Communication skills training in healthcare: a review of the literature

Artificial Intelligence Supporting the Training of Communication Skills in the Education of Health Care Professions: Scoping Review

BACKGROUND

Communication is a crucial element of every health care profession, rendering communication skills training in all health care professions as being of great importance. Technological advances such as artificial intelligence (AI) and particularly machine learning (ML) may support this cause: it may provide students with an opportunity for easily accessible and readily available communication training.

OBJECTIVE

This scoping review aimed to summarize the status quo regarding the use of AI or ML in the acquisition of communication skills in academic health care professions.

METHODS

We conducted a comprehensive literature search across the PubMed, Scopus, Cochrane Library, Web of Science Core Collection, and CINAHL databases to identify articles that covered the use of AI or ML in communication skills training of undergraduate students pursuing health care profession education. Using an inductive approach, the included studies were organized into distinct categories. The specific characteristics of the studies, methods and techniques used by AI or ML applications, and main outcomes of the studies were evaluated. Furthermore, supporting and hindering factors in the use of AI and ML for communication skills training of health care professionals were outlined.

RESULTS

The titles and abstracts of 385 studies were identified, of which 29 (7.5%) underwent full-text review. Of the 29 studies, based on the inclusion and exclusion criteria, 12 (3.1%) were included. The studies were organized into 3 distinct categories: studies using AI and ML for text analysis and information extraction, studies using AI and ML and virtual reality, and studies using AI and ML and the simulation of virtual patients, each within the academic training of the communication skills of health care professionals. Within these thematic domains, AI was also used for the provision of feedback. The motivation of the involved agents played a major role in the implementation process. Reported barriers to the use of AI and ML in communication skills training revolved around the lack of authenticity and limited natural flow of language exhibited by the AI- and ML-based virtual patient systems. Furthermore, the use of educational AI- and ML-based systems in communication skills training for health care professionals is currently limited to only a few cases, topics, and clinical domains.

CONCLUSIONS

The use of AI and ML in communication skills training for health care professionals is clearly a growing and promising field with a potential to render training more cost-effective and less time-consuming. Furthermore, it may serve learners as an individualized and readily available exercise method. However, in most cases, the outlined applications and technical solutions are limited in terms of access, possible scenarios, the natural flow of a conversation, and authenticity. These issues still stand in the way of any widespread implementation ambitions.

Evaluation of a Theory-Based Virtual Counseling Application in Nursing Education

Effective communication skills in nursing are necessary for high-quality nursing care, but given the decline in nursing students' attitudes and their low self-confidence in effective communication with patients, a participatory and experiential training method is needed. Therefore, a virtual counseling application was developed using artificial intelligence and a three-dimensional avatar to facilitate learning of communication skills. This study aimed to evaluate the effectiveness of this theory-based virtual intervention on nursing students' learning attitudes, communication self-efficacy, and clinical performance. A longitudinal quasi-experimental study was conducted. Ninety-three undergraduate nursing students received virtual patient trainings with four clinical scenarios over 2 years. Data were analyzed using McNemar test and analysis of variance. Virtual patient training improved students' learning attitudes toward communication skills for scenarios involving the pregnant woman (20.4%, P = .03) and depressed patient (17.1%, P = .01) and enhanced perceived self-efficacy for scenarios involving the pregnant woman (22.6%, P = .002) and stressed nursing student (18.3%, P = .002). Students received lower clinical communication scores for pediatric, obstetric, and medical practicums compared with a previous cohort who received no training. Overall, this virtual counseling application can provide a valuable and cost-effective communication learning resource for the nursing curriculum.

Does it make sense to use written instruments to assess communication skills? Systematic review on the concurrent and predictive value of written assessment for performance

OBJECTIVES

To evaluate possible associations between learners' results in written and performance-based assessments of communication skills (CS), either in concurrent or predictive study designs.

METHODS

Search included four databases for peer-reviewed studies containing both written and performance-based CS assessment. Eleven studies met the inclusion criteria.

RESULTS

Included studies predominantly assessed undergraduate medical students. Studies reported mainly low to medium correlations between written and performance-based assessment results (Objective Structured Clinical Examinations or encounters with simulated patients), and gave correlation coefficients ranging from 0.13 to 0.53 (p < 0.05). Higher correlations were reported when specific CS, like motivational interviewing were assessed. Only a few studies gave sufficient reliability indicators of both assessment formats.

CONCLUSIONS

Written assessment scores seem to predict performance-based assessments to a limited extent but cannot replace them entirely. Reporting of assessment instruments' psychometric properties is essential to improve the interpretation of future findings and could possibly affect their predictive validity for performance.

PRACTICE IMPLICATIONS

Within longitudinal CS assessment programs, triangulation of assessment including written assessment is recommended, taking into consideration possible limitations. Written assessments with feedback can help students and trainers to elaborate on procedural knowledge as a strong support for the acquisition and transfer of CS to different contexts.

Developing communication curricula in healthcare education: An evidence-based guide

OBJECTIVE

To present a guide for communication curriculum development in healthcare professions for educators and curriculum planners.

METHODS

We collated a selection of theories, frameworks and approaches to communication curriculum development to provide a roadmap of the main factors to consider when developing or enhancing communication skills curricula.

