Need Statement
Communication skills are a specific set of verbal and non-verbal ways of constructive communication by a nurse, necessary in a typical clinical situation, including with patients, patients’ relatives, doctors, and colleagues. Thus, basic communication skills include establishing contact, gathering information, active listening, empathy, commenting, informing, and ending a conversation. Nevertheless, according to Ronning and Bjorkly (2019), nurses are not inclined to attach a unique role to communication and carry out careful preparation and organization of the communication space. This is since, in the learning process, students develop a mindset for treating the disease with the help of specific manipulations, without highlighting the importance of communication with the patient in future activities.
Fitzpatrick (2018) notes that communicative unpreparedness often leads to various difficulties in nursing practice. As a result of ineffective communication, deontological violations, conflict situations, discontent, and complaints of patients and their relatives arise. So, when discussing nurses, patients less often touch upon their professional duties and more often complain about inadequate communication. According to Ferreira et al. (2016), in the absence of adequate communication, both between the medical professional and the patient and in the team of the medical institution, the likelihood of medical errors increases. Moreover, the interaction of nurses with patients with mental disorders who need a particular approach from the medical staff deserves special attention. Thus, my project aims to study the new RN students’ lack of the necessary knowledge and skills, questioning, paraphrasing, summarizing, listening, silence, and non-verbal techniques to help their communication with patients with mental health disorders.
Population and Setting
New RN students will be allowed to develop communicative competence during the education, which is essential as the nurse has to carry out various medical procedures, prepare the patient for research, and conduct educational activities. The doctor is not able to explain the same thing to the patient several times. Its representatives, among the patients, are nurses who convey to patients misunderstood information.
Communication knowledge is vital for nurses no matter what area of medicine they work in, but they are of particular importance when working with patients with mental disorders. The work of nurses in mental health clinics is not limited to simple patient care. A specific personal attitude and skill in work are required in order not only to understand mentally ill people, but also to provide them with psychological support. Nurses need to understand the complex world of emotional experiences of patients and respond to these experiences with words of sympathy and consolation that the patient understands, which requires special communication training.
Intervention Overview
Communication issues are compulsorily considered at seminars and lectures on deontology; therefore, specialists have to be guided by the experience of their teachers, which is not always successful. The practicum setting is a classroom setting at a local community college teaching new nursing students completing their Associates Degree of Science. The development of communication skills will take place at the center of practical skills in simulations.
In the course of the classes, common mistakes of medical workers in terms of communication will be considered by analyzing prepared videos of specific clinical situations. However, it will be precious in the practice of communication skills to play the clinical case by the learners themselves with a simulated patient. At the same time, students will always have the opportunity to replay the proposed scenario and receive feedback from a simulated patient, which is difficult in actual practice. The acquired communication skills will be brought almost to perfection and will form communicative competence. My project fits my target population and meets the target setting and the identified need as it will train new nursing students in how to deal with mental health problems in a mental health clinic.
Comparison of Approaches
Alternatively, it is proposed to use an interprofessional approach, which involves the interaction of all unit employees. The principle of collective work in working groups to improve the quality of medical care is implemented by organizing a creative environment for specialists of various professions and qualifications. This provides an opportunity to explore all aspects of the quality assurance of medical services. The principle of an interdisciplinary approach requires the provision of group work of specialists of different professions by attracting knowledge from the relevant fields. Thus, since the doctor and nurse are the dominant couples influencing other multidisciplinary interactions and the nature of the relationship with the patient, it is crucial that doctors and senior staff are involved in teaching communication skills to nurses. This alternative is suitable for the target population, meets the target setting, and satisfies the identified need. However, it requires agreement on the schedule of all specialists, which can be difficult in clinical practice.
Initial Outcome Draft
It is assumed that during the practice, the communicative competencies of new RN students will be improved. They will know the most common mental disorders based on the available data, including their prevalence, causes and treatment, principles of effective communication with patients, patient relatives, and colleagues, and barriers to effective interaction between a nurse and a patient with mental disorders. Students will be able to apply the principles of effective communication with patients, relatives of patients, colleagues, select and use the appropriate model of medical interviews focused on patients with mental disorders, and establish initial contact with them. Moreover, they will be able to use verbal and non-verbal communication methods with patients, correctly inform the patient in an accessible form, and show attention and respect for the patient’s privacy, comfort, and safety. Thus, students will be aware of the basic communication skills with patients with mental disorders and will be able to apply this knowledge in their practice.
Time Estimate
It is assumed that the development of the program will take five months. This time is necessary for detailed study and analysis of the target audience, determining the goals of the intervention, and selecting information material that will challenge the trainees. Students in the learning process should feel that they are going beyond their knowledge and feel how the practice fills them with a new experience. Furthermore, it is essential to develop various methodological techniques and present information in multiple forms, including webinars, graphic catalogs, methodological collections, video, and audio clips, and case studies. The program will be designed for 75 hours, including the exam. Classes will be held once a week for 3 hours. The entire program will be compiled on a modular basis and consist of several blocks, at the end of which the appropriate forms of certification will be determined. This time is quite enough for mastering communication skills for communicating with patients with mental disorders.
