Evaluation of communication training programs in nursing care: a review of the literature

Creativity, Critical Thinking, Communication, and Collaboration: Assessment, Certification, and Promotion of 21st Century Skills for the Future of Work and Education

This article addresses educational challenges posed by the future of work, examining "21st century skills", their conception, assessment, and valorization. It focuses in particular on key soft skill competencies known as the "4Cs": creativity, critical thinking, collaboration, and communication. In a section on each C, we provide an overview of assessment at the level of individual performance, before focusing on the less common assessment of systemic support for the development of the 4Cs that can be measured at the institutional level (i.e., in schools, universities, professional training programs, etc.). We then present the process of official assessment and certification known as "labelization", suggesting it as a solution both for establishing a publicly trusted assessment of the 4Cs and for promoting their cultural valorization. Next, two variations of the "International Institute for Competency Development's 21st Century Skills Framework" are presented. The first of these comprehensive systems allows for the assessment and labelization of the extent to which development of the 4Cs is supported by a formal educational program or institution. The second assesses informal educational or training experiences, such as playing a game. We discuss the overlap between the 4Cs and the challenges of teaching and institutionalizing them, both of which may be assisted by adopting a dynamic interactionist model of the 4Cs-playfully entitled "Crea-Critical-Collab-ication"-for pedagogical and policy-promotion purposes. We conclude by briefly discussing opportunities presented by future research and new technologies such as artificial intelligence and virtual reality.

Nurses' comfort care of transarterial chemoembolization patients based on their perceptions around postembolization syndrome and symptom interference

AIM

Post-embolization syndrome is a common adverse event following trans-arterial chemoembolization, which negatively impacts the daily life of the patients involved. This study examined whether perceptions around post-embolization syndrome and symptom interference among nurses affect their comfort care performance toward patients who have undergone this procedure.

DESIGN

A descriptive cross-sectional study.

METHODS

One hundred and fifty registered nurses were surveyed from September to November 2020. Perceived post-embolization syndrome, symptom interference, and comfort care (including physical, psychospiritual, sociocultural, and environmental dimensions) were measured. Data were analyzed using t-tests, analysis of variance, Pearson's correlation, and a multivariate analysis of variance.

RESULTS

There were no individual effects found of perceived post-embolization syndrome or symptom interference on nurses' comfort care performance. However, statistically significant interaction effects were found in terms of their sociocultural and environmental care.

CONCLUSION

Nurses who recognized both high post-embolization syndrome and symptom interference among their patients were found to provide greater sociocultural and environmental care. As such, nurses should improve their early symptom and symptom interference detection protocols based on current care guidelines and provide physical, psychospiritual, sociocultural, and environmental comfort care.

Translating knowledge into practice for communication skills training for health care professionals

Despite the evidence that person-centred communication underpins all that we do in our interactions with patients, caregivers and team members, the knowledge about the implementation of systematic communication skills training is still in its infancy. This position paper describes some of the main contextual facilitators for translating knowledge about communication skills training for health care professionals (HCP) and recommends ways to guide practical implementation. Based on the literature that has been published over the last two decades, it seems evident that communication skills training programs should be underpinned by clinician self-reflection, be experiential, and focused on behaviour change and implementation of new skills into practice. The programs should be delivered by trainers possessing an understanding of communication micro skills, the skills and confidence to observe interactions, and coach learners through the rehearsal of alternative approaches. Communication skills programs should be flexible to adapt to individual learners, local needs, and circumstances. Interventions should not be limited to the empowerment of individual HCP but should be a part of the organisational quality assurance framework, e.g., by including communication skills in clinical audits. Implementation science frameworks may provide tools to align programs to the context and to address the determinants important for a sustained implementation process. Programs need to be embedded as 'core business', otherwise the culture change will be elusive and sustainability under threat if they are only dependent on provisional funding.

The Impact of a Communication Training on the Birth Experience: Qualitative Interviews with Mothers after Giving Birth at Obstetric University Departments in Germany

(1) Background: Patient safety is a pressing issue in healthcare. Besides economical and organizational issues, human factors play a crucial role in providing safe care. Safe and clear communication on both the healthcare workers' and patients' sides contribute to the avoidance of medical errors and increase patients' and healthcare workers' satisfaction. Globally, the incidence of experiencing at least one adverse event in obstetrics is about 10%, of which half are classified as preventable. According to international research, improving communication skills may decrease preventable adverse events. The research question was to what extent communication training for pregnant women impacts the quality of communication and mutual understanding during birth. (2) Methods: Communication interventions with pregnant women were conducted in two German university obstetric departments in a mixed methods research design, based on the Health Action Process Approach. The online classes covered the awareness of personal wishes, the understanding and usage of communication strategies, self-efficacy and empathy. This study presents the qualitative results. Out of 142 mothers who answered two questionnaires before the communication training and after the birth, 24 in-depth semistructured interviews were conducted to explore the subjective impact of the communication training. The results were analyzed with qualitative content analysis. (3) Results: The majority of participants felt incentivized to be aware of their personal wishes for birth and to express them. Perceived positive experiences with sufficient competency in communication, empathy and mutual understanding outweighed negative treatments and experiences in the hospital, some of which could be attributed to structural problems. (4) Discussion: The reported positive effects of the communication training underline the need but also the potential for communication lessons to reflect and improve communication skills in obstetrics. However, negative experiences due to structural problems in the healthcare system may be buffered by communication skills but not solved.

