Nurse responsiveness to cancer patient expressions of emotion.

It is well accepted that communication skills are essential to providing optimal care in the oncology setting. Provider use of behaviors that facilitate disclosure of emotional concerns has been shown to decrease patient distress, a common response to a cancer diagnosis. Many of these emotionally laden conversations are spontaneous and arise during routine care. Effectively responding to patient concerns requires affective behaviors that acknowledge and assess the patient's experience. Most studies describe communication occurring during doctor-patient interactions, but few studies have explored and quantified nurse responses to patients. Interactions that include negative emotions, such as anger and sadness, have been seen as more difficult by nurses. Using a theoretically based, experimental design, this study used two phases to explore nurse responsiveness to oncology patient expressions of emotion, i.e., anger and sadness. In the first phase, cognitive interviews were conducted with experienced oncology nurses, applying the constructs of the Crick and Dodge Model of social-information processing. A videotape of a simulated cancer patient expressing emotions was created in a three-step process and used as a scripted probe during the interviews. The interviews captured the nurses' perceptions of the process of responding to patients and added a new construct to the theoretical model: peer support. In the second phase, nurses with oncology experience responded verbally to the simulated patient in the videotape developed in the first phase. Quantifying the audiotape nurse responses to the videotape was done with the Roter Interaction Analysis System coding system. The variables that are hypothesized to affect nurse behaviors (age, education, length or work experience, work stress, self-efficacy, and anxiety) were examined with correlations and regression analyses. The correlations between the variables were significant implying complex relationships between demographic factors, personality characteristics, and work factors. Affective behaviors could not be predicted with these variables. Communication between nurses and patients is a complex process and may influence patient adjustment to a cancer diagnosis. The cognitive interviews validated the theoretical model and added the construct of peer support. The videotape was useful in eliciting nurse responses and quantifying communication. Understanding the communication process has implications for enhancing nurse communication skills and improving patient outcomes.