Literature Review
Evidence validating identified need
The transition from an educational environment to a world of work is a challenge for all professions, including nursing. Students practice skills in a safe environment to become safe, predictable, and competent practitioners during the learning process. However, students have conflicting experiences as they move between class and practice to understand the user experience and validate their skills. According to Ferreira et al. (2016), although teachers pay sufficient attention to teaching students communication skills, many students negatively assess the training they received in this area and stated that there is some room for improvement. Gutiérrez-Puertas et al. (2020), after analyzing a large number of peer-reviewed articles, conclude that, despite the various pedagogical methods used to develop patient communication skills among nursing students, they need practices to improve communication skills.
Research by Schwartz (2019) focuses on the difficulties faced by nursing students, among which there is also a lack of communication skills. New graduates note that their education did not adequately prepare them for work. The author explores the concept of reality shock, introduced by Marlene Kramer in 1974, and its relationship to a lack of communication skills. Moreover, Schwartz (2019) asserts that communication skills tend to decline: nursing students tend to pay less attention to an integrated approach to patients due to the complexity and scope of their therapeutic responsibilities. Thus, communicative competencies often fade into the background.
Evidence supporting the appropriateness of attempting to address the identified need within the target population
Communication in nursing is one of the critical skills required for quality nursing. Communication between people is an essential part of everyday life. According to Fitzpatrick (2018), nursing, along with a friendly, technically competent implementation of treatment procedures and manipulations, implies communication between a nurse and a patient who sometimes experiences physical and psychological difficulties, depression, fearful or aggression. Patients may have a wide variety of communication needs; they may need advice, comfort, support, counseling, or simply an opportunity to share their experiences. The value of the psychotherapeutic influence that is possible with effective communication is well known, and its results sometimes surpass all other treatment methods. Communication skills are necessary to gain the patient’s trust, interact with doctors and other professionals involved in the treatment process.
The need for nurses to have and use a wide range of communication skills has never been greater. Communication takes place continuously between the nurse and the patient, the patient’s family, staff, and the management. Nurses are increasingly working in interdisciplinary teams, increasing the need for advanced communication and interaction skills. In healthcare settings, poor communication can be disastrous if ineffective. Trifkovič et al. (2017) note that up to 440,000 people die each year from preventable medical errors, the third leading cause of death in the United States. In 80% of these cases, misunderstandings are the cause. Thus, the frequency of medical errors directly depends on the quality of communication. Studeny et al. (2017) note that medical error rates dropped by 23% after a data transfer program was launched to improve and standardize communications. Accordingly, improved communication also increased the recovery rate, increased feelings of safety and protection, and increased patient satisfaction and adherence to treatment. Thus, it is vital that nurses know the key components of the communication process, ways to improve skills, and existing potential communication problems and can successfully apply this knowledge in practice.
Evidence supporting the appropriateness of attempting to address the identified need within the target setting
Persons with mental disorders are the most vulnerable and unprotected category of the population, in working with whom, it is necessary to carefully evaluate the correct understanding and processing of the information provided to them by patients. Mental disorders are characterized by various clinical manifestations, the dynamics of the development of existing diseases. Therefore, it is rather challenging to propose a unified behavior model with a patient suffering from a mental disorder. In light of the above, it is necessary to raise nurses’ awareness in terms of working with citizens with mental illnesses and when considering their appeals. To this end, it is essential to develop methodological recommendations and conduct educational seminars and training for nurses facing with persons with mental disorders.
Kilbourne et al. (2018) state that mental disorders are responsible for 32% of disabilities worldwide. In addition, individuals with these disorders face an increased incidence of common diseases and a higher risk of premature mortality. Thus, the quality of medical care for this category of patients should be adequate, which is directly related to the communicative competence of nurses. A qualitative study by Liao and Murphy (2019) suggests that the therapeutic relationship in mental health plays a vital role in the rehabilitation of patients with severe mental illnesses such as schizophrenia. The authors believe that communication between nurses and patients with mental disorders directly influences the outcome of treatment.
An extensive study by Furnes et al. (2018) explores the role of nurses’ communication with patients with psychological disorders and improving communication skills. The authors state that many people, including nurses, have biases against patients with dementia, anxiety, depression, and other severe mental disorders. The study describes students’ fear of psychiatric patients as a stereotypical fear of people with mental illness. In the interpersonal relationship between nurses and patients or their relatives, nurses are faced with different emotions, which also applies to mental health care. Therefore, to communicate effectively, nurses must acknowledge their emotional responses. Moreover, treating patients appropriately requires not only self-awareness on the part of nurses, but also an understanding of specific behaviors that they may find challenging. Thus, these sources confirm the need to practice nurses’ communication skills when working with patients with mental disorders.