RESULTS

We present an evidence-based guide for developing and enhancing communication curriculum that can be applied to undergraduate and postgraduate healthcare education. Recommended steps to consider during the communication curricula development process include thoughtful examination of current communication education, needs assessment, focused learning goals and objectives, incorporation of experiential educational strategies allowing for skills practice and feedback and use of formative and summative assessment methods. A longitudinal, developmental and helical implementation approach contributes to reinforcement and sustainment of learners' knowledge and skills.

CONCLUSION AND PRACTICE IMPLICATIONS

Drawing on best practices in developing communication curricula can be helpful in ensuring successful approaches to communication skills training for any level of learner or healthcare profession. This position paper provides a guide and identifies resources for new and established communication curriculum developers to reflect on strengths and opportunities in their own approaches to addressing the communication education needs of their learners.

Development and national consensus finding on patient-centred high stakes communication skills assessments for the Swiss Federal Licensing Examination in Medicine

OBJECTIVE

To describe and evaluate a consensus finding and expert validation process for the development of patient-centred communication assessments for a national Licensing Exam in Medicine.

METHODS

A multi-professional team of clinicians and experts in communication, assessment and role-play developed communication assessments for the Swiss Federal Licensing Examination. The six-month process, informed by a preceding national needs-assessment, an expert symposium and a critical literature review covered the application of patient-centred communication frameworks, the development of assessment guides, concrete assessments and pilot-tests. The participants evaluated the process.

RESULTS

The multiple-step consensus process, based on expert validation of the medical and communication content, led to six high-stakes patient-centred communication OSCE-assessments. The process evaluation revealed areas of challenge such as calibrating rating-scales and case difficulty to the graduates' competencies and integrating differing opinions. Main success factors were attributed to the outcome-oriented process and the multi-professional exchange of expertise. A model for developing high stakes patient-centred communication OSCE-assessments was derived.

CONCLUSIONS

Consensus finding was facilitated by using well-established communication frameworks, by ensuring outcome-orientated knowledge exchange among multi-professional experts, and collaborative validation of content through experts.

PRACTICE IMPLICATIONS

We propose developing high-stakes communication assessments in a multi-professional expert consensus and provide a conceptual model.

Longitudinal curriculum development: gradual optimization of a biochemistry seminar

Objective: The Master Plan for Medical Studies 2020 places additional emphasis on curricular development processes. In addition, institutes may recognize a need to optimize their courses, for example because of poor evaluations. Frequently, however, the resources required for comprehensive optimizations are not available. In the present study, we aimed to use the example of a biochemistry seminar that takes place in the preclinical part of the medical degree at Ulm University Medical School to show how a course can be successfully optimized in small steps and evaluation results can be used for quality assurance. Methods: Similar to a continuous improvement process (CIP), over the course of five years a biochemistry seminar was gradually optimized in three steps. This process used structural, methodological, and content components, such as vertical integration, the inverted classroom method, and competence orientation. For quality assurance, we analyzed the official, standardized evaluation sheets from a total of n=1248 students. We evaluated the optimization process on the basis of responses to evaluation statements that were arranged into categories such as "organization, structure, implementation" and "quality of teaching," free text information, and the results of a pilot study conducted in parallel. We then determined the usefulness of the students' evaluation results for evaluating the optimization process. Results: Each developmental step resulted in a significantly more positive overall evaluation of the seminar by the students. This result was independent of whether the development was on a structural or methodological/content-related level. In addition, the evaluations of the categories that were optimized were significantly better. For example, the vertical integration and introduction of the inverted classroom method were accompanied by a better evaluation of the "quality of teaching" and a change in the structure led to a higher score in the category "organization, structure, implementation." A comparison with the free text evaluation sheets and the results of the pilot study supports the results. Conclusion: Although optimization of a curriculum or course is a major task, it can also be successfully completed in small steps. With this approach, new learning goals, for example as required in the Master Plan for Medical Studies 2020, can be continuously integrated and student satisfaction with a course can be increased. Student evaluation results can represent a kind of quality assurance in this process and can provide important impulses for optimization.

A Virtual Counseling Application Using Artificial Intelligence for Communication Skills Training in Nursing Education: Development Study

BACKGROUND

The ability of nursing undergraduates to communicate effectively with health care providers, patients, and their family members is crucial to their nursing professions as these can affect patient outcomes. However, the traditional use of didactic lectures for communication skills training is ineffective, and the use of standardized patients is not time- or cost-effective. Given the abilities of virtual patients (VPs) to simulate interactive and authentic clinical scenarios in secured environments with unlimited training attempts, a virtual counseling application is an ideal platform for nursing students to hone their communication skills before their clinical postings.

OBJECTIVE

The aim of this study was to develop and test the use of VPs to better prepare nursing undergraduates for communicating with real-life patients, their family members, and other health care professionals during their clinical postings.

METHODS

The stages of the creation of VPs included preparation, design, and development, followed by a testing phase before the official implementation. An initial voice chatbot was trained using a natural language processing engine, Google Cloud's Dialogflow, and was later visualized into a three-dimensional (3D) avatar form using Unity 3D.

RESULTS

The VPs included four case scenarios that were congruent with the nursing undergraduates' semesters' learning objectives: (1) assessing the pain experienced by a pregnant woman, (2) taking the history of a depressed patient, (3) escalating a bleeding episode of a postoperative patient to a physician, and (4) showing empathy to a stressed-out fellow final-year nursing student. Challenges arose in terms of content development, technological limitations, and expectations management, which can be resolved by contingency planning, open communication, constant program updates, refinement, and training.

