Comparison of barriers to effective nurse-patient communication in COVID-19 and non-COVID-19 wards.

BACKGROUND: Communication is a basic need of humans. Identifying factors that prevent effective nurse-patient communication allows for the better implementation of necessary measures to modify barriers. This study aims to compare the barriers to effective nurse-patient communication from the perspectives of nurses and patients in COVID-19 and non-COVID-19 wards. MATERIALS AND METHODS: This cross-sectional descriptive study was conducted in 2022. The participants included 200 nurses (by stratified sampling method) and 200 patients (by systematic random sampling) referred to two conveniently selected hospitals in Shahroud, Iran. The inclusion criteria for nurses were considered having at least a bachelor's degree and a minimum literacy level for patients to complete the questionnaires. Data were collected by the demographic information form and questionnaire with 30 and 15 questions for nurses and patients, which contained similar questions to those for nurses, based on a 5-point Likert scale. Data were analysis using descriptive indices and inferential statistics (Linear regression) in SPSS software version 18. RESULTS: The high workload of nursing, excessive expectations of patients, and the difficulty of nursing work were identified by nurses as the main communication barriers. From the patients' viewpoints, the aggressiveness of nurses, the lack of facilities (welfare treatment), and the unsanitary conditions of their rooms were the main communication barriers. The regression model revealed that the mean score of barriers to communication among nurses would decrease to 0.48 for each unit of age increase. Additionally, the patient's residence explained 2.3% of the nurses' barriers to communication, meaning that native participants obtained a mean score of 2.83 units less than non-native nurses, and there was no statistically significant difference between the COVID and non-COVID wards. CONCLUSION: In this study, the domain of job characteristics was identified by nurses as the major barrier, and patients emphasized factors that were in the domain of individual/social factors. There is a pressing need to pay attention to these barriers to eliminate them through necessary measures by nursing administrators.

A Qualitative Analysis of Cancer Patients' Perceptions of an Interprofessional Counseling Service on Complementary and Integrative Healthcare.

Medical guidelines recommend actively addressing patients' information needs regarding complementary and integrative healthcare (CIH). Within the CCC-Integrativ study, an interprofessional counseling program on CIH was developed and implemented at four comprehensive cancer centers (CCCs) in Germany. As part of the process evaluation, this study examines cancer patients' experiences with interprofessional CIH counseling sessions conducted by a physician and a nurse. Forty problem-centered interviews were conducted using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and analyzed using deductive-inductive content analysis based on Kuckartz and Rädiker's approach. Findings revealed that most participants had prior experience with CIH approaches and were burdened by physiological and psychological symptoms. Counseling sessions focused on cancer- and treatment-related symptoms and appropriate CIH recommendations (e.g., herbal poultice against anxieties and acupressure against nausea). Participants appreciated the mutual exchange and integration of perspectives from different healthcare professions within the interprofessional approach. They noted that the counseling team comprehensively addressed their healthcare and CIH information needs. Suggestions for improvement included the specificity of the CIH recommendations. As the participants only received counseling and no CIH treatments, information about reputable CIH providers was particularly important to many seeking advice. Patients with cancer receiving tailored CIH counseling from two healthcare professionals experienced benefits in CIH counseling for symptom management. The interprofessional teams offered a comprehensive perspective on patients' needs, proposing personalized recommendations for symptom control. These insights may foster collaboration between healthcare professionals interested in CIH counseling, enabling them to expand and consolidate their counseling services.

Analysis of 100 Cases of Nurse-patient Communication from the Perspective of Ethic, Psychology and Law / 中国医学伦理学

With the implementation of the Healthy China Strategy, the value of care has become increasingly prominent. It has become an important nursing topic to strengthen the theoretical and practical research of nurse-patient communication, especially to understand the current state, and explore the essential characteristics, the influencing factors and the differences in interdisciplinary perspectives of nurse-patient communication. Through systematic analysis of 100 real clinical nurse-patient communication cases, this paper found that the problem of poor nurse-patient communication still existed widely, which is prominently manifested as the inhibition of communication willingness, the dislocation of communication topics and the lack of communication consensus. The causes of poor nurse-patient communication were nurses’ poor communication skills, negative emotional distress, the lack of humanistic literacy and insufficient energy investment in communication, as well as the patient’s fragile state, the limitation of knowledge and cultural level, and insufficient trust in nurses. The interdisciplinary perspective analysis of ethics, psychology and law is conducive to enriching and developing the theoretical basis and research methods of nurse-patient communication, and can also provide useful suggestions for improving nurse-patient communication in clinical.