Compliance of existing health policies with identified needs
One of the health policies that meet the identified need is simulation-based learning. It is a new teaching strategy that gives students good opportunities to learn and apply what they learn to safe patient care. According to Mohamed and Fashafsheh (2019), simulation provides realistic scenarios that allow nursing students to practice and evaluate TS with patients without putting patients at risk. Moreover, various studies show that simulation enables nursing students to practice TC before clinical practice, allowing improved patient communication in a clinical setting. The authors identify such tools as multimedia sources, anatomical models, and human body simulators as the core of simulation-based learning. The results of this study showed that the simulation-based program of students improves the average scores of communication skills, self-efficacy, and clinical competence after participating in simulation-based learning.
An equally important study on the study of simulation-based learning outcomes for clinical practice is Hustad et al. (2019). The authors conducted eight focus group interviews with 32 second and third-year nurse students who participated in the simulation-based training organized in preparation for clinical placement. The experts concluded that simulation-based learning emphasizes the importance of communication skills. Thus, the use of communication tools in the context of modeling increased among students the understanding of the importance of effective communication to ensure optimal patient care, especially in emergency situations, which, among other things, include interaction with patients with mental disorders. Moreover, the participants became more aware of their role in relation to the patient’s relatives, and modeling made them more prepared to communicate with relatives and meet their needs. Thus, simulation can be effective in teaching communication skills for nurses.
Impact of health policies on how identified needs are met
Thompson Martin et al. (2016) conducted a study that showed improvements in both verbal and non-verbal communication skills of nurses with mental health patients and after practice with simulation. In addition, they were also able to understand the use of silence in therapeutic communication better. The study participants noted that the modeling was effective and helped to improve their communication skills.
In turn, according to a study by Soccio (2017), the participants’ experience gained as a result of simulation-based learning remains a stable and conscious learning outcome throughout their nursing practice. A few weeks after the simulation training, the participants still clearly remembered most of their personal and professional knowledge gained during the simulation training. Participants’ focus group dialogues were rich and meaningful about their experiences of simulation-based learning and how they transferred this experience to their clinical settings.
Thus, through a review of sources, it can be concluded that new student nurses need to improve communication skills to interact with patients with mental disorders. This is since, in the learning process, the development of this competence is fraught with some difficulties, as a result of which additional practice is required. Developing communication skills through modeling would be an excellent way to improve professionalism in general. Evidence shows that the practice of modeling helps nursing students work directly with patients and mental disorders.
References
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Fitzpatrick, L. (2018). The importance of communication and professional values relating to nursing practice. Links to Health and Social Care, 3(1), 27-40.
Furnes, M., Kvaal, K.S. & Høye, S. (2018). Communication in mental health nursing – Bachelor Students’ appraisal of a blended learning training programme – an exploratory study. BMC Nursing, 17(20), 1-10.
Gutiérrez-Puertas, L., Márquez-Hernández, V. V., Gutiérrez-Puertas, V., Granados-Gámez, G., & Aguilera-Manrique, G. (2020). Educational interventions for nursing students to develop communication skills with patients: A systematic review. International Journal of Environmental Research and Public Health, 17(7), 2241.
Hustad, J., Johannesen, B., Fossum, M., & Hovland, O. J. (2019). Nursing students’ transfer of learning outcomes from simulation-based training to clinical practice: a focus-group study. BMC Nursing, 18(53), 1-8.
Kilbourne, A. M., Beck, K., Spaeth-Rublee, B., Ramanuj, P., O’Brien, R. W., Tomoyasu, N., & Pincus, H. A. (2018). Measuring and improving the quality of mental health care: a global perspective. World psychiatry: official journal of the World Psychiatric Association (WPA), 17(1), 30–38.
Liao, F. & Murphy, D. (2019). Evaluation of therapeutic relationship skills training for mental health professionals: the Therapeutic Relationship Enabling Programme (TREP). MedEdPublish, 8(2), 1-27.
Mohamed, S. and Fashafsheh, I. (2019). The Effect of Simulation-Based Training on Nursing Students’ Communication Skill, Self-Efficacy and Clinical Competence for Nursing Practice. Open Journal of Nursing, 9, 855-869.
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Ronning, S. B., & Bjorkly, S. (2019). The use of clinical role-play and reflection in learning therapeutic communication skills in mental health education: an integrative review. Advances in Medical Education and Practice, 10, 415–425.
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Studeny, S., Burley, L., Cowen, K., Akers, M., O’Neill, K., & Flesher, S. L. (2017). Quality improvement regarding handoff. SAGE open medicine, 5, 1-6.
Thompson Martin, C. & Chandra, N. (2016). Mental health clinical simulation: Therapeutic communication. Clinical Simulation in Nursing, 12(6), 209-214. Web.
Trifkovič, K. Č., Lorber, M., Denny, M., Denieffe, S., Gönc, V. (2017). Attitudes of nursing students towards learning communication skills. In G. Stiglic, M. Pajnkihar & D. Vrbnjak (Eds.), Teaching and learning in nursing. IntechOpen.