Designing A Training Program For Improving Patient, Student

Journal oI Biology, Agriculture and Healthcare www.iiste.
org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.3, No.3, 2013

58

Designing A Training Program For Improving Patient, Student
Nurse Communication
Eman Talaat El-Shamaa
Assist. ProI. oI Medical Surgical Nursing Department
Faculty oI Nursing, Ain Shams University, Egypt
E. Mail: dreman2011hotmail.com

SuccessIul communication has three major components: a sender, a receiver, and a message. In nursing practice, we
Irequently have a great deal oI inIormation to send to others in a short period oI time. The present study aimed to
design a training program through assess the Iactors aIIecting communication between patients and Iirst year nursing
students and to answer the research question; what are the Iactors aIIecting communication between patients and
Iirst year nursing students?Methods:the study was conducted at medical and surgical units in Ain Shams, University
Hospitals. One hundred nursing students communicated with one hundred patients in the hospital (area oI training)
have been selected. Data were collected through: (1) patient's opinionair sheet to assess patient's opinion about
nursing students communication,(2) student's questionnaire sheet to assess the nursing students' knowledge in
relation to communication, and(3) observational checklist to assess the communication skills oI nursing
students.ResultsoI this study, revealed that most oI the nursing students had satisIactory knowledge about
communication, and most oI them had adequate communication skills. More than halI oI the patients had satisIactory
opinionair about communication with nursing students,. The present study concluded that, the Iactors aIIecting
communication were age (oI the nursing students and patients), sex oI patient, level oI knowledge, amount oI
training, and students' skills .The study recommended :increasing theoretical input in relation to interpersonal skills
and communication theory ,implementation oI training programs to the nursing students about communication,
Encouraging seminars and workshops about communication andFurther researches are highly recommended to be
carried out in more wider areas about communication.
Key words: EIIective communication- Nursing students- Patients, Training program

INTRODUCTION
Communication in nursing proIession can be a complicated process, and the possibility oI sending or receiving
incorrect messages Irequently exists. It is essential that we know the key components oI the communication process,
how to improve our skills, and the potential problems that exist with errors in communication
(1)
.
SuccessIul communication has three major components: a sender, a receiver, and a message. In nursing practice, we
Irequently have a great deal oI inIormation to send to others in a short period oI time. To do this eIIectively, we need to
know that there are Iactors which could inIluence how our message is interpreted. We must consider the setting in
which the communication occurs, the past experiences and personal perceptions oI both the sender and receiver, the
timing oI the message
(1)
.
Communication takes place on many diIIerent levels including intrapersonal communication, interpersonal
communication, small group communication, organizational communication, collegial communication, therapeutic
communication and social communication
(2)

IneIIective communication is reported as a signiIicant contributing Iactor in medical errors and inadvertent patient
harm. In addition to causing physical and emotional harm to patients and their Iamilies, adverse events are also
Iinancially costly. In Victoria, the direct cost oI medical errors in public hospitals is estimated at halI a billion dollars
annually . Today, healthcare is ever more complex and diverse, and improving communication among healthcare
proIessionals likely to support the saIe delivery oI patient care
(3)
.
Communication is an important aspect in nursing practice since nurses can not practice without communication.
EIIective communication is the master key that unlocks such human resources, enabling a nurse to understand, to
care and to help another person. Communication can be considered as a personal process that involves the transIer oI
Journal oI Biology, Agriculture and Healthcare www.iiste.org
Vol.3, No.3, 2013

59

inIormation and also involves some behavioral input. Communication is something people do. It does not exist
without people taking some Iorm oI action
(25) .

There is a growing body oI evidence that nursing students are not as eIIective as they ought to be when interacting
with patients and the others in the health care setting and this underlines the importance oI teaching these skills
(4)
.

