Literature Review
Whether nurse training is helpful in generating inter-personal communication skills (I: intervention) among the nursing professionals (P: population) which in turn helps to develop therapeutic relationship with the patient and improving the outcome of care (O: outcome)
Literature Review
Nursing in the healthcare domain mainly focus on serving the requirement of the people both under the biopsychosocial and spiritual domain. A comprehensive nursing practice not only requires in-dept nursing knowledge but also requires effective inter-personal communication skills along with other technical abilities (Kourkouta & Papathanasiou, 2014). Kourkouta and Papathanasiou (2014) argued that the profession of nursing is guided by a scientific method, which encompasses exercise and implementation of the nursing practice through proper dialogue delivery. Delivery of the dialogue can be achieved via exercising proper inter-personal communication skills (verbal and non-verbal communication skills).
Proper interpersonal communication skills helps in proper exchange of the information with proper thoughts and feelings and this help the patients and their family of carers to participate in the informed decision making process (Kourkouta & Papathanasiou, 2014). The study conducted by McCarthy, Trace and O’Donovan (2014) highlighted that the social and behavioural factors of the nursing professionals is an important pillar of the science of nursing.
The proper inter-personal communication skills help the nursing professionals to not only communicate with the patient’s information in an ordered manner but also help the nursing professionals to maintain the proper body language. Execution of the proper body language with active listening and maintenance of the proper eye –contact help the nursing professionals to connect with the patients and their feelings. In this way integration of the inter-personal communication skills help to elevate the psychological perspective in the nursing practice. The study conducted by Hagemeier et al. (2014) are of the opinion that increase in the level of the inter-personal communication skills helps to increase the level of self-efficacy and belief among the nursing professionals and thereby helping to improve their level of dedication in the care process. Hagemeier et al. (2014) stated that the inter-personal communication skills hold prominent significance in the academic health science.
Completion of the course of the inter-professionals communication skills help to improve the inter-personal communication in the nursing practice and thereby increase the overall performance of the nursing professional. Xie et al. (2013) conducted a study with an aim to investigate communication abilities and other potential factors that can influence the success of the nursing students during the later stages of their career. Xie et al. (2013) selected a cluster of 312 nursing students from 22 different nursing colleges and universities. The communication ability of this selected group of the nursing students was evaluated on the basis of the 4 different questionnaires. The analysis of the questionnaire was done based on the Cronbach’s alpha index.
The analysis of the response of the questionnaire highlighted that the majority of the nursing students lack proper inter-personal communication skills. The nursing professionals lack the proper confidence to perform effectively under tensed atmosphere and live circumstances. Xie et al. (2013) recommended proper training of the nursing professionals based on their proper communication skills. Xie et al. (2013) mainly stressed over the clinical communication in order to improve the overall level of the inter-personal communication skills.
Relevance to nursing knowledge
Relevance to nursing knowledge
According to Kourkouta and Papathanasiou (2014) communication is an important ability in the nursing practice in several domain of activity starting from the procurement of the nursing interventions, therapy, treatment, prevention, rehabilitation, education and healthcare promotion. In nursing communication is mainly defined by the term-effective communication. Effective communication requires proper understanding of the patient’s mental state. In order to understand the patient’s mental state and to connect with them emotionally, practice of the inter-personal communication skill is important.
Use of proper verbal and non-verbal communication skills helps in the establishment of the therapeutic relationship with the patients. Establishment of the therapeutic relationship helps to improve the overall health outcome of the patients via helping the patient to participate in the care process and increasing the level of the therapy adherence (Kourkouta & Papathanasiou, 2014). The development of the therapeutic relationship with the patients and their family members coincides with standard 9 of the professional code of the nursing practice as highlighted by the Nursing and the Midwifery Board of Australia (2018). According to the 9th code of conduct, the nursing and the midwives it is the duty of the nursing professionals be establish healthy yet professional relationship with the patient and their family members. The development of the therapeutic relationship must be supported by empathy, trust, respect and dignity with the individuals and their family members.
