Development of a Short-Term Course to Strengthen the Health Communication Skills of Nursing Students During Their Undergraduate Training

Introduction

Communication skills are of paramount importance for healthcare professionals working with patients (Lau, 2013). Healthcare team members are expected to deliver a high level of patient care and as part of their responsibility, to communicate effectively and efficiently with each other (Matzke, 2014). Healthcare providers often lack the training needed to cope with their patients’ communication difficulties. Patients routinely face a wide range of intrinsic and extrinsic factors that preclude successful interactions with healthcare providers. Paasche-Orlow (2017) emphasized on how poor communication can lead to miscommunication, misunderstanding and errors. Maleficence is an outcome of poor communication which is an ethical problem. Rosenbaum (2017) pointed out that there is a lack of training on communication skills during the training programme leading to ineffective communication skills during the practice period. Hence, teaching of communication skills as a core skill early in the students’ education should be emphasized.

Background

Communication is an integral part of nursing education. It has been recognized as an important element of nursing training, with many arguing that effective communication is fundamental to quality nursing practice (Mullan, 2010). Even though the Indian Nursing council has incorporated communication as one of the topics in the syllabus of the undergraduate nurses, the curriculum has provided only ten hours for this topic in the first year and a review of four hours in the second year of nursing, out of a total of nearly 6000 hours of theory during the whole undergraduate course. This is too meager and further, there is no prescribed structured training for development of communication skills through role plays, small group discussions, etc. There is neither follow up nor reinforcement of the communication skills during the later years of the study and during internship. The students hail from various parts of the country with widely different backgrounds, and since English is not their first language, the development of a suitable training requires much thought and planning. Experiences from studies conducted in developed countries may not be applicable in India and other developing nations. Published literature on this topic from India is scarce. Ozturk et al (2013) observed in their study that more than 50% percent of the students expressed that they experienced problems related to communications skills during the clinical practice and they strongly recommended a communication instruction course throughout four years degree programme.

Method and design

Aims/ Objectives

1. To assess the comprehension level of students and practice of communication skills related to nursing care.

2. To determine factors responsible for poor communication skills of the nurses in the patient care settings.

3. To assess the attitudes and opinions of other health team members on improving health communication skills (HCS) of nurses.

4. To formulate and validate possible methods of training nursing students in enhancing their health communication skills.  

Outcome of the study

To make recommendations to the higher authorities to modify the existing curriculum of Bachelor of Science in Nursing (B.Sc., (N)).

Methodology

The setting was at a multispecialty training hospital that runs various health science courses in Bangalore, India. A mixed approach of observational study, questionnaire, focus group discussion and in-depth interviews were used.

Data collection

a. The observation checklist was adopted and modified. All the final year students of B.Sc. (N) and GNM were included for observational study.

b. A questionnaire on attitudes regarding the importance of health communication skills for nurses was developed for doctors, nurse managers, nurse educators, and administrators. This tool was developed essentially to validate the perceptions on the need for the communication skills training in the health care.

c. The interview focused on the individual area of expertise that would contribute to the development of the training module.

d. FGD allowed for freedom of expression within a small group to opine their views on the health communication skills essential as an integrated training for nursing undergraduate programme.

Designing of a curriculum on HCS course

The researcher investigated the wider aspect of communication skills that are required specific for nursing students to apply in their practice, especially as a registered nurse. The researcher’s exposure to US nursing schools and its curriculum on HCS was an eye opener. The nursing faculty in US also expressed the need for a comprehensive HCS training for nursing students. The HCS was developed for all levels of programme from first year of nursing till the final year. Nikanunye (2017) recommended that health communication must be integrated at all levels. The topics are spread out in a phased-out manner starting from simple skills to advanced. Carvalho (2011) indicated that a longer exposure to the communications skills training. Street Jr. (2013) recommended that educators must interpret the interpretive frames applied by assessors to judge the communication skills. The pre-test and post-test assessment for every training was incorporated to motivate students to perform better.

The training modules were randomly selected for all levels of students and tested. The results are projected below.

Results

Distribution of scores pre-test and post test 

The post-test scores were significantly higher than the pre-test scores indicating that the training on communication skills was effective.

Limitations

1. The HCS training module may be first of its kind in India, which will be integrated in the undergraduate nursing programme. The modules were selected randomly at all levels and implemented only once among students to test its effectiveness.

2. Availability of the students was the biggest challenge since they were sent home due to COVID-19 pandemic situation.

3. The comprehensiveness and effectiveness of the short-term course for the undergraduate curriculum can be revisited only after four years. The feedback at the end of fourth year on overall communications skills competency from students, faculty and nursing in-charges and doctors who interact with these students will be realistic and accurate.

Conclusion

The importance and need for an integrated short-term course on HCS training is evident in the study. The success of the HCS training and its effectiveness in practice by nursing students depends on the larger perspective of the organizational interest towards importance of communication skills. A two day workshop was conducted for the final year students; they were appreciative and had expressed that it would have been better if it was implemented more rigorously from first year level. Hence, from the results of the present study, it can be concluded that HCS course is a vital need that must be integrated in the undergraduate nursing programme.