Aim of the study
This study is aiming to:
1-Assess Iactors aIIecting communication between patients and Iirst year nursing students.
2- Design a training program Ior eIIective communication between nursing students and patients.
Research Question:
What are the Iactors aIIecting communication between patients and Iirst year nursing students?
Subjects and Methods
Research Design:
The Present study is a descriptive exploratory design .
A. Setting: This study was conducted at Ain Shams University Hospitals as clinical area Ior training Iirst year
nursing students, medical and surgical units.
B. Subjects: A convenience sample Irom the Iirst year nursing students oI the academic year 2011\2012 (n100),
and one hundred patients who communicated with the nursing students at the hospital (area oI training) Irom medical
and surgical units were recruited Ior this study.
C. Tools used for data collection:
1- Patient's opinionair sheet to assess patients' opinion about nursing students communicated with them .
2- Students questionnaire sheet to assess the nursing students' knowledge in relation to communication .
3- Observational checklist to assess the communication skills oI nursing students .
4- Training program Ior eIIective communication.
Patient's Opinionair sheet: -
It was developed to assess patients' opinion about nursing students communication. It was designed and developed
by the researcher. It was designed in simple Arabic language to Iacilitate understanding and to minimize
misconception. It consisted oI 26 questions modiIied Irom (TawIik, 2004).
The Iirst part included variables pertaining to the demographic characteristics oI the study patients such as; name,
age, sex, marital state, qualiIication and job.
The second part contained 18 questions. It included variables related to patients' opinion about nursing students'
communication.
This opinionair was constructed in the Iorm oI "Yes", "No" and "Sometimes". The total score oI patient's opinionair
sheet was 18 grades
A score oI (1) Ior positive points (answers with yes and sometimes)
A score oI (0) Ior negative points (answers with No).
SatisIactory ~ 60.UnsatisIactory 60.
Students questionnaire sheet:
It was directed to nursing students in their class in Faculty oI Nursing. It was designed in an Arabic language, to
assess the nursing students' knowledge about communication. The questionnaire consisted oI (4) items and (28)
questions modiIied Irom (Farouk, 2004) and constructed by (Abu El-Rous, 2004).It covered the Iollowing two main
parts:
1-Sociodemographic characteristics oI nursing students included in the study which include (name, age,
qualiIication, and marital status).
2-Questions to assess the students' level oI knowledge.
The scoring system regarding students' questionnaire:
It included Iour main questions with sub-questions. Each item was classiIied into "correct" and "Incorrect", in the
Iorm oI "Yes" and "No" a score oI (1) was assigned Ior right choice, and a score oI (Zero) Ior a wrong choice. The
total score oI students' questionnaire sheet was 151 grades distributed as Iollowing:
1-Basic knowledge about communication process (24 grades).
2-Ways oI communication process (42 grades).
3- Factors that impede communication (24 grades).
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4-Methods oI caring (61 grades).
Two score levels were considered:~ 60 was considered satisIactory.
60 was considered unsatisIactory.
An observational checklist:
It was developed to assess the communication skills oI nursing students while dealing with the patients. It was
designed and developed in an Arabic language .The observational checklistcontained (7) items and (60)questions:
The scoring system regarding observational checklist:
The observational checklist constructed in Iorm oI "Yes" and "No" answers. A score oI (1) Ior a correct
perIormance, and a score oI zero Ior an incorrect one. The total score oI the observational checklist was 54 grades .~
60 was considered satisIactory and 60 unsatisIactory.
-The training program which is a combination between theoretical education as a teaching strategy oI the training.
involved computer-assisted instruction consisting oI Iour modules; basic communication skills, breaking bad news,
eIIectively providing inIormation and how to deal with patient's emotions. Each module consisted oI video examples
oI poor and adequate communication, with practice questions about the video and immediate Ieedback. Each module
oI this program could be completed within an hour. Followed by real-time training involved in the work place. The
median duration oI these program will be18 30.5 h (range 105 h). Role-playing exercises with regular Ieedback
would be part oI these training program. The group size ranged Irom three to 15 participants, the latter being quite
large
(5,6)
.

*Pilot study:
A pilot study was conducted on 10 patients and 10 students Ior testing clarity, relevance and time consuming to Iill
in the Iorms. The necessary modiIications and adjustments were carried out as revealed Irom the pilot Iindings.
Students who shared in the pilot study were excluded Irom the study sample.
*Content validity:
It was established by a panel oI ten expertise who reviewed the instruments Ior clarity, relevance, comprehensivess,
understanding, applicability and easiness Ior administration was established, minor modiIications were required.
*Fieldwork: The actual Iiledwork was carried out at the Iirst week oI March 2012up to the middle oI May 2012 Ior
data collection. it was detected that the average time to Iill all the tools was 45-55 minutes. The researcher
explained the aim oI the study to all the students and patients that were included in the study then. The questionnaire
was Iilled by the nursing students in their class at the Faculty oI Nursing.The researcher was checking the
observation sheet during the period oI training. and collected the patients' opinionair through interviews during the 2
days oI training.
Administrative Design:
An oIIicial permission Irom the Dean oI the Faculty oI Nursing, Ain Shams University to the directors oI each
hospital, and head oI the units chosen Ior conduction oI the study.
Statistical Analysis:
It was done using IBM PC. Data entry and analysis were conducted by using a statistical package Ior social science
(SPSS) version 10. Data were presented in tables and charts using number and percentage, range, arithmetic mean X,
and standard deviation (SD).