Establishment of rapport and with the patients and their family members helps the patients to express their feelings or the thought process for their treatment and thereby helping to devise patient centred care plan. The NMBA 9th standard (2018) also highlights that the development of the therapeutic relationship with the patients must be done through effective communication. The style of the effective communication can be both verbal or non-verbal. Proper use of communication guided by culturally sensitivity and spiritual thoughts of the service uses helps in the development of the effective therapeutic relationships.
Bramhall (2014) are of the opinion that inter-personal communication skills are the main pillar of the development of the therapeutic relationship with the client. Kelley et al. (2014) conducted a systematic review and meta-analysis of the randomised control trials (RCT) in order to elucidate the relationships between the therapeutic relationships and its relationship with the patient’s outcomes. Kelley et al. (2014) reviewed 13 RCTs based on the random model effect. The analysis of the results highlighted that patient-clinician relationship has a small but statistically significant effect on the health-related outcome of the patients.
Improvement of the patient’s outcome is another important aspect of the patient’s care as per the professionals’ standards of the NMBA (2018). According to NMBA, standard 7, it is the duty of the nursing professionals to practice in a culturally safe and in an effective manner via following evidence based practice. Use of the proper inter-personal communication skills helps in delivering the care in a cultural sensitive manner and thereby helping to improve the patient’s overall health outcome (Foronda, MacWilliams & McArthur, 2016).
Research gap
Thus from the above discussion it can be stated that inter-professional communication skills is an important aspect towards nursing. Inter-personal communication skills help in the development of the therapeutic relationship with the patients and this again helps to improve the overall level of patient’s outcome. Improving the patient’s outcome is an important aspect of the NMBA professional code of conduct. However, the review of the literature also highlighted that the nursing professionals lack proper inter-professional communication skills. The research conducted by Foronda, MacWilliams and McArthur (2016) highlighted that there is link between the miscommunication and poor patient outcomes.
The nurses are trained different in comparison to the doctors and thus they exhibit different communication styles. Due to their lower hierarchical position in comparison to the physicians, the nursing professionals suffer from the lack of confidence and poor self-esteemed. This hampers their inter-professional communication skills. Foronda, MacWilliams & McArthur (2016) mainly suggested proper training programs in order to improve the inter-professional communication skills among the nursing professionals and thereby helping to improve the patient’s overall health outcome. However, none of the research so far has highlighted that whether proper training is actually effective in increasing the interpersonal communication skills among the nursing professionals.
Moreover, there is also a gap in the research stating how the inter-professional communication skills obtained through month or weekly training session by the nursing professionals is executed for the development of the therapeutic relationships for the improvement of the patients’ outcome. Thus the aim of this research project is mainly directed towards the evaluation of the training process towards the development of the inter-professional relationships and how this skill helps in the development therapeutic relationship and helping to improve the patient’s outcome.
Project Framework
Method of data collection
20 perspective nurse manager from 3 different hospitals with more than 5 years experience in the nursing training and quality improvement were approached in order to participate in the study. Official mail was circulated to all the 2 nurse managers after seeking permission from the respective hospital administrative authority. The mail highlighted the scope and the purpose of the interview. Out of the 20 prospective nurses, 15 agreed to participate in the research process. Out of those 15 nurses, 3 nurses were finalized.
The nurse managers with high years of experience were given preference. The select nurse managers from 3 different hospitals were asked to sign the consent form before the conduction of the interview. The consent followed the required norms of the data protection act based on the ethical issue of the autonomy, privacy and confidentiality. The interview mainly consisted of three questions and lasted for around 15 minutes and was conducted in the respective hospital buildings. The interview was recorded through audio recorder which was later transcribed into written format (hard copy). [The details of the interview are given in appendix portion].
Method of data-analysis
The main method of the data-analysis is qualitative data-analysis. The interview transcript was read and re-read several times in order to highlight the important excerpts and those selected excerpts of the interview was used of generate meaningful themes, which coincided with the scope of the research aim. This process is known as interpretive phenomenological analysis (IPA). According to Murray and Holmes (2014), IPA is the best suited data analysis approach for analysing the semi-structured interview. It is suited to the generation of new theories based on the existing data.