CONCLUSIONS

The creation of VPs to assist in nursing students' communication skills training may provide authentic learning environments that enhance students' perceived self-efficacy and confidence in effective communication skills. However, given the infancy stage of this project, further refinement and constant enhancements are needed to train the VPs to simulate real-life conversations before the official implementation.

Exploring supported conversation with familial caregivers of persons with dementia: a pilot study

Background

Dementia can lead to difficulties in communication between caregivers and patients. Teaching conversational strategies has been effective for a wide array of clients with acquired neurologic disorders and their caregivers. Research indicates positive results for Supported Conversation for adults with Aphasia (SCA) secondary to stroke. Applying this method to work with caregivers of individuals with dementia could prove to be a valid intervention tool. This investigation examined the applicability of SCA with individuals with dementia and their familial caregivers.

Method

Four dyads (caregiver and individual with dementia) participated in the SCA program with some adaptation for dementia. The program was 4 weeks with a pre-training and post training assessment. The Measure of Skill in Supported Conversation (MSC) and Measure of Level of Participation in Conversation (MPC) were given to measure the overall effectiveness of SCA at teaching and improving communication, respectively. A qualitative analysis of unproductive coping mechanisms also occurred. The Zarit Burden Interview (ZBI) was given to gauge caregiver burden from pre- to post-training.

Results

MSC and MPC scores were significantly improved from baseline to post training, and a significant reduction in unproductive coping behaviors also occured. ZBI scores were variable across participants.

Conclusions

Results suggest that the SCA has the potential to be used to improve communication between persons with dementia and their caregivers. Findings suggest that further research is warranted into the effectiveness of SCA in dementia.

Trial registration

Retrospectively registered 9/5/2018 ISRCTN17622451.

Evaluation of a toolkit resource package to support positive workplace behaviours in relation to quality end-of-life care in Australian hospitals

Background

The study aimed to determine the effectiveness of an action-orientated toolkit in supporting behaviour change in relation to quality end-of-life care in acute hospital settings. The toolkit was developed to complement a programme of online end-of-life care education.

Methods

A toolkit was developed from an international review of peer-reviewed literature on end of life. Toolkits were distributed (n=428) to Australian healthcare professionals over a 4-week period. An online survey was sent to all recipients; 65 responses were received (16% response rate, excluding emails returned as undeliverable). Semistructured interviews (n=10) were conducted using purposeful sampling to ensure a range of views were captured. The focus of the evaluation was on investigating (1) users’ responses to the toolkit and (2) individuals’ reported behaviour change.

Findings

The toolkit was well received by users who reported increased confidence in communication around end-of-life matters. 59.3% of users reported making a behaviour change over the previous 4 weeks; 70.8% of those who had not made a change reported they intended to in the near future. Against expectation, the toolkit’s appeal went beyond its intended audience in acute hospital settings, for example, personal care workers in aged care settings.

Conclusions

Despite study limitations (self-report of a small, self-selected sample), these early findings suggest that the toolkit has potential to positively impact on end-of-life care practices. However, additional evaluation is needed to determine whether such a toolkit can positively impact on practice and on patient experience at the end of life.

A staff training intervention to improve communication between people living with dementia and health-care professionals in hospital: the VOICE mixed-methods development and evaluation study

Background

Twenty-five per cent of hospital beds are occupied by a person living with dementia. Dementia affects expressive communication and understanding. Health-care professionals report a lack of communication skills training.

Objectives

To identify teachable, effective strategies for communication between health-care professionals and people living with dementia, and to develop and evaluate a communication skills training course.

Design

We undertook a systematic literature review, video-recorded 41 encounters between staff and people with dementia, and used conversation analysis to investigate communication problems and solutions. We designed a communication skills training course using coproduction and multiple pedagogic approaches. We ran a pilot, followed by six courses for health-care professionals. We measured knowledge, confidence and communication behaviours before, immediately after and 1 month after the course, and undertook interviews with participants and managers. Behaviours were measured using blind-rated videos of simulations.

Setting

General hospital acute geriatric medical wards and two hospital clinical skills centres.

Participants

We video-recorded 26 people with dementia and 26 professionals. Ten experts in dementia care, education, simulation and communication contributed to intervention development. Six health-care professionals took part in a pilot course, and 45 took part in the training.

Results

The literature review identified 26 studies describing 10 communication strategies, with modest evidence of effectiveness. Health-care professional-initiated encounters followed a predictable phase structure. Problems were apparent in requests (with frequent refusals) and in closings. Success was more likely when requests were made directly, with high entitlement (authority to ask) and with lowered contingencies (made to sound less difficult, by minimising the extent or duration of the task, asking patients ‘to try’, offering help or proposing collaborative action). Closings were more successful if the health-care professional announced the end of the task, made a specific arrangement, body language matched talk, and through use of ‘closing idioms’. The training course comprised 2 days, 1 month apart, using experiential learning, including lectures, video workshops, small group discussions, simulations (with specially trained actors) and reflections. We emphasised the incorporation of previous expertise and commitment to person-centred care. Forty-four participants returned for the second training day and 43 provided complete evaluation data. Knowledge and confidence both increased. Some behaviours, especially relating to closings, were more commonly used after training. The course was rated highly in interviews, especially the use of simulations, real-life video clips and interdisciplinary learning. Participants reported that they found the methods useful in practice and were using them 1 month after the course finished.