Improving Chinese nursing undergraduates' nurse-patient clinical communication competence in English: A study based on a target situation needs analysis.

Background: The internationalization of higher education has stimulated an ever-increasing demand for English for Medical Purposes (EMP) courses for nursing undergraduates in China. EMP courses are designed to provide learner-centered language instruction to satisfy students' English communication needs in the future workplace. To date, far too little attention has been paid to developing a well-rounded and theory-guided nurse-patient communication teaching model based on target needs analysis in nurse-patient communication. Objective: To develop an EMP teaching framework to improve Chinese nursing undergraduates' nurse-patient communicative competence in clinical settings based on target situation needs analysis. Methods: A survey of nurses' target situation needs analysis in clinical nurse-patient communication was conducted among nurses in five teaching hospitals in China. A teaching model was developed based on the survey analysis to improve nursing undergraduates' nurse-patient communicative competence. Results: A total of 411 nurses participated in this study. There were no significant differences in the overall satisfaction in target-situation communication and self-assessment in three-aspect communicative competence in clinical communication among nurses with different sociodemographic characteristics. Nurses with better self-assessment in the three-aspect communicative competence are more likely to satisfy their needs of nurse-patient clinical communication in target situation. Nurses self-reported the tasks and language skills commonly involved in nurse-patient clinical communication. A four-step teaching model was developed to respond to the findings of the target situation needs analysis. Conclusion: This study provides important insights into the essential role of employing and integrating a language communicative competence framework and a target-situation analysis framework in formulating a needs-driven and tailor-made EMP teaching model. Based on the previous framework, the teaching model is adapted and characterized by systematic and interconnected teaching steps, core target-situation topics, and a complete set of task forms, providing EMP instructors with operable scaffolds to help nursing students observe, analyze, practice, and assess nurse-patient communication. The study will be of significance for EMP researchers and instructors simulated to conduct further research and practice in English communication in the wider medical field.

Nurse-led pre-test counseling for Alzheimer's disease biomarker testing: Knowledge and skills required to meet the needs of patients and families.

INTRODUCTION: Biomarker testing for Alzheimer's disease and related disorders (ADRD) brings new opportunities for nurses to foster shared decision-making by leading pre-test counseling (PTC) for patients and families. METHODS: Audio-recordings of 18 nurse-led PTC sessions were analyzed to characterize questions posed by patient and family members dyads considering whether to pursue amyloid positron emission tomography. RESULTS: Sessions lasted 20 to 75 minutes and generated rich discussion of the purpose and potential implications of amyloid imaging. Dyads posed questions regarding: basic neuroanatomy; the spectrum of normal cognitive aging to dementia; clinical phenotypes and pathological hallmarks of ADRD; secondary prevention of ADRD; and advance planning. In response, PTC facilitators provided disease-specific education, clarification of overt misconceptions, caregiver support, and emotion de-escalation. CONCLUSION: Nurses conducting PTC for AD biomarker testing should be equipped to answer questions about topics both directly and indirectly related to testing, and also provide emotional support.

Nurse-Patient Communication and Relationship When Wearing Personal Protective Equipment: Nurses' Experience in a COVID-19 Ward.

