护患沟通双方对沉默方式感受的质性研究

Perception of silence from nurses and patients in nurse-patient communication:aqualitative study

目的了解护患沟通双方对沉默这一非语言沟通方式的使用感受,为医护人员有效应对沉默提供参考。方法采用录像法、深度访谈及焦点小组访谈相结合的质性研究方法,对150名医院实习护生客观结构化临床考试(OSCE)中的护理人文部分护患沟通进行录像分析并初步建模,结合对7名护士的深度访谈及5名患者及家属的焦点小组访谈,运用话语分析和内容分析方法分析访谈内容形成主题编码。结果提炼出7个主题,分别为安全的沉默、解决问题的沉默、缺乏兴趣的沉默、共情的沉默、中立的沉默、制造压力的沉默、尴尬的沉默。结论沉默行为在护患沟通过程中的出现主要与护患双方为表达某种特定情感或需求如安全、解决问题、缺乏兴趣、共情、中立、制造压力、尴尬等有关。制定护患沟通中的沉默应对模型,形成护理人员对沉默的应对措施,将利于良好护患关系建立,减少护患纠纷。

Objective To understand the perception of nonverbal communication silence from nurses and patients for providing references to effectively cope with silence for medical staff. Methods We utilized combined quahtative research method, such as videotape, in-depth interview and focus group interview, analyzed the nurse-patient communication videotape from the humanistic part of 150 intern-students＇ Objective Structured Clinical Examination, and established the model, and combined with in-depth interview of 7 nurses and focus group interview of 5 patients and related family members, then analyzed interview content using discourse analysis and content analysis methods to form theme code. Results Totally 7 themes were extracted, which were safety silence, problem solving silence, lack of interest silence, empathy silence, neutral silence, stress creating silence and embarrassed silence. Conclusion The appearance of silence behavior in nurse-patient communication is mainly related with the expression of certain feelings or needs from nurses or patients, such as safety, problem solving, lack of interest, empathy, neutrality, creating stress, embarrassment and so on. It is necessary to build silence coping model according to this study, and form silence coping intervention for nurses, in order to establish a good nurse-patient relationship and reduce nurse-patient disputes.