspects of communication, attitudinal shift toward more patient-centered interviewing, perceived changes in personal practice, and initiation of teaching programs for junior staff. RESULTS: Less than 35% of the participants had received any previous communications training. Time, experience, and seniority had not improved skills; before the course, oncologists expressed difficulty with 998 different communication issues. Primary problems concerned giving complex information, obtaining informed consent, and handling ethnic and cultural differences. Confidence ratings for key communication areas were significantly improved postcourse (P < .01). Three months postcourse, 95% of the physicians reported significant changes in their practice of medicine. Seventy-five percent had started new teaching initiatives in communication for junior clinicians. Clinicians showed positive shifts in attitude toward patients' psychosocial needs (P=.0002) and were more patient centered (P=.03). The courses were highly rated and 97% would "definitely" recommend them to colleagues. CONCLUSION: Oncologists are hampered by inadequate communication skills training and will give up time to correct this. Subjective improvements reported immediately postcourse were maintained at 3 months. Resources for educational initiatives are needed to help both patients and their physicians.     

Comparison of self, nurse, and physician assessment of residents rotating through an intensive care unit

OBJECTIVE: Compare resident evaluations by self, nurses, and attending physicians. DESIGN: Prospective cohort. SETTING: University intensive care unit. SUBJECTS: Sixty residents. INTERVENTIONS: End-rotational evaluation using a standardized, multiple-choice examination and one of two subjective instruments, Global Rating Scale and Behaviorally Anchored Rating Scale. MEASUREMENTS AND MAIN RESULTS: Means for overall competence, using both the Behaviorally Anchored Rating Scale and the Global Rating Scale clustered between 3 to 4 on a 5-point scale. Physicians' evaluations correlated with the multiple-choice test scores (Spearman's rho 0.3082, p = .005, n = 82), whereas neither self-evaluation (Spearman's rho 0.1124, p = .65, n = 42) nor nurses' evaluations (Spearman's rho 0.2060, p = .069, n = 79) had a significant correlation with test scores. Spearman's correlations were not significant for either overall competence or specific medical knowledge by any category of evaluator using the Global Rating Scale. Spearman's rho correlations and kappa statistic between the three types of evaluators (physicians, nurses, and self) for each criterion of the Behaviorally Anchored Rating Scale demonstrated significant correlations between the ratings of physicians and nurses, except for the assessment of humanistic qualities. Pooled clinical skills-history taking (b = 0.277, p <.009), humanistic qualities (b = 0.607, p <.000), and professional attitudes and behavior (b = 0.488, p < .000) systematically differed in ratings comparing self with nurse and physician (by analysis of variance). The explanatory power of the model of ratings (independent variables of year of residency, category of evaluator, evaluation criteria, and interaction terms) was 47.3% (r2adj). CONCLUSIONS: Self-rating by residents did not correlate to multiple-choice test scores and differed in some criteria with physicians' or nurses' evaluations. We found many similarities and some differences between physicians' and nurses' evaluations of residents. We speculate that different categories of evaluators assess different aspects of performance. Assessment by a varied group of evaluators should be used when attempts to predict future practice are made.     

Evaluation of a self-management plan for chronic obstructive pulmonary disease

We hypothesized that the use of an Action Plan might assist self-management for patients with chronic obstructive pulmonary disease (COPD). A pilot process and randomized, controlled study were undertaken to evaluate an Action Plan that provided advice on management of usual care and exacerbations, together with a booklet on self-management. Fifty six subjects with COPD recruited through general practitioners (GPs) completed the 6 month study, 27 in the control group and 29 in the intervention group. The control group received usual care from their GP, and the intervention group received a booklet and Action Plan from their practice nurse plus a supply of prednisone and antibiotic from their GP. The two groups were demographically similar with a mean age of 68 yrs. The resources were well received by GPs, practice nurses and intervention group subjects. After 6 months, there were no differences in quality of life scores or pulmonary function. There were significant changes in self-management behaviour in the intervention group compared to controls. In response to deteriorating symptoms, 34 versus 7% (p=0.014) initiated prednisone treatment and 44 versus 7% (p=0.002) initiated antibiotics. Subjects in the intervention group readily adopted self-management skills but did not show any difference in quality of life or lung function parameters. A larger, prospective, controlled, clinical trial of this approach is warranted.