Little is known about which communication strategies nurses carried out and whether the nurse-patient relationship has been altered due to the mandated use of personal protective equipment during the COVID-19 pandemic. This study describes how nurse-patient communication and relationships took place from the point of view of nurses engaged in caring for patients with COVID-19. A qualitative descriptive study design following COREQ guidelines was conducted. Semi-structured telephone interviews with nurses working in the COVID ward of an Italian university hospital were performed between September 2020 and June 2021. Ten nurses were recruited using convenience sampling. One overarching theme, three main themes, and nine sub-themes were identified. The overarching theme 'The in-out relationship: 'in here and out there' and 'inside me and out of me' included the main themes 'A closed system different from normal', 'Uncovering meaningful human gestures', and 'A deep experience to live''. The relational nature of nursing-where 'me and you' and the context are the main elements-leads nurses to find new ways of interacting and communicating with patients, even in a new situation that has never been experienced. Enhancing human gestures, thinking about new contexts of care, and educating new generations to maintain human-to-human interaction, regardless of the context of care, are the directives to be explored for creating the future of nursing care.

[An Alternative Interpretation of Conflict Management: Interpersonal Conflicts and Doctor (Nurse)/Patient Communications].

In this paper, interpersonal conflict is redefined to highlight the conflict dimension, which is ignored in traditional definitions of this term. In this new definition, the "no conflict" situation refers to unnoticed differences, disagreements, or dissatisfaction that are accommodated or negotiated prior to being noticed. An essential element of conflict management is identifying the ideal time to express and respond to questions/complaints/disagreement. Communicative efforts for conflict management include increasing (affective) motives related to expressing and responding to disagreement; increasing (cognitively) confidence and competencies in managing interactive flows, and (behaviorally) engaging in communicative actions.

Experience of Patients With Rheumatoid Arthritis: A Qualitative Study of a Nurse-Led Clinic.

Rheumatoid arthritis (RA) is an extremely prevalent chronic inflammatory rheumatic disease. This study explores the experiences of patients with RA under nurse-led care, the roles that nurses play, and the outcomes achieved when applying the patient-centered care (PCC) approach. A purposive sample of 12 participants who had been diagnosed with RA for at least 1 year were recruited from a nurse-led rheumatology clinic. They were also receiving treatment with disease-modifying antirheumatic drugs. All of the participants reported high levels of satisfaction with the care they received in the nurse-led clinic, along with high levels of medication adherence. The nurses were highly accessible to the participants, and they regularly communicated information regarding their symptoms, medication, and treatment management. These findings illustrate the importance of the holistic care that nurses provide to their patients, as the participants agreed that nurse-led services could have a wider outreach in hospitals and the community.

Health-seeking, intercultural health communication, and health outcomes: An intersectional study of ethnic minorities' lived experiences.

AIMS: To explore ethnic minorities' lived experiences of health-seeking and healthcare utilization in Hong Kong, and to examine the impact of intersectionality of sociocultural identities on intercultural health communication. DESIGN: Qualitative exploratory design. METHODS: Data collection methods were semi-structured interviews, unstructured observations, and unstructured informal group discussions. Twenty-five informants, including eight Pakistanis, seven Nepalese, five Indians, four Bangladeshis and one Sri Lankan, were recruited using the snowball sampling method and individually interviewed between 25th June and 23rd September 2019. RESULTS: Sixteen females and nine males, aged 21-76 years, were in the study. Two-thirds could communicate in English, but eight required interpreters. Thematic analysis reveals four factors affecting intercultural health communication: healthcare professionals' cultural insensitivity, red-tapism and ethnic minorities' language improficiency and/or deficiency in medical knowledge. Health professionals' workplace stress and cultural insensitivity prompt ineffective intercultural communication, making ethnic minority patients feel disrespected despite having adopted the Hong Kong culture. The intersectionality of sociocultural identities plus health professionals' blocking behaviours results in health inequalities. CONCLUSION: The unequal power relationship between health professionals and ethnic minority patients may lead to dehumanizing and depersonalized experiences for patients, as humanity is the heart and soul of medicine. Therefore, the government should raise healthcare providers' cultural sensitivity and diversity awareness, and offer ethno-specific care and more interpretation services. IMPACT: The study addresses health inequalities among Hong Kong ethnic minority patients with different sociocultural identities. About the impact of ineffective intercultural health communication on health inclusion and health outcomes, policies and practices should ameliorate health professionals' cultural sensitivity, awareness of the unequal power relationship and respect for diversity. PATIENT OR PUBLIC CONTRIBUTION: Referred by organizations serving ethnic minorities, the minority patients shared their lived experiences in health-seeking.