Effectiveness of Communication Interventions in Obstetrics-A Systematic Review

(1) Background: Obstetric work requires good communication, which can be trained through interventions targeting healthcare providers and pregnant women/patients. This systematic review aims to aggregate the current state of research on communication interventions in obstetrics. (2) Methods: Using the PICOS scheme, we searched for studies published in peer-reviewed journals in English or German between 2000 and 2020. Out of 7018 results, 71 studies were included and evaluated in this synthesis using the Oxford Level of Evidence Scale. (3) Results: The 63 studies that included a communication component revealed a positive effect on different proximal outcomes (i.e., communication skills). Three studies revealed a beneficial effect of communication trainings on distal performance indicators (i.e., patient safety), but only to a limited extent. Most studies simultaneously examined different groups, however, those addressing healthcare providers were more common than those with students (61 vs. 12). Only nine studies targeted expectant mothers. Overall, the evidence level of studies was low (only 11 RCTs), with 24 studies with an evidence level I-II, 35 with level III, and 10 with level IV. (4) Conclusions: Communication trainings should be more frequently applied to improve communication of staff, students, and pregnant women and their partners, thereby improving patient safety.

An Objective Pain Score for Chronic Pain Clinic Patients

Objectives

Although numerous studies have looked at the numeric rating scale (NRS) in chronic pain patients and several studies have evaluated objective pain scales, no known studies have assessed an objective pain scale for use in the evaluation of adult chronic pain patients in the outpatient setting. Subjective scales require patients to convert a subjective feeling into a quantitative number. Meanwhile, objective pain scales utilize, for the most part, the patient's behavioral component as observed by the provider in addition to the patient's subjective perception of pain. This study aims to examine the reliability and validity of an objective Chronic Pain Behavioral Pain Scale for Adults (CBPS) as compared to the traditional NRS.

Methods

In this cross-sectional study, patients were assessed before and after an interventional pain procedure by a researcher and a nurse using the CBPS and the NRS. Interrater reliability, concurrent validity, and construct validity were analyzed.

Results

Interrater reliability revealed a fair-good agreement between the nurse's and researcher's CBPS scores, weighted kappa values of 0.59 and 0.65, preprocedure and postprocedure, respectively. Concurrent validity showed low positive correlation for the preprocedure measurements, 0.34 (95% CI 0.16-0.50) and 0.47 (95% CI 0.31-0.61), and moderate positive correlation for the postprocedure measurements, 0.68 (95% CI 0.56-0.77) and 0.67 (95% CI 0.55-0.77), for the nurses and researchers, respectively. Construct validity demonstrated an equally average significant reduction in pain from preprocedure to postprocedure, CBPS and NRS median (IQR) scores preprocedure (4 (2-6) and 6 (4-8)) and postprocedure (1 (0-2) and 3 (0-5)), p < 0.001. Discussion. The CBPS has been shown to have interrater reliability, concurrent validity, and construct validity. However, further testing is needed to show its potential benefits over other pain scales and its effectiveness in treating patients with chronic pain over a long-term. This study was registered with ClinicalTrial.gov with National Clinical Trial Number NCT02882971.

Acceptability and efficacy of a communication skills training for nursing students: Building empathy and discussing complex situations

Nurses must demonstrate effective communication across complex interpersonal domains, as emphasized by numerous professional healthcare organizations. However, formal communication skills training has been only modestly integrated into baccalaureate nursing programs, and of those studied systematically, there are notable methodological concerns. The current study focused on application of a well-researched communication program (Comskil) to student nurses completing summer internships at a comprehensive cancer center as part of their clinical education. The Comskil training program for student nurses is an in-person, day-long training that includes three sections: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging family interactions. Student nurse participants provided strongly favorable perceptions of the program, with 90% indicating that they agreed or strongly agreed with all perception items. A significant pre-to post-training improvement in self-reported confidence was observed (p < .01). Additionally, pre- and post-training observational coding of standardized patient assessments indicated significant improvements in usage of the following skill categories: total skill use, information organization, and empathic communication (p < .001). Overall, these results suggest that communication skills training for student nurses is a feasible, acceptable, and effective way of increasing confidence and skills usage in complex clinical scenarios.

The effectiveness of training interventions on nurses' communication skills: A systematic review

OBJECTIVES

The objective of this systematic review was to identify, critically appraise and synthesise evidence for the effectiveness of communication skills training interventions in nursing practice.

DESIGN

A systematic review of literature.

DATA SOURCES

Randomised controlled trials published in English from 1998 to 2018, identified in five computerised databases (Medline, Cinahl, Embase, Psychinfo and Cochrane Database). Studies were included if they reported an educational intervention to enhance nurses' communication with patients and contained an objective measure of communication skills and/or patient outcome measures.

REVIEW METHODS

The Preferred reporting Items for Systematic reviews and Meta-Analyses guided the review. Data were extracted regarding study design and effectiveness on nurses' communication skills. Trial quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The heterogeneity of the included studies prohibited meta-analysis.

RESULTS

Of the 7811 papers identified, seven trials met the eligibility criteria. The quality was modest. Training programs varied significantly in duration, structure, location and use of outcome measurement tools. Five trials focused on communication with cancer patients using simulated patients. All trials found at least one statistically significant improvement for nurses' communication skills.