Limitations

Data were from people with moderate to severe dementia, in an acute hospital, during health-care professional-initiated interactions. Analysis was limited to problems and solutions that were likely to be ‘trainable’. Actors required careful preparation to simulate people with dementia. Communication skills training course participants were volunteers, unlikely to be representative of the general workforce, who displayed high levels of baseline knowledge, confidence and skills. Before-and-after evaluations, and qualitative interviews, are prone to bias.

Conclusions

Requests and closings pose particular difficulties for professionals communicating with people with dementia. We identified solutions to these problems and incorporated them into communication skills training, which improved knowledge, confidence and some communication behaviours. Simulation was an effective training modality.

Future work

Further research should investigate a wider range of health, social care and family carers. Conversation analysis should be used to investigate other aspects of health-care communication.

Study registration

The systematic literature review is registered as CRD42015023437.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Blended learning pedagogy designed for communication module among undergraduate nursing students: A quasi-experimental study

BACKGROUND

Effective communication is important for nurse and patient outcomes. Nursing students often feel unprepared to communicate effectively with patients and other healthcare workers within the clinical environment. Blended learning pedagogy-based communication skills training can provide an alternative to traditional methods of teaching to enhance students' satisfaction and self-efficacy levels in communicating with others.

OBJECTIVES

To examine the effectiveness of blended learning pedagogy in a redesigned communication module among nursing undergraduates in enhancing their satisfaction levels and attitudes towards learning communication module as well as self-efficacy in communication.

DESIGN

A single group pre-test and post-test quasi-experimental design was adopted.

SETTINGS AND PARTICIPANTS

Data were collected from August 2016 to November 2016 from 124 nursing undergraduates from a leading nursing school.

METHODS

Blended learning pedagogy was adopted to redesign a communication module that offered a wide array of learning opportunities via face-to-face classroom and online sessions. Validated and reliable instruments were used to measure satisfaction levels with blended learning pedagogy, attitudes towards learning communication, and communication self-efficacy. Descriptive and inferential statistics were used to analyze the data.

RESULTS

Participants had enhanced satisfaction levels with blended learning pedagogy, better attitudes in learning communication skills, and improved communication self-efficacies at posttest (week 13 of the semester) when compared with their pre-test scores (week one of the semester). Participants scored higher in the Blended Learning Satisfaction Scale, the Communication Skills Attitude Scale, and the communication skills subscale of the Nursing Students Self-Efficacy Scale.

CONCLUSIONS

Blended learning pedagogy can be effectively used in facilitating communication modules and enhancing student outcomes among nursing undergraduates. The long-term effectiveness of using blended learning pedagogy in facilitating communication modules should be evaluated from students' and patients' perspectives. Additionally, the technology should be constantly improved by incorporating more interactive functions and should be tested to accommodate the learners' needs.

Using root metaphors to analyze communication between nurses and patients: a qualitative study

BACKGROUND

Metaphors in communication can serve to convey individuals' backgrounds, contexts, experiences, and worldviews. Metaphors used in a health care setting can help achieve consensual communication in professional-patient relationships. Patients use metaphors to describe symptoms, or how disease affects them. Health professionals draw on shared understanding of such metaphors to better comprehend and meet patient needs, and to communicate information that patients can more easily integrate into their lives. This study incorporated a theoretical framework based on four worldviews, each with an underlying foundational metaphor (root metaphor). The use of these root metaphors (formism, mechanism, contextualism, and organicism) can have an explanatory function and serve to impart new meanings, as each type of metaphor can lead to a particular interpretation. The study aimed to extract and discuss the root metaphors, with a view to analyzing the communication between health professionals and patients.

METHODS

In a case study in Spain over a six-month period, we analyzed the content of recorded, transcribed interviews conducted by one nurse with 32 patients who had chronic illnesses. We inductively extracted five categories that emerged from the interviews: blood sugar, cholesterol, exercise, blood pressure, and diet. We then examined these categories from the standpoint of each of the four root metaphors using two approaches: A series (deductive) and an emergent (inductive) approach.

RESULTS

The results show that the nurse tended to primarily use two worldviews: mechanism and formism. In contrast, patients tended to favor mechanism when discussing cholesterol, blood pressure, and blood sugar levels, whereas contextualism was predominant when the category was diet or exercise.

CONCLUSIONS

This study adds to the existing literature on health professionals and patients' communication. It shows how the use of Pepper's root metaphors help to analyze the communication between the nurse and patients. Furthermore, it shows they are both using different root metaphors when they are talking about illness and treatments especially regarding blood sugar, cholesterol, exercise, blood pressure, and diet. Further qualitative and quantitative studies are needed to solidly these findings.

Medical students' communication skills in clinical education: Results from a cohort study

OBJECTIVE

To assess students' communication skills during clinical medical education and at graduation.

METHODS

We conducted an observational cohort study from 2007 to 2011 with 26 voluntary undergraduate medical students at Hamburg University based on video-taped consultations in year four and at graduation. 176 consultations were analyzed quantitatively with validated and non-validated context-independent communication observation instruments (interrater reliability ≥0.8). Based on observational protocols each consultation was also documented in free-text comments, salient topics were extracted afterwards.

RESULTS

26 students, seven males, were enrolled in the survey. On average, graduates scored higher in differential-diagnostic questioning and time management but showed deficiencies in taking systematic and complete symptom-oriented histories, in communication techniques, in structuring consultations and in gathering the patients' perspectives. Patient-centeredness and empathy were rather low at graduation. Individual deficiencies could barely be eliminated.

