The Communication Training Needs of Registered Nurses

Clinical communication: Innovative education for graduate nurses in paediatrics

The Royal Children's Hospital (RCH) is a specialist paediatric centre in Melbourne, Australia. RCH provides a full range of clinical services including tertiary care and health promotion and prevention for children and adolescents. RCH has 250 beds and treats approximately 32,000 in-patients a year. A total of 280,000 children are seen by this centre annually. The graduate nurse programme (GNP) at RCH has been established for over 20 years, as a twelve-month internship following a three-year bachelor degree in nursing. The aim of our GNP is to support each newly qualified registered nurse through their experience of transition from student to registered nurse. After initial orientation, the programme requires attendance at ten development days. The graduate nurses are supported by preceptors in the clinical environment whose role is to enable the application of new knowledge and skills. The Programme philosophy is that through a combination of reflective practice and individual goal setting, the graduate will fulfil the scope of their practice as set out in their Hospital job description.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Baccalaureate Nursing Students' Communication Process in the Clinical Setting

The purpose of this study was to describe and generate theory about how baccalaureate nursing students communicate with patients in the clinical setting using the qualitative method of grounded theory. Third-year and fourth-year generic baccalaureate nursing students were the primary participants in this study. Data were gathered during two academic semesters from formal and informal interviews and observations in hospital and home care settings. Transcribed audiotapes and field memos constituted the data generated in the study and were subjected to generating categories through open coding of data, applying theoretical codes to the data, collapsing and expanding categories reflective of the data, and memoing and uncovering the core category of the data. The core category then became the grounded theory. Analysis of the data revealed that students encountered a basic social psychological problem of "saying the right things to patients" in the clinical setting, which was preceded by the antecedent problem of "fear of saying the wrong things to patients." Students solved the problem, in part, by employing communication strategies and patterns. Eight communication strategies and five communication patterns incorporating communication strategies were identified. In addition, students went through a four-stage basic social psychological process. The process of learning a personal communication repertoire was uncovered as the substantive grounded theory. The repertoire was learned by students in the dynamic environment of the clinical setting in which RNs served as role models and communicating with difficult patients was the crucial step in the process of communication development.

From nurse-centered health counseling to empowermental health counseling

The main goals of this study were to examine aspects of the delivery and reception of advice and questions in interaction between nurses and patients and to describe linguistic features that constructed nurse-centered and empowermental health counseling. The research data, 38 health counseling sessions, were videotaped, transcribed verbatim, and analyzed by using an adaptation of conversational analysis. During nurse-centered discussions, the nurses' advice did not correspond to the patients' need for information. These counseling sessions began with check-up questions about the patients' condition and continued with factual questions about their illnesses and health care measures. During empowering health counseling, the nurses made use of the patients' knowledge of their circumstances and supported the patients' ability to reflect on their health behavior. Questioning and advising strategies were found to be crucial for building up empowermental conversation and enhancing the impact of health counseling.

Nurses' self-reflection via videotaping to improve communication skills in health counseling

The purpose of this qualitative research was to describe nurses' opinions of their communication skills in health counseling situations and to analyze the levels of reflectivity in their evaluations according to Mezirow. Nineteen nurses participated in the research on a voluntary basis and evaluated their interaction with patients on video on two occasions half a year apart. Nurses gave verbal feedback in an interview immediately after videotaping, after which they read education materials, watched their counseling on video and wrote an evaluation of their communication skills. Transcribed audiotaped interviews and written evaluations were analyzed using content analysis. Nurses said that they were able to use familiar language, to listen and to encourage patients to express their feelings and ask questions. Nurses gave little feedback on nonverbal communication. They wanted to develop their listening skills and their ability to encourage patients to ask and express their feelings. They also wanted to improve their preparations for counseling sessions. On Mezirow's scale, nurses' evaluations weighted heavily towards the lower levels of reflectivity. Only one nurse's evaluations were on the sixth level and no evaluations were on the seventh level. The results indicated a need for training programs dealig with communication skills and self-reflection. Using the videotape and self-reflection were found to be good methods to enhance the quality of health counseling.

CORE characteristics for survival in patient care redesign

As patient care delivery systems evolve and facility redesign occurs, innovative models of care delivery require clinicians to possess certain qualities for successful implementation of redesign efforts. Certain specific "CORE" abilities are key for all clinicians. They are: C: the ability to think critically, communicate, and collaborate with patients, families, and other health care team members. O: the need to be outcome-oriented, that is, striving to optimize patient and family outcomes along the continuum. R: realization of the value of research and the ability to use research resources to develop and evidence-based practice. E: the ability to keep abreast of a wide variety of clinical and other health care-related topics. Demonstration of these CORE abilities will increase a clinician's opportunity to achieve professional success into the 21st century.