Statement of purpose
In the broadest sense, communication is a message, the transfer of the necessary information, which occurs through communication (verbal or non-verbal). The professional communication skill of a nurse implies a communicative action consciously performed by them to solve a specific problem. Together with a set of necessary knowledge, manual skills, and clinical thinking, this skill is an integral part of general professional competence. Communication skill is a medical aid tool of the modern nurse, and it requires particular time to form. At the same time, the methods and techniques themselves of nurses’ communication skills need to improve and be upgraded as well constantly.
This research focuses on preparing students for real-life communication topics in the medical world with the help of a newly developed process that combines virtual techniques with actual interactions. Thus, the expected accomplishments include increasing nursing students’ ability to communicate effectively and developing their professional communication skills. However, in order to develop a program that is theoretically grounded and ready to be transferred into general training practice in medical, and educational institutions, it is necessary to outline and study variables that are vital for the process. The study aims to examine variations in experiences and sensations in different communication situations in potential clinical practice. With the help of simulations of such situations, the study will identify possible opportunities and limitations of teaching communication skills to nursing students and novices using online technologies. The aim of empirical research is, therefore, to create a sound theory of difficulties, obstacles, psychological and varied non-verbal barriers to learning, as well as benefits and positive experiences. The creation of such a theory in the future will help to develop a standardized program for teaching social and communication skills communication practice via virtual platforms. In addition, the study also seeks to assess the participants’ experience in assessing learning progress. Thus, the study design is intended to provide an empirically valid theory for answering the research questions posed.
The population studied is nursing students and novices who are about to enter their clinical practice and/or have just started working in a medical facility or elsewhere as a nurse. The sample population from the general population was carried out by haphazard selection, that is, selection on the principle of voluntariness and availability of the entry of units of the general population into the sample. The most accessible respondents are selected to participate in the research from the side of students. The size and composition of the haphazard sample were not known in advance and were determined by only one parameter – the activity and availability of the participants. Such type of sampling is used in this study because of its economy, and in this study, the formation of a sample population in any other way is simply impossible. Knowledge of the English language was also an important selection criterion for the study participants since entry into clinical practice presupposes an English-speaking environment.
Description of the methodology
The study was conducted following a mixed-method strategy. Since there have been two streams of data collection, the description will outline both qualitative and quantitative methods applied to the analysis of the obtained data. First, the study involved gathering data from the participants concerning their feedback in terms of experiences and perceptions. The qualitative method of grounded theory was applied, specifically in the two first stages: open coding and axial (theoretical) coding, in order to conceptualize, generalize, and test the concepts and their interrelation with other relevant variables.
This study focuses on systematic design as it provides the most rigorous and structured procedural guidelines for conducting research based on a “grounded theory” strategy (Guetterman et al., 2019). This rigor is provided primarily due to the need to focus on the paradigm model, which is a sequence of the following elements: (A) Causal conditions → (B) Phenomenon → (C) Context → (D) Intermediate conditions → (E) Action/interaction strategies → (F) Consequences (Vollstedt & Rezat, 2019). As used in this study, a grounded theory can be defined as a qualitative research method that uses a systematic series of procedures to develop an inductively derived grounded theory of the phenomenon under study (Charmaz & Belgrave, 2019). These procedures primarily include the use of theoretical sensitivity, specific types of coding, and theoretical sampling. These research procedures are discussed in more detail in the Trustworthiness section. Thus, the chosen methodological approach creates, develops, and verifies the theory in different conditions through systematically collecting and analyzing data related to the studied phenomenon. Data collection, analysis, and theory are intertwined with each other.
The goal of grounded theory is to build a theory by rooting it as much as possible in the data. Thus, the choice of this method, rather than phenomenological, ethnographic, narrative, or historical, was dictated by the fact that only a well-founded theory can ensure that the goals of theoretical validation of the results are met. Of course, each of the listed methods has its own methods of theoretical validation. However, it is the grounded theory that makes it possible to obtain a consistent, systematic theory of the phenomenon under study, for which a generally divided conceptual framework has not yet been formulated (Charmaz & Belgrave, 2019). Since the project involves the development of a novel program for the training of nurses’ communication skills, the creation of a theory has yet to be created.
For the audio/video materials analysis process, a quantitative strategy is applied. The purpose of the analysis is to measure objectively manifested non-verbal communication signals that are theoretically linked to the expression of various experiences, perceptions, and intentions (Purnell, 2018). The method presupposes a descriptive analysis of the frequency and combinations of gestures, postures, intonations, and other manifestations. However, these descriptive characteristics will be correlated with the qualitative direction of the analysis, namely the study of the experience and impressions of the communicative scenario (Al Tawil, 2019). This step is also intended to ensure the study’s validity, which will be discussed in the Trustworthiness section. In this case, video materials represent a quasi-text that will be subjected to quantitative content analysis based on the selection of visual elements that are significant from the point of view of the goal and objectives of the study, the frequency of their appearance in the sample, and then the analysis of quantitative results. The coding of materials is based on the assignment of established categories and units of analysis to each video or audio. The quantitative analysis consists of the frequency of occurrence of the feature of the category of analysis, including binary analysis: is there a given element on the video/audio or not, as well as the calculation of the frequency of occurrence of this element within the boundaries of the communicative situation.
