Nurses' emotional tone toward older inpatients: Do cognitive impairment and acute hospital setting matter?

Abstract

The emotional tone of nurses' voice toward residents has been characterized as overly controlling and less person-centered. However, it is unclear whether this critical imbalance also applies to acutely ill older patients, who represent a major subgroup in acute hospitals. We therefore examined nurses' emotional tone in this setting, contrasting care interactions with severely cognitively impaired (CI) versus cognitively unimpaired older patients. Furthermore, we included a general versus a geriatric acute hospital to examine the role of different hospital environments. A mixed-methods design combining audio-recordings with standardized interviews was used. Audio-recorded clips of care interactions between 34 registered nurses (M _age = 38.9 years, SD = 12.3 years) and 92 patients (M _age = 83.4 years, SD = 6.1 years; 50% with CI) were evaluated by 12 naïve raters (M _age = 32.8 years, SD = 9.3 years). Based on their impressions of the vocal qualities, raters judged nurses' emotional tone by an established procedure which allows to differentiate between a person-centered and a controlling tone (Cronbach's α = .98 for both subscales). Overall, findings revealed that nurses used rather person-centered tones. However, nurses' tone was rated as more controlling for CI patients and in the geriatric hospital. When controlling for patients' functional status, both effects lost significance. To our knowledge, this is the first study that examined nurses' emotional tone in the acute hospital setting. Findings suggest that overall functional status of older patients may play a more important role for emotional tone in care interactions than CI and setting differences.

Keywords: Cognitive impairment; Elderspeak; Functional status; Inpatient; Person-centered communication.

Fig. 1

Mean differences in emotional tone ratings between a the general and b the geriatric acute hospital setting. Mean emotional tone ratings for the person-centered (blue line/crosses) and the control-centered subscale (red line/circles) ranging from 1 (not at all) to 5 (very). c Mean emotional tone (im)balance (ratios) for the general (green line, triangle up) and the geriatric acute hospital (blue line, triangle down) as well as for both (black line, circles). 1 = balance, < 1 = tendency toward a controlling tone of voice, > 1 = tendency toward a person-centered tone of voice. Standard deviations are represented by error bars; p values for differences between severely cognitively impaired (CI) patients (n = 46) and cognitively unimpaired (CU) patients (n = 46)