نوع مقاله : مقاله پژوهشی
نویسندگان
1 دانشجو ، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی و خدمات بهداشتی درمانی بیرجند، بیرجند، ایران
2 استاد، مرکز تحقیقات سلامت سالمندان، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران؛ ب. استاد، گروه پرستاری ، دانشکده پرستاری و مامایی،
3 استادیار، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی بیرجند، بیرجند، ایران
چکیده
زمینه و هدف: بخشهای اورژانس با چالشهایی از جمله شلوغی و فشار کاری بالا مواجه هستند که بر تجربه بیماران تأثیر منفی میگذارد. ارتباط مؤثر و مذاکره با بیماران نقش اساسی در بهبود پیامدهای بالینی و رضایت بیماران دارد. این مطالعه با هدف بررسی تأثیر مذاکره ساختاریافته بر تجربه بیماران در بخش اورژانس انجام شد.
مواد و روشها: این کارآزمایی بالینی تصادفیشده بر روی بیماران مراجعهکننده به بخش اورژانس بیمارستان امام رضا (ع) بیرجند در سال 1404 انجام شد. در مجموع 70 بیمار بهصورت تصادفی در دو گروه مداخله (35=n) و کنترل (35=n) تخصیص یافتند. گروه مداخله، جلسات مذاکره فردی دریافت کردند. پرسشنامۀ تجربه بیمار، قبل و بعد از مداخله تکمیل شد. دادهها با استفاده از تحلیل کوواریانس چندمتغیری در سطح معنیداری 05/0 تحلیل شدند.
یافتهها: نتایج تحلیل کوواریانس چندمتغیری نشان داد که مذاکره با بیمار، تأثیر معناداری بر بهبود تجربه کلی بیماران در گروه مداخله داشت (0.05>P). همچنین مؤلفههای حمایت عاطفی، احترام به ترجیحات بیمار، مشارکت خانواده و دوستان و تداوم و انتقال مراقبت بهطور معناداری افزایش یافتند. با این حال، در مؤلفههای اطلاعات و آموزش، هماهنگی مراقبتها و آسایش جسمی تفاوت معناداری بین دو گروه مشاهده نشد (P>0.05).
نتیجهگیری: نتایج نشان داد اجرای مذاکره در بخشهای اورژانس بهویژه در ابعاد روانی و ارتباطی، تجربه بیماران را بهطور معناداری بهبود میبخشد. مؤلفههایی مانند اطلاعات، هماهنگی و آسایش جسمی نیازمند مداخلات سازمانی و سیستمی فراتر از ارتباطات فردی هستند. ادغام آموزش مهارتهای مذاکره در برنامههای توسعه کارکنان اورژانس میتواند بهطور مؤثر مراقبت بیمارمحور را ارتقا دهد.
تازه های تحقیق
https://scholar.google.com/citations?user=fHCx-hwAAAAJ&hl=fa
https://pubmed.ncbi.nlm.nih.gov/42091952/
https://scholar.google.com/citations?user=aaBUOKkAAAAJ&hl=fa
https://pubmed.ncbi.nlm.nih.gov/?term=Mostafa%20Rad
https://scholar.google.com/citations?hl=en&user=I15tRmAAAAAJ
https://pubmed.ncbi.nlm.nih.gov/?term=simin%20sharafi
کلیدواژهها
موضوعات
عنوان مقاله [English]
The Effect of Negotiation on Patient Experience in the Emergency Department: A Randomized Clinical Trial
نویسندگان [English]
- Yeganeh Salehi 1
- Mostafa Rad 2
- Simin Sharafi 3
1 Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
2 Professor، Iranian Research Center of Healthy Aging, Sabzevar University of Medical Sciences, Sabzevar, Iran; Professor, Department of Nursing, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
3 Assistant Professor, Department of Nursing, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
چکیده [English]
Background and objective: Emergency departments face challenges including overcrowding, long wait times, and high workload that negatively impact patient experience. Effective communication and negotiation with patients play a fundamental role in improving clinical outcomes and patient satisfaction. This study aimed to evaluate the effect of structured negotiation on patient experience in the emergency department.
Materials and Methods: This randomized clinical trial was conducted on 70 patients presenting to Imam Reza Hospital emergency department in Birjand in 2025. Participants were randomly assigned to intervention (n=35) and control (n=35) groups. The intervention group received individual negotiation sessions lasting 10-15 minutes based on Botelho's negotiation model (1992), encompassing content, relationship levels, and problem-solving phases. The control group received routine care. The Picker Patient Experience Questionnaire (15-item version) was administered before and after intervention. Data were analyzed using MANCOVA.