CONCLUSIONS

Educational interventions to enhance nurses' capacity to communicate with patients show promise. The paper reports the first systematic review of randomised controlled trials concerning the effect of communication skills training on nurses' abilities to communicate with patients, inclusive of non-cancer settings. The direct impact of educational interventions on nurses' communication skills is difficult to measure arising from non-standardised outcome measurement tools. Further research is particularly needed in acute, chronic illness, aged care and community settings.

Evaluación del impacto de un programa de formación en entrevista motivacional a enfermería nefrológica

Resumen: Introducción: Los profesionales de enfermería de cinco servicios de nefrología recibieron entrenamiento en Entrevista Motivacional mediante un taller de ocho horas centrado en como promover la adhesión al tratamiento en el paciente renal y su familia. El objetivo fue evaluar cambios en: competencia percibida en habilidades comunicativas especificas, respuesta empática espontanea e implantación de las habilidades in vivo medido a través de una rejilla observacional. Material y Métodos: Diseño pretest-postest sin grupo control. La muestra estaba formada por 46 profesionales del ámbito de la enfermería nefrológica. Resultados: Los resultados muestran cambios en la capacidad percibida de validar al paciente (p

Using conversation analysis to inform role play and simulated interaction in communications skills training for healthcare professionals: identifying avenues for further development through a scoping review

BACKGROUND

This paper responds to previously published debate in this journal around the use of sociolinguistic methods in communication skills training (CST), which has raised the significant question of how far consultations with simulated patients reflect real clinical encounters. This debate concluded with a suggestion that sociolinguistic methods offer an alternative analytic lens for evaluating CST. We demonstrate here that the utility of sociolinguistic methods in CST is not limited to critique, but also presents an important tool for development and delivery.

METHODS

Following a scoping review of the use of role play and simulated interaction in CST for healthcare professionals, we consider the use of the specific sociolinguistic approach of conversation analysis (CA), which has been applied to the study of health communication in a wide range of settings, as well as to the development of training.

DISCUSSION

Role play and simulated interaction have been criticised by both clinicians and sociolinguists for a lack of authenticity as compared to real life interactions. However they contain a number of aspects which healthcare professionals report finding particularly useful: the need to think on one's feet in real time, as in actual interaction with patients; the ability to receive feedback on the simulation; and the ability to watch and reflect on how others approach the same simulation task in real time. Since sociolinguistic approaches can help to identify inauthenticity in role play and simulation, they can also be used to improve authenticity. Analysis of real-life interactions using sociolinguistic methods, and CA in particular, can identify actual interactional practices that are used by particular patient groups. These practices can then be used to inform the training of actors simulating patients. In addition, the emphasis of CA on talk as joint activity means that proper account can be taken of the way in which simulated interaction is co-constructed between simulator and trainee. We suggest that as well as identifying potential weaknesses in current role play and simulation practice, conversation analysis offers the potential to enhance and develop the authenticity of these training methods.

Comparative impact of two continuing education activities targeted at COPD educators on educational outcomes: protocol for a non-randomized controlled study using mixed methods

Background

Therapeutic patient education (TPE) improves quality of life and reduces health care utilization among patients with chronic obstructive pulmonary disease (COPD). However, benefits from TPE might depend on the performance of the educators and training is needed to ensure the effective delivery of TPE interventions. Based on the framework by Moore et al. (J Contin Educ Health Prof 29:1-15, 2009), we will compare the impact of two continuing education (CE) activities on TPE in regard to the following educational outcomes: (1) learning, (2) self-report of competence, (3) performance of the educators, and (4) outcomes of COPD patients who will meet the newly trained educators for TPE.

Methods

We will conduct a non-randomized controlled study using mixed methods. Educators will first participate in a CE activity on TPE that will include a role-playing simulation (experimental group) or in a lecture on TPE (comparison group) and then will perform TPE in COPD patients. Among educators, we will assess: (1) learning, by measuring knowledge about TPE, and (2) self-report of competence using self-administered questionnaires before and after the activity. Then, after the CE activity, we will assess (3) educators’ performance levels in delivering TPE by rating a videotaped TPE intervention. In COPD patients who will meet the newly trained educators for TPE after either CE activity, we will assess (4) quality of life and resource utilization using interviewer-administered questionnaires, before and after TPE. Statistical analyses will compare the experimental group against the comparison group using multivariate models. Using a semi-structured interview guide, we will conduct interviews with educators and perform content analysis. Results will be integrated in order that qualitative results further explain the quantitative ones.

Discussion

To the best of our knowledge, this is the first controlled mixed methods study to compare the impact of two CE activities on TPE in regard to four educational outcomes. We believe this study will serve as a model for evaluating CE activities on TPE. Results from this study could increase educators’ performance levels in delivering effective TPE interventions, and, in turn, COPD patient outcomes.

Trial registration

The study was registered on https://clinicaltrials.gov/ (NCT02870998) on March 15, 2016.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3284-6) contains supplementary material, which is available to authorized users.

The VOICE study - A before and after study of a dementia communication skills training course

Background

A quarter of acute hospital beds are occupied by persons living with dementia, many of whom have communication problems. Healthcare professionals lack confidence in dementia communication skills, but there are no evidence-based communication skills training approaches appropriate for professionals working in this context. We aimed to develop and pilot a dementia communication skills training course that was acceptable and useful to healthcare professionals, hospital patients and their relatives.

