Sit and deliver
Nurse researchers show that sitting caregivers improve patient satisfaction
March 8, 2012 -- Today the Kansas City Community News site posted a good story by Linda Friedel about a study done at the University of Kansas Hospital showing that, when a clinician sits at the bedside rather than standing, patients are more satisfied and actually believe that the clinician has spent more time with them. The researchers reportedly followed Paul Arnold, MD, as he made 120 consultations of two minutes or less using both methods. Patients perceived that Arnold had spent far longer with them when he sat, even as much as 15 minutes. The piece explains that Jennifer Moran, RN, BSN, CNRN, a clinical nurse educator at the hospital, collected data, and Joan K. McMahon, MSA, BSN, CRRN, Spinal Cord Program Coordinator, supervised the study. The report includes good quotes from those two, as well as from Arnold, who says that he was known as a fast rounder, but now he sits with patients and tries to take a little more time. The article provides a good look at nursing research into how the care environment affects patients, which is a classic focus of the profession. Whether a clinician sits or stands may not seem critical, but it can make a difference in patients' outlook and so presumably in their outcomes. In fact, the piece might have spent a little time on that link, perhaps citing other studies about the effect of patient attitudes on recovery. And the piece might have asked whether patients would benefit even more if clinicians actually spent more time talking to them. The piece does give the nurse researchers most of the quotes, includes their job titles and educational credentials, and of course, tells readers that they are nurses--which is not something we can take for granted in reports about nursing research. We thank Ms. Friedel and the Kansas City Community News.
The headline attempts a pun: "Sitting down on the job stands out with patients." Moving on, the piece sums up the research by noting that it has confirmed "what many nurses already believed to be true," namely that "patients feel more satisfied when clinicians sit at the bedside versus standing." Moran, introduced and quoted in the first paragraph, marvels that "it was a simple position change." The report then explains that Moran "collected data as research assistant on the Effect of sitting vs. standing on perception of provider time at bedside: A pilot study, led by Kelli Swaden, RN." Readers might guess that this is the title of the study, but the piece might have made that clearer, as well as whether and where it was published. (It was published in Patient Education and Counseling, February 2012, pp. 166-71.) The piece makes no further mention of Swayden, who was the primary investigator, and it also misspells her last name, which may make it harder for readers to find the study.
The article provides helpful details about the methods and findings of the study. Arnold was chosen because, Moran says, he "always stood when rounding with patients and was perceived by patients to be in a hurry." Arnold did 120 consultations, each lasting 60 to 120 seconds, some while standing and some while sitting. Then the researchers asked the patients about their perceptions. They found that "patients perceive a clinician has spent more time at their bedside when they sit rather than stand." Moran says she was "amazed" that patients believed that the clinician had spent between five and 15 minutes with them in the consultations in which Arnold sat, even though, as Moran notes, "most of the patients were alert and oriented." Moran reports that patients said that they felt the sitting clinician was more "open, friendly and relaxed" and that they had "his undivided attention." Explaining the results, Moran points to the calming effect of sitting at their level, or taking a "non-intimidating stance," similar to an adult moving to the same level as a child. She also notes that nurses themselves are busy and on their feet doing things for patients, such as "managing IVs, turning patients, drawing blood or monitoring vital signs," but they will take a few moments if they can to try to sit and "converse with patients." Moran says that because of the study, she herself will make a point to sit at the bedside when she gets her "degree as a nurse practitioner." However, the study has had an immediate effect on Arnold:
Moran said after the study, Arnold makes a point to sit with patients during his consultations; however he still spends less than two minutes, communicating in the same manner. A few minutes of sitting has made a big impression, she said. "It has made a profound difference. Patient satisfaction scores were not high," she said. "Patients were frustrated with his bedside manner. His scores are excellent now."
The piece also consults Joan McMahon, the Spinal Cord Program Coordinator who "supervised the study." She agrees that the study underlines the importance of being "eye to eye" with the patient so they don't feel "vulnerable." McMahon also says that the study confirmed what she had already believed, noting that "we all learn in school that it is good to sit down when interacting with patients, but I am not sure we were ever told why." She notes that there may be nowhere for clinicians to sit in patients' rooms because chairs are occupied with objects, so during the study, Arnold would sit on the window sill or, with the patient's permission, the edge of the bed. She adds that the study has caused more clinicians in the hospital to sit with patients in the outpatient setting, and that she would like to see the study repeated with nurse practitioners.
And the report consults Arnold himself. He admits that he is "known for his fast rounding," but he says that the study "inspired him to sit at the bedside and helped him to slow down a little." There is some tension here with the earlier note that he is still spending two minutes or less with patients; has he slowed down or not? Anyway, Arnold echoes McMahon's point about being taught to sit during his medical training, but he says that before the current study, there had been no data to support the claim that sitting caused patients to believe health professionals were staying longer. He emphasizes the study's potential benefits for medical education, noting that 65 percent of U.S. medical schools teach "communication skills" and "this survey provides the exact type of qualitative and quantitative data that we need to support teaching these skills," adding that "taking the time to listen and respond to patient concerns is a significant part of this job."
This article does a good job of highlighting important nursing research. It portrays nurses as thoughtful professionals capable of undertaking scientific research about the health care environment and gaining insights with tangible effects on patient wellbeing. Even though the vehicle for the study was a physician, it is the two nurses who appear to have led the study and they get the most attention. The article makes sure to include their current hospital positions and their credentials, though it might have done more with Moran's nurse practitioner studies, perhaps making clear what graduate degree she will receive--at least it does note that she will receive a "degree." The piece might have explored some aspects of the research topic further. Possible areas of interest include other research on how patient attitudes affect recovery, and whether it would be beneficial not only to give patients the impression that clinicians are spending more time with them, but to have clinicians actually spend more time, which could help them to better observe and educate patients. Frankly, it's hard to imagine a clinician having a very meaningful interaction with a patient in 60 seconds, no matter how many interpersonal tactics he may deploy. And the piece could have conveyed more information like that in the space available; not all of the quotes add much to the discussion.
Still, the piece offers a good look at important nursing research, and it presents nurses as educated, autonomous professionals. We thank Linda Friedel and the Kansas City Community News.
See the article "Sitting down on the job stands out with patients" by Linda Friedel from the Kansas City Community News. You can contact the author at firstname.lastname@example.org.