Impact of Communication Skills between Patients and Nurses on Nursing Care Outcomes - Research Proposal Example

Impact of communication skills between patients and nurses on nursing care outcomes Name: Tutor: Course: Date: Table of Contents Table of Contents 2 1.1 Introduction 3 1.2 Statement of aims and objectives 5 1.2.1 Objectives 5 1.2.2 Hypothesis 5 2.0 Research approach 5 2.1 Methodology and design 5 2.1.1 Electronic searches 6 2.1.2 Types of participants, interventions and outcomes 6 2.2 Data collection and analysis 7 2.2.1 Data extraction and management 7 2.2.2 Quality assessment of the procedure 7 2.3 Rigor and quality considerations 9 2.3.1 Instruments to measure nurse and patient outcomes 9 2.3.2 Mitigating risk of bias in the included studies 9 3.0 Ethical considerations and interpretation of previous discussions 10 References 14 1.1 Introduction Every patient requires individualized nursing care from nurses. Successful outcome of this individualized care is facilitated by good communication between patients and nurses. While nurses devote most of their time to communicate to patients about their disease and treatment, they need to do so with sincerity, kindness and courtesy. Good communication is based on experience, education and physical abilities of nurses that create a therapeutic effective relationship that guarantees patients support, comfort, empathy and understanding. Several studies claim that communication skills lead to positive patient outcomes (Kruijver et al., 2000; Asnani, 2009; Lein & Wills, 2007; Duffy et al., 2007; and Moore, 2003). Asnani (2009) observes that the patients’ capacity to adopt preventive health behaviors, self-manage a chronic medical condition and follow medical recommendations highly depends on communication skills of the healthcare team. Experience of care and patient satisfaction relating to their functional and biological health outcomes is affected by the ability of the clinician to empathize, listen and explain (Duffy et al., 2007). The Royal College of Physicians (2014) published a report in England relating to the end of life care in British hospitals. The report found that found that just some few days to the death of the patient is when most of the serious discussions with families and friends took place. From these findings, it is evident that healthcare givers have some degree of reluctance to engage in these sensitive discussions. If this could have been done earlier, families could have been contended with the illness of their loved ones. This reluctance is not only exhibited by nursing staff but also by multi-professional team members spread across community, hospital and health and social care settings. According to the report, training in communication skills is highly recommended or if possible made mandatory for all staff caring for patients with life-limiting illnesses (Bramhall, 2014). Where there is confidence and competence among healthcare professionals, it is possible to engage in more sensitive discussions relating to dying patients (Wilkinson et al., 2008). In addition, those close to the patients will be able to adjust to the situation and adequately prepare. As a result, training of nurses and staff involved in communication skills is vital. Promoting effective communication is complex, challenging and demanding in health care settings due to stressful and pressurized work environment that nurses are subjected to (Neese, 2015). More often this environment has little or no time for communication (Bramhall, 2014). In the future, nurses require high-quality, evidence-based training and support to be able to meet these challenges. Nurses who feel confident and competent in their roles are those who receive regular training on communication skills (Connolly et al., 2010). Good communication has huge benefits for healthcare professionals, carers and patients (Department of Health, 2012). It influences their function and physiological measures, symptom resolution and emotional health. Consequently, there is reported reduction in drug use and pain (Brouwer et al., 2014). Most nurses can remember patient who felt less anxious and frightened by communicating to them and easing their pain. Pain increases potentially due to fear (Otley, 2011). This situation can impede the birthing progress, especially in the labor ward. Increases in nursing communication create positive patient outcomes and lessen medical errors. A study by Papagiannis (2010) found that medical errors rate decreased by 23 percent in nine children’s hospitals after a standardized handoff communication program. Effective communication leads to adherence to treatment options, improved patient satisfaction levels, a sense of safety and increased recovery rates. However, Kourkouta and Papathanasiou (2014) argue that it is not sufficient for nurses understand the patient only and should aspire to convey messages that are acceptable and understandable to patients and their families. Conversely, most medications and treatments have been missed because of incomplete communication between nurses and patients. Furthermore, communication breakdown is more likely to cause negative outcomes (Wanzer, 2004). Moore et al. (2003) suggests that experience do not reliably improve communication skills and considerable effort may be required through evidence-based teaching and practice among