Correlation between Proficient Communication Skills and Nurses’ Performance
Nurses’ professional competence is formed on the basis of necessary medical skills, scientific knowledge, and moral values. Its main components are the ability to acquire and use knowledge, integrate it with the help of clinical thinking, as well as implement and transmit it in the process of communication with patients and colleagues, guided by ethical principles (Abdolrahimi, 2017). The Declaration of the World Federation for Medical Education established that every patient should be able to receive treatment from a medical professional who is an attentive listener, a careful observer, and an effective clinician with high sensitivity in the field of communication (Walton, 1993). The key to correct diagnosis and treatment is precisely an effective communication process (Noviyanti et al., 2017). The use of communication skills by nurses has a positive impact on their professional performance.
Numerous studies conducted in healthcare settings around the world have shown significant differences in treatment outcomes between healthcare professionals who are proficient in communication skills and those who do not attach importance to these skills in their work. Such studies were performed both in institutions providing primary health care (ambulance stations, surgical departments) and in institutions providing specialized care (oncological, therapeutic, pediatric, and others). More successful in their activities were the specialists who correctly used their communication skills (Pun et al., 2015; Stovall, 2015). Thus, it is crucially important to develop the communication skills of all nurses before entering real-life interactions with patients and interprofessional teams.
The development of communication skills among nurses is an important independent task of professional education. It was officially enshrined by the World Health Organization (World Health Organization, 1993). Studies show that at the beginning of training, students interact with the patient by imitating the facial expressions, gestures, posture, and style of behavior of the teachers whose work they observe (Lee et al., 2018). With the accumulation of experience in professional communication, the young specialist has already consciously begun to use a variety of psychological skills that facilitate communication with the patient. The longer the work experience of a nurse, the more attention they pay to the psychological aspects of diagnostic and therapeutic processes, which largely ensure the effectiveness of professional interaction (Kim & Jang, 2019). Thus, nurses’ skills should include not only medical professional training but also communication competencies based on interdisciplinary training.
Virtual Platforms and Simulation Implication for Social Skills Improvement
The main motivation for developing various simulators is to bridge the gap between students’ theoretical knowledge and their communication skills in a real clinical environment. The second reason for the introduction of virtual technologies is the need to standardize the assessment of the clinical and diagnostic competencies of nurses and the possibility of repeating the clinical situation the required number of times, exploring various strategies and options for action (Foronda et al., 2020). One of the formats of simulation training is the use of virtual patients. In the scientific literature, one can find a different understanding of the term “virtual patient”: computerized robotic simulators, standardized clinical cases performed by actors, and computer multimedia simulations of clinical situations. Currently, standardized patients are widely used in Europe and the United States to assess the clinical competence of nurses, including as part of government licensing programs. The area of this review is, in a sense, the “polar” format of simulation, used not for practicing manual techniques but for developing clinical thinking and professional communication skills.
There has been a fruitful stream of research dealing with virtual training implementation for nurses and the medical profession in general. The results of the first attempts to use computer simulations to train doctors, nurses, and students were published in the 1960s – 1970s. (Harless et al., 1971; Ellaway, 2019). Since then, these technologies have been used in different fields of medicine and for different groups of students, but systematic use began in the United States and Western Europe only in the 1990s. The term “virtual patient” has become widely used in foreign scientific publications after a number of works. The literary review of Kononowicz et al. (2015) considered the meaning of this term used in 536 articles: 37% of publications dealt with interactive imitations of the therapeutic and diagnostic process on robots, 19% – talked about computer simulations of clinical situations, 16% – about standardized patients performed by actors (p.18). Continuing this work, the authors analyzed 185 definitions of a virtual patient and built a conceptual map of this subject area (Hege et al., 2016, p.149). Solving situational problems in the course of studying individual diseases has always been part of the training process for future nurses. In an expanded form, they are cases that contain multimedia data from a patient’s examination and are used to analyze the information when solving medical and diagnostic problems (Williams et al., 2020). The case method ensures the strength and consistency of knowledge and a process approach to decision-making; important components of the case method are the assessment of the student’s actions and the explanation of the mistakes made (Liaw et al., 2019). Educational technologies using clinical cases are considered in a number of works both at the level of conceptual models and practical use.
It can be noted that the main goal of working with the use of simulation technologies is to increase the efficiency of mastering manual, therapeutic-tactical, and communication skills. It is usually done by introducing high-tech robotic dummies and virtual simulators into the educational process to improve the quality of training of a future medical practitioner (Verkuyl & Mastrilli, 2017). The use of simulation simulators in the educational process contributes to the mobilization of the knowledge of students, and future specialists in the field of medicine, through the use of various means of working out practical professional skills, technical support, and emotional support, which contributes to the implementation of their motivational-value attitude to future professional activities. Thus, virtual training in communication skills has proved fruitful and promising in nursing.
Poor Communication Skills in Student/Novice Nurses and Gaps in Addressing Them
One of the main problems of modern medical education is the difficulty of developing the skills of effective professional communication among specialists, both in interdisciplinary teams within the organization and with patients. It includes verbal and non-verbal communication tools, methods for improving interpersonal interactions, and deepening self-control and self-awareness. It also involves psychological techniques such as active listening, differential questioning, competent communication, and gentle communication of potentially traumatic information to the patient (Kim et al., 2018). Psychologically sound approaches aimed at activating the patient, forming a constructive dialogue, developing a partner position, joint therapeutic decision-making, counteracting assessment, and working with psychological resistances, are also of great importance (Niemeyer, 2018). Thus, the list of communication skills required by nurses is extensive.
Despite different definitions of communicative competence, most researchers agree that the communicative competence of a nurse can be characterized as a certain level of formation of interpersonal and professional experience in interacting with others, which is necessary for an individual to function successfully in the professional sphere and society (Hemberg & Vilander, 2017). This definition focuses on the experiential basis of skills acquisition.
The experience of a nurse is formed inside and outside of professional training and is developed in a broader cultural context. The communicative culture of a nurse also assumes that they have certain professional views and beliefs, an attitude towards an emotionally positive attitude towards the patient, regardless of their personal qualities, and a whole range of communication skills and abilities necessary for a specialist for medical interaction (building a therapeutic alliance with a patient) (Bennet, 2017). Thus, it follows from this definition that a nurse, when implementing her communication skills, focuses not only on experience but also on a wider background. It is he who often remains outside the scope of research in relation to improving the communication skills of students and young professionals with the help of a variety of tools and, first of all, with the help of virtual simulation.
Thus, one essential gap in the current literature concerns nurses’ cognitive and socially determined strategies for communication development. These can include not only racial and socio-economic variables but also more subtle features like coping strategies, ways of a situation assessment, and others. This study is going to address this gap by pointing out two different modes of communicative strategies. First, there are people who constantly monitor themselves, are well aware of where and how to behave, and control their emotional manifestations. At the same time, they might experience significant difficulties in the spontaneity of self-expression, and they do not like unpredictable situations. Second, there are spontaneous and open people who can be perceived by others as overly direct and intrusive. In addition, since the nurse interacts with the patient for much longer than the doctor, the level of empathy must be included in the consideration. The inclusion of this variable in the development of a virtual platform for social skills improvement will make the program more sensitive and effective in relation to the relationship between simulation and real practice.
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