BEING TACTFUL: COMMUNICATION SKILL TRAINING IN MANAGING CHALLENGING SITUATIONS FOR
II. MATERIALS AND METHODS
The researcher used a mixed method to develop the curriculum and evaluate the impact of the communication workshop. The study was approved by the Ethical committee of the University College.
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Figure 11.1 Challenging Communication Situations in Paediatric Unit
Challenging encounters can be de-escalated by employing communications strategies training for novice nurses.
Preliminary Phase
The research initiated from the general comments received from the Pediatric teams regarding competency gaps of new graduates in the general Pediatric units.
In this study, during the preliminary qualitative stage, data triangulation using semi-structured interviews and focused group discussions were conducted to identify the most needed competency of novice nurses. A total of 36 informants included Pediatricians, Unit mangers of Pediatric unit, Pediatric specialist nurses, and novice nurses. Communication skill was the most highlighted competency gap identified among the new graduates. The qualitative findings showed that novice nurses are unable to convince parents when posed with questions or complaints. They tend to label parents as “fussy parents” and try to avoid them.
On the contrary, expectations of the patients in the private care facility are very high in terms of quality of care. The informants’ felt that there was a compulsive need for formal communication training for novice nurses in dealing with difficult situations or demanding parents.
The Development of the Workshop Training Materials
A 14 items guideline for clinical communication in challenging communication situation was self-developed by the researcher from literature review; Focused group discussion of Pediatric specialist nurses; and corporate communication trainers of the University College. The items were validated by experts in the Pediatric specialty and communication skill trainers. The adjusted I-CVI for the scale was 0.971 and the S-CVI/Ave for the scale was 0.971.The Cronbach’s of internal consistency was 0.986 (Yaghmale, 2003).The 14 items were used as a guideline during training .The guideline is shown in Table 1.
The communication workshop content for presentations and clinical cases were developed by the Pediatric team including academician from the Pediatric nursing
Being Tactful: Communication Skill Training in Managing Challenging…
specialty; Pediatric unit managers; and Local Preceptors of the Pediatric unit. Role play using scenarios developed based on the trainer’s real-life experiences.
Table 11.1 Guideline for the Communication Skill Training Never blame customers
1. Listen attentively to the parent/caregiver.
2. Project calm, relaxed and respectful facial expression.
3. Acknowledge their issues, problems and frustrations by nodding.
4. Summarize on what they say to show that you are actively listening.
Conflict resolution
1. Identify key messages; issues or frustrations.
2. Ask clarifying questions if needed.
3. Say or use the word “you seem to be upset: I am sorry for the misunderstanding;”
4. Be non-defensive: even though it is not our fault
5. Offer privacy to the parents/caregiver to sit down and discuss.
6. Offer assistance to resolve the problem.
Closing the communication gap
1. Discuss the options or alternatives to solve the problem.
2. Ask the patient and parent -“anything else you want to say” before you leave the room.
3. Treat the patient and parent in a non-judgmental attitude after an incident.
4. Uphold professional dignity at all times.
Table. 1 Guide for tactful communication in challenging situations
The communication workshop content for presentations and clinical cases were developed by the Pediatric team including academician from the Pediatric nursing specialty; Pediatric unit managers; and Local Preceptors of the Pediatric unit.
Role play using scenarios developed based on the trainer’s real-life experiences.
Some of the clinical scenarios used were as follows.
• Non availability of single room.
• Continuing to have fever despite antibiotic treatment.
• Medication refusal by parents.
• Delay in pediatrician rounds.
• Child vomits after administering medication.
• Last minute cancellation from Operation theatre list.
• Bill amount beyond expectation of parents Recruitment of the Participants
Recruitment of an adequately large sample which met the inclusion criteria was challenging. A purposive sampling technique was used for recruitment of participants. The researcher contacted the Chief Nursing officers through emails and
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telephone calls. The Chief Nursing officers, with the assistance of Unit managers of the Pediatric unit, identified the new graduates with less than one-year experience and enrolled them in the study. A total of 32 participants were recruited from nine hospitals.
Communication Skill Workshop
A two-day workshop on communication skill was conducted for the Pediatric nurses with less than one-year clinical experience. The main theme chosen for the development of the workshop was handling parents and caregivers during challenging communication situations. The workshop was organized with the conjoined effort of corporate communication training expert, Pediatric Unit managers and Local Preceptors of the Pediatric units. Strategies mainly included brief presentations;
communication skill games; role-play and videos; and debriefing. Throughout the workshop the 14-item guideline were reinforced. The 2 days content outline is shown below in Table 2.
Table 11.2 Content Outline for the 2 days’ Workshop Session Activities
Session 1 Effective communicator in the corporate world: Building customer’s confidence.
Session 2 Develop your communication skills - active listening & acknowledgement of Personal barriers.