Methods

The course was developed using conversation analytic findings from video recordings of healthcare professionals talking to patients living with dementia in the acute hospital, together with systematic review evidence of dementia communication skills training and taking account of expert and service-user opinion. The two-day course was based on experiential learning theory, and included simulation and video workshops, reflective diaries and didactic teaching. Actors were trained to portray patients living with dementia for the simulation exercises. Six courses were run between January and May 2017. 44/45 healthcare professionals attended both days of the course. Evaluation entailed: questionnaires on confidence in dementia communication; a dementia communication knowledge test; and participants’ satisfaction. Video-recorded, simulated assessments were used to measure changes in communication behaviour.

Results

Healthcare professionals increased their knowledge of dementia communication (mean improvement 1.5/10; 95% confidence interval 1.0–2.0; p<0.001). Confidence in dementia communication also increased (mean improvement 5.5/45; 95% confidence interval 4.1–6.9; p<0.001) and the course was well-received. One month later participants reported using the skills learned in clinical practice. Blind-ratings of simulated patient encounters demonstrated behaviour change in taught communication behaviours to close an encounter, consistent with the training, but not in requesting behaviours.

Conclusion

We have developed an innovative, evidence-based dementia communication skills training course which healthcare professionals found useful and after which they demonstrated improved dementia communication knowledge, confidence and behaviour.

A Critique of the Shannon-Weaver Theory of Communication and Its Implications for Nursing

With the Joint Commission's revelation that as much as 65%-70% of the time miscommunication has been discovered to be the root cause of many sentinel events, it may be time to examine a communication theory to support practice improvement efforts. Effective communication has been shown to decrease medical errors, improve patient satisfaction, and increase adherence to treatment plans leading to better health outcomes; yet very few studies have examined communication theories and their applicability to practice. This article will examine the Shannon-Weaver Communication Theory as one theory that may support future studies examining the teach-back communication method as a means to improving patient health literacy leading to improvements in clinical practice.

Consult, Negotiate, and Involve: Evaluation of an Advanced Communication Skills Program for Health Care Professionals

Effective communication is central to children, young people, and their families’ experiences of health care. Most patient complaints in developed health care systems result from ineffective communication, including inadequate information provision, not feeling listened to, failure to value patients concerns, and patients not feeling involved in care decisions. Advanced communication skills training is now embedded within cancer care policy in the United Kingdom and now features prominently within cancer education in many countries. Here, we share findings from a research evaluation of an advanced communication skills training program dedicated to health professionals caring for children and young people with cancer. We evaluated participants’ (n = 59) perceptions of the program, impact on their skills, knowledge, competence, and confidence. An appreciative inquiry design was adopted; data included interviews, precourse-postcourse evaluations, e-mail blog survey, and 360-degree reflective work records. The framework approach underpinned data analysis and triangulation of data sets. Key findings highlighted good and poor practice in health professionals’ engagement with children, young people, and their families; the purpose of communicating effectively was not always consistent with collaborative working. Attending a program helped participants expand their knowledge of communication theories and strategies. Participants valued using simulated scenarios to develop their skills and were keen to use their new skills to enhance care delivery. Our emphasis within this evaluation, however, remained on what was communicated, when and how, rather than to what effect. The impact of programs such as these must now be evaluated in terms of patient benefit.

Contextualisation of patient-centred care: A comparative qualitative study of healthcare professionals' approaches to communicating with seriously ill patients about their dependent children

Patients' family relations play an important part in the provision of patient-centred cancer care, not least when healthcare professionals encounter seriously ill patients with dependent children. Little is known about how children are perceived and dealt with in clinical encounters. In this qualitative comparative study, we explore the influence of medical contexts in three Danish hospital wards, haematology, oncological gynaecology and neuro-intensive care, on communication with patients about their children. In exploring the degree to which the inclusion of children in clinical encounters is dependent on context, we took a comparative approach based on fieldwork in wards either exclusively focusing on cancer treatment or partially involved in critical phases of cancer treatment. We conducted 49 semi-structured, in-depth interviews with doctors and nurses, and 27 days of participant observation. The thematic analysis was based on Bateson's conceptualisation of communication. We found that healthcare professionals' approach to children in clinical encounters and the ways in which children were positioned on each ward were influenced by aspects specific to the ward, including the diagnosis and treatments that related specifically to the patient. Our findings suggest the need to explore further the influence of medical contexts on the inclusion of children in patient communication.

Teaching psychology to nursing students-a discussion of the potential contribution of psychology towards building resilience to lapses in compassionate caring

Psychology is a required element in nursing education in many countries. It is particularly aimed at teaching nursing students to get a better understanding of patients, colleagues, health care organizations and themselves, and moreover to apply what they learn about psychology to optimise their care. A meaningful integration of psychology within nursing education requires an emphasis on its application in understanding aspects of care and skills development. However, its ultimate value is demonstrated when addressing problem areas in nursing and health care. In this paper the authors outline an approach to psychology education in nursing which emphasises its development as a problem solving support. An example is presented which focuses on the application of psychology to the challenge of care erosion and deficient critical nursing reflection. The discussion includes the organisational context, social pressure, social cognition, reflection and the role of inner conflict (cognitive dissonance). Nursing educators can contribute to the prevention of care erosion by a combined effort to teach awareness of psychological mechanisms, 'critical' reflection, mastery in practice, strong values and standards, and 'inoculation' against justifications of substandard care.