Limitations of the study:
Some oI patients reIused to participate in the study -
-The type oI sample (convenience sample) led to inability to generalize the result oI the study as there was possibility
oI bias.
Results
Part I: Socio-demographic Characteristics oI Patients and Nursing Students.Table (1): shows that two IiIths (40) oI
the patients under study were Irom 40 to less than 60 years old, with mean oI 46.0816.55. Most oI them (76) were
males, the majority oI the study group oI patients(87) were employees,(58) were married, nearly one third oI
them (33) were illiterate.
Table (2): shows that slightly more than two thirds oI the student nurses under study (74), their age were between
1820 years old, with a mean oI 17.810.581. All oI them (100) were single, while more than halI oI them
(56) reside rural areas.
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Table (3): The table shows also that most oI nursing students (99) mentioned the components oI communication. It
also clariIies that most oI students (99) answered that modes oI communication are verbal, (93) oI them list
establish needs between persons and( 96) oI students mentioned that these are expressed in Iacial expression, body
motion and space.
Table (4) A: demonstrates that, all oI the nursing students (100) mentioned that respecting and accepting the
patient is the principle Iollowed while conversing with the patient, Iollowed by( 97) oI them who were using
simple and clear language. For the behavioral ways to improve communication,( 96) oI students list giving enough
time to the patient, Iollowed by( 94) who reported get rid oI the noise.
Table (4) B: (Continued): This table reveals that most oI the students (97 & 95) answered that listening and
attention are eIIective communication skills. This table clariIies that( 98) oI students answered importance oI
listening to give the patient Ieeling oI acceptance and respect. Almost two thirds oI the students (67) chose
stimulating and orienting the patient.
Table (5): This table shows that (91)oI students mentioned that reduced or impaired patient's ability to talk is a
Iactor that impede communication with patient, and slightly more than one third oI them (36) mentioned increasing
patient's needs. As well, this table clariIies that 94 oI students reported that socio cultural habits as a Iactor
aIIecting communication and 92) oI them mentioned values as a Iactor aIIecting communication. (
.Table (6): This table indicates that all students (100) mentioned good listener and the least percentage oI them
(32) reported talking in humorous manner too much as a characteristics oI good communicator with the patient and
(99) oI the study group oI the students listed, to be patient, smiley Iace, appropriate Iacial expression also use
simple easy and clear speech Ior eIIective communication.
Table (7): Shows the patient's opinionair about positive communication points, that all the patients (100) saw that
the student has a good appearance, most oI patients (99) told that the student use a suitable and easy language
during conversation, while the least percentage oI them (28) said that the student gives the Iamily enough
inIormation about his condition and its progress.
Table (8): Shows the patient's opinionair about negative communication points. The majority oI patients (75) do
not Ieel upset when speaking with students Ior long time, minority oI them (7) want time to pass quickly and
(73) oI the patients don't Ieel that speech with student hasn't importance Ior listening also don't Ieel that student
avoids dealing with him/her due to his/her appearance.

Table (9): clariIies that, there was a very highly statistically signiIicant diIIerence between the beginning and the end
oI training period related to talking to the patients. There was also a signiIicant diIIerence related to overall
communication skills.
Table (10): Shows that, there were highly statistically signiIicant relations between nursing students' knowledge
about basics oI communication process, their communication skills related to talking to the patient , environment
around patient, and there were statistically signiIicant relations related to overall communication skills and oIIering
nursing care needed Ior the patient.
Table (11): indicates that, there were highly statistically signiIicant relations between students' knowledge about
Iactors that impede communication and their communication skills related to talking to the patient, environment
around the patient and overall communication skills.Table (12): Shows that, there were highly statistically signiIicant
relations between overall nursing students' knowledge and their communication skills related to receiving the patient
and environment around the patient. However, there were very highly statistically signiIicant relations related to
dealing with the patient listening to the patient, and overall communication skills.
Table (1): Socio-demographic characteristics oI patients.

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Table (2): Socio-demographic characteristics oI nursing students.
(N100) Items

25

74

1

25

74

1
Age (years):
16 18

1820

20
16-20 Range
17.810.581 MeanSD

100 100
Marital status:
Single

44
56

44
56
Residence:
Urban
Rural
Part II: Nursing Students knowledge about communication.
Table (3): Percentage distribution oI students as regards their inIormation about basics oI communication process.