health professionals. As a result, effective communication training programs for nurses is required to observe their behavioral change which will lead positive changes in patient outcomes (Wood, 2016). Nursing care outcomes are skills measured on validated and objective scales or changes in behavior (Anoosheh et al., 2009). While most hospitals and healthcare units have made great attempts to improve physical facilities, remuneration and availability of drugs in their facilities, without good communication skills it is difficult to realize positive patient outcomes. It is inadequate to consider only changes in knowledge or attitudes without examining the resulting changes in behavior of the health professionals. For example, patients and their families are sensitive to tone of voice, eye contact and body language expressed by the caregivers. While the quality and availability is variable with respect to communication skills training, there is proven positive effect on clinical practice through some workshops with clear evidence of participation and attendance. This study will assess the impact of communication skills between patients and nurses on nursing care outcomes. 1.2 Statement of aims and objectives The aim of this study is to assess the impact of communication skills between patients and nurses on nursing care outcomes 1.2.1 Objectives a) To examine the relationship between nurse experience and communication skills in healthcare settings b) To evaluate the effect of communication training programs on nursing care outcomes c) To explore the effect of communication skills on nursing care outcomes 1.2.2 Hypothesis H10: There is no statistically significant relationship between nurse experience and communication skills in healthcare settings H20: Communication training programs have no impact on nursing care outcomes H30: Communication skills have no influence on nursing care outcomes 2.0 Research approach 2.1 Methodology and design This study will involve classic experimental research approach. The secondary searches are expected to use randomized design based on pretest-post-test techniques. This will be a secondary research study involving cluster randomized studies and randomized controlled trials (RCTs) based on databases running from 2000 to 2012. The database searches will use the MEDLINE strategy. All the studies that meet these criteria will be included in the study. The following databases will be used; MEDLINE (1986-November 2012), SINGLE (2002-November 2012), CINAHL (1992-November 2012), CENTRAL (Cochrane Library, Issue 3, 2012) and AMED (1995-October 2012). Also Evidence-Based Medical Reviews (2000-June 2012) and Dissertation Abstracts International (1960 to March 2013). Bibliographies of other relevant studies will be search. There will be no language restrictions. Irma (2000) argues that there were scarce studies on training programs to improve the communication skills of nurses. Majority of these studies have been done as from early 1980s. As observed, most of the searches will be done between 1986 and 2013. 2.1.1 Electronic searches The electronic searches will include the following terms; 1 exp communication/ 2 exp education, continuing, nursing/ 3 exp palliative care/ 4 exp oncology nursing/ 5 (communicat or interview) 6 (palliate$ or cancer$ or hospice$ or oncol$ or terminal$) 7(evaluate$ or outcome$ or result$ or measure% or critique$) 8(train$ or teach$ or workshop$ or learn$) 9(nurse experience$ or skills$ or nursing care$) 2.1.2 Types of participants, interventions and outcomes Participants will be all the qualified health professionals including allied health, nursing and other medical professionals. These participants are predominantly nurses and can also include physicians, psychologists, dieticians, nursing and medical students. These participants will be working within ambulatory care settings, hospices and hospitals in-charge of patients with life-limiting illnesses such as cancer and diabetes. Special attention goes to the participants who work in the general health care setting, psycho geriatric setting, psychiatric setting and oncology setting. Due to variation in groups, training of intermediaries such as self-help groups, advocates and interpreters will not be considered. Studies with intervention groups in which communication training or teaching of communication skills has been undertaken will be included. The experimental group will have mode of training as role play, didactic teaching, distance learning, audiotape feedback and study days, videotapes, group discussion and workshops. These methods have been used in several research studies to assess communication skills. On the other hand, the control group will receive nothing beyond the alternative training given to the intervention group. Outcomes are skills measured in validated and objective scales or changes in behavior observed. Many of the observed measures are study specific for use in evaluating communication and observational rating scales (Bowles et al., 2001). Studies that do not examine changes in behavior despite showing attitudinal change as outcomes will be excluded from the study. It is sometimes over-optimistic to show self perceived improvements (Chant, 2002). Working experience of participants to be included in the study is expected to change upon training though more is expected in terms