Intensive care nursing students' perceptions of simulation for learning confirming communication skills: A descriptive qualitative study

AIM

The aim of this study was to explore intensive care nursing students experiences with confirming communication skills training in a simulation-based environment.

RESEARCH METHODOLOGY

The study has a qualitative, exploratory and descriptive design. The participants were students in a post-graduate program in intensive care nursing, that had attended a one day confirming communication course. Three focus group interviews lasting between 60 and 80min were conducted with 14 participants. The interviews were transcribed verbatim. Thematic analysis was performed, using Braun & Clark's seven steps.

FINDINGS

The analysis resulted in three main themes: "awareness", "ice-breaker" and "challenging learning environment". The participants felt that it was a challenge to see themselves on the video-recordings afterwards, however receiving feedback resulted in better self-confidence in mastering complex communication.

CONCLUSION

The main finding of the study is that the students reported improved communication skills after the confirming communication course. However; it is uncertain how these skills can be transferred to clinical practice improving patient outcomes.

Making a difference? Teaching communication skills in preregistration nurse education in England. A comparison of Project 2000 and Making a Difference curricula

This paper reports on a survey of the teaching of communication skills on pre-registration nursing programmes in England in 2000. Questionnaires were devised for the Common Foundation Programme and the four Branch Programmes. These were sent to academic staff responsible for both Project 2000 and Making a Difference curricula. Comparisons are made between the two curricula, between matched pairs of curricula in institutions offering them both, and according to whether the institutions were designated as pilot sites for the Making a Difference curricula. The overwhelming finding was that there was no difference between any of the particular comparisons made. Lecturer-practitioners were more likely to be used to teach communication skills on Making a Difference curricula, but otherwise the picture was one of inconsistency and widespread differences between curricula and institutions. The lack of a greater emphasis on communication skills in Making a Difference curricula is surprising, given that it is intended to be skills-based. Recommendations are made for further research.

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.

Recommendations for enhancing psychosocial support of NICU parents through staff education and support

Providing psychosocial support to parents whose infants are hospitalized in the neonatal intensive care unit (NICU) can improve parents' functioning as well as their relationships with their babies. Yet, few NICUs offer staff education that teaches optimal methods of communication with parents in distress. Limited staff education in how to best provide psychosocial support to families is one factor that may render those who work in the NICU at risk for burnout, compassion fatigue and secondary traumatic stress syndrome. Staff who develop burnout may have further reduced ability to provide effective support to parents and babies. Recommendations for providing NICU staff with education and support are discussed. The goal is to deliver care that exemplifies the belief that providing psychosocial care and support to the family is equal in importance to providing medical care and developmental support to the baby.

"How to do things with words" in health professions education

This paper reports on a qualitative study of journal entries written by students in six health professions participating in the Interprofessional Health Mentors program at the University of British Columbia, Canada. The study examined (1) what health professions students learn about professional language and communication when given the opportunity, in an interprofessional group with a patient or client, to explore the uses, meanings, and effects of common health care terms, and (2) how health professional students write about their experience of discussing common health care terms, and what this reveals about how students see their development of professional discourse and participation in a professional discourse community. Using qualitative thematic analysis to address the first question, the study found that discussion of these health care terms provoked learning and reflection on how words commonly used in one health profession can be understood quite differently in other health professions, as well as on how health professionals' language choices may be perceived by patients and clients. Using discourse analysis to address the second question, the study further found that many of the students emphasized accuracy and certainty in language through clear definitions and intersubjective agreement. However, when prompted by the discussion they were willing to consider other functions and effects of language.

Strengthening patient-centred communication in rural Ugandan health centres: A theory-driven evaluation within a cluster randomized trial

This article describes a theory-driven evaluation of one component of an intervention to improve the quality of health care at Ugandan public health centres. Patient-centred services have been advocated widely, but such approaches have received little attention in Africa. A cluster randomized trial is evaluating population-level outcomes of an intervention with multiple components, including 'patient-centred services.' A process evaluation was designed within this trial to articulate and evaluate the implementation and programme theories of the intervention. This article evaluates one hypothesized mechanism of change within the programme theory: the impact of the Patient Centred Services component on health-worker communication. The theory-driven approach extended to evaluation of the outcome measures. The study found that the proximal outcome of patient-centred communication was rated 10 percent higher (p < 0.008) by care seekers consulting with the health workers who were at the intervention health centres compared with those at control health centres. This finding will strengthen interpretation of more distal trial outcomes.

Cue-responding during simulated routine nursing care: a mixed method study

BACKGROUND

Failure of nurses to recognize, acknowledge, and/or explore patient cues/concerns may result in patients' unrecognized psychosocial and information needs that could have untoward consequences. With the continuous evidence of the need for nurses to improve their communication, a greater emphasis is needed in the undergraduate nursing curriculum on training students in such skills.

OBJECTIVE

This study is to explore the cue-responding behaviors of nursing students during their routine care of patients in a simulated setting.

DESIGN

A mixed methods approach.

PARTICIPANTS

Senior year students.

METHOD

Data was collected by video-taping the students' cue-responding behavior performance, through individual debriefing interviews, and from the student-patient actors' written comments and the focus group.