(N100) Items

4
32
40
24

4
32
40
24
Age (years):
20
20- 40
40- 60
60
16-75 Range
46.0816.55 MeanSD

76
24

76
24
Gender:
Male
Female

87
13

87
13
Job:
Employee
HousewiIe

22
58
1
19

22
58
1
19
Marital status:
Single
Married
Divorced
Widowed

33
26
12
22
7

33
26
12
22
7
Education:
Illiterate
Read/write
Basic
Intermediate
High
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No Yes Items

No No

8
60
11
23

8
60
11
23

92
40
89
77

92
40
89
77
Communication is:
-TransIer oI inIormation, ideas, and Ieelings between
people
-Judgment on conversation
-Giving advice and helping others
-Helping others to communicate

1
21
53
54

1
21
53
54

99
79
47
46

99
79
47
46
Components oI communication:
-Sender and receiver
-Message
-Evaluation oI the conversation
-Channel oI sending the conversation

1
56
43
18

1
56
43
18

99
44
57
82

99
44
57
82
Modes oI communication:
-Verbal
-Written
-Non-verbal
-Published words (or conversation)

7
9
42
26

7
9
42
26

93
91
58
74

93
91
58
74
Functions oI communication:
-Establish needs between persons
-Making relationship between persons
-Making an eIIect between persons
-Showing interest between persons

13

64
27
40

13

64
27
40

87

36
73
60

87

36
73
60
Importance oI non-verbal communication skills:
-Express oI Ieeling and emotion..
-Validation or contradiction oI verbal message
-Express the opinion in conversation
-Testing personality oI sender

4

51
66
54

4

51
66
54

96

49
34
46

96

49
34
46
Nonverbal communication is expressed in:
-Facial expression, body motion and space, appearance and
tone oI voice
-Body space and touching during communication
-Verbal speech
-Writing

Table (4) A: Percentage distribution oI students as regards their inIormation about communication strategies.
No Yes Items

No No

0
3

0
3

100
97

100
97
Principles Iollowed while conversing with the patient:
Respect and accept the patient.
Use simple and clear language.
Give criticism to the patient's behavior.
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51
31
51
31
49
69
49
69
Communicate in more subjects/topics

62
44
85
9

38
9
6

4

62
44
85
9

38
9
6

4

38
56
15
91

62
91
94

96

38
56
15
91

62
91
94

96

Behavioral ways to improve communication:
Sit beside the patient.
Speak slowly.
Ask Irequent questions.
Use Irequent repetitions and clariIications oI speech.
Communicate in more topics.
Make sure oI patient's concentration.
Get rid oI the noise.
Give enough time to the patient to understand the
conversation.

22
43
37
62
27
21
25
44
52

22
43
37
62
27
21
25
44
52

78
57
63
38
73
79
75
56
48

78
57
63
38
73
79
75
56
48

Communication problems while conversing with the patient:
Impaired speech, hearing, and vision.
Forgetting recent events.
Forgetting old events.
A lot oI question Irom the patient.
Nervousness oI the patient.
Noise
Lack oI attention or no attention.
Impaired patient Iacial expression.
Patient speaks Ior long periods.
Table (4) B: Percentage distribution oI students as regards to their inIormation about communication strategies.
No Yes Items

No No

3
69
5

87

35

3
69
5

87

35

97
31
95

13

65

97
31
95

13

65

EIIective
communication
skills are:
Listening skill.
Touching skill.
Attention.
Supporting
nervousness oI the
patient.
Observing body
motions.

23
23
64
18
76
38

23
23
64
18
76
38

77
77
36
82
24
62

77
77
36
82
24
62
Dealing with patient diIIers according to:
Age
Sex
Social status
Health condition
Economic state
His way oI dealing
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35

15

2
94

35

15

2
94

65

85

98
6

65

85

98
6
The importance oI listening to patient:
Detecting weak points during communication.
Giving him a chance to communicate Ior a long time.
Giving him a Ieeling oI acceptance and respect.
Giving him a Ieeling oI non interest.

33
53
68
47

83

33
53
68
47

83

67
47
32
53

17

67
47
32
53

17
EIIects I touching skills during conversation:
Stimulating and orienting the patient.
ClariIying the points oI conversation.
Speeding communication with patient.
Expressing warmth relationship with patient.
Expressing upset oI communication with patient.