Results: The results of multivariate analysis of covariance showed that the structured negotiation had a significant effect on improving the overall patients experience compared to the control group. Also, the components of emotional support, respect for patient preferences, family involvement and continuity of care increased significantly (p<0.01). However, no significant difference was observed between the two groups in the components of information and education, care coordination, and physical comfort (p>0.05).
Conclusion: Structured negotiation based on Botelho's model significantly improves patient experience in emergency departments, particularly in psychological and relational dimensions. Components such as information provision, care coordination, and physical comfort require organizational and systemic interventions beyond individual communication. Integrating negotiation skills training into Emergency Department staff development programs can effectively enhance patient-centered care.
کلیدواژهها [English]
- Communication
- Emergency Department؛ Negotiation؛ Patient Experience؛ Patient-Centered Care؛ Randomized Controlled Trial
- Pearce S, Marchand T, Shannon T, Ganshorn H, Lang E. Emergency department crowding: an overview of reviews describing measures causes, and harms. Internal and Emergency Medicine. 2023;18(4):1137-58.https://doi.org/10.1007/s11739-023-03239-2
- Wolf JA, Niederhauser V, Marshburn D, LaVela SL. Reexamining “Defining Patient Experience”: the human experience in healthcare. Patient Experience Journal. 2021;8(1):16-29.https://doi.org/10.35680/2372-0247.1594
- Sharkiya SH. Quality communication can improve patient-centred health outcomes among older patients: a rapid review. BMC Health Serv Res. 2023;23(1):886.https://doi.org/10.1186/s12913-023-09869-8
- Gangopadhyay S. A review-based study on the importance of doctor-patient communication in healthcare. International Journal of Science and Research. 2024;11(9):87-90.https://doi.org/10.35629/076x-11098790
- Conway A, Kartha N, Anagnostou A, Abrams EM, Oppenheimer J, Lang DM, et al. The art of clinical negotiation. The Journal of Allergy and Clinical Immunology: In Practice. 2025;13(4):786-92.https://doi.org/10.1016/j.jaip.2024.12.040.
- Falcão H, Gouveia R, Lamarque H. Understanding Healthcare Systems and Their Negotiations. Pharma, Prices and Power: Reshaping Pharmaceutical Pricing Negotiations for a Healthier Future: Springer; 2025. p. 9-37.
- Sevedzem VN. Challenges faced by nurses in ensuring patient safety in the emergency departments. 2024.https://doi.org/
- Kim EJ, Koo YR, Nam IC. Patients and Healthcare Providers' Perspectives on Patient Experience Factors and a Model of Patient-Centered Care Communication: A Systematic Review. Healthcare (Basel). 2024;12(11).https://doi.org/10.3390/healthcare12111090
- Çakmak C, Uğurluoğlu Ö. The Effects of Patient-Centered Communication on Patient Engagement, Health-Related Quality of Life, Service Quality Perception and Patient Satisfaction in Patients with Cancer: A Cross-Sectional Study in Türkiye. Cancer Control. 2024;31:10732748241236327.https://doi.org/10.1177/10732748241236327
- Manojlovich, M., Bettencourt, A. P., Mangus, C. W., Parker, S. J., Skurla, S. E., Walters, H. M., & Mahajan, P. (2024). Refining a framework to enhance communication in the emergency Department during the diagnostic process: an eDelphi approach. The Joint Commission Journal on Quality and Patient Safety, 50(5), 348-356. https://doi.org/10.1016/j.jcjq.2024.01.013
- Edgman-Levitan S, Schoenbaum SC. Patient-centered care: achieving higher quality by designing care through the patient's eyes. Isr J Health Policy Res. 2021;10(1):21.https://doi.org/10.1186/s13584-021-00459-9
- Almulhim, K. N., AlMudayris, L. A., Alshehri, Z. K., Alnawah, A. K., Aljeri, D. A., & Hadadi, A. S. (2025). Effect of the provision of estimated waiting time on patient satisfaction with the Emergency Department: A randomized controlled trial. Journal of Family and Community Medicine, 32(1), 36-43. https://doi.org/10.4103/jfcm.jfcm_173_24
- Manukumar, A. G., Mariathas, H. H., Patey, C., Anaraki, N. R., Walsh, A., Hurley, O., ... & Asghari, S. (2025). “They Just Don’t Want to Feel Forgotten”: A Mixed-Methods Research on Patient Satisfaction With Wait Times in Emergency Departments. Journal of Patient Experience, 12, 23743735251333213. https://doi.org/10.1177/23743735251333213
- Botelho RJ. A negotiation model for the doctor-patient relationship. Fam Pract. 1992;9(2):210-8.https://doi.org/10.1093/fampra/9.2.210