The Acknowledge-Normalize-Partner (ANP) Framework: A novel empathic communication tool for oncology nurses.

OBJECTIVE: To describe the development and implementation of a novel tool designed to enhance nurse-patient communication in a major academic cancer center, which nurses can learn quickly, incorporate into their primary palliative care practice, and broadly disseminate in order to improve the patient experience. METHOD: An evidence-based empathic communication tool and educational program were designed to provide essential skills to oncology nurses in having discussions with patients about their personal values. Evaluation included nurse focus groups, pre- and post-course evaluations and interviews, and patient questionnaires. RESULTS: Nurses were satisfied with the educational program and found the communication tool effective in a variety of clinical situations including discussions about personal values. Patients reported increased occurrences of these discussions when nurses utilized the framework (97% vs. 58%, p < 0.0001) and a higher quality of clinician communication (mean [SD] from 0 = very worst to 10 = very best: 7.18 [2.3] vs. 5.04 [2.9], p = 0.001). SIGNIFICANCE OF RESULTS: Skilled, empathic communication is an essential component of high-quality primary palliative care. Oncology nurses are well suited to lead communication and provide this care as part of an interprofessional team. The training and tool described here are targeted and efficient, and prepare nurses to respond skillfully to emotion while facilitating important discussions about patient values.

Application of standardized patient teaching based on Calgary-Cambridge communication model in nurse patient communication training for junior college interns / 中国实用护理杂志

Objective:To explore the effect of applying standardized patient teaching based on Calgary-Cambridge communication model in nurse patient communication training for junior college interns, and to enrich the teaching methods of nurse patient communication training in domestic medical institutions.Methods:This study was a quasi-experimental study. In July 2022, 78 students were selected from 335 junior college interns in the First Affiliated Hospital of Shandong First Medical University by random coding method, and were randomly divided into the experimental group (39 students) and the control group (39 students) by lot. The control group received routine training. The experimental group received standardized patient teaching based on Calgary Cambridge communication model: teaching the key points of communication, guiding demonstration based on Calgary Cambridge communication model, and guiding reflection and exploration. The nurse patient communication ability, nurse patient communication practice skills, communication self-efficacy, and teaching satisfaction of the two groups of interns were compared between the two groups after 8 weeks of training.Results:After training, the total score of nurse patient communication ability evaluation in the experimental group was (91.41 ± 5.35) points, higher than that in the control group (88.08 ± 7.40) points, there was significant difference ( t=2.24, P<0.05); after training, the communication self-efficacy score of the experimental group was (30.21 ± 4.28) points, higher than that of the control group (27.94 ± 5.09) points, there was significant difference ( t=2.09, P<0.05); the total score of communication practice skills in the experimental group was (173.59 ± 18.48) points, higher than that in the control group (158.44 ± 15.57) points, there was significant difference ( t=3.82, P<0.05); the total score of communication teaching and training satisfaction in the experimental group was (16.77 ± 2.94) points, higher than that in the control group (15.22 ± 1.90) points, and there was significant difference ( t=2.68, P<0.05). Conclusions:The standardized patient teaching based on Calgary Cambridge communication model can effectively improve the practical skills of nurse patient communication of junior college interns, and promote the improvement of their nurse patient communication self-efficacy, which is conducive to the improvement of nurse patient communication ability junior college intern.

Cultural safety and patient trust: the Hui Process to initiate the nurse-patient relationship.