Table (5): Percentage distribution oI students as regards to their inIormation about Iactors impeding communication.
No

Yes Items

No No

64
62
51
43
40
36
35
33

64
62
51
43
40
36
35
33

36
38
49
57
60
64
65
67

36
38
49
57
60
64
65
67
Factors that impede communication with patient:
Increasing patient's needs.
Patient's conversation about remote events.
Speaking in more than one topic.
InsuIIicient time to make Ieedback.
Speaking in one topic.
Repeating conversation points.
Ignorance oI patent's emotion.
Disharmony between verbal and nonverbal messages.
29
29
21

20
19
18

17
13

12

9
29
29
21

20
19
18

17
13

12

9
71
71
79

80
81
82

83
87

88

91
71
71
79

80
81
82

83
87

88

91
InsuIIicient time to receive message.
A lot oI questions to the patient.
Advertising patient's secrets to others.
Interrupting the patient during conversation.
Dealing with patients when busy.
DiIIiculty to clear and send the message.
Speaking with the patient in a way he/she didn't understand.
Conversation that let the patient Ieel boring.
Social withdrawal oI patient and unacceptance to
communicate.
Reduced or impaired patient ability to talk.

19
18
16
11

19
18
16
11

81
82
84
89

81
82
84
89
Factors aIIecting communication include:
Age
Sex (male/Iemale)
Language
Perception
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8
6
8
6
92
94
92
94
Values
Socio cultural habits

Table (6): Percentage distribution oI students as regards their inIormation about eIIective communication.
No Yes Items

No

No

1

4
1
0
1
2
4
68
1
67

6

1

4
1
0
1
2
4
68
1
67

6

99

96
99
100
99
98
96
32
99
33

94

99

96
99
100
99
98
96
32
99
33

94
Characteristics oI good communicator with patient:
Be patient and tolerate all patient's behaviors.
Complete awareness oI patient's status.
Has smiley Iace.
Be good listener.
Has appropriate Iacial expressions.
Speaking in a simple way.
Decrease tension and be calm.
Talk in humorous manner too much.
Use simple, easy and clear speech.
Not being aIIected by patient's speech.
Has complete awareness oI diIIerent ways oI communication
and their application methods.

Part III: Patient's opinionair about Nursing Students Communication:
Table (7): Patient's opinionair about positive communication points perIormed by nursing students.
Sometimes

No Yes Items
No No No

11

11

31

5

26

11

11

31

5

26

39

7

8

1

5

39

7

8

1

5

50

82

61

94

69

50

82

61

94

69

PreIer that the topic oI
conversation to be Irom
patients side.

Keep his privacy.

Accept any words that
he/she says.

Empathy with his
condition.

Help him in making
things can't make it
alone without shaming.

Feel that the time
he/she spent with the
students was important.

Feel that the student is
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14

5

0

31

1

27

28

14

5

0

31

1

27

28

7

0

0

5

0

28

44

7

0

0

5

0

28

44

79

95

100

64

99

45

28

79

95

100

64

99

45

28

patient.

See that the student has
a good appearance.

See that the student
Iacilitates a suitable
environment during
conversation.

uses a suitable and easy
language during
conversation.

gives enough
inIormation about his
condition and its
progress.

gives the Iamily
enough inIormation
about his condition and
its progress.

Table (8): Patient's opinionair about negative communication points.
Sometimes

No Yes Items
No No No

9

24

9

24

75

69

75

69

16

7

16

7
Feel upset when
speaking with the
student Ior long time.

Want time to pass
quickly.
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15

17

17

15

17

17

73

73

72

73

73

72

12

10

11

12

10

11

Feel that speech with
student hasn't
importance Ior
listening.

Feel that student avoids
dealing with him/her
due to his/her
appearance.

Feel that student avoids
dealing with him/her
due to his/her illness.

Table (9): DiIIerence between communication skills oI nursing students at the beginning and end oI training period.
P-Value X

At the end At beginning Items

No No

0.004
(HS)

8.39

6
94

6
94

21
79

21
79
Receiving patient:

Inadequate
Adequate

0.002
(HS)

9.408

27
73

27
73

48
52

48
52
Dealing with patient's
anxiety

Inadequate
Adequate

0.5
(NS)

Fisher
0
100

0
100

1
99

1
99
Dealing with the
patient
Inadequate
Adequate

0.000
(VHS)

37.72
8
92

8
92

48
52

48
52
Talking to the patient
Inadequate
Adequate

0.34
(NS)

Fisher
4
96

4
96

2
98

2
98
Listening to the patient
Inadequate
Adequate

OIIering nursing care
needed Ior the patient
Inadequate
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0.002
(HS)