- Botelho RJ. A Negotiation Model for the Doctor-Patient Relationship. Family Practice. 1992;9(2):210-8.https://doi.org/10.1093/fampra/9.2.210
- Jenkinson C, Coulter A, Bruster S. The Picker Patient Experience Questionnaire: development and validation using data from in-patient surveys in five countries. International Journal for Quality in Health Care. 2002;14(5):353-8.https://doi.org/10.1093/intqhc/14.5.353
- Taghdir R, Asgari M, Ganjparvar Z, Abdollahifar S, Kargar Jahromi S, Ghadami L et al . Validation of the Persian Version of the Picker Patient Experience Questionnaire. Iranian Journal of War & Public Health. 2023;15(2).https://doi.org/10.58209/ijwph.15.2.207
- Sonis JD, White BA. Optimizing patient experience in the emergency department. Emergency Medicine Clinics. 2020;38(3):705-13.https://doi.org/10.1016/j.emc.2020.04.008
- Walsh A, Bodaghkhani E, Etchegary H, Alcock L, Patey C, Senior D, et al. Patient-centered care in the emergency department: a systematic review and meta-ethnographic synthesis. International journal of emergency medicine. 2022;15(1):36.https://doi.org/10.1186/s12245-022-00438-0
- Manojlovich, M., Bettencourt, A. P., Mangus, C. W., Parker, S. J., Skurla, S. E., Walters, H. M., & Mahajan, P. (2024). Refining a framework to enhance communication in the emergency Department during the diagnostic process: an eDelphi approach. The Joint Commission Journal on Quality and Patient Safety, 50(5), 348-356. https://doi.org/10.1016/j.jcjq.2024.01.013
- Kim E-J, Koo Y-R, Nam I-C, editors. Patients and healthcare Providers’ perspectives on patient experience factors and a model of patient-centered care communication: a systematic review. Healthcare; 2024: MDPI.
- Milton, J., Åberg, N. D., Andersson, A. E., Gillespie, B. M., & Oxelmark, L. (2023). Patients’ perspectives on care, communication, and teamwork in the emergency department. International emergency nursing, 66, 101238. https://doi.org/10.1016/j.ienj.2022.101238. Epub 2022 Dec 24
- Manukumar, A. G., Mariathas, H. H., Patey, C., Anaraki, N. R., Walsh, A., Hurley, O., ... & Asghari, S. (2025). “They Just Don’t Want to Feel Forgotten”: A Mixed-Methods Research on Patient Satisfaction With Wait Times in Emergency Departments. Journal of Patient Experience, 12, 23743735251333213. https://doi.org/10.1177/23743735251333213
- Isbell LM, Tager J, Beals K, Liu G. Emotionally evocative patients in the emergency department: a mixed methods investigation of providers’ reported emotions and implications for patient safety. BMJ quality & safety. 2020;29(10):1-2.https://doi.org/10.1136/bmjqs-2019-010110
- Sharkiya SH. Quality communication can improve patient-centred health outcomes among older patients: a rapid review. BMC Health Services Research. 2023;23(1):886.https://doi.org/10.1186/s12913-023-09869-8
- Milton J, David Åberg N, Erichsen Andersson A, Gillespie BM, Oxelmark L. Patients' perspectives on care, communication, and teamwork in the emergency department. Int Emerg Nurs. 2023;66:101238.https://doi.org/10.1016/j.ienj.2022.101238
- Sonis JD, Aaronson EL, Lee RY, Philpotts LL, White BA. Emergency Department Patient Experience: A Systematic Review of the Literature. J Patient Exp. 2018;5(2):101-6.https://doi.org/10.1177/2374373517731359
- Degabriel D, Petrino R, Frau ED, Uccella L. Factors influencing patients' experience of communication with the medical team of the emergency department. Intern Emerg Med. 2023;18(7):2045-51.https://doi.org/10.1007/s11739-023-03298-5
- Seo W, Jain S, Le V, Li J, Zhang Z, Singh H, et al. Designing patient-centered interventions for emergency care: participatory design study. JMIR Formative Research. 2025;9(1):e63610.https://doi.org/10.2196/63610
- Asiri M, AlMohimeed AS, Almoneef M. Factors Affecting Patient Satisfaction in the Emergency Department: A Systematic Review. Cureus. 2025;17(12):e99509.https://doi.org/10.7759/cureus.99509
- de Steenwinkel M, Haagsma JA, van Berkel EC, Rozema L, Rood PP, Bouwhuis MG. Patient satisfaction, needs, and preferences concerning information dispensation at the emergency department: a cross-sectional observational study. International journal of emergency medicine. 2022;15(1):5.https://doi.org/10.1186/s12245-022-00407-7
- McKenna L, Shimoinaba K, Copnell B. Family-centered care and pediatric death in the emergency department: A qualitative study using framework analysis. J Pediatr
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