Ibero-American Consensus on Communication Skills for Nursing Degree students

Pérez-Martín, Ana María; García Madrid, Mercedes Gómez del Pulgar; Ruiz-Moral, Roger; Crespo-Cañizares, Almudena; Mena, Cristina García de Leonardo; Caballero-Martínez, Fernando

doi:10.1590/1518-8345.5653.3523

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 30 • 2022 • https://doi.org/10.1590/1518-8345.5653.3523 copy

Ibero-American Consensus on Communication Skills for Nursing Degree students

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

as a health care profession focused on caring for people, Nursing requires sound communication skills. Based on an international expert consensus, a proposal on learning outcomes in clinical communication for undergraduate Nursing education curricula in Spanish speaking countries is presented.

Method:

a steering committee, consisting of 5 nurses and experts in communication in health care sciences, drew up the first list of communication skills specific to the Nursing degree. Their proposal was reviewed and improved by a committee of 7 international scientific advisers. 70 experts from 14 countries were selected using a snowball sampling procedure and invited to participate in a distance modified Delphi consensus process in two survey rounds. Statistical analysis was carried out to establish the final consensus level for each item.

Results:

a questionnaire with 68 learning outcomes in clinical communications was submitted for panel assessment. In the first Delphi round, the panel reached a statistical consensus on all the items assessed. There was no need for a second round to reconcile positions.

Conclusion:

an academic proposal, approved by a high level of international consensus, is presented to guide and unify the learning outcomes on the clinical communication curriculum for undergraduate Nursing studies in Spanish speaking countries.

Descriptors:
Nurse-Patient Relations; Health Communication; Graduate Nursing Education; Learning; Consensus; Delphi Technique