10.03 17
83

17
83

38
62

38
62
Adequate

0.009
(HS)

6.84

29
71

29
71

48
52

48
52
Environment around
the patient
Inadequate
Adequate

0.043
(S)

4.08

0
100

0
100

4
96

4
96
Overall communication
skills
Inadequate
Adequate

Table (10): Relation between nursing students' knowledge about basics oI communication process and their
communication skill.
P-Value X

Students knowledge

Items

SatisIactory
(n67)
UnsatisIactory
(n33)
No No

0.608
(NS)

Fisher

19.4
80.6

13
54

24.2
75.8

8
25
Receiving patient:

Inadequate
Adequate

0.179
(NS)

1.809

43.3
56.7

29
38

57.6
42.4

19
14
anxiety

Inadequate
Adequate

0.202
(NS)

1.628
0
100

0
67

3
97

1
32
Dealing with patient
Inadequate
Adequate

0.013
(HS)

6.23

34.3
65.7

23
44

60.6
39.4

20
13
Talking to patient
Inadequate
Adequate

0.202
(NS)

1.628
0
100

0
67

6
94

2
31
Listening to patient
Inadequate
Adequate

0.017
(S)

5.723

29.9
70.1

20
47

54.5
45.5

18
15
needed Ior patient.

Inadequate
Adequate
Vol.3, No.3, 2013

70

0.009
(HS)

6.88

38.8
61.2

26
41

66.7
33.3

22
11
Environment around
patient

Inadequate
Adequate

0.018
(S)

5.6

0
100

0
67

12.1
87.9

4
29
skills
Inadequate
Adequate

Table (11): Relation between nursing students' knowledge about Iactors that impede communication and their
communication skills.
P-Value

X

Students knowledge

Items

SatisIactory
(n79)
UnsatisIactory
(n21)
No No

0.014
(S)

6.08

15.2
84.8

12
67

42.9
57.1

9
12
Receiving patient.

Inadequate
Adequate

0.807
(NS)

Fisher

46.6
53.2

37
42

52.4
47.6

11
10
anxiety.

Inadequate
Adequate

0.058
(NS)

3.587
0
100

0
79

4.8
95.2

1
20
Inadequate
Adequate

0.003
(HS)

8.765
35.4
64.5

28
51

71.4
28.6

20
1
Talking to patient
Inadequate
Adequate

0.058
(NS)

3.59
0
100

0
79

9.6
90.5

2
19
Inadequate
Adequate

0.127
(NS)

2.33

34.2
65.8

27
52

52.4
47.6

11
10
needed Ior patient.

Inadequate
Adequate

0.004

8.464

Environment around
patient.

Vol.3, No.3, 2013

71

(HS) 40.5
59.5
32
47
76.2
23.8
16
5
Inadequate
Adequate

0.001
(HS)

11.107

0
100

0
79

19
81

4
17
skills.
Inadequate
Adequate

Table (12): Relation between overall nursing students' knowledge and their communication skills.
P-Value

X

Students knowledge

Items

SatisIactory
(n92)
UnsatisIactory
(n8)
No No

0.001
(HS)

11.95

16.3
83.7

15
77

75
25

6
2
Receiving patient

Inadequate
Adequate

0.475
(NS)

Fisher

46.7
53.3

43
49

62.5
37.5

5
3
anxiety.

Inadequate
Adequate

0.0001
(VHS)

12.44
0
100

0
92

12.5
87.5

1
7
Inadequate
Adequate

0.125
(NS)

2.35
40.2
59.8

42
50

75
25

6
2
Talking to patient
Inadequate
Adequate

0.0001
(VHS)

12.44
0
100

0
92

25
75

2
6
Inadequate
Adequate

0.062
(NS)

3.49

34.8
65.2

32
60

75
25

6
2
needed Ior patient
Inadequate
Adequate

0.007
(HS)

7.292

43.5
56.5

40
52

100
0

8
0
Environment around
patient
Inadequate
Adequate
Vol.3, No.3, 2013

72

0.0001
(VHS)