Session 3 Video–Effective communication skills.
Session 4 Create engaging conversation and maintain good body language.
Session 5 Things that should be avoided in communication.
Session 6 Communication games
Confronting and difficult situations in the Pediatric unit: sharing of experiences.
Managing difficult and confronting clinical communication situations.
Session 7 Role play simulation–Difficult communication situations.
Debriefing
Training Evaluation
Participant’s feedback form was used for the training evaluation. The Likert scale had 5 points from strongly agree to strongly disagree. Also had few free text questions in the participant feedback form.
Data Analysis
Descriptive statistics was used for data analysis. The qualitative data was analyzed using manual content analysis.
Being Tactful: Communication Skill Training in Managing Challenging…
III. RESULTS
Thirty –two participants completed the training, and all participated in the evaluation.
Demographic characteristics of participants are shown in Table 3.
Participants Characteristics
The Participants characteristics is as shown in Table 3.
Table 11.3 Participant’s Profile (N=32)
Characteristic n=41
Age(Years) 20–25
>25 years
26 6 Gender
Male Female
0 32 Duration of experience in Pediatric ward
<3months 3–6moths 7–12 months
23 6 3 Is pediatric your preferred choice
Yes No
24 8
All the participants were from Diploma in nursing program. There were 24 participants who chose pediatric ward as their preferred discipline to work as a Registered Nurse.
Participant’s Feedback
Satisfaction with and impact of the course was assessed immediately following the course using a 5- Point Liker scale (5=excellent to 1=poor). All the 14 items had a mean score of >4.5 /5. The Patient feedback had 14 items had been divided into three sections. They are the organization of the training, program content and instructional strategies used in the implementation of the communication skill training program. In the program organization section, the highest mean score was for item 3 (M=4.81) which stated that the “aims and objectives of the communication skill training program were very clear and evident in the program.” All the items in the communication skill training content section had a score above 4.55/5 in the participant’s feedback form. The third section was regarding the instructional strategies used in the implementation of the communication skill training. All the items had a mean score of > 4.5.
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Table 11.4 Overall Ratings of the Questionnaire upon Completion of the Workshop (N=32)
Items Excellent
(N)
Good (N)
Satisfactory (N)
Fair (N)
Poor (N)
Mean score(N) I found the communication
skill Training course interesting.
22 10 0 0 0 4.69
Aims & objectives of the course were clearly evident in the program.
26 6 0 0 0 4.81
The teaching methods used in the program were helpful and effective.
21 11 0 0 0 4.66
The complexity of the training was manageable.
16 16 0 0 0 4.5
Found the various parts of the course well organized.
16 15 1 0 0 4.47
The program helped me to improve my competencies.
22 10 0 0 0 4.69
The training helped to improve my self- confidence in the Pediatric clinical practice.
24 8 0 0 0 4.75
Role paly Simulation training was relevant to the clinical practice.
19 13 0 0 0 4.59
The training sessions provided me with a variety of learning activities to promote my learning the Pediatric nursing module.
19 13 1 0 0 4.59
I enjoyed how my facilitators conduct the teaching sessions.
23 9 0 0 0 4.72
The way the facilitators conducted the training sessions was suitable to the way I learn.
21 11 0 0 0 4.66
Being Tactful: Communication Skill Training in Managing Challenging…
My training facilitators
‘used helpful resources and examples to conduct the sessions.
21 10 1 0 0 4.63
The debriefing sessions provided me the opportunities to reflect on my experience in the ward and the meaning of my actions.
20 11 1 0 0 4.59
The highest score was for the item “I enjoyed how my facilitators conduct the teaching sessions” with a mean score of 4.72/5 (SD=0.46).
In the free text section, the participants’ highlighted that the communication skill training program facilitated them to gain better soft skills. A participant exclaimed the training have taught how to tackle ‘hard’ situations. The participants also highlighted that they learned something new from every scenario. The participants felt that the skills are useful for their daily practice in the Pediatric ward.
One of the participants emphasized that the program gave them much experience to handle Pediatric patients and their parents. They also commented that the program was such an excellent platform for new nurses and such a fantastic experience with friends in the same discipline. The participants also wished to have more programs like this to improve their clinical skills. The participants mentioned as follows. “Try to practice whatever we have learned in the daily routine in the ward.” The second participant reported as follows. “I have gained more confidence in attending to Pediatric patients. “One of the participants also stated that the facilitators shared their expertise very well and used soft skills well in dealing with the participants. The participants’ reiterated that the program provided useful information for daily clinical practice and wished to get more opportunity for similar training in the future.
