Introduction: Patient-centred communication is vital to ensure a good patient experience in the emergency department. Visits to the emergency department leave patients disillusioned regarding the communication experienced and this increases patient dissatisfaction. There is a need to put the "patient" back in communication in order to make it more patient-centred and provide the patient the opportunity to voice their individual needs pertaining to patient-centred communication. The aim of the study was to co-design patient-centred communication in an emergency department. In order to reach the aim of the study the following objectives were set: To explore current communication in an emergency department as experienced by patients and healthcare professionals. To collaboratively co-design strategies to enhance patient-centred communication in an emergency department. Research design and methods: An Experience-based Co-design has been used. Unstructured observation was done to observe existing communication in the emergency department. Patients have told their stories through narrative-based film interviews and healthcare professionals have been interviewed to share their experiences regarding communication in the emergency department. The observation notes and interviews have been shared during a Co-design event. Patients and healthcare professionals have collaboratively analysed the data to identify key touch points and co-design strategies to enhance patient-centred communication in the emergency department. Results: Three (3) key touch points were identified namely; professionalism, communication and daily focus. The patients and healthcare professionals were equal partners to change the communication culture in the emergency department to be more patient-centred. This may lead to positive patients' experiences with an increase in patient satisfaction. Conclusion: The ultimate goal of this study was to raise awareness relating existing communication in the emergency department and collaboratively plan strategies to work towards patient-centred communication. / Dissertation (MCur)--University of Pretoria, 2017. / Nursing Science / MCur / Unrestricted

京都大学 / 0048 / 新制・論文博士 / 博士(社会健康医学) / 乙第13358号 / 論社医博第15号 / 新制||社医||11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 小川 修, 教授 松村 由美 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

Communication between the patient and healthcare professional is pivotal in enabling effective self-care management to occur (Street et al., 2009) which in turn leads to improved health outcomes (Kravitz et al., 1993). However, there is little published data exploring the most effective tools for evaluating whether these communication skills occur and what particular attributes enhance the process (Goodchild, Skinner & Parkin, 2005; Heisler et al., 2003; Parkin & Skinner, 2003). This study aims to identify patient-centred communication skills occurring in consultations and to explore their link with a tool-recording agreement on reported decisions made. Quantitative analysis was conducted on 86 dietetic consultations across four outpatient diabetes services. Audio recordings from 20 of these were qualitatively analysed. Greater agreement on reported decisions correlated significantly with level of empathy demonstrated (t = .283, p = .0005). In consultations featuring agreement, dietitians expressed more empathy (p = .02), used more active listening skills, asked significantly more exploratory questions on self-care practices (U = 18.5, p = .007), provided significantly more supportive/collaborative information-giving exchanges (U = 11, p = .003) and were more likely to set an agreed agenda at the start of consultations. In contrast, consultations featuring disagreement had low levels of empathy, fewer active-listening skills and exploratory questions, significantly greater numbers of persuasive information-giving exchanges (U = 17, p = .007) and more recommending exchanges. Generally, agendas were not set. In conclusion, recording patient/healthcare professional agreement on reported decisions made during a consultation is a simple tool that can indicate the presence of patient-centred communication skills. Active-listening skills allow expressions of empathy that facilitate patient involvement and interactive dialogue. The measure of agreement should be used frequently as a marker of effective dietetic consultations and to provide further data on the relationship between patient-centred communication and implementation of behaviour change for improved health outcomes.