CONCLUSION

Medical students were able to enhance their clinical reasoning skills and their time management. Still, various communication deficiencies in final year students became evident regarding appropriate history taking, communication skills, empathy and patient-centeredness.

PRACTICE IMPLICATIONS

The necessity of developing a longitudinal communication curriculum with enhanced communication trainings and assessments became evident. A curriculum should ensure that students' communication competencies are firmly achieved at graduation.

The role of language skills and internationalization in nursing degree programmes: A literature review

Globalization and internationalization have had major influences on higher education, including nursing education. Since the signing of the Bologna declaration, many institutions in Europe have adopted English as the "scientific lingua franca", and have instated courses and entire degree programmes taught in English. Several countries in the European Union also offer nursing degree programmes in English. With the rise of multilingualism in Europe, new challenges have become apparent in multilingual education. The Content and Language Integrated Learning (CLIL) approach has emerged as a new, innovative way to learn languages. The approach has become mainstream in primary and secondary education with proven success, and has also spread to higher education. Nurses are required to develop their linguistic skills such that they can communicate well with their patients and colleagues. Due to globalization, nurses are faced with increasingly diverse patients, presenting new challenges in nursing education concerning linguistic and transcultural preparation of students. Although CLIL is becoming more widely accepted in many academic faculties, it has not yet been studied sufficiently in the nursing education context.

Factors predicting emotional cue-responding behaviors of nurses in Taiwan: An observational study

OBJECTIVE

Responding to emotional cues is an essential element of therapeutic communication. The purpose of this study is to examine nurses' competence of responding to emotional cues (CRE) and related factors while interacting with standardized patients with cancer.

METHODS

This is an exploratory and predictive correlational study. A convenience sample of registered nurses who have passed the probationary period in southern Taiwan was recruited to participate in 15-minute videotaped interviews with standardized patients. The Medical Interview Aural Rating Scale was used to describe standardized patients' emotional cues and to measure nurses' CRE. The State-Trait Anxiety Inventory was used to evaluate nurses' anxiety level before the conversation. We used descriptive statistics to describe the data and stepwise regression to examine the predictors of nurses' CRE.

RESULTS

A total of 110 nurses participated in the study. Regardless of the emotional cue level, participants predominately responded to cues with inappropriate distancing strategies. Prior formal communication training, practice unit, length of nursing practice, and educational level together explain 36.3% variances of the nurses' CRE.

CONCLUSIONS

This study is the first to explore factors related to Taiwanese nurses' CRE. Compared to nurses in other countries, Taiwanese nurses tended to respond to patients' emotional cues with more inappropriate strategies. We also identified significant predictors of CRE that show the importance of communication training. Future research and education programs are needed to enhance nurses' CRE and to advocate for emotion-focused communication.

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.

Evaluation of a Communication Skills Training Program for Companion-Animal Veterinarians: A Pilot Study Using RIAS Coding

Effective veterinarian communication skills training and the related key outcomes provided the impetus for this study. We implemented a pre-experimental pre-test/post-test single-group design with a sample of 13 veterinarians and their 71 clients to evaluate the effects of a 6.5-hour communication skills intervention for veterinarians. Consultations were audiotaped and analyzed with the Roter Interaction Analysis System (RIAS). Clients completed the Consultation and Relational Care Measure, a global satisfaction scale, a Parent Medical Interview Satisfaction Scale, and the Adherence Intent measure. Veterinarians completed a communication confidence measure and a workshop satisfaction scale. Contrary to expectation, neither veterinarian communication skills nor their confidence improved post-training. Despite client satisfaction and perceptions of veterinarians' relational communication skills not increasing, clients nevertheless reported an increased intent to adhere to veterinarian recommendations. This result is important because client adherence is critical to managing and enhancing the health and well-being of animals. The results of the study suggest that while the workshop was highly regarded, either the duration of the training or practice opportunities were insufficient or a booster session was required to increase veterinarian confidence and integration of new skills. Future research should utilize a randomized control study design to investigate the appropriate intervention with which to achieve change in veterinarian communication skills. Such change could translate to more effective interactions in veterinarians' daily lives.

Communication education for pre-licensure nursing students: literature review 2002-2013

OBJECTIVES

Effective communication skills are fundamental to good nursing care and required by certification bodies for nursing education. The purpose of this literature review was to update one done in 2002 of communication education to pre-licensure registered nursing students. That review concluded that it was unclear which interventions were most effective due to methodological and other quality issues. The goal of this review was to identify recent educational methods, frameworks, and evaluation tools and to assess the quality of this recent evidence.

DESIGN

Literature review.

DATA SOURCES

PubMed, CINAHL, and PsychINFO.

REVIEW METHODS

Inclusion criteria were articles in English, 2002 to 2013, full text available, addressing nurse:patient communication, and educational interventions. Exclusion criteria were inter-professional interventions as they are not yet as widely available. Studies were evaluated using the Johns Hopkins Nursing Evidence-based Practice (JHNEBP) Rating Scale. This scale categorizes the levels of evidence and methodological quality.

RESULTS

The search yielded 457 titles, 115 abstracts, and 38 articles. Twenty studies met inclusion and exclusion search criteria. They included a range of research designs, samples, and outcomes. In line with recent communication educational trends, the interventions all involved active learning. Using the JHNEBP scale, the quality of the 20 studies was low due to both research design and methodological issues.