The Fundamentals of Care framework is recognised for its essential elements to provide quality patient-centred care. Connection and trust as a basis for a caring relationship is a central tenet of this framework. Indigenous people of Aotearoa New Zealand face barriers to health care that are historically and socially constituted. The Hui Process is a model informed by Maori values on connection; when used to inform the Fundamental of Care framework, offers a point of entry for nursing students to develop culturally safe fundamental nursing care. We offer the use of Hui Process and the Fundamental of Care framework as an accessible approach to teach new undergraduate nursing students' relationship-based nursing through culturally safe practice and communication. The Hui Process involves four culturally safe steps; mihi, whakawhanuangatanga, kaupapa and poroporoaki Students engage with the Fundamentals of Care and the Hui Process during their introduction to nurse-patient communication, to support their first steps towards developing culturally safe nursing praxis.

Nurses' perspectives on alternative communication strategies use in critical care units.

BACKGROUND: Critically ill patients have the right to communicate and participate in their treatment to avoid adverse medical outcomes due to the severity of their illness, their responsiveness, and level of consciousness. This human right has often been neglected by health care professionals, as a result of limited alternative communication support provided to patients who are unable to speak due to, for example, endotracheal intubation. Despite the successful use of alternative communication strategies in critical care units (CCUs) in other countries, limited implementation in South African hospitals has been reported. AIMS AND OBJECTIVES: This study aimed to determine the perspectives of South African nurses working in CCUs on the frequency of use of alternative communication strategies to support patient-centred communication with critically ill adult patients. DESIGN: The study followed a quantitative non-experimental survey research design. METHODS: A total of 210 nurses working in both private and public hospitals completed a survey on their perspectives on the use of alternative communication strategies in CCUs. RESULTS: Nurse participants reported experience working with critically ill and communication-vulnerable patients. Nurse-patient communication mainly involved the use of pen and paper, facial expressions and gestures to obtain information relating to patients' needs and their health history. Limited use of speech-generating communication devices was reported. CONCLUSION: Nurse training on the use and implementation of alternative communication strategies, such as communication boards or electronic speech-generating devices, should be investigated to improve nurses' communication with communication-vulnerable patients in South Africa. RELEVANCE TO CLINICAL PRACTICE: The results are applicable in clinical practice due to patients' need for alternative communication. The nurses mainly used low-tech solutions, which are cheap and easy to access. However, there exists an opportunity to increase the use of available digital solutions.

Development and validation of the questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication.

OBJECTIVE: The purpose of this study was to develop and analyze the psychometric properties of an instrument that could analyze the communication of nursing professionals in nurse-patient therapeutic communication. METHODS: A literature review and a panel of experts were used (N = 10) to develop the questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication. The final version of the questionnaire was composed of 49 items and applied to a convenience sample of 370 nurses. RESULTS: The construct validity was assessed by an exploratory factor analysis (EFA) and the reliability using Cronbach's Alpha. Three dimensions were identified that determine therapeutic communication: professional, contextual and/or situational and patient. The Cronbach's α total coefficient was 0.90, ranging from 0.71 to 0.81 for the dimensions. CONCLUSION: The questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication represents a valid and reliable questionnaire to measure nurses' communication with patients in the clinical setting. IMPLICATIONS FOR PRACTICE: The use of the questionnaire enables the analysis of elements that interfere with effective communication. This can assist in developing interventions to improve nurses' therapeutic communication with patients.

Nurse Coaching: Providing Holistic Care to Patients With Cancer.

Patients with cancer face many challenges from the time of diagnosis to the end of life. It is important for nurses to explore new approaches that may enhance care for patients. Nurse coaching is a practice that has the potential to significantly influence care of patients with cancer. This article describes how nurse coaching practices provide holistic support to patients in a way that may help to relieve cancer-related distress and assist patients in achieving their goals. Based on the nurse coaching scope of practice and competencies, this article reviews tools and strategies to assist patients in reaching their individual goals and presents a case study demonstrating how a patient, with guidance, came to realize his own needs.

Patients' perspective on prostatic artery embolization: A qualitative study.