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Theme 1: Training helps to increase inter-personal communication skills |
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Nurses |
Excerpts from interview leading to theme generation |
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Nurse 1 |
Training of the inter-personal communication skills help the nurse to excel on their effective communication |
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Nurse 2 |
Nurses who attain training are found to be more confident in their body language AND Trained nurses are effective in developing therapeutic relation and this increases the outcome of care |
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Nurse 3 |
Nurses who are trained in the inter-personal communication skills are best person to interact effectively both with the patients and the doctors AND Therapeutic relationship increase patient’s participation in care process |
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Theme 2: Training must be given based on live feedbacks |
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Nurse 1 |
Training must be given live while on duty |
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Nurse 2 |
Training must be given through live feedbacks |
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Nurse 3 |
I think training must be given live and must be started early |
Findings of the research
Research highlighted two themes. First theme stated “training helps to increase inter-personal communication skills”. From the interview, it can be highlighted that the training of the nursing professionals on their inter-personal communication skills, helps to increase their level of confidence. A nurse with high level of confidence maintains proper body language and this is effective in communicating with the patients in an ordered and in a friendly manner. The nurse manager also highlighted that such training must be given during the under graduate courses only in order to make the nurse self competent while they start their professional career (Kourkouta & Papathanasiou, 2014).
Under this theme, it can also be stated that nurses training with inter-personal communication skills can practice effective communication. Proper use of the effective communication helps in the development of the therapeutic relationship and thereby helping to improve the patient’s outcome. The second theme highlighted that training must be given based on live feedbacks. The training given with live feedbacks helps the nursing professionals to quickly grasp the concept of the inter-personal communication skills and thereby helping to excel in effective communication. Live feedbacks must be given within the training process and one to three months of training is effective in educating nurses about the inter-personal communication skills.
Conclusion
Thus from the above discussion, it can be concluded that the research project was effective in answering the main research question. The research highlighted that inter-personal communication training by live feedbacks helps the nurse to excel in the effective communication. A nurse having proper effective communication skills help to improve the overall outcome of the patient care.
References
Bramhall, E., (2014). Effective communication skills in nursing practice. Nursing Standard (2014+), 29(14), p.53. https://search.proquest.com/openview/25fa168cc7fdb8d84b68e177ce23f439/1?pq-origsite=gscholar&cbl=2042228
Foronda, C., MacWilliams, B., & McArthur, E. (2016). Interprofessional communication in healthcare: an integrative review. Nurse education in practice, 19, 36-40. https://doi.org/10.1016/j.nepr.2016.04.005
Hagemeier, N. E., Hess Jr, R., Hagen, K. S., & Sorah, E. L. (2014). Impact of an interprofessional communication course on nursing, medical, and pharmacy students’ communication skill self-efficacy beliefs. American Journal of Pharmaceutical Education, 78(10), 186. https://www.ajpe.org/doi/abs/10.5688/ajpe7810186
Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PloS one, 9(4), e94207. https://doi.org/10.1371/journal.pone.0101191
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica, 26(1), 65. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990376/
McCarthy, B., Trace, A., & O’Donovan, M. (2014). Integrating psychology with interpersonal communication skills in undergraduate nursing education: Addressing the challenges. Nurse education in practice, 14(3), 227-232. https://doi.org/10.1016/j.nepr.2014.01.008
Murray, S. J., & Holmes, D. (2014). Interpretive phenomenological analysis (IPA) and the ethics of body and place: critical methodological reflections. Human Studies, 37(1), 15-30. https://doi.org/10.1007/s10746-013-9282-0
Xie, J., Ding, S., Wang, C., & Liu, A. (2013). An evaluation of nursing students’ communication ability during practical clinical training. Nurse education today, 33(8), 823-827. https://doi.org/10.1016/j.nedt.2012.02.011
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