Data collection
Data will be collected in two ways. Participants will first need to involve in a communication scenario. These enacted situations will be recorded on audio and video recordings. Participants will be advised of the record-keeping and will be required to sign a separate consent to this to ensure ethical standards in the conduct of the study. Thus, this step provides the collection of data for quantitative interpretation. After the communicative situation has been played out, both parties (student and quasi-patient / colleague/patient/relatives) will be asked to give a short interview. This stage allows one to collect data for a reasonable interpretation. The result of data collection at this stage will be a series of audio and video materials for further encoding and quantitative analysis.
Whereas quantitative data collection requires only the technical side of the process, qualitative data collection requires the creation of a series of semi-structured interview guides to ensure that data collection is systematic and monitored by researchers. The questions in the guide will be directly related to variables of interest and relevant to the study. The major blocks of the guide will correspond to the main internal variables which follow the SPIKES model: Setting – establishment of contact, Perception – assessment of readiness for perception, Invitation – an invitation to dialogue, Knowledge – the message of information, Emotion – emotional support, Strategy and Summary – discussion of further actions and summing up (Hanya et al., 2017). Thus, the result of the collection of data at this stage will be a series of texts, which will be further analyzed using the method of grounded theory. The choice of just such a data collection technique is dictated by the best balance of convenience and compliance with the goals and objectives of the study.
The study involves the use of online technologies to play out communication situations and practice from anywhere in the world (which is especially important during the COVID-19 pandemic) (Sari & Nayir, 2020). Accordingly, all data will be collected online using specific programs and tools. Communication situations will be recorded using programs such as Skype, MSTeams, and Zoom. These programs allow the team to make an online meeting of all parties (student, other parties, and researcher), as well as to make a video recording. After the general conference, the researchers contact through the same program that was used to enact the communicative situation) one-on-one with the research participants and conduct a semi-structured interview with them. At the same time, participants can be in any place convenient for them; the main requirement is the absence of noise and a stable Internet connection.
Trustworthiness
In qualitative research, data quality is just as crucial as in quantitative research, and this research uses both strategies. Since, in the qualitative part of the study, epistemological and ontological premises differ from those in quantitative terms, in the former, trustworthiness is ensured by ensuring its credibility, dependability, confirmability, and transferability (Korstjens & Moser, 2018). Credibility means confidence in the accuracy of data and their interpretation (Korstjens & Moser, 2018). Research is also believable when third-party readers can recognize the relevant experience when faced with it after reading about it in the research. Another criterion for assessing the reliability of research results is dependability. In this case, the researcher should ask himself if the same results would be obtained if repeated interviews with the same participants or in a similar context.
Confirmability refers to the accuracy of research results based on the participants’ points of view. Thus, the research results should be clearly based on the opinions of the participants and not be a figment of the researcher’s imagination. The researcher’s motives, interests, biases, and points of view should not influence the research results. To ensure the credibility of the study, researchers must identify their own biases (Korstjens & Moser, 2018). Confirmability in the project is also provided by the internal logic of a grounded theory. Instead of labeling the studied experiences and practices, the researcher will code the research materials in vivo, thus reflecting in categories the immediate phenomena reflected and objectified by the participants themselves. In addition, another condition for ensuring the validity of qualitative research through the grounded theory method is theoretical sampling, i.e., a strategy that assumes a flexible variable change in the sample during the research process by attracting new people and information (Korstjens & Moser, 2018). In this study, the theoretical sampling is aimed at forming an exhaustive grid of categories that will reveal the source material in a variety of semantic shades. The selection of material and the attraction of additional data will be completed at the moment when theoretical saturation comes, that is, the highest degree of detail of the categories, when the attraction of additional data already fits into the formulated categories and does not bring new information.
Transferability (sometimes referred to as applicability and analog generalizability) is another measure of how well research can be transferable to other settings, contexts, or other groups (Korstjens & Moser, 2018). In this study, in order to meet this criterion, the detailed description necessary to allow the interested in the transfer to conclude that the transfer is possible will be provided. For example, medical educators can apply research findings to their own assessment methods that demonstrate that role-based video recording of communication situations helps students prepare for real-life clinical practice. To ensure the transferability of the study, a detailed description of the study methodology, in particular the approach to its conduct, the study participants, the study conditions, and the data analysis methodology, will be provided, which will allow other researchers also to determine the validity of the study results.
Triangulation and participant validation are sometimes used to validate research results. Triangulation means the use of different methods (for example, qualitative and/or quantitative) to check the validity of research results and to minimize the source of error (for example, researcher bias) (Korstjens & Moser, 2018). Triangulation also helps the researcher to understand the phenomena better. Triangulation, in this context, is a one-phase blended study design combining methods for collecting and analyzing qualitative and quantitative data. The mixed methods strategy used in this study makes it possible to obtain more reliable empirical data for the reason that the quantitative method complements and validates the overall qualitative strategy. When validating the study results, the research team will also ask study participants to review the study results and their interpretations as provided by the researchers. This will provide an excellent opportunity to substantiate the highlighted meanings, themes, and interpretation of research results.
References
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Hanya, M., Kanno, Y., Akasaki, J., Abe, K., Fujisaki, K., & Kamei, H. (2017). Effects of communication skill training (CST) based on SPIKES for insurance-covered pharmacy pharmacists to interact with simulated cancer patients. Journal of pharmaceutical health care and sciences, 3(1), 1-8. Web.
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