OBJECTIVES: The aim was to describe the patients' experience of undergoing prostatic artery embolization. METHODS: A retrospective qualitative interview study was undertaken with 15 patients of mean age 73 years who had undergone prostatic artery embolization with a median duration of 210 min at two medium sized hospitals in Sweden. The reasons for conducting prostatic artery embolization were clean intermittent catheterization (n = 4), lower urinary tract symptoms (n = 10) or haematuria (n = 1). Data were collected through individual, semi-structured telephone interviews 1-12 months after treatment and analysed using qualitative content analysis. RESULTS: Four categories with sub-categories were formulated to describe the results: a diverse experience; ability to control the situation; resumption of everyday activities and range of opinions regarding efficacy of outcomes. Overall, the patients described the procedure as painless, easy and interesting and reported that while the procedure can be stressful, a calm atmosphere contributed to achieving a good experience. Limitations on access to reliable information before, during and after the procedure were highlighted as a major issue. Practical ideas for improving patient comfort during the procedure were suggested. Improved communications between treatment staff and patients were also highlighted. Most patients could resume everyday activities, some felt tired and bruising caused unnecessary worry for a few. Regarding functional outcome, some patients described substantial improvement in urine flow while others were satisfied with regaining undisturbed night sleep. Those with less effect were considering transurethral resection of the prostate as a future option. Self-enrolment to the treatment and long median operation time may have influenced the results. CONCLUSIONS: From the patients' perspective, prostatic artery embolization is a well-tolerated method for treating benign prostate hyperplacia.

Embedded spiritual conversation in cancer communication: lived experiences of nurses and patients/relatives.

AIM: The study aimed to illuminate the experiences of patients, relatives and nurses in an oncology setting by exploring communication in cancer care. BACKGROUND: Like elsewhere in health settings, communication is a major component in cancer care and has an impact on patient's outcome. However, nurse-patient/relatives communication is still recognized as an ongoing challenge. Evidence is lacking on the nurse-patient communication in Indonesia particularly in oncology settings. DESIGN OF STUDY: The current study explored the lived experiences of patients, relatives and nursing regarding communication in an oncology setting at a private Islamic hospital. A phenomenological research design on the basis of the naturalistic paradigm was employed. The researchers purposely selected 16 participants and conducted semi-structured interviews using an interview guide. Colaizzi's naturalistic phenomenological approach was utilized to analyse the data. RESULTS: Three themes emerged from the data: Building a compassionate relationship, Spiritual and religious discussion, Maintaining hope. Developing trust and providing empathy as well as showing genuineness are elements in building the compassionate relationship. The religious and spiritual discussion includes reminders to pray and increase self-transcendence awareness. Patients and their relatives welcome such discussion. Maintaining hope is part of communication that can preserve positive feelings, goals and beliefs of patients and their families for their well-being. CONCLUSION: Establishing compassionate relationship is the basis of communication in cancer care. Spiritual and religion, and hope are aspects that nurses and patients and their relatives discuss among themselves. These aspects may affect patient's outcome and quality of care and require further research. IMPLICATION FOR NURSING AND HEALTH POLICY: Findings suggest that it is important to have communication during cancer care, which includes compassion, spiritual and religious aspect, and hope as it potentially enables patients and relatives to deal with their cancer journey. Our findings have implications for nursing practice, education and policy so that there is an integration of biopsychosocial, and spiritual and religious aspects in cancer communication.

The effect of a short-term Balint group on the communication ability and self-efficacy of pre-examination and triage nurses during COVID-19.