35.78

0
100

0
92

50
50

4
4
skills.
Inadequate
Adequate

Discussion
Communication is one oI the most important aspects oI nursing care. Good communication skills are essential
whether the nurse is gathering admission inIormation Ior taking a health history, teaching, or implementing care. It is
a process that requires interpretation, sensitivity, imagination, and active participation, and it is used to establish and
maintain relationships with others (Perry,2006).
Socio-demographic Characteristics oI Patients and Nursing Students.
Finding oI the present study revealed that, two IiIths oI patients under study were Irom 40 to less than 60 years old.
Regarding to marital status, the study Iindings showed that more than halI oI patients were married, this might be due
to that more than two-thirds oI patients were aged over Iorty years.
In relation to the education oI the patients, the results oI the present study revealed that approximately one-third oI
them were illiterate. White (2005), who stated that education has a strong inIluence on communication.
As regards residence, results indicated that slightly less than two thirds oI patients were Irom urban areas, which
have their own standards oI communication, especially with regard to non verbal behavior.
The Iinding oI the present study revealed that approximately two-thirds oI the students' age was eighteen years, it
might be due to that students' were in their Iirst year, and this is the suitable age Ior this year.
As regards residence, results indicated that more halI oI the students were Irom rural areas.
Nursing Students' Knowledge About Communication:
This study clariIied that the majority oI the students deIined communication as a transIer oI inIormation, ideas, and
Ieeling between people. This deIinition is consistent with white (2005), who stated that communication is the process
by which inIormation is exchanged between the sender and receiver. As well, perry (2006) stated that
communication is the process involving sending, receiving messages, actions, Ieeling, behavior and words.
As regards the nursing student's knowledge about components oI communication, it has been Iound that the majority
oI them considered components oI communication as sender, receiver and message. This could be due to the Iact that
most people and students deIine communication simply as the transIer oI inIormation or meaning Irom one human
being to another. This is consistent with (Hegner& Caldwell, 2004) who explained that communication occurs as a
sequence oI events process that involve message, sender, receiver, Ieedback and context.
This study revealed that more than Iour-IiIth oI the students knew the importance oI non-verbal communication
skills in expressing Ieeling and emotions. This might be due to that Ieeling are believed to be most honestly
expressed nonverbally because there is little conscious control over non-verbal communication. This study Iindings
is consistent with Mohr (2003) and Sears (2004), who pointed out that nonverbal communication is a learned
behavior and is generally unconscious. Clients are particularly sensitive to non-verbal messages and seen to believe
them.
The present study showed that, all oI the students consider that the principles Iollowed while conversation with the
patient are respecting and accepting the patient, that she respects the patient because he/she is a human being and has
emotions and Ieeling, and accepting him/her Iosters the relationship between them. This study Iindings agrees with
Abd El-Salam (2004), who explained that acceptance conveys a willingness to hear a message or to acknowledge
Ieeling ad respect Ior others, so "patients" will help the nurse to be more successIul in establishing relationships.
On the other hand, this study revealed that the majority oI the students considered that the behavioral ways to
improve communication is giving enough time to the patient to understand the conversation. This study Iinding
agrees with Boscart (2006), who explained that the nurse must allow the patient to share relevant inIormation and
also gives the patient an opportunity to consider what is being said, weight alternatives, and Iormulate an answer.
On the other hand, this study articulated that, the majority oI the students' mentioned that a Iactor that impedes
communication with patient is reduced or impaired patients ability to talk, which can lead to Irustration to both the
patient and the nurse and make communication more diIIicult. This study result conIorms with Adel and RaIat
(2004), who explained that patients with sensory and motor impairments require individualized approaches and
Vol.3, No.3, 2013