CONCLUSION

Despite the importance of communication in nursing education, the quality of evidence to support specific communication interventions continues to be low. Recommendations for future communication education research are to (1) explore the highest quality designs available and use randomization where possible; (2) more consistently use theoretical frameworks and their accompanying outcome measures; and (3) that tools be tested for evidence of reliability and validity.

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 European consensus on learning objectives for a core communication curriculum in health care professions

OBJECTIVE

To develop learning objectives for a core communication curriculum for all health care professions and to survey the acceptability and suitability of the curriculum for undergraduate European health care education.

METHODS

Learning objectives for a Health Professions Core Communication Curriculum (HPCCC) in undergraduate education were developed based on international literature and expert knowledge by an international group of communication experts representing different health care professions. A Delphi process technique was used to gather feedback and to provide a consensus from various health care disciplines within Europe.

RESULTS

121 communication experts from 15 professional fields and 16 European countries participated in the consensus process. The overall acceptance of the core communication curriculum was high. 61 core communication objectives were rated on a five-point scale and found to be relevant for undergraduate education in health care professions. A thematic analysis revealed the benefits of the HPCCC.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Based on a broad European expert consensus, the Health Professions Core Communication Curriculum can be used as a guide for teaching communication inter- and multi-professionally in undergraduate education in health care. It can serve for curriculum development and support the goals of the Bologna process.

The effect of communication skills training on quality of care, self-efficacy, job satisfaction and communication skills rate of nurses in hospitals of tabriz, iran

INTRODUCTION

Having an effective relationship with the patient in the process of treatment is essential. Nurses must have communication skills in order to establish effective relationships with the patients. This study evaluated the impact of communication skills training on quality of care, self-efficacy, job satisfaction and communication skills of nurses.

METHODS

This is an experimental study with a control group that has been done in 2012. The study sample consisted of 73 nurses who work in hospitals of Tabriz; they were selected by proportional randomizing method. The intervention was only conducted on the experimental group. In order to measure the quality of care 160 patients, who had received care by nurses, participated in this study. The Data were analyzed by SPSS (ver.13).

RESULTS

Comparing the mean scores of communication skills showed a statistically significant difference between control and experimental groups after intervention. The paired t-test showed a statistically significant difference in the experimental group before and after the intervention. Independent t-test showed a statistically significant difference between the rate of quality of care in patients of control and experimental groups after the intervention.

CONCLUSION

The results showed that the training of communication skills can increase the nurse's rate of communication skills and cause elevation in quality of nursing care. Therefore, in order to improve the quality of nursing care it is recommended that communication skills be established and taught as a separate course in nursing education.

Effective teaching of communication to health professional undergraduate and postgraduate students: A Systematic Review

REVIEW QUESTION/OBJECTIVE

The objective is to identify and assess the effectiveness of tools and methods of teaching communication skills to health professional students in undergraduate and postgraduate programs, to facilitate communication in hospitals, nursing homes and mental health institutions.For this review, effective communication will be defined as that which enhances patient satisfaction, safety, symptom resolution, psychological status, or reduces the impact/burden of disease and/or improved communication skills within undergraduate or postgraduate studentsThe review question is: What is the best available evidence on strategies to effectively teach communication skills to undergraduate and postgraduate medical, nursing and allied health students (nutrition and dietetics, occupational therapy, physiotherapy, speech pathology etc)?

