Communication skills training in healthcare: a review of the literature

Communication enhancement: nurse and patient satisfaction outcomes in a complex continuing care facility

AIMS

This paper presents an evaluation of a communication enhancement intervention on staff and patients in a complex continuing care facility.

BACKGROUND

The importance of effective communication as a fundamental element of nursing has been emphasized and is regarded as integral to the provision of quality patient care. For people residing in complex continuing care (similar to long-term care facilities), opportunities for socialization occur primarily during interactions or communication with staff, and these interactions have been found to be limited. One way to improve nursing staff communication is through a communication enhancement intervention.

METHODS

Twenty-one nursing staff members (Registered Nurses, Registered Practical Nurses and healthcare aides) working in a complex continuing care environment and 16 patients participated in this study, conducted in the summer of 2003. A repeated measures design was used to evaluate the effects of the communication enhancement intervention on outcomes. Data were collected from patients and nurses at baseline, 5 weeks into the intervention and at 10 weeks after the intervention. Nurse outcome variables included nurses' job satisfaction and their relationships with patients; patient outcome variables included two measures of patient satisfaction with care.

RESULTS

Nursing staff felt closer to their patients (F(2,40) = 3.0, P = 0.045) following the intervention and reported higher levels of job satisfaction (F(2,40) = 4.1, P = 0.02). No changes were found in the level of patient satisfaction with care.

CONCLUSIONS

Our results suggest that nursing staff can feel better about their job and about their patients as they enhance their communication skills. Understanding the barriers to finding time to talk with patients for a few minutes a day, outside of direct hands-on caregiving, requires further exploration.

The use of the nominal group technique as an evaluative tool in the teaching and summative assessment of the inter-personal skills of student mental health nurses

Nominal group technique is a semi-quantitative/qualitative evaluative methodology. It has been used in health care education for generating ideas to develop curricula and find solutions to problems in programme delivery. This paper aims to describe the use of nominal group technique and present the data from nominal group evaluations of a developing module which used novel approaches to the teaching and assessment of interpersonal skills. Evaluations took place over 3 years. Thirty-six students took part in annual groups. Analysis of the data produced the following themes based on items generated in the groups: role play, marking, course content, teaching style and user involvement. Findings indicate that students valued the role play, feedback from service users and emphasis on engagement and collaboration elements of the module. The areas which participants found difficult and desired change included anxiety during experiential practice, the "snap shot" nature of assessment and the use of specific interventions. Indications are also given regarding the impact of changes made by teaching staff over the 3 year evaluation period. The findings support themes within the existing literature on the teaching of interpersonal skills and may to some extent point the way toward best practice in this area. The paper discusses these findings and their implications for nurse education.

Understanding interpersonal communication processes across health contexts: advances in the last decade and challenges for the next decade

Interpersonal communication processes are central to the provider-patient interaction and in relationships with someone who is ill or needs care. The last decade of research has documented the ways communication processes predict better outcomes in the provider-patient interaction and key constructs for consideration in close relationships in which a health issue in some way defines the relationship. The current article highlights findings from the previous decade and the ways previous findings serve as a theoretical and methodological foundation for more sophisticated analysis of interpersonal communication processes in health contexts. A relational perspective serves as a link between the provider-patient relationship and close relationships with someone with a health issue. Implications for provider-patient contexts, medical education, and close relationships highlight future directions for theory building, health literacy, health outcomes, family communication, developmental issues, and a life span perspective.

Addressing Limited English Proficiency and Disparities for Hispanic Postpartum Women

The National Institutes of Health Office of Minority Health challenges health providers to eliminate health disparities for Hispanic women, especially those women with limited English proficiency. This article addresses this challenge by identifying areas of health disparities for low-risk postpartum Hispanic women with limited English proficiency, by describing the legal basis for improving language access, and by proposing implementation of Office of Minority Health national guidelines. Health providers can use a social equity framework to support improvements in communication practices when language differs.

Evidence-Based Nursing Education: Myth or Reality?