RESULTS

Of the 110 cues in the conversation, 47% were acknowledged, only 12% were explored, and 53% were responded to with distancing behavior. Students' cue-responding behavior was a negative 21.8% with more cues being responded to through distancing behaviors than were acknowledged. Their pattern of communication was characterized by a focus on task completion, the use of predominately close-ended questions, and the giving of explanations and information based on unchecked assumptions.

CONCLUSIONS

Learning from their individual video-taped performance and debriefing with facilitators helped the students to not only develop a deeper level of self-awareness and reflection but also caused them to think more about time, the culture of nursing, and the tension between task-focused and patient-centered care. They came to value cue-responding in communication as one way of learning about communicating with patients. Focusing on cue-responding in communication also provided us with insights on the students' understanding of communication and the need for educators to re-emphasize person-centered communication and to deal with issues that go beyond technical skills. Future research is critical to examine its transferability to practice with continuous coaching and role modeling for students in clinical settings.

A classification model of patient engagement methods and assessment of their feasibility in real-world settings

OBJECTIVE

Examine existing reviews of patient engagement methods to propose a model where the focus is on engaging patients in clinical workflows, and to assess the feasibility of advocated patient engagement methods.

METHODS

A literature search of reviews of patient engagement methods was conducted. Included reviews were peer-reviewed, written in English, and focused on methods that targeted patients or patient-provider dyads. Methods were categorized to propose a conceptual model. The feasibility of methods was assessed using an adapted rating system.

RESULTS

We observed that we could categorize patient engagement methods based on information provision, patient activation, and patient-provider collaboration. Methods could be divided by high and low feasibility, predicated on the extent of extra work required by the patient or clinical system. Methods that have good fit with existing workflows and that require proportional amounts of work by patients are likely to be the most feasible.

CONCLUSION

Implementation of patient engagement methods is likely to depend on finding a "sweet-spot" where demands required by patients generate improved knowledge and motivate active participation.

PRACTICE IMPLICATIONS

Attention should be given to those interventions and methods that advocate feasibility with patients, providers, and organizational workflows.

[We cannot care alone: volunteers in dementia care at Nürnberg General Hospital]

BACKGROUND

People with dementia have specific care needs especially in an acute care setting. Professionals in clinical routine have limited capacities in meeting the needs of dementia patients as far as communication, interaction and orientation are concerned.

AIMS

For 2 years, the Department of Internal Medicine and Geriatrics at Nürnberg General Hospital has hosted volunteers in dementia care who accompany and visit people with dementia during their acute care stay. We present the organization of the volunteer training program, training content, and preliminary evaluation results.

METHODS

We chose a mixed methods approach for research and evaluation. Baseline data, motivational profile of volunteers, paper and pencil data on attitudes, skills and knowledge before and after training were assessed.

RESULTS

Preliminary results show a positive effect on attitudes, skills, and knowledge after volunteer training. Volunteers and professionals need continual support and education to enable volunteers to act as an integrative part of the acute geriatric care team.

CONCLUSION

The admission to an acute care setting is often frightening and confusing for dementia patients. Trained volunteers have the potential to make the hospital stay more pleasant for people with dementia.

More than communication skills: experiences of communication conflict in nursing home nurses

CONTEXT

Communication conflicts are inevitable in nursing homes. Understanding communication conflicts experienced by practising nurses could provide insights to guide the development of sound communication education programmes.

OBJECTIVES

The purpose of this study was to explore the experiences of nurses in nursing homes of communication conflict in encounters with nursing home residents and their families in Taiwan.

METHODS

Data were collected from April 2010 to December 2011 through audiotaped, individual, in-depth interviews with 26 nurses at five nursing homes in Taiwan. Data were analysed according to van Manen's interpretive phenomenological method.

RESULTS

Data analysis revealed that nurses' experiences of communication conflicts during encounters with nursing home residents and their families could be categorised under three themes: differences in perspectives of nursing home services; differences in views of nurturing health, and mediation between family members and others.

CONCLUSIONS

The findings of this study can be considered by clinical educators and policymakers when designing communication education programmes for nurses and other clinicians. These programmes should include ways to increase nurses' independent thinking in settings in which power differences exist, as well as their cultural sensitivity as embodied in Leininger's culture care theory. These programmes should also include education in telephone communication and alternative methods of communication (e.g. videoconferencing).

A pan-Canadian web-based education program to support screening for distress: Evaluation of outcomes

Objective:

Cancer-related distress has been endorsed as the sixth vital sign by many international cancer organizations, and some countries such as Canada have implemented national screening for distress programs. The completion of a screening tool is an important first step in improving responsiveness to cancer-related distress, but screening must be followed with skilled supportive care to make a difference in patient-reported outcomes. Our objective was to create a web-based education program to support nurses and other frontline staff in providing an initial response to screening results.

Method:

To address screening and supportive care learning needs, the Canadian Association of Psychosocial Oncology (CAPO), with support from the Canadian Partnership Against Cancer, created a web-based education program as one component of the national screening for distress agenda. The program provides clinically grounded and interactive learning through the use of PowerPoint presentations, video clips of clinical interactions with patients and family members, and test questions. Presentation topics include, for example, strategies for dealing with screening results, managing referrals, and supportive counseling. We employed a matched pairs, pre-post survey design to assess the effect of the education program on confidence in screening and in providing initial supportive care.

Results:

Our analysis of the first 147 matched pairs to complete the course suggests that satisfaction with the course was high. Statistically significant increases in confidence in relation to screening for distress and assessing distress, and in providing initial supportive care, were evident.