BACKGROUND

Communication is a two-way interaction where information, meanings and feelings are shared both verbally and non-verbally. Effective communication is when the message being conveyed is understood as intended. Effective communication between the health professional and patient is increasingly being recognised as a core clinical skill. Research has identified the far reaching benefits of effective communication skills including enhanced patient satisfaction, patient safety, symptom resolution and improvements in functional and psychological status. Poor communication can result in omitted or misinterpretation of information resulting in declining health of the patient. Despite the importance of effective communication in ensuring positive outcomes for both the patient and health professional, there is concern that contemporary teaching and learning approaches do not always facilitate the development of a requisite level of communication skills, both verbal and written and a difficulty for the current generation of communication skills teachers is that many have not had the experience of being taught communication skills themselves.Studies have shown that communication skills can be taught, although proven learning strategies should be the basis of any communication teaching. It is reported that the communication skills teachers themselves be trained in communication skills and assessment of communication skills should be an important component of the health professionals' accreditation. Not only should the communication skills of the teacher be evaluated but the teaching modules within the program should also be evaluated on a regular basis.In all cases of communication teaching, strong faculty support is required for any communication skills programme to be successful. Early introduction of communication skills programmes, which are continued throughout all the years of the curriculum, has been shown to be effective in improving confidence and reducing the number of errors made and establishing a more permanent understanding of communication. Throughout the undergraduate degree, increased integration between communication and clinical teaching is important in learning to use the two skill sets together, so as to closely reflect what happens in clinical practice. Research suggests that communication training is most effective when longitudinal in nature and coincides with ongoing professional practice education.Many studies have shown that communication skills programmes with a strong experimental and/or practical component are more effective than programmes that are solely theory or discussion based. Simulations and role-play are effective instructional methods for developing communication skills including opening and closing consultations, conducting the consultation in a logical manner, improving body language, using language at the level of understanding of the patient and using clear verbal and written communication. One particular strategy that has been shown to be effective is the use of videotaped consultations with standardised patients.Although measuring the effectiveness of communication skills training is difficult, there are a few common strategies used in the current literature. It has been suggested that evaluation of the competence of students' verbal communication skills is best assessed during observations of simulated consultations with standardised patients followed by constructive feedback. The quality of the constructive feedback is crucial, needing to be specific, non-judgemental and descriptive. A number of studies have used objective structured clinical exams (OSCE) where a marking scheme is used to evaluate different components of communication whilst ensuring a more standardised assessment for all students.Given the concern with communication skills of contemporary health professionals, and the variability in current communication education programmes, it is important that an educational model be developed to foster the development of effective communication. This model should be multi-faceted, that is, address knowledge, skill and attitude domains and cover both verbal and non-verbal forms of communication.A preliminary search of JBI Library of Systematic Reviews, Cochrane Library of Systematic Reviews, Medline, CINAHL, DARE, PROSPERO has been performed and one existing systematic review was identified. The review investigated communication teaching in nurse education in the United Kingdom (UK). The review discusses a number of points including 1) who teaches communication skills; 2) the methods used; 3) time spent on communication skills training; 4) the goals or content of the teaching and; 5) assessment, evaluation and overall effectiveness of communication teaching. From the 17 studies included in this review, it was found that team teaching provides greater depth and more perspectives therefore likely to be more effective. Experiential methods, standardised patients, and group work are commonly used as methods of teaching with course content including empathy, self-awareness, interviewing skills and critical thinking. The time spent in teaching communication skills is often not reported with information on the methods of assessment of communication skills also limited although the use of standardised patients and OSCEs most commonly used. This review concluded that there was a lack of research in this area and the strength of conclusions from these studies were lessened due to the flaws in methodological design, Therefore, the question still remains as to what aspects of teaching communication are effective.Given the poor methodological design of the studies included in the above review, the time since publication of the last review (2002), and the lack of recent research specific to this topic, this review is somewhat exploratory and hopes to further explain effective methods of communication teaching and evaluation.

Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews

OBJECTIVE

Physicians need good communication skills to communicate effectively with patients. The objective of this review was to identify effective training strategies for teaching communication skills to qualified physicians.

METHODS

PubMED, PsycINFO, CINAHL, and COCHRANE were searched in October 2008 and in March 2009. Two authors independently selected relevant reviews and assessed their methodological quality with AMSTAR. Summary tables were constructed for data-synthesis, and results were linked to outcome measures. As a result, conclusions about the effectiveness of communication skills training strategies for physicians could be drawn.

RESULTS

Twelve systematic reviews on communication skills training programmes for physicians were identified. Some focused on specific training strategies, whereas others emphasized a more general approach with mixed strategies. Training programmes were effective if they lasted for at least one day, were learner-centred, and focused on practising skills. The best training strategies within the programmes included role-play, feedback, and small group discussions.

CONCLUSION

Training programmes should include active, practice-oriented strategies. Oral presentations on communication skills, modelling, and written information should only be used as supportive strategies.

PRACTICE IMPLICATIONS

To be able to compare the effectiveness of training programmes more easily in the future, general agreement on outcome measures has to be established.

Teaching health care professionals about health literacy: a review of the literature

Low health literacy is a common and serious issue in U.S. health care. Health care professionals lack adequate training in health literacy principles. Increasing and improving health literacy training for the health care workforce is needed. Health professions educators have responded to this need by developing health literacy curricula, which use a wide variety of didactic and experiential teaching techniques and tools. This article reviews the literature on teaching health literacy principles to health professionals and presents a menu of teaching options for health professions educators.

The use of expressive methods for developing empathic skills

Empathy is one of the fundamental concepts in nursing, and it is an ability that can be learned. Various education models have been tested for improving empathic skills. Research has focused on using oral presentations, videos, modeling, practiced negotiation based on experiences, and psychodrama methods, such as role playing, as ways to improve empathy in participants. This study looked at the use of expressive arts to improve empathic skills of nursing students. The study was conducted with 48 students who were separated into five different groups. All groups lasted for two hours, and met for 12 weeks. Expressive art and psychodrama methods were used in the group studies. The Scale of Empathic Skill was administered to participants before and after the group studies. Before the group study took place, the average score for empathic skill was 127.97 (SD = 21.26). After the group study, it increased to 138.87 (SD = 20.40). The average score for empathic skill increased after the group (t = 3.996, p = .000). Results show that expressive methods are easier, more effective, and enjoyable processes in nursing training.

Strengthening Communication Education in an Undergraduate Nursing Curriculum

As effective communication is an essential professional competency that is conceptualized and developed during undergraduate education, the purpose of this study was to investigate and reinforce the role of communication in the nursing undergraduate curriculum. Analysis of faculty and student focus group discussions revealed the benefit of purposefully structuring and explicitly articulating communication education throughout the undergraduate curriculum for increased accessibility and visibility of communication education, expanded ranges of available teaching and learning methods and resources, and strengthened ability to address undermining mixed communication messages. These findings have implications for how to specifically include communication education in a learning-centered undergraduate curriculum.