73

special communication techniques Ior successIul nurse-patient interaction and the nurse will have more work to
communicate.
The majority oI the students in the current study considered social withdrawal oI patients and unacceptance to
communicate as Iactors that impede communication with patient and the nurse must respect the patient and ask
another nurse to deal with him/her. This study agrees with Jones (2003) who revealed that the nurse must know that
patients would choose to Iorm a deeper relationship with some oI them.
Regarding to student's knowledge about communication with patients, the study Iinding clariIied that the majority oI
the students had satisIactory knowledge about communication during care and overall knowledge about
communication, and that minority oI them had satisIactory knowledge about basic knowledge communication
process.
Communication Skill oI Nursing Student's while Dealing with Patients:
This study conIirms with Jones (2003); Abd El-Salam (2004) & Moore (2005), and who conIirmed that, in order to
be eIIective communicators, nurses require an appropriate interaction techniques or skills.
At the same time, this study revealed that slightly more than two thirds oI student nurses don't instruct the patient
about his condition and how to deal with it. This will not relieve the patient's anxiety and also can't help the patient to
become cooperative with them to carry out needed care. This study Iinding disagrees with Farouk (2004), who
pointed out that the majority oI patients are wishing to know as much as possible about their illness, its causes,
treatment, and its outcomes. Whereas, White (2005) pointed out that clariIication is a critical step to understanding
important practice concepts.
Whereas, this study showed that, more than halI oI the students move Irom one topic to another one without Iinishing
it, which means that conversation is interrupted and shows a lack oI empathy to the patient, this study conIirms with
Doane and Varcoe (2006); Dowling (2006), and who clariIied that changing the subject stalls oII progress oI a
therapeutic communication. The person's thoughts and spontaneity are interrupted, ideas become tangled, and the
inIormation provided may be inadequate.
This study indicated that while listening to the patient, all the students were sitting in Iront oI the patient and also
were maintaining a suitable space between them and the patient during conversation, because listening requires
attention and concentration in what the patient says and lets the patient Ieel with comIort during conversation. This
study conIirms with Abd El-Salam (2004); TawIik (2004) and Foster (2005), who explained that listening is the most
important communication technique that involves both hearing and interpreting what the other says. They suggested
not to cross arms or legs because body language conveys a message oI being close to the patients comments.
On the other hand, this study revealed that the majority oI the students kept patient's privacy which means that the
patient knows that the students respect him/her. This study conIirms with Berlo (2002) and Moore (2005), who Iound
that patients who are in a private setting, where they will Ieel comIortable, will ask questions and express their
Ieelings.
Interestingly, this study mentioned that the majority oI patients see that the student shows empathy with his/her
condition to establish successIul helping relationships. This study agrees with Lee (2004), who emphasized that an
empathic nurse is sensitive to the patient's Ieelings and problems.
Factors Affecting Communication of Nursing Students while Communicating with Patients:
In relation to diIIerence between communication skills oI nursing students at the beginning and end oI training
period, results showed that about Iour-IiIths oI the students had adequate communication skills while receiving the
patient at the beginning oI training, and most oI them had adequate skills, at the end oI training period. When dealing
with the patient's anxiety and environment around that patient at the beginning oI training, more than halI oI the
students had adequate skills and at the end period, about three quarters oI them had adequate dealing with the
patient's anxiety and environment around the patient. This Iinding was parallel with Acello (2005), who stated that,
when the period oI experience increased, nurses have to learn more to improve their knowledge and skills Ior
patient's care.
As regards talking to the patient, Iindings in this study revealed that, more than halI oI the students were adequate at
beginning while most oI them were adequate at adequate at the end. Concerning nursing care needed Ior the patient,
about two thirds oI students were adequate at the beginning and at the end period more than Iour IiIths oI them were
adequate when the period oI training increased. The researcher attributes this Iinding to that the student with time
becomes more oriented and active, having good background about dealing and interacting with the patient. This
Vol.3, No.3, 2013

74

result is in agreement with Perry (2006), who mentioned that the new nurses had unsatisIactory theoretical and
practical background and aIter a period they become well experienced.
As regards the relation between nursing students' knowledge about basis oI communication process and their
communication skills, results oI this study showed that less than two thirds oI the students had satisIactory
knowledge and more than halI oI them had adequate communication skills while talking to the patient, oIIering
nursing care needed Ior the patient and environment around patient. This study agrees with Mohamed (2006), who
reported that basics oI communication process provide the nurse with the guidance and direction needed to
communicate with patients eIIectively.
It is important that the student nurse must have knowledge about strategies oI communication in order to apply it
practically. In this respect, Abd El-Salam (2004), explained that the therapeutic use oI communication requires
knowledge and practice that makes the nurse to be perIect.
Regarding to the relation between nursing students' age and their communication skills, the study Iindings revealed
that more than two-thirds oI the students had eighteen years old and most oI them had adequate skills while dealing
with the patient, listening to the patient and overall communication skills. However, more than halI oI them had
adequate skills while dealing with the patient's anxiety and environment around the patient. These results agreed with
Lois (2005), who explained that the age oI patients and nurses can aIIect communication and interaction between
them.
Conclusion:
The present study concluded that:
*Nursing students have satisIactory level oI knowledge about communication.
*In relation to students perIormance, they have adequate level oI communication skills.
*There were statistically signiIicant diIIerences in nursing students perIormance at the beginning and at the end oI
training period.
*Patients have satisIactory level as regards the overall opinionair about communication with nursing students.
*Factors aIIecting communication between patients and Iirst year nursing students were age oI the patients and the
students, sex oI the patient, knowledge level, amount oI training.

Recommendations:
Based on the results oI the present study, the Iollowing recommendations are suggested:
1-Implementing oI training programs to the nursing students about communication.
2-Encouraging seminars and workshops about communication.
3-Further researches are recommended to be carried out in more wider areas about communication.

References
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