Student nurses perceptions of their interpersonal skills: a re-examination of Burnard and Morrison's findings

The Effect of Empathy Training on the Empathic Skills of Nurses

Background

The profound impact of empathy training on quality nursing care has been recognized. Studies have shown that there has been little improvement in nurses’ communication skills, and that they should work to enhance this area. Relevant training will lead to an improvement in nurses’ empathic skills, which in turn, will enable them to understand their patients better, establish positive interpersonal relationships with them, and boost their professional satisfaction.

Objectives

To reveal the effect of empathy training on the empathic skills of nurses.

Patients and Methods

This study was conducted as an experimental design. The research sample consisted of 48 nurses working at the pediatric clinics of Farabi hospital of Karadeniz Technical University in Turkey (N = 83). Two groups, an experimental group (group 1) and a control group (group 2) were determined after questionnaires were supplied to all nurses in the study sample. At first, it was intended to select these groups using a random method. However, since this may have meant that the experimental and control groups were formed from nurses working in the same service, the two groups were selected from different services to avoid possible interaction between them. The nurses in the Group 1 were provided with empathy training through group and creative drama techniques. Pre-tests and post-tests were conducted on both groups. Data was collected via a questionnaire designed around the topic “empathic skill scale-ESS”, developed by Dokmen. The Kolmogorov Smirnov test was employed to assess whether the measurable data was suitable for normal distribution. Data was presented as numbers and percentage distributions, as mean ± standard deviation and Chi-square, and as student t tests and paired t tests. The level of significance was accepted as P < 0.05.

Results

The nurses in the experimental group had a mean score of 146.7 ± 38.8 and 169.5 ± 22.1 in the ESS pre-test and post-test, respectively. Although the nurses in the control group had a pre-test mean score of 133.7 ± 37.1, which increased to 135.1 ± 51.7 after the training, no statistically significant difference was found (P = 0.886). A comparison of the groups indicated that they scored similarly in the pre-test. However, the experimental group scored significantly higher than the control group in the post-test (P = 0.270 and P = 0.015, respectively).

Conclusions

In the light of these findings, it is recommended that communication skills should be widely included in in-service training programs; similar studies should be conducted on broader control groups formed through randomization; and a comparison should be made between the findings.

Lecturers' accounts of facilitating clinical supervision groups within a pre-registration mental health nursing curriculum

In 1994 the Department of Health recommended that nurses be introduced to the process of clinical supervision during pre-registration training. Since then a body of literature has emerged, largely focusing on students' experiences of a variety of training initiatives in supervision. There is however a paucity of literature exploring the experiences of nursing lecturers engaged in such initiatives. This paper reports the findings from one part of a three-year prospective longitudinal study examining mental health students' and lecturers' experiences of group clinical supervision undertaken as part of a pre-registration course. In this part of the study eight mental health nursing lecturers participated in semi-structured individual interviews in which they discussed their experiences of facilitating student supervision groups. Content analysis of the interview data produced eight major categories: 'attitudes to supervision'; 'perceptions of the student experience'; 'preparation and support'; 'approaches to supervision'; 'the "good" supervisor'; 'the lecturer as supervisor'; 'the structure and process of sessions; and 'the content of supervision'. The findings suggest that the idea of undertaking supervision for students is attractive to lecturers. However, several issues need to be addressed if this type of initiative is to be successful in preparing students for their future role as supervisee.

Developing empathy in nurses: an inservice training program

The purpose of this study was to determine whether inservice communication training enhanced the empathic skills of 263 nurses employed at Hacettepe University Hospital. Data were collected using a nurse information form, participants' satisfaction form, and the Empathic Communication Skill B (ECS-B) form developed by Dökmen [Dökmen, U. (1988). A new measurement model of the empathy and developing empathy by using psychodrama. Journal of Education Faculty of Ankara University, 21, 155-190]. The ECS-B was used as both a preintervention and a postintervention measure. The data were expressed as means, percentages, and standard deviations, and were analyzed using Pearson's chi-square test and repeated-measures analysis of variance. The posttest scores of nurses increased from 155.6 to 180.5, and training played a role in enhancing nurses' empathic skills with regard to all variables (P < .05). However, a more comprehensive and continuous training should be planned, and its impact on behavior and patient outcomes should be investigated.

Communication strategies and interpersonal skills of instructors of esophageal speech: an observation study

OBJECTIVE

In this article, the way that the Instructor of Esophageal Speech (IES) works is considered from an interactive-analytic perspective.

