Evaluation of communication training programs in nursing care: a review of the literature

Abstract

An important aspect of nursing care is communication with patients. Nurses’ major communication tasks are not only to inform the patient about his/her disease and treatment, but also to create a therapeutically effective relationship by assessing patients’ concerns, showing understanding, empathy, and providing comfort and support. In this review, 14 studies, which focus on the evaluation of the effects of communication training programs for nurses, have been evaluated. The selected studies were screened on several independent, process and outcome variables as described by Francke et al.[8]. In this way not only is the training program taken into account as a variable which may be responsible for nurses’ behavioural change and for changes in patient outcomes, but also a range of other variables which can give more nuanced explanations for a training program’s degree of effectiveness. On the whole, the studies reviewed showed limited or no effects on nurses’ skills, on nurses’ behavioural changes in practice, and on patient outcomes. Finally, the majority of the studies had a weak design. The use of experimental research designs should be pursued in future studies in order to eliminate the influence of confounding variables.

Introduction

Within current nursing care, increasing attention is being paid to effective communication, which according to Wilkinson [1], [2] is defined as open two-way communication in which patients are informed about the nature of their disease and treatment and are encouraged to express their anxieties and emotions. Two communicative behaviours employed by nurses seem to be important in meeting the communication needs of patients as defined above. First are the instrumental behaviours, which are of significance in informing the patient about the disease and treatment. Second are affective behaviours, such as showing respect and providing comfort and trust [3] which are important in creating a good relationship with the patient. An additional distinction to be made is that between the verbal and nonverbal components of communication within instrumental and affective communication. Nonverbal communication refers to paralinguistic features and behaviour, which conveys messages without the use of verbal language. Examples are speech rate, speech volume, facial expression, eye contact, posture, gesture, physical appearance and touch. Nonverbal communication appears to be especially important with respect to building rapport with others, and for conveying empathy and support [4], [5].

In the case of life-threatening diseases such as cancer, in particular, nurses report a need for communication training programs in which they can learn how to communicate effectively on emotional issues and psychosocial aspects, and also how to integrate these issues purposefully in delivering medical or technical care in nursing practice [6], [7].

During the last decade, many training programs in communication have been developed which target the improvement of nurses’ communicative behaviours in daily practice. However, the literature reveals that relatively few of these programs have been evaluated. Evaluation studies are useful in gaining insight into the effect of these programs on nurses’ levels of communication skill and other nurse and patient outcomes.

The effectiveness of communication training programs is not only dependent on program characteristics, but may be affected by a range of other variables as well. On the basis of a review of the literature, Francke et al. [8] described several independent and process variables, which may be related to behavioural changes in nurses following training programs.

In the first place, nurses’ working experience is an independent variable. It is a background characteristic. The fact that inexperienced participants who have only a few years of nursing experience, may profit more from training programs than experienced nurses [9], [10] illustrates its influence. Other independent variables further include characteristics of the program itself (e.g., topics and duration), and the professional background of the teachers. Finally, independent variables include the social system in the working environment. Characteristics of the social system in the working environment include social support from superiors, and encouragement from colleagues in applying the newly acquired knowledge and skills in daily practice.

Process variables include the characteristics of the relationship with the teacher and that among the participants. Nurses often prefer warm, enthusiastic, friendly teachers with a great deal of expertise. Reciprocal sympathy and support, respect and feedback among participants may also contribute to the success of the learning process [8].

Francke et al. [8] also described several outcome variables, which may be important mediators for behavioural change in practice. These include knowledge, skills, attitudes and an intention to change behaviours after the training. These variables mediate nurses’ behavioural changes. However, the literature reveals [11], [12] that positive changes in knowledge, skills, attitudes and the intention to change do not automatically lead to actual behavioural changes. Yet, we consider behavioural changes highly important, since they are, in turn, (partially) responsible for positive changes in patient outcomes.

We screened selected studies of the independent process and outcome variables mentioned in this review of the literature. This allowed us not only to take the training program into account as a variable, possibly responsible for nurses’ behavioural change and changes in patient outcomes, but also for a range of other variables. It may be helpful in explaining the effects of a communication training program. In addition, we looked at the research methods used in the selected evaluation studies to interpret the value of the effects measured.

The research questions addressed in this article are:

• What are the characteristics of the communication training programs evaluated for nurses with regard to the following independent variables: participants’ background characteristics, professional background of the teachers, characteristics of the training program?

• What research methods are used to evaluate the outcomes of the training?

• What are the process-oriented and effect-oriented outcomes of the training programs?