IV. DISCUSSIONS
General Pediatric department admit children with diverse medical surgical and specialty problems. The purpose of the study was to develop a communication skill training program for novice Pediatric nurses to manage challenging communication situations. The program was tailored to meet the specific needs of the new Diploma in nursing graduates employed in the Pediatric ward. Developing and implementing training on communication skill was one of the Continuous Program Development (CPD) activities to improve the professional resilience of Pediatric nurses. The approach of communication skill training was used to modify the communication skill behaviors of the new graduates in the Pediatric ward. The participant’s feedback and
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qualitative findings suggested that the program was useful in improving the soft skill of new graduates.
Levetown (2008) mentioned that healthcare communication is the most important but generally neglected part of Pediatric practice. “Communication is the most common procedure in medicine” (Levetown, 2008, p.1441). According to Levetown, healthcare communication is different from standard social disclosure because healthcare communication may involve the sharing of hopes, fears, developmental concerns, or other painful concerns. Communication is the foundation of any therapeutic relationship. Effective communication is the essence of everything nurses do in the clinical practice related to patient care. Poor communication can prompt lifelong anger, regret, and even medico-legal consequences for the practitioner. Taking time to establish rapport and understand child and family helps to build trust and will patient outcome and satisfaction. However, healthcare communication is currently learned through trial and error (Levetown, 2008). Most importantly, in this study the participant feedback shows that the training helped them to be more confident in dealing with difficult encounters in the future.
There are many guidelines to effective communication mainly developed for medical student’s communication skill training. Nevertheless, not all of them are culturally suited to our population. The modified 14 item guideline for managing challenging clinical communication situations was designed and validated by the researcher to guide the participants in dealing with parents or care givers of Pediatric patients.
There is a lack of similar local studies to compare the effect of similar interventions used in this study. Mullan and Kothe (2010) highlighted that one of the critical elements in quality and safe nursing care is skillful communication. However, nurses often lack the art of effective communication skill to communicate with patients, cares, and other health care professionals. The researcher used self-rating of the participants’
self-satisfaction with a communication skill training course.
Luff et al. (2016) used a program to enhance relationship and communication skills (PERCS). The participants included physicians, nurses, social workers, psychologists, and chaplain’s (N=110). The program was conducted in a “retreat”
style to provide a relaxed environment for the participants. The training session had sharing experience of challenging communication; a didactic session on critical points and two challenging conversation scenarios. The participants had improved abilities in the five aspects of the PERCS scale. The aspects were preparation; ability to engage in challenging conversation; relationship; confidence and in reducing anxiety.
A study by Fisher et al., (2014) used brief emotion-based training based on simulation strategies to train communication skill of new graduates had similar findings. The study used validated four habits model of communication training to improve communication skills. In this study, the control group watched a video on effective communication. The researchers collected both qualitative and quantitative data on the effectiveness of the training. The study findings revealed that when
Being Tactful: Communication Skill Training in Managing Challenging…
compared to the control group, the experimental group scored better in four of the five areas. The area showed significant improvement includes preparation; communication skills; relationship and confidence. The aspect which needed more significance is an experience. The study findings are similar to the findings of this study.
Communication training approaches vary significantly concerning their length and intensity, participant characteristics, teaching methods, the role of faculty, and choice of outcome measure. Most of the communication skill training in Pediatric had been conducted in high-intensity settings such as Intensive care; Emergency or Oncology departments (Meyer et al., 2009). The literature search suggests that the communication training focused on the initial encounter of parent and health care provider, and more intensive training focused on communication and relationship issues throughout the disease trajectory.
Communication skill training has an immeasurable impact on the quality of care. The findings of the study revealed that communication skill programs could help to assess, monitor, and improve new graduate nurse’s competency in delivering high-quality nursing care. Ensuring competency builds up confidence and courage among the new graduates and ultimately, job satisfaction. The findings of the study could be used for transition programs to include professional communication skills as part of orientation programs, preceptorship programs, or continuous professional development programs.
There were some limitations to the study. The primary limitation of the study was the small sample size. Other limitation included lack of objective assessment of participant’s communication skills. The study also did not assess impact of training on patient outcomes. . Also, it is not known to what extent the training has benefited the participants in real clinical practice.
The study can be conducted on a larger sample to improve the generalization of the findings. The study can have a descriptive time series design to study the effectiveness as a time-series design. The participants also recommended the inclusion of stress management and conflict management as part of the training in the future. In the future, we hope to continue the communication skill training workshop to all the staff nurses in the General Pediatric units of the 26 hospitals within the organization to improve parents over all experience in the General Paediatric units.
V. CONCLUSION
In any healthcare organization doctors and nurses communication skills are the most critical drivers of overall patient satisfaction. Communication skill training enhances Professional Resilience development. Such training will benefit the customers;
employee, and organization equally. Continued emphasis on educating nurses on skilled clinical communication is one of the essential initiatives in improving patient’s satisfaction and quality of care.
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