METHODS

The observation project data were gathered during 6 months in 2004 at the training sessions of the Ginreikai-Asian Federation of Laryngectomees' Association using the Six Category Intervention Analysis framework (6CIA) by a trained communication specialist as an active-observer.

RESULTS

Mean scores of each of the six categories and a series of percentage distributions were extracted from the usage-frequency data and interpreted together with the results of Chi-square analysis of usage-frequency units. We found the IES used more frequently authoritative categories and used less facilitative categories. Our results of the data analysis show that the 30 IES used more authoritative interventions and used more frequently the prescription and information giving than the confrontation or cathartic interventions.

CONCLUSION

The results of the present study show that the 6CIA framework has its potential and value as an analytic tool to explore the IES' actual behavior in a specific therapy related context.

PRACTICE IMPLICATIONS

We argue for the utility of the 6CIA as an analytic framework to investigate the interpersonal behavior of the IES in the Japanese cultural setting.

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.

Student nurses' use of their interpersonal skills within clinical role-plays

Heron's six-category intervention analysis is a component of many counselling courses and is used extensively by teachers of interpersonal skills within nursing curricula. In addition, researchers have used six-category intervention analysis as a theoretical framework for exploring nurses' perceptions of their interpersonal skills. This study aimed to advance previous research by using Heron's framework to analyse student nurses' actual skills, as deployed in clinical role-plays, and then to compare them to earlier findings. Analysis of the data produced the following rank order of interventions based on Heron's framework: catalytic, prescriptive, supportive, informative, confronting and cathartic. The findings both challenge and support previous findings on nurses' perceptions of their interpersonal skills. The paper discusses these findings and their implications for clinical practice.

Nurse-patient communication: an exploration of patients' experiences

BACKGROUND

Patient-centred communication is a basic component of nursing and facilitates the development of a positive nurse-patient relationship which, along with other organizational factors, results in the delivery of quality nursing care. Nurses are frequently described in the literature as poor communicators, however, very few studies have examined patients' experiences of how nurses communicate.

AIMS AND OBJECTIVES

The aim of the study was to explore and produce statements relating to patients' experiences of how nurses communicate.

DESIGN

A qualitative perspective using an hermeneutic phenomenological approach was considered to be the most appropriate methodology for this study.

METHODS

Using purposeful sampling, eight patients in a general teaching hospital in the Republic of Ireland were interviewed. Data were collected using unstructured interviews. Data analysis was a reflective process and the findings were presented through the description and interpretation of themes and sub-themes.

RESULTS

Following data analysis four themes emerged. These were, 'lack of communication', 'attending', empathy' and 'friendly nurses'.

CONCLUSIONS

The findings of this study indicate that, in contrast to the literature that suggests that nurses are not good at communicating with patients, nurses can communicate well with patients when they use a patient-centred approach. However, health care organizations do not appear to value or recognize the importance of nurses using a patient-centred approach when communicating with patients to ensure the delivery of quality patient care.

RELEVANCE TO CLINICAL PRACTICE

The implication of these findings for clinical practice is that the task-centred approach to patient care that is associated with nursing in the past, appears to be alive and well. If health care management want to ensure that patients receive quality nursing care, they will need to consider patient-centred communication to be essential to encourage and support nurses to communicate in this manner.

Mental health nursing students' rationales for self-disclosure: 2

This is the second of two articles that consider the findings of a study exploring mental health nursing students' reasons for their use and non-use of self-disclosure in their relationships with patients. The first article (Vol 12(20): 1220–7) described the background to the deployment of this skill within therapeutic approaches, the paucity of literature discussing its use within nursing, the methods employed in this study and the findings for mental health nursing students' reasons for using the skill. This second article focuses on students' reasons for not deploying this skill, which are discussed in the following categories: ‘crossing the line’, ‘unhelpful’, ‘name, rank and serial number’ and ‘students’ vulnerability'. A discussion of the findings from both articles and their implications is offered.