Significance of results:

Our ongoing experience with CAPO's Interprofessional Psychosocial Oncology Distance Education (IPODE) project (www.ipode.ca) project suggests that healthcare professionals value web-based learning for its accessibility and convenience. Such programs appear to offer excellent opportunities for cost-effective education that supports practice change.

Communication skills training in dementia care: a systematic review of effectiveness, training content, and didactic methods in different care settings

BACKGROUND

Caring for and caring about people with dementia require specific communication skills. Healthcare professionals and family caregivers usually receive little training to enable them to meet the communicative needs of people with dementia. This review identifies existent interventions to enhance communication in dementia care in various care settings.

METHODS

We searched MEDLINE, AMED, EMBASE, PsychINFO, CINAHL, The Cochrane Library, Gerolit, and Web of Science for scientific articles reporting interventions in both English and German. An intervention was defined as communication skills training by means of face-to-face interaction with the aim of improving basic communicative skills. Both professional and family caregivers were included. The effectiveness of such training was analyzed. Different types of training were defined. Didactic methods, training content, and additional organizational features were qualitatively examined.

RESULTS

This review included 12 trials totaling 831 persons with dementia, 519 professional caregivers, and 162 family caregivers. Most studies were carried out in the USA, the UK, and Germany. Eight studies took place in nursing homes; four studies were located in a home-care setting. No studies could be found in an acute-care setting. We provide a list of basic communicative principles for good communication in dementia care. Didactic methods included lectures, hands-on training, group discussions, and role-play.

CONCLUSION

This review shows that communication skills training in dementia care significantly improves the quality of life and wellbeing of people with dementia and increases positive interactions in various care settings. Communication skills training shows significant impact on professional and family caregivers' communication skills, competencies, and knowledge. Additional organizational features improve the sustainability of communication interventions.

Patient compliance with telephone triage recommendations: a meta-analytic review

OBJECTIVE

To systematically investigate the extent to which patients comply with triage advice from telenurses and to identify factors that potentially influence compliance.

METHODS

Findings from 13 studies identified through interdisciplinary research databases (1990-2010) were meta-analyzed. Separate pooled analyses compared patients' compliance rates for emergency services and office care (13 outcomes), emergency services and self care (13 outcomes), and self care and office care (12 outcomes).

RESULTS

Overall patient compliance was 62%, but varied by intensity of care recommended with low compliance rates for advice to see a general practitioner. Reasons for noncompliance include patients reporting to have heard a different disposition, patients' intentions and health beliefs.

CONCLUSION

Patient compliance to triage recommendations was influenced by the interactive role of patient perceptions and the quality of provider communication, both of which were mediated by access to health services. Further research is needed to clarify whether noncompliance is attributable to poor communication by the nurse or patient misinterpretation.

PRACTICE IMPLICATIONS

We highlight the need for communication-skills training in a telephone-consultation context that is patient centered, and specifically addresses building active listening and active advising skills and advantages to structuring the call.

Non-verbal communication between Registered Nurses Intellectual Disability and people with an intellectual disability: an exploratory study of the nurse's experiences. Part 1

This is the first of two articles presenting the findings of a qualitative study which explored the experiences of Registered Nurses Intellectual Disability (RNIDs) of communicating with people with an intellectual disability who communicate non-verbally. The article reports and critically discusses the findings in the context of the policy and service delivery discourses of person-centredness, inclusion, choice and independence. Arguably, RNIDs are the profession who most frequently encounter people with an intellectual disability and communication impairment. The results suggest that the communication studied is both complicated and multifaceted. An overarching category of 'familiarity/knowing the person' encompasses discrete but related themes and subthemes that explain the process: the RNID knowing the service-user; the RNID/service-user relationship; and the value of experience. People with an intellectual disability, their families and disability services are facing a time of great change, and RNIDs will have a crucial role in supporting this transition.

Communicating with Nurses: The Experiences of 10 Individuals with an Acquired Severe Communication Impairment

Successful communication is integral to quality health care and successful nursing practice. Ten people who had been in hospital in the 12 months prior to the study and who had no functional speech at that time were interviewed about their communication experiences with nurses. Overall, these individuals experienced difficulties, some of which appeared to be related to a lack of augmentative and alternative communication (AAC) resources and a lack of knowledge of AAC among nurses. In addition, the participants noted that nurses did not always have the time or the skills to communicate effectively with them. The participants suggested strategies to improve communication interactions between patients with no or limited functional speech and nurses. These strategies include pre-admission briefing and training nurses about effective strategies for communicating with patients who are unable to speak, including the use of augmentative and alternative communication systems.

Assessing quality of a worksite health promotion programme from participants' views: findings from a qualitative study in Malaysia

BACKGROUND

An assessment of the process and outcomes of a health promotion programme is necessary for the continuous improvement of a programme.

OBJECTIVE

To explore the participants' perceptions of the quality and effectiveness of the 'Love Your Heart Programme'.

DESIGN

A qualitative study using semi-structured interviews with a purposive sample of participants of the 'Love Your Heart' programme. Interviews were based on an interview guide that grouped questions into four main subgroups: structure, process, immediate outcomes and impact. The interviews were audio-recorded, transcribed verbatim and analysed using the principles of grounded theory.