A) COMMUNICATION WITH THE PATIENT
A.1. General aspects of the Clinical Interview with patients.Recognise the value of the clinical interview for the preparation of the care plan, knowing, integrating and structuring its different components.Learning outcomes:	x̄^*	M^†	IQR^‡	% out M^§
Describe the different communication skills (verbal and non-verbal), or relationship skills, needed to prepare history of care needs prepared by nurses.	8.01	9	2	9.46
Recognise the mechanisms through which clinical communication influences health care outcomes (Demonstrate kindness, empathy, interest, active listening, satisfaction, perceived self-efficacy, trust, increased adherence).	8.55	9	1	1.35
Carry out a personalised clinical interview integrating the contents of the Nursing context with the communication and relationship skills.	8.7	9	0.5	1.35
A.2. Tasks and Skills to communicate with patients.Learning outcomes:	x̄^*	M^†	IQR^‡	% out M^§
A.2.1. Establish and maintain a therapeutic relationship (Connect) (The student establishes and maintains a therapeutic relationship through a patient-centred approach)
Establish a nurse-patient relationship in which the patient feels comfortable and listened to regarding his/her needs.	8.69	9	1	0
Perceive the patient’s non-verbal language (mimic, kinaesthetic, proxemic, and tactile) and respond appropriately to the context.	8.53	9	1	1.35
Use medical history records (paper/computerised) in communication with the patient in a way that reduces or avoids interference.	7.69	8	2	13.51
Apply social skills to receive patients which encourage the establishment of an effective relationship (greet, call the patient by their name, make them feel comfortable, smile...).	8.78	9	0	0
Apply social skills to say goodbye to patients, which encourages maintaining an effective relationship (say goodbye cordially, accompany, thank...).	8.72	9	0	1.35
Recognise the patient’s emotions in different contexts, difficult situations and communication challenges (crying, strong emotions, interruptions, aggressions, anger, anxiety, sensitive or embarrassing issues, cognitive difficulties, bad news, first encounter...).	8.59	9	1	0
Respond emphatically (explore the origin of emotions, understand them and communicate understanding) to the patient’s emotions in difficult situations and communication challenges.	8.55	9	1	0
Establish a relationship with the patient based on respect and consideration of their rights, autonomy, beliefs, values and individuality as a human being.	8.72	9	0	2.7
Use a sense of humour in the relationship with the patient (in situations that require the surroundings to be relaxed, for the approach...).	7.85	8	2	13.51
A.2. Tasks and Skills to communicate. Learning outcomes with patients:	x̄^*	M^†	IQR^‡	% out M^§
A.2.2. Exchange information and understand it.
A.2.2.1. Obtain the information (The student collects the relevant information for the proper development of the Nursing work).
Recognise the advantages and disadvantages of different communication skills (open/closed questions, facilitation...) in order to obtain information.	8.19	8.5	1	1.35
Use verbal and non-verbal techniques of active listening (paraphrasing, facilitating speech, showing low reactivity, capturing clues, summarising...).	8.54	9	1	0
Summarise the information obtained as a form of verification to the patient.	8.41	9	1	4.05
Establish an adequate accompaniment of the physical examination (asking for permission, explaining what you propose to do and why, sharing the findings with the patient...).	8.69	9	0	1.35
A.2.2.2. Offer the information (The student offers the information in a clear and personalised way, which the patient needs to understand, accept, implement the plan of care).
Estimate the patient’s level of knowledge about their problem and how much they wish to know in order to deliver the amount of information they really need and can be given.	8.38	9	1	4.05
Adequately communicate risks and possible discomforts to the patient, during Nursing care.	8.61	9	1	1.35
Properly use information aids (written, graphical, etc.) and instructions to supplement verbal information when necessary.	8.51	9	1	0
Adapt communication to the patient’s level of comprehension and language, avoiding technical terms.	8.61	9	0	4.05
Provide information to the patient in a timely manner (appropriate circumstance).	8.47	9	1	4.05
Explain to the patient the benefits, risks and expected outcomes of interventions derived from the Nursing care process.	8.72	9	0	0
Check that the patient has understood the information provided, facilitating the expression of doubts.	8.74	9	0	1.35
Refer the patient to the most appropriate professional when the nurse’s level of competence in information requirements is exceeded.	8.53	9	0	5.41
Transmit information related to Nursing care, in a manner adapted to the patient’s degree of tolerance and needs.	8.54	9	1	1.35
Share, with the patient’s consent, the information with third parties (colleagues, family and others...), when both consider it necessary and/or if the patient requests it.	8.26	9	1	6.76
A.2.3. Agree and Assist the patient in carrying out what has been agreed on for the care plan (promote the patient’s participation, taking into consideration the patient’s capabilities to develop and implement the care plan proposed).
Identify and assume their Nursing role in the decision-making process of each patient’s individualised plan.	8.23	9	1	6.76
Explore the patient’s disposition and capacity (information, autonomy, trust, responsibility, psychological traits...) to facilitate their involvement in the care process.	8.53	9	1	1.35
Reach agreements with the patient using negotiation skills.	8.19	9	1	8.11
Clarify, when appropriate, how and when the agreed upon decisions should be taken (abandoning toxic habits, change of diet, etc.).	8.36	9	1	2.7