Self-disclosure in adult and mental health nursing students

Self-disclosure, the process whereby people verbally reveal themselves to others, is an important interpersonal skill in initiating, developing, maintaining, and terminating therapeutic relationships. Studies of this interpersonal skill in nursing have, primarily, focused on adult nurses. They are dated, make no comparisons between this and other nursing specialisms, and have not considered the patient as a focus for nurses' self-disclosure. This study attempts to address these issues in relation to student nurses by: replicating a previous study of self-disclosure in adult nursing students (ANS) and offering a comparison of two nursing specialisms, reporting on the use of this skill in relation to the patient. A matched sample of 25 ANS and 25 mental health nursing students (MHNS) were asked to complete a modified version of Jourard's 25-item self-disclosure questionnaire. The findings suggest that: ANS were more self-disclosing than students sampled in an earlier study (Burnard and Morrison, 1992); both sets of students disclosed significantly less items to the patient as target-person than to other categories; and MHNS disclosed significantly more items than the ANS to the patient category.

John Heron's six-category intervention analysis: towards understanding interpersonal relations and progressing the delivery of clinical supervision for mental health nursing in the United Kingdom

AIMS

This paper provides a critique of how Heron's six-category intervention analysis framework has been adopted by nursing in the United Kingdom (UK) as a theoretical framework in nursing research and model for clinical supervision. From this, its merits as an analytic framework and model for clinical supervision in nursing are discussed.

BACKGROUND

Heron's six-category intervention analysis has been acknowledged as a means by which nursing could develop its therapeutic integrity. It has also been used as a theoretical framework in nursing research focusing on nurses' perceptions of their interpersonal style. More recently descriptions of this framework have been proposed as a structure for clinical supervision. However, its use as a theoretical framework to underpin research investigating the interpersonal skills of nurses and as a model of clinical supervision must firstly be scrutinized.

FINDINGS

Returning to Heron's original description and comparing this with its current adoption in the UK, misconceptions of this framework can be identified. Its value as an analytic tool investigating interpersonal relations in nursing has still to be evaluated. Furthermore, nursing's emphasis on certain intervention categories has undermined the potential potency of this framework and its contribution as a model for clinical supervision in nursing.

CONCLUSION

We argue that Heron's six-category intervention analysis as a framework to investigate the interpersonal competence of nurses, particularly mental health nurses, requires investigation. This, in turn, would provide an opportunity to challenge the framework's theoretical standpoint. In addition to its value as an analytic tool, all six categories of Heron's framework have equal relevance to its contribution in nursing as a supervision model.

Assessing therapeutic intervention used by NHS Direct nurse advisers

The National Service Framework for Mental Health has identified NHS Direct as a "new point of access" to appropriate mental health services. Mental health calls account for approximately 4% of all calls received by NHS Direct but raise the greatest level of anxiety among advisers and take twice as long to deal with as other calls. In order to provide adequate advice, it is essential to ensure nurse advisers can deal with this type of call. As a first step in meeting these needs this short research article reports on the types of interventions deployed by 18 nurse advisers during role-plays with a mental health "client" expressing self-harm.

Patterns of self-disclosure among mental health nursing students

Self-disclosure, a process by which we let ourselves be known to others, is an important skill across a diverse range of therapeutic approaches used in mental health nursing. Previous studies of nurses' self-disclosure have been confined to small samples of female, adult nurses. This study aims to extend existing knowledge by providing information on a sample of male and female mental health nursing students.A modified version of Jourard's 25-item self-disclosure questionnaire (JSDQ) was utilized in the study. The findings from this study show that mental health students disclosed more items than adult students sampled in earlier studies (Jourards 1961, Burnard & Morrison 1992). However, students disclosed significantly fewer items to the patient as target-person than to other categories. No differences were observed in disclosure patterns for males and females. A discussion of these findings and their implications is offered.

Nursing student-patient relationship: a review of the literature from 1984 to 1998

AIM AND BACKGROUND

The aim of this review is to examine the research of the nursing student-patient relationship for planning an empirical study in this area.

METHODS

A literature search was made focusing on relationship from student and patient perspectives. The sample included 104 articles from 1984 to 1998. The articles were analysed using an inductive analysis of the literature.

RESULTS

The review shows that there has been an increasing research interest in the issue since the 1980s, with the main focus on nursing students. Most of the studies were of a descriptive nature, using both qualitative and quantitative approaches. It seems that the relationship with a patient is an important part of a meaningful learning process, teaching nursing students about the patient's individualised care and promoting their personal and professional growth, confidence and self-esteem. Patients are willing to participate in students' learning process and they tend to benefit from therapeutic and social interaction with students. Instruction has the effect of changing students' attitudes and improving their interaction skills, but it does not affect their feelings of anxiety in novel situations.

CONCLUSIONS

In future empirical research should be based more firmly on theory-based illuminations of the student-patient relationship.