Evaluating a nursing communication skills training course: The relationships between self-rated ability, satisfaction, and actual performance

Effective communication is a vital component of nursing care, however, nurses often lack the skills to communicate with patients, carers and other health care professionals. Communication skills training programs are frequently used to develop these skills. However, there is a paucity of data on how best to evaluate such courses. The aim of the current study was to evaluate the relationship between student self rating of their own ability and their satisfaction with a nurse training course as compared with an objective measure of communication skills. 209 first year nursing students completed a communication skills program. Both qualitative and quantitative data were collected and associations between measures were investigated. Paired samples t-tests showed significant improvement in self-rated ability over the course of the program. Students generally were very satisfied with the course which was reflected in both qualitative and quantitative measures. However, neither self-rated ability nor satisfaction was significantly correlated with the objective measure of performance, but self-rated ability and satisfaction were highly correlated with one another. The importance of these findings is discussed and implications for nurse education are proposed.

A survey of interprofessional education in communication skills in health care programmes in the UK

There is considerable evidence to indicate that patient satisfaction is directly related to the communication skills of health care providers. However, communication is an area in which health care practitioners often fail to meet patients' needs. Interprofessional education (IPE) is advocated as one way of improving health care communication for the consequent development of interprofessional care. However, poorly planned and delivered IPE can reinforce professional differences, so it is imperative that its introduction is based upon sound evidence of local need, opportunity and resources. A multidisciplinary and cross university project was designed to identify opportunities for, and best practice in, IPE in communication skills amongst undergraduate health care practitioners within one Workforce Development Directorate (WDD) in England. Methods included a comprehensive literature review of relevant educational initiatives, together with telephone and e-mail interviews with key informants in higher education institutions (HEIs) across the UK. This paper reports the findings from the interviews. Based upon these findings, a series of recommendations are made for the planning, implementation, and evaluation of IPE in communication skills, which should be taken into account by local curriculum planning groups.

An evaluation of a DVD trigger based assessment of communication and care delivery skills

This article describes the implementation and evaluation of a novel form of assessment of communication skills and knowledge for all branches of nursing students in a multi-campus UK Midlands university. The assessment took the form of a recorded scenario which was presented on DVD and a series of assessment questions inviting students to consider communicative and care delivery aspects of the events depicted. This 'DVD trigger' assessment yielded theoretically informed, practically relevant answers from the students, over 80% of whom passed. Student reactions to the assessment were elicited via a specially designed questionnaire which indicated broad approval for the assessment and yielded a high degree of internal reliability, and suggested that attitudes to the assessment could be grouped into three major factors. The first factor comprised items relating to the practical aspects of the examination, the second to teaching, learning resources and exam support and the final factor represented the perceived relationship between the examination and the skills involved in care delivery and communication in professional practice. This highlights the value of evaluating students' responses to assessment in developing new forms of examination and in harmonising assessments with learning resources, teaching and appropriate preparation for exams. Moreover, we argue that the face validity of assessments is important in ensuring students' engagement with the learning tasks and assessment activities and may contribute to the broader validity of the assessment enterprise in predicting and enhancing skills in subsequent professional practice.

Are interventions to enhance communication performance in allied health professionals effective, and how should they be delivered? Direct and indirect evidence

OBJECTIVE

(1) To systematically review direct evidence about effects of interventions to improve communication performance amongst allied health professionals (AHPs). (2) To summarise indirect evidence pertinent to design, delivery, effects, and evaluation of such interventions.

METHODS

(1) Systematic search and narrative review of evaluations of interventions for AHPs. (2) Systematic search and narrative summary of reviews of corresponding interventions in medicine and nursing.

RESULTS

Five reports of interventions for AHPs were included. All reported positive effects of training. Strongest evidence was from two small-n within-subjects controlled studies that evaluated highly specific training for qualified therapists in brain injury rehabilitation environments. Indirect evidence from nine systematic reviews in medicine and nursing indicated positive effects of communication training. Robust designs yielded smallest effect sizes. Interventions based on strong conceptual and empirical foundations and targeting specific areas of practice appeared more effective. Strongest evidence is for performance-based training for clinicians already working with patients.

CONCLUSION

More empirical and conceptual understandings about AHPs' communication practices are required so as to improve the design, delivery and subsequent evaluation of communication training amongst these important healthcare workers.

PRACTICE IMPLICATIONS

Preliminary and indirect evidence suggest it is possible to positively influence AHP clinicians' performance and patients' outcomes if training interventions are specific, founded on evidence about effective practice and delivered using practical modalities.

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.

Evaluation of a multiple component intervention to support the implementation of a 'Therapeutic Relationships' best practice guideline on nurses' communication skills

OBJECTIVE

To determine if there was an improvement in nurses' communication skills 5 months after a multiple component intervention to implement the Registered Nurses' Association of Ontario best practice guideline 'Establishing Therapeutic Relationships'.

METHODS

A matched pair, before and after design was used. Eight client scenarios with corresponding client comments were read aloud to nurses who were asked to respond verbally, as though they were interacting with the client. Responses were audio-taped and transcribed. The frequency and quality of nurses' active listening, initiating and assertiveness skills were measured pre- and post-implementation of the guideline.

RESULTS

Twenty-two nurses responded at both time points. Active listening skills were most frequently used. There was a statistically significant decrease in the number of active listening skills used, but a statistically significant improvement in the quality of active listening and initiating statements and frequency of initiating skills.

CONCLUSION

Nurses demonstrated improvements in selected communication skills following the implementation of a multiple component intervention that included a best practice guideline.

PRACTICE IMPLICATIONS

A combination of strategies that support the implementation of a best practice guideline is described. Results indicate some improvement in communication skills that are essential to the establishment of therapeutic nurse-client relationships.