Evaluation of Nursing Students’ Communication Abilities in Clinical Courses in Hospitals

Background: Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has established, improving communication as a priority for improving patient safety since 2006. Therefore, the present study aimed to evaluate nursing students’ communication abilities to recognize their strengths and weaknesses in communication skills. Method: This cross-sectional study was carried out in 2014. The study participants included all the nursing students who passed two semesters in Fatemeh School of Nursing and Midwifery in Shiraz, Iran. The students’ communication skills were assessed using a self-administered questionnaire. Then, the data were entered into the SPSS statistical software (v. 16) and analyzed using both descriptive (mean and percentage) and inferential statistics (Pearson correlation and ANOVA). Results: Among the 200 students who completed the questionnaires, 58% were female and 42% were male with the mean age of 21.79 years (SD=2.14). The results of Pearson correlation analysis demonstrated a significant correlation between the nursing students’ clinical communication behavior scores and treatment communication ability scores (P<0.001). The findings demonstrated that most nursing students required improvement in their communication skills in both clinical communication behavior and treatment communication ability. Besides, a significant difference was observed among the students of different terms regarding clinical communication behaviors (P≤0.05), but not concerning communication abilities. Nursing students in higher semesters had better communication skills. Conclusions: The results showed that nursing students in this university had a moderate ability in clinical and treatment communication. Thus, paying attention to standard education, curriculum revision, and adding some specific theoretical lessons for improving communication skills are mandatory during the bachelor’s degree.

blood pressure, pain, and anxiety during hospitalization (Reader, Flin, & Cuthbertson, 2007). On the other hand, failure in communication could lead to stress, errors in diagnosis, decrease of patient participation in care plans and information exchange, poor outcomes, and even death (Fallowfield, Saul, & Gilligan, 2001;Greco, Spike, Powell, & Brownlea, 2002;Leonard, Graham, & Bonacum, 2005;Meyer & Arnheim, 2002). Recent studies showed that most medical errors were not really due to defect in medical technologies or negligence of healthcare providers; rather, they were absolutely related to ineffective communication between patients and physicians (Xie et al., 2013).
Despite the effect of communication skills on the quality of nursing care and patient improvement and participation in care, the results of different researches showed that nurses were not successful in communicating with patients and families (Chant, Jenkinson, Randle, & Russell, 2002;McCabe, 2004;A. R. Zamani, Shams, Farajzadegan, & Tabaeian, 2003;A. Zamani, Shams, & Moazzam, 2004). Nurses communicated with patients for a very short period of time, they talked with patients superficially, and the communication was always about physical needs and little attention was paid to psychological needs (Krautscheid, Scholarship 2008;Sabet Sarvestani, Moattari, Nikbakht, Momennasab, & Yektatalab, 2013). This problem is evident in nursing students, too. Zay et al. in a descriptive study showed that 88.1% of nursing students had poor skills in clinical, treatment, and interpersonal communication (Xie et al., 2013) . Besides, Sabzevari et al. showed that nurses' performance was almost favorable in starting the conversation and interactive skills, intermediate in following the problems and describing the current disease, and completely inappropriate in terminating the conversation (Sabzevari, Soltani Arabshahi, Shekarabi, & Koohpayehzadeh, 2006).
Communication skills used in nursing and treatment communication behaviors are the most important skills that aim to resolve some main problems of communicating (Swinny & Brady, 2010). Expressing support, providing information and feedback, giving hope to patients, and helping them cope with anxiety are some examples of treatment communication behaviors (Elizabeth, 2006).

Since communication between nurses and patients is a core principle in patient care and Joint Commission on
Aaccreditation of Health care organizations (JCAHO) has established improving communication as a priority for improving patient safety since 2006 (Schroeder, 2006), recognition of nursing students' strengths and weaknesses in this regard is a priority for planning and modification in future. Therefore, the present study aims to evaluate and analyze different communication skills in nursing students.

Method
This cross-sectional study was carried out in Fatemeh (P. B. U. H) School of Nursing and Midwifery in Shiraz, Iran in 2014. The study participants included all the nursing students who had passed two clinical semesters in this school. The study was approved by the Research and Ethics Committee of Shiraz University of Medical Sciences and after an explanation of the study objectives, written informed consent for taking part in the study were obtained from all the students. The nursing students' communication skills were assessed using a self-administered questionnaire which consisted of three different parts. The first part of the questionnaire was related to the demographic data. The second part which involved treatment communication behaviors contained 9 items and 42 subscales. These 9 items included sharp listening, effective transfer of information, participation, establishing harmonized relationships, preparation for communication, effective improvement, process control, ending communication work, and self-evaluation. The 42 subscales were responded through a 5-point Likert scale ranging from 1 (never) to 5 (always), but the last question was self-evaluation and scored as well, approximately good, no idea, approximately week, and week. The last part of the questionnaire was related to clinical communication behaviors and included the following 8 items: communication with schoolmates in the clinical setting and university, clinical teachers, theoretical teachers, patients' family members, doctors, and other personnel. These items were scored through a Likert scale ranging from 1 (very comfortable) to 4 (very hard), but the last question was self-evaluation and scored as very well, well, no idea, weak, and very weak. After all, the data were entered into the SPSS statistical software (v. 16) and analyzed using descriptive and inferential statistics. Besides, P<0.05 was considered as statistically significant.

Reliability and Validity
At first, the original Japanese version of the questionnaire (Xie et al., 2013) was translated into the target language (Persian) by a bilingual translator. Then, the psychometric characteristics of the translated version were evaluated using two methods of random probe and committee approach. In random probe, the researcher asked 20 individuals of the target population to answer the following questions: "What do you think the question is about?" and "What do you mean?" and also determine if any item of the translated form was ambiguous or not understandable. If discrepancies were found, the related items were revised. In committee approach, on the other hand, 6 experts reviewed the clarity and linguistic appropriateness of the translated version of the questionnaire www.ccsenet.org/gjhs Global Journal of Health Science Vol. 7, No. 4;2015 and the necessary changes were applied. The face and content validity of the items were examined with the help of 6 experts in the field of nursing and psychometric. Also, the items were assessed with respect to comprehension, ambiguity, clarity, and relation to the study objectives. In addition, the reliability of the questionnaire was confirmed using Cronbach's alpha test.

Results
In this study, 200 students in practical clinical training completed the questionnaires. The mean age of the participants was 21.79 years (SD=2.14), 58% were female, and 42% were male. Other demographic characteristics of the participants have been presented in Table 1. The results of Pearson correlation analysis demonstrated a significant correlation between the nursing students' clinical communication behavior scores and treatment communication ability scores (r=0.352, P<0.001). Also, a significant correlation was observed between the students' educational semester and their clinical communication behavior scores (r=0.21) and treatment communication ability scores (r=0.132) ( Table 2).