Person centered communication with older persons in need of health care. Development of a research based education platform

Person centered communication with older persons in need of health care. Development of a research based education platform. The COMHOME study. Background: Person-centred communication is vital for the quality of healthcare for older people. To develop high quality education for health professionals in person-centred communication is therefore important. More senior citizens will need health care in the near future. Today not everybody gets the care and health services they need. In addition to physical needs related to illness and aging processes older people have both information and emotional needs that must be safeguarded. The services provided in home care are carried out both by nurses, nurse assistants and unskilled. There are few studies of how the different groups communicate with older people, the communicative challenges encountered and whether the communication is person-centred. Objectives and methodology: The overall overall aim of this project was to develop a research based foundation for simulation based- and online training in person-centered communication with older persons in need of health care. Researchers in Norway, Sweden, the Netherlands and the United States have cooperated with users to investigate: a) communication challenges in home care, b) how older people´s expressed concerns can be met in conversation, c) how seniors citizens and senior peer students can contribute to communication training and mentoring students, d) how online resources can support the students' learning process, e) how opticians interact with older clients about decisions and f) the relationship between the nonverbal and verbal communication between older patients and doctors in hospitals. We have used both qualitative and quantitative methods to analyze sound - and video recordings from visits in home healthcare, at the optician, consultations in hospitals, CT-lab consultations in hospitals as well as questionnaire data. Results: More than 500 visits in home care were recorded in Norway, Sweden and the Netherlands. Both nurse assistants and registered nurses participated. Qualitative and qualitative analysis of both the Swedish and Norwegian sound recordings show that communication is particularly challenging a) when the seniors want something else than the specified task that was planned involving the patient being disappointed or angry and b ) when the needs were expressed vaguely, often about existential issues, worries about daily life functions and conditions surrounding frailty and dependence. A feedback intervention (ZORG) to increase nurses' emotional interactions with patients was tested in a pilot study with 10 nurses and 50 patients in the Netherlands. The sample was small, but the results of the intervention promising when it comes to meeting the emotional needs that were identified in the qualitative and quantitative studies. The coding system VR-CoDES (Verona Coding Definition of Emotional Sequences) was chosen because it was developed to detect patients' health concerns, which often are communicated indirectly but accompanied by an emotional expression more or less clear. The system also includes codes for clinicians´ immediate responses. The method has been adapted and further develop for use in the homecare setting. Mindfulness is a factor affecting the student's communication skills both in optometry and nursing. Shared decision making has being explored in optician's practice to identify which type of decisions are to be made and how the customer is involved in the decision making. Communication skills training has been conducted in two iterations for 1st year undergraduates in nursing. Third year students attended a "train the trainer" course and were supervisors during simulation training where students practiced along with an older person who was trained to play the role as recipient of community nursing as well as in how to give supportive feedback to the students. Digital resources were developed in partnership with Conexus AS. The evaluation shows that the students were highly satisfied with the training, and particularly enjoyed the student tutors, the older person performing as patient and other peer students´ feedback. Communication skills training is also implemented in the bachelor and masters´ program in optometry and visual science. Implications for further practice and research: Enhancing communication skills by further developing training focusing on existential communication as well as shared decision making is needed. Investigating the relationship between negative and positive emotions in encounters can contribute to better understand how communication can contribute to wellbeing in homecare settings. How to better integrate video-recordings that can promote learning and reflection on own communication practice need to be further explored.

There is a need for improvement of basic and continuing education for healthcare professionals in person-centered communication with older persons. This is a large, heterogeneous and constantly growing group in society with demanding emotional and informa tional needs, currently often not receiving optimal care. This study will contribute to the field by developing, testing and implementing an online training program in communication for health care providers working with older adults. The program is step- wise developed using input from everyday practice in medicine and home health care and theoretical models. Training students and clinicians in a safe, controlled and simulated environment gives them the possibility to reflect on their own performance a nd to receive constructive criticism from peers and teachers (including older persons). The online training content will be based on analyses of video-recorded real-life physician-older adult encounters (study 1), on audio-recorded nurse/nurse assistant-e lderly encounters in home health care in three countries (study 2), and on established theoretical communication models applied in simulation training (study 3). The communication during the real-life and simulated encounters will be evaluated with the R oter Interaction Analysis System (RIAS) and the Verona Coding Definitions of Emotional Sequences (VR-CoDES) to capture different aspects of communication such as emotional talk, interactivity and verbal dominance. In addition, communication will be examin ed on effectiveness in terms of satisfaction, communicative self-efficacy and empathic attitudes. This combination of data will provide a rich and useful picture of the feasibility, content and value of the different parts of the training program. By foc using on enhancing the communication between older persons and health care providers, the present project intends to contribute to better health care for this group.