AIMS AND OBJECTIVES: To investigate the effect of a short-term Balint group on the improvement in communication ability and self-efficacy of pre-examination and triage nurses during coronavirus disease 2019 (COVID-19). BACKGROUND: Working on the front lines of COVID-19 has brought unprecedented psychological stress on pre-examination and triage nurses. Nurse-patient communication ability and the level of self-efficacy are both significant for nurses' psychosomatic health and work input. However, limited empirical evidence exists regarding nurse-patient communication and self-efficacy and specific psychological intervention effects. DESIGN: Cross-sectional research fulfilling the completed checklist of items that should be included in reports of cross-sectional studies (Appendix S1). METHODS: Nurses (n = 41) in the first layer of pre-examination and triage were engaged in a Balint group activity twice a week for two weeks. They were assessed with the General Self-Efficacy Scale (GSES) pre- and postintervention, and a nurse-patient communication survey form was developed for further postintervention evaluation. The sample was recruited from a class A third-grade hospital in Sichuan, China. RESULTS: Most of the subjects reported improvement in nurse-patient communication, increased cooperation between patients and their families, and a decreased missed examination rate after the intervention. Moreover, the total mean score of the GSES of nurses after the intervention was increased, but the difference was not statistically significant. The scores of all items in the GSES were improved, and the scores increase for item 4 (I am confident that I can effectively deal with any unexpected event) was statistically significant. CONCLUSIONS: During the COVID-19 pandemic, a short-term Balint group activity can improve the communication ability and self-efficacy level of front-line nurses to some extent. RELEVANCE TO CLINICAL PRACTICE: This information may provide some theoretical support for the development of early psychological interventions during major epidemic situations.

Challenges encountered by patients with end-stage kidney disease in accessing symptom management services: A narrative inquiry.

AIM: To understand the storied experiences of accessing symptom management services of patients with end-stage kidney disease (ESKD) who are receiving maintenance dialysis. DESIGN: Narrative inquiry. METHODS: Ten patients with ESKD who were receiving dialysis were recruited at two regional hospitals in Hong Kong and interviewed three times each between July 2017-July 2018 to capture their narratives. The data were analysed using the narrative inquiry approach from the perspective of Levesque's framework of access to care. RESULTS: Five themes emerged from the participants' narratives. The first theme illustrated access to care as a process by which symptom management needs were met. However, clinicians occasionally identified patients based on their diseases instead of their needs and this process was affected differently by interpersonal and system factors. The themes 'building trust' and 'facilitating communication' described interpersonal factors that were essential to maintaining a constructive patient-clinician partnership. The themes 'balancing efficiency' and 'navigating fragmented system' described system-related factors. CONCLUSIONS: This study identified the factors that influenced the delivery and/or reception of symptom management services for patients with ESKD who were receiving dialysis. The results suggest that healthcare services should be streamlined based on patients' needs and that this process should address the important elements of trust and communication. IMPACT: The study's results suggest potential improvements to symptom management services that would enable patients' needs to be addressed in a timely and humanistic manner.

Strengthening and supporting nurses' communication with mechanically ventilated patients in the intensive care unit: Development of a communication intervention.

Background: Nurse-patient communication in intensive care units is challenged by the fact that patients are voiceless due to intubation and mechanical ventilation. Difficult communication affects nurses negatively, and it requires knowledge and expertise to facilitate communication in this complex and technologically tense setting. Augmentative and alternative communication has been suggested as a way of optimising communication; several approaches can be combined in a multi-component intervention. Also, a communication algorithm has been proposed as a way of providing structure in patient communication. To enhance transparency and avoid poorly reported interventions, this paper describes the process, rationale and reflections behind developing a communication intervention called the ICU-COM. Objectives: To present the development process of a communication intervention prototype that aims to support and strengthen nurses' communication with mechanically ventilated patients in an intensive care unit. Design: The Medical Research Council's framework for developing complex interventions in health was applied. The approach was target-population centred. Settings: The intervention was developed and tailored to four intensive care unit departments at Aarhus University Hospital in Denmark. Participants: Intensive care nurses and various experts, namely, speech-language pathologists, graphic designers, a software company, the local Centre for E-learning and nurse specialists were involved in its development. Results: An intervention consisting of: 1) a multi-component communication bundle, 2) delivery of the bundle via a teaching session and 3) initial implementation via nurse communication guides was developed. The communication bundle contained: 1) a communication strategy with a BASIS framework and algorithm, 2) a nurse education programme and 3) low-tech and high-tech communication tools. Conclusions: A systematic approach was applied in the development process. However, the acceptability and feasibility of the intervention is at present unknown.