This article explores the concept of evidence-based nursing education. Because nurse educators incorporate evidence-based practice as a basic tenet of their programs, they assume nursing education itself is evidence based. Nursing education has a body of knowledge on which nurse educators base teaching, educational strategies, and curricular designs, but most of this knowledge is tacit, experiential, and based on practice. This knowledge relates to the art of teaching in nursing and can warrant the practice of nurse educators. However, research is also necessary to demonstrate the effectiveness of teaching approaches and strategies. Nurse educators need to develop the science of nursing education through qualitative and quantitative research, to add to the tacit knowledge underpinning nursing education strategies. When the science of nursing education is adequately developed through rigorous research, we will truly be able to say that nursing education is evidence based. Until then, it may be only a myth.

Using a communication audit to improve communication on clinical placement in pre-registration nursing

This article describes a novel communication audit conducted with those concerned with the practice placements of pre-registration Nursing students. The study, uniquely, addressed all who were involved in communication concerning placement in what is described as an organisational analysis. The aim of the audit was to identify levels of satisfaction and dissatisfaction with present communication processes and to identify points for improvement. The audit used the Hogard-Barker Communication Audit of Practice a customized version of a well established tool, devised to cover issues relevant to practice placements. A key feature of the tool is the opportunity for participants to identify the amount of communication they are receiving on particular topics and issues against the amount they would like to receive. Participants in the audit included students, assessor mentors, ward managers, clinical facilitators and link tutors. Overall there was considerable dissatisfaction with what was perceived to be the insufficient amount of communication received on a number of topics including allocations, the curriculum, students' learning outcomes and commitments in terms of college work. In addition to identifying points for improvement the audit provides a baseline against which progress can be assessed through a future audit.

Evaluation of a computer assisted instruction resource in nursing education

The STEP-DIET program, a computer assisted instruction (CAI) tool, was developed to prepare dietetic students for their hospital based practical training in the academic setting. This study aimed to evaluate the potential for using the programme within nursing education. The evaluation framework of Kirkpatrick [I. Forsyth, A. Jolliffe, D. Stevens (Eds.), Evaluating a Course, second ed. Kogan Page, London, p. 5] was employed to assess student response to STEP-DIET and its effectiveness as a teaching tool, with regards to perceived learning achievements. Knowledge and attitudes towards nutrition education were also investigated. Quantitative and qualitative methodologies were employed, with nine second and six final year BSc (Adult) nursing students completing questionnaires and taking part in two focus groups, separated by year group. Students rated STEP-DIET highly in terms of design and content and reported a number of perceived learning achievements including increase in nutritional knowledge, understanding of Type 2 diabetes management and the dietitian's role, however there was a reluctance to accept CAI as a teaching method. Students reported a poor knowledge of nutrition, but recognised its importance. This study demonstrates that multidisciplinary learning by the sharing of resources has benefits to students. However, the integration of CAI into taught programmes needs to be managed to take into account student's reluctance to rely on this method of instruction.

Communicating with patients in cancer care; what areas do nurses find most challenging?

BACKGROUND

Patient communication is a cornerstone of comprehensive oncology nursing care. Oncology nurses, however, do not appear to receive much advanced training in communication skills and many nurses do not feel adequately trained in this area.

METHOD

We designed a 33-item questionnaire to assess nurses' perceived level of difficulty and skill in a variety of common clinical situations where patient communication was a challenge. Three hundred fifty oncology nurses in a major cancer center completed the questionnaire.

RESULTS

Nurses rated areas where they addressed the physical complaints (pain, fatigue, appetite and weight loss) as least challenging and areas in which they were most prepared. Several items ranked as most difficult and where nurses felt they had the least skills had to do with issues related to death and dying, especially requests for euthanasia and patient loss. Advanced practice nurses rated their perceived communications skills more highly in several different areas.

CONCLUSION

The communication challenges faced by oncology nurses require skills that go beyond simple supportive techniques like empathy and listening. Teaching advanced communications skills geared to specific problems identified by nurses may be useful.