Abstract
BackgroundResearch into relational care in hospitals will be facilitated by a focus on staff-patient interactions. The Quality of Interactions Schedule (QuIS) uses independent observers to measure the number of staff-patient interactions within a healthcare context, and to rate these interactions as ‘positive social’; ‘positive care’; ‘neutral’; ‘negative protective’; or ‘negative restrictive’. QuIS was developed as a research instrument in long term care settings and has since been used for quality improvement in acute care. Prior to this study, its use had not been standardised, and reliability and validity in acute care had not been established.MethodsIn 2014 and 2015 a three - phase study was undertaken to develop and test protocols for the use of QuIS across three acute wards within one NHS trust in England. The phases were: (1) A pilot of 16 h observation which developed implementation strategies for QuIS in this context; (2) training two observers and undertaking 16 h of paired observation to inform the development of training protocols; (3) training four nurses and two lay volunteers according to a finalised protocol followed by 36 h of paired observations to test inter-rater agreement. Additionally, patients were asked to rate interactions and to complete a shortened version of the Patient Evaluation of Emotional Care during Hospitalisation (PEECH) questionnaire.ResultsProtocols were developed for the use of QuIS in acute care. Patients experienced an average of 6.7 interactions/patient/h (n = 447 interactions). There was close agreement between observers in relation to the number of interactions observed (Intraclass correlation coefficient (ICC) = 0.97) and moderate to substantial agreement on the quality of interactions (absolute agreement 73%, kappa 0.53 to 0.62 depending on weighting scheme). There was 79% agreement (weighted kappa 0.40: P < 0.001; indicating fair agreement) between patients and observers over whether interactions were positive, negative or neutral.ConclusionsObservers using clear QuIS protocols can achieve levels of agreement that are acceptable for the use of QuIS as a research instrument. There is fair agreement between observers and patients’ rating of interactions. Further research is needed to explore the relationship between QuIS measures and reported patient experience.
Highlights
Research into relational care in hospitals will be facilitated by a focus on staff-patient interactions
Quality of Interactions Schedule (QuIS) is a reliable instrument within this context [6], its use has not been standardised and its reliability and validity in acute care has not been established
This paper reports a study which examined the feasibility of developing QuIS for use in acute care settings
Summary
Research into relational care in hospitals will be facilitated by a focus on staff-patient interactions. There is widespread international concern that staff-patient interactions within acute hospitals do not always promote compassionate and high quality relational care [1,2,3]. Relational care and compassion are demonstrated through interactions between healthcare staff and service users [4] and so the quality of staff-patient interactions is an important and appropriate focus for healthcare research. The Quality of Interactions Schedule (QuIS) was developed by Dean et al in 1993 [6] to measure the quality and quantity of staff-patient interactions in long term care settings. QuIS is a reliable instrument within this context [6], its use has not been standardised and its reliability and validity in acute care has not been established. This paper reports a study which examined the feasibility of developing QuIS for use in acute care settings
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