ABSTRACT
BACKGROUND: The importance of appropriate communication skills within a health care setting rests upon the need for effective information sharing. When successful, this provides a supportive working environment for staff and has a positive impact on patient care and outcomes. AIMS: The purpose of this study was to explore how knowledge/evidence is acquired, shared, and applied in the Critical Care (CC) environment for staff and patients/family members. STUDY DESIGN: A qualitative approach was used, consisting of semi-structured interviews and focus groups. Data analysis was conducted using an iterative thematic approach. RESULTS: Data collected prior to the COVID-19 pandemic from United Kingdom (UK) critical care workers (N = 46), patients, and family members (N = 21) identified four communication roles performed by the nursing staff: team member; diplomat; translator and friend. CONCLUSIONS: It was evident that without suitable training and support, the stresses and demands placed upon the nurses could lead to disenfranchisement and burnout. RELEVANCE TO CLINICAL PRACTICE: These findings are relevant and timely given the impact of the pandemic, highlighting the need for accessible and alternate communication strategies to support nurses by reducing stress, moral distress and increasing psychological safety. Improved communication can provide tailored information for staff and patients/family improving the CC experience for all.
Subject(s)
Health Personnel , Pandemics , Humans , Focus Groups , Communication , Critical CareABSTRACT
UNLABELLED: Patients will often reflect on the meaning of a painful episode, as, for example, when completing questionnaire measures of subjective pain experience or in clinical interviews. Neuroimaging studies of the human cortical and subcortical physical pain response have identified a neural network consistently referred to as the "pain matrix." We used functional magnetic resonance imaging to investigate whether the pain matrix could be activated through the retrieval of memories relating to previously painful events, in the absence of any direct peripheral noxious input. Fourteen pain-free participants were explicitly instructed to recall autobiographical memories of painful episodes in response to pain-related words and non-painful episodes in response to equally salient but non-pain words. Memories triggered by pain-related words produced significantly greater activation of left caudal anterior cingulate cortex (BA32'), and left inferior frontal gyrus (BA44, extending to BA47/45) more than memories triggered by equally salient but non-pain words. We suggest that these activations demonstrate a semantic retrieval process for pain-related memories, which may provide a means of cognitively reappraising the memory of the painful episode, thus allowing the person to elaborate on the circumstances surrounding the event, without physically re-experiencing it. PERSPECTIVE: The present study reveals a putative neural mechanism for the retrieval of autobiographical memories of previously painful events, which may provide a means of cognitively reappraising a painful episode, without physically re-experiencing it. This finding has implications for understanding disease mechanisms of chronic pain and their impact on subsequent treatment.