of behavioral change from nurses with little experience. The behavior and communication skills of nurses working in the oncology settings caring for cancer patients is expected to get more attention. Also, most of the participants to be expected are student nurses and registered nurses (RNs). Most of the studies are expected to document the working experience of nurses. Regarding the training program, focus will be on communication skills taught to improve interactions between patients and nurses. These trainings are expected to facilitate skills and encourage patients into disclosing the concerns about the behavior of nurses and carers after the training programs. The training program will be evaluated based on the decrease in the stress of nurses, positive change in the attitude of nurses regarding their work environment and improvement in their communication skills. Studies to be considered are those laying emphasis on patient compliance and communication skills. The training program will be expected to teach the chosen participants on how to optimize psychosocial treatment and provision of patient friendly environment for patients with life-limiting illnesses. 2.2 Data collection and analysis 2.2.1 Data extraction and management The overall results of the studies will be recorded and reviewed in the data extraction sheet to determine inter-trial heterogeneity. Two tables will be generated from the data extraction sheet; characteristics of Excluded studies and characteristics of included studies. Included studies will be those studies with details sufficient to be included in the review while excluded studies comprise those studies whose details could not qualify for inclusion into the review based on the required methodological criteria. 2.2.2 Quality assessment of the procedure Three independent reviewers will assess the quality of each study to determine their eligibility. Available data will be recorded on suitable software such as RevMan software on issues that will be extracted. The criteria for quality assessment will be based on the method of randomization, concealment of allocation, and blinding among others. Regarding the method of randomization, the quality of randomization will be classified methodologically as adequate, unclear or inadequate. Adequate randomization is one with pseudo-random or random sequence. For example, computer-generated randomization may have low risk of bias of random numbers while the unknown risk of bias is attributed to unclear randomization. On inadequate randomization, it can assume high risk of bias such as subjects approached on alternate days or tossed coins. Regarding concealment of allocation, the assessment will be adequate, unclear or inadequate. Adequate may mean enrolling investigators and is concealed from patients (Schofield et al., 2008). Unclear randomization is low risk and can include third party or computer, opaque sealed envelopes or serially numbered randomized envelopes. On the other hand, inadequate is based on the day of week or on subject’s name. Under blinding, the study of communication skills training of the providers of the training and the subjects will be known. This underscores the specific arm of the study that the training has been allocated. However, the people concerned with the assessment of training outcomes could or could not be having any knowledge of the study arm that the subjects fall in. Therefore, protection against detection bias will be assessed by finding out the any existence of blinded assessment of primary outcome(s). Assessment of the record of recruitment and dropouts will depend on whether the sample that will be invited to participate comprise a volunteer or convenience sample, a random or systematic sample, all available participants or not sufficiently described. It will also be critical to the actual number of participants that will be recorded such as those to be included within the final analysis and those invited to participate. Validity and reliability will be key methods to assess communication and outcomes. As well, the other issues in the quality assessment of the procedure to be taken into consideration will be will be the length of follow -up, sample size and cluster randomized studies. To know if the analysis accounts for the cluster randomization then cluster randomized studies will be undertaken. This randomization, if found before and after controlling the studies will be assessed on protection against contamination, using second site as control to understand the characteristics for studies, use of appropriate statistical methods, similarity of intervention and treatment groups and comparability of groups established. Furthermore, the similarity of intervention and treatment groups will take into consideration the outcome variable at baseline and the relevant demographic characteristics. In addition, it will look into how the suitable the statistical methods were applied such as multivariate methods and the analysis of covariance. 2.3 Rigor and quality considerations The studies will be analyzed, if explicitly documented, to determine the nature of inter-rater reliability of the coding systems. Studies with the Cronbach‘s coefficient above 0.7 will be regarded as appropriate while correlations above 0.5 will be termed as significant. As well, the kappa coefficient will vary from p Read More