The effects of empathic accurate response to implicit and explicit expressions of negative emotions should be explored further. The combination of coding systems used appears to be valid and reliable for assessing verbal empathic accuracy by observers in nursing settings.

Objectives: Clinicians' recognition of patients' concerns is an important component of effective treatment and care. During a consultation, patients often do not express their concerns directly, but rather present them indirectly as hints or cues. The aim of this study was to explore the types of concerns and cues patients expressed in an initial consultation with a nurse at a pain clinic, how and who initiated these cues and concerns, and predictors of these expressions. Methods:Initial consultations between patients with fibromyalgia (n = 58, 85% female, duration 30 minutes, mean age 47.8 (SD 10.7) and clinical nurse specialists (n=5) were videotaped. Patients' cues and concerns were coded using the Verona Coding Definitions of Emotional Sequences. Nurses' responses to patients' cues and concerns were evaluated using the Hierarchical Coding Scheme of Comforting Strategies. In addition, pain intensity and duration, overall evaluation of health, affect at the start of the consultation, and psychological distress were evaluated. Results:Patients expressed more cues than concerns, mostly about pain, interpersonal relationships, and/or emotional reactions. Both lack of empathic responding and unspecific empathic responding were associated with the expression of an increased number of cues in the consultation while higher evaluation of health was associated with less cues. More concerns were expressed by patients when nurses exhibited a high level of empathic responding and when the patient entered the consultation with a higher level of negative affect.Discussion: Findings from this study highlight the importance of a patient centered communication style to facilitate the expression of cues and concerns. 4

Scand J Caring Sci; 2012; 26; 545-552 Attitudes, beliefs and self-reported competence about postoperative pain among physicians and nurses working on surgical wards Aims: To investigate attitudes, beliefs and self-reported competence with regard to pain management in nurses and physicians on surgical wards. Interprofessional differences between physicians and nurses were also examined. Methods: A total of 795 physicians and nurses from different surgical departments in Norway were invited to complete a questionnaire measuring attitudes, beliefs and self-reported competence about postoperative pain. Findings: In total, 128 physicians and 407 nurses completed the questionnaire (response rate 68%). Of these, 77% of physicians and 57% of nurses reported more than 4 years' work experience with postoperative pain. Most of the physicians (95%) and nurses (86%) reported that patients 'often' or 'very often' achieved satisfactory pain relief. Overall, 69% of the sample evaluated themselves as being highly competent or competent in treating nociceptive pain, while only 16% reported they were highly competent or competent in treating neuropathic pain. There were no statistically significant differences between the professions regarding their self-reported competence in pain management, and nurses and physicians only differed on three out of 18 conditions regarding their appraisal of conditions related to postoperative pain management after controlling for years of experience. Only 20% of respondents were satisfied with the annual updates for staff about pain relief for patients with postoperative pain. Conclusions: Even though the majority of physicians and nurses described themselves as competent in management of nociceptive pain, and thought that patients often or very often achieved satisfactory pain relief, the respondents reported dissatisfaction with the annual updates in pain management and poor competence in treatment of neuropathic pain.