108 Research in Brief

Implications for midwifery pract ice

The present study showed that there is considerablematernal morbidity associated with caesarean delivery andthat this can persist long after the mother is dischargedhome from hospital. Much more information is requiredabout the health of women after delivery. There is a needfor large-scale systematic studies to determine the compar-ative rates of morbidity associated with different deliverymethods. This information could then be used by mid-wives to more effectively plan and deliver midwifery care.

Source

This work was carried out as part of the requirement for anunpublished PhD thesis. Further details of the study areavailable from the author.

ReferencesInformation and Statistics Division (1989) Hospital and Health

Board comparisons in obstetrics—1985-1987. Common ServicesAgency, Edinburgh.

Placek P.J., Taffel S.M. & Moien M.S. (1988) 1986 c-sections rise;VBAC's inch upward. American Journal of Public Health 7,562-563.

Rosen M.G. (1981) Cesarean Childbirth: Report of a ConsensusDevelopment Conference. National Institutes of Health, Bethesda,Maryland (NIH Publication no 82-2067).

Interpersonal communication betweennurses and elderly patients: refinementof an observation scheduleSARAH OLIVER BSc, RGNResearch Associate, Nursing Research Unit, King's College London

S. J. REDFERN BSc, PhD, RGNDirector, Nursing Research Unit, King's College London

Correspondence: Nursing Research Unit, King's College London, Corn-wall House Annex, Waterloo Road, London SEl 8TX, UK

further than this, focusing specifically on non-verbal inter-actions such as touch. They developed an observationschedule which enabled them to record and classify touchand its associated components (the nature and duration ofthe interaction, the nurse and patient's verbal and non-verbal responses and their physical positions). However,the schedule required extensive observer training beforeacceptable reliability was obtained and even then, aspectsrelating to nurse-patient conversation and the recipient'sresponse to the communication remained unreliable.

The present study proposed to modify Le May andRedfern's schedule to see whether the touch episodes andtheir related variables could be recorded easily and morereliably.

Specific a i m s

• To modify the Le May and Redfern schedule for usewith a tape recorder and a portable computer pro-grammed as an event recorder.

• To test the reliability of the modified observation sched-ule against an observer using a hand-completed sched-ule.

• To compare the amount and type of nurse—patient touchwith that found by Le May and Redfern. ., i .,;

Methods-..,,,

The schedule was tested in an acute/rehabilitation care ofthe elderly ward, focusing on five patients and the nurseswho interacted with them. Each patient was observed for atotal of 7 hours which involved 2 days' observation.Interobscrver reliability testing involving an observerusing a handwritten version of the schedule took place ontwo occasions during the study. The first occasion wasused to test the feasibility of the technique and so theresults of the second occasion only were analysed.

Introduction

Previous research has shown that interpersonal communi-cation between nurses and elderly patients is often inad-equate. Nurses' interactions with patients tend to beinfrequent and brief, confined to physical care and treat-ment matters, and are almost invariably initiated by anurse during the course of a physical task (Macleod Clark,1983).

Much of the research in this field has been confined toverbal communication. Le May & Redfern (1987) went

Findings

Interobserver reliability was acceptable for the followingschedule components: ^̂• the task/purpose of the interaction;• duration of the interaction;• type and site of touch;• the verbal communication between the nurse and

patient.

The new technique indicated that there was no point inrecording the recipient's non-verbal response to the touch

Research in Brief 109

or in placing verbal communication into the categoriesused by Le May & Redfern ('Emotional/Psychosocial','Treatment/Care', 'Social chat', 'Other' and 'Silence');tape recording the conversations was much more valuablethan reducing the data to categories. Use of the computerproduced no additional benefits over the handwrittenschedule. The observation findings confirmed those ofprevious studies that relatively little expressive touch takesplace between nurses and elderly patients.

Recommenda t ions

It was recommended that a simplified version of thehandwritten schedule be produced, and a tape recordershould be used to record verbal communication. Trainingto use touch appropriately was also recommended fornurses working with elderly patients.

Acknowledgments

We are grateful to the University of London CentralResearch Fund for supporting the study.

References ' . ; . ' . . ' i -

Le May A. & Redfern S.J. (1987) A study of non..verbal communica-tion between nurses and elderly patients. In Research in theNursing Care of Elderly People (Fielding P., ed). Wiley, Chiches-ter.

McCleod Clark J. (1983) Nurse-patient communication—an analy-sis of conversations from surgical wards. In Nursing Research: TenStudies in Patient Care (Wilson-Barnett J., ed). Wiley, Chiches-ter.

A full report of this study has been published in the Journal ofAdvanced Nursing (1991) 16, 30-38.

Addendum

Tomalin D.A. & Moyer A. (1992) Diabetic children's skill in bloodglucose monitoring. Journal of Clinical Nursing 1, .SO-51.

We regret that the following acknowledgment was omittedfrom the above article.

This research was undertaken when both authors wereworking at the Daphne Heald Research Unit, RoyalCollege of Nursing, London, UK.