RESULTS

A total of 17 interviews were conducted. The participants were satisfied with the structural aspects of the programme. Different opinions arose regarding the ideal frequency and duration of the programme. The content of the seminars was thought to be too general. There was also a lack of interest in the 'Road to a Healthy Heart' booklet. All of the respondents had positive opinions about the communication skills and attitude of the health educator. The potential advantages and disadvantages of participating in the programme were discussed. Finally, the respondents expressed their satisfaction with the programme and the impact it had on them.

DISCUSSION AND CONCLUSIONS

In general, the participants who were interviewed held the programme, and the health educator conducted the programme in high regard. The suggestions that were received can be used to further improve the acceptability and feasibility of the programme.

The development and descriptions of an evidence-based case management educational program

Educational preparation is the key to successful case management and better patient outcomes. Closer examination reveals that existing case management education programs often lack a theoretical underpinning. In order to address the issues, this paper describes the development process of using an expanded version of Donabedian's structure-process-outcome framework as a base and program itself. Four main stages were used in the development process. A systematic literature review and needs assessment provided relevant evidence for the program design. Then, a panel review was undertaken and pilot testing initiated with public health nurses. The expert panel review and the findings of the pilot test both supported the selection of the program content and the learning approaches adopted throughout the program. Sixteen hours of workshops provided detailed content on the case management process. Four main learning strategies were chosen based on transformative learning theory and the findings of the needs assessment. The paper provides an example of the development of a program based on existing theory and evidence.

The effect of a structured behavioral intervention on poorly controlled diabetes: a randomized controlled trial

BACKGROUND

Although maintaining nearly normal glycemia delays onset and slows progression of diabetes complications, many patients with diabetes and their physicians struggle to achieve glycemic targets. The best methods to support patients as they follow diabetes prescriptions and recommendations are unclear.

METHODS

To test the efficacy of a behavioral diabetes intervention in improving glycemia in long-duration, poorly controlled diabetes, we randomized 222 adults with diabetes (49% type 1) (mean [SD] age, 53 [12] years; mean [SD] disease duration 18 [12] years; mean [SD] hemoglobin A(1c) [HbA(1c)] concentration, 9.0% [1.1%]) to attend (1) a 5-session manual-based, educator-led structured group intervention with cognitive behavioral strategies (structured behavioral arm); (2) an educator-led attention control group education program (group attention control); or (3) unlimited individual nurse and dietitian education sessions for 6 months (individual control). Outcomes were baseline and 3-, 6-, and 12-month postintervention HbA(1c) levels (primary) and frequency of diabetes self-care, 3-day pedometer readings, 24-hour diet recalls, average number of glucose checks, physical fitness, depression, coping style, self-efficacy, and quality of life (secondary).

RESULTS

Linear mixed modeling found that all groups showed improved HbA(1c) levels (P < .001). However, the structured behavioral arm showed greater improvements than the group and individual control arms (3-month HbA(1c) concentration changes: -0.8% vs -0.4% and -0.4%, respectively (P = .04 for group × time interaction). Furthermore, participants with type 2 disease showed greater improvement than those with type 1 (P = .04 for type of diabetes × time interaction). Quality of life, glucose monitoring, and frequency of diabetes self-care did not differ by intervention over time.

CONCLUSIONS

A structured, cognitive behavioral program is more effective than 2 control interventions in improving glycemia in adults with long-duration diabetes. Educators can successfully use modified psychological and behavioral strategies.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT000142922.

Psychodrama: an innovative way of improving self-awareness of nurses

The aim of this educational session was to form a group interaction model for improving the self-awareness of nurses via psychodrama. The structured group interaction session was conducted three times, with three separate groups, during the 'Intensive Care Nursing' training programme at a teaching hospital in Ankara. An assessment was made using the written records and observations of the group director and co-directors and feedback from nurses regarding the session. The nurses were highly motivated, adapting readily to the learning environment and following the instructions without difficulty. They were able to describe their personal experience with a specific patient and also to identify the fundamental emotion engendered by that interaction. Their feedback regarding the session was favourable. The psychodrama technique helped the nurses to understand themselves, to explore the perspective of others and to make the connection between their own thoughts/feelings and those of their patients. Psychodrama can be an effective teaching tool in addressing the communication issues that arise in nursing.

Exploring the community pharmacist's role in palliative care: focusing on the person not just the prescription

OBJECTIVE

Changes in health care provision have led to an emphasis on providing end of life care within the home. community pharmacists are well positioned to provide services to community-based palliative care patients and carers.

METHODS

A multiple qualitative case study design was adopted. A total of 16 focus groups and 19 interviews with pharmacists, nurses, general practitioners and carers were undertaken across metropolitan and regional settings in Western Australia, New South Wales, Queensland and Victoria. Data were analysed thematically using a framework that allowed similarities and differences across stakeholder groups and locations to be examined and compared.

RESULTS

Three main themes emerged: effective communication; challenges to effective communication; and: towards best practice, which comprised two themes: community pharmacists' skills and community pharmacists' needs.

DISCUSSION

A key component of the provision of palliative care was having effective communication skills. Although community pharmacists saw an opportunity to provide interpersonal support, they suggested that they would need to develop more effective communication skills to fulfil this role.

CONCLUSION

There is clear need for continuing professional development in this area - particularly in communicating effectively and managing strong emotions.

PRACTICE IMPLICATIONS

Community pharmacists are willing to support palliative care patients and carers but need education, support and resources.