Share the range of possible consequences of a decision with the patient.	8.14	9	1	9.46
Offer the patient the option of involving third parties (colleagues, relatives) in the decision-making process.	7.71	8	2	15.07
B) COMMUNICATION WITH THE PATIENT’S FAMILY
B.1. The patient’s family context (The student recognises and evaluates the role of the family in the patient’s care and establishes effective communication with the family for the patient’s benefit).Learning outcomes:	x̄^*	M^†	IQR^‡	% out M^§
Request and evaluate relevant information from other family members and caregivers of the patient, if this is necessary and available.	8.29	9	1	5.56
Assist the family in the process of caring for minors or disabled patients (dementia, coma patients, incapacitating mental problems...).	8.51	9	1	2.74
Recognise specific communication challenges with family members (confidentiality, secrecy, the sick companion, the need to accompany...).	8.34	9	1	5.48
C) INTRAPERSONAL COMMUNICATION (SELF-PERCEPTION)
C.1. The nurse as a person (self-knowledge, self-reflection, self-criticism and self-care) (The student usually reflects on his/her behaviour and the way in which he/she communicates, developing and improving his/her self-knowledge, self-reflection, self-criticism, self-care).Learning outcomes:	x̄^*	M^†	IQR^‡	% out M^§
Distinguish the main sources of errors, related to communication failures that may jeopardize patient safety (poor information or assessment of patient needs, inadequate understanding...)	8.48	9	1	0
Recognise the cognitive biases (deficiencies or lack of knowledge updating) that hinder development of the Nursing work.	8.34	9	1	5.48
Recognise negative emotions (insecurity, antipathy, rejection...) that can make Nursing difficult, to distance oneself from them and create empathy.	8.37	9	1	4.11
Use strategies to reduce stress and overload (relaxation, reflection groups, Balint groups, supervision and support...).	8.26	9	1	10.96
Control one’s own emotional reactions and work efficiently, even in difficult situations (patient with high degree of suffering, demanding patient...).	8.47	9	1	0
Develop self-knowledge strategies required for the recognition of own biases, through the use of specific techniques (reflexive questions, observation with perspective, full presence [mindfulness], suspension of judgement, non-judgmental attitude, etc.).	8.36	9	1	2.74
D) INTER-INTRA-PROFESSIONAL COMMUNICATION
D.1. The nurse’s professional context: Inter- and intra-professional communication.(The student communicates efficiently with professionals who are part of his/her team or outside it).Learning outcomes:	x̄^*	M^†	IQR^‡	% out M^§
Facilitate the flow of information from the opinions in the team and willingly allow and accept that team members give diverse opinions.	8.41	9	1	5.41
Provide feedback to team members appropriately (first-person comments, highlight the positive first, do not judge).	8.47	9	1	1.35
Contribute effectively to continuity of care in reference/referral and return of patients between different care levels (primary, specialised).	8.43	9	1	1.35
Carry out clinical or scientific presentations in public effectively.	8.46	9	1	2.7
Give clear and precise instructions to team members.	8.47	9	1	4.5
Contribute to creating a positive work atmosphere through the use of collaborative, non-hierarchical strategies.	8.43	9	1	2.7
Maintain confidentiality about decisions made in the team.	8.64	9	0	2.7
Respect individuality, the subjective perception of team members and the mastery (expertise) of different health care professionals by accepting differences constructively.	8.61	9	1	2.7
Be assertive with the rest of the team members.	8.61	9	1	2.7
E) COMMUNICATION BY DIFFERENT MEANS
E.1. Communication Channels (The student efficiently uses different ways of communicating).Learning outcomes:	x̄*	M^†	IQR^‡	% out M^§
E.1.1. Direct communication (face-to-face).
Identify whether there is a discrepancy between the verbal and non-verbal components of communication.	8.38	9	1	1.35
Properly use proxemic communication (physical distance of communication).	8.26	9	1	6.76
E.1.2. Written communication.
Recognise the formats and supports of clinical histories and the documents usually used for written communication with patients and between professionals (discharge reports, referral, request for tests...).	8.61	9	1	2.7
E.1.3. Computer or electronic communication.
Manage information technologies (office automation, typing, e-mails, WhatsApp, web2.0...) in health care aspects, guaranteeing confidentiality.	8.35	9	1	8.11
E.1.4. Telephone communication.
Recognise the uses and limitations of telephone communication with patients.	8.2	9	1	8.11
Communicate by telephone with patients attending to the specific demands and communication adaptations that this medium requires.	7.54	8	2	16.22
F) COMMUNICATION IN SPECIAL SITUATIONS
F.1. Specific communication contexts (The student applies and adapts the core communication skills to specific clinical situations and uses specific skills that each situation may require).Learning outcomes:	x̄^*	M^†	IQR^‡	% out M^§
F.1.1. Sensitive situations.
Recognise delicate situations that represent communication challenges (such as giving bad news, dealing with end-of-life issues, mourning situations, sexual history, gender violence, child abuse, HIV infection, explaining situations of clinical uncertainty...).	8.49	9	1	5.41
Address delicate situations sensitively and constructively by applying specific strategies and skills that each situation may require, such as empathy and sensitivity.	8.77	9	0	0
F.1.2. Management of emotions.
Recognise situations of emotional tension in consultations (such as stress, fear, anger, aggressiveness, denial, collusion, shame...).	8.58	9	1	2.7
Address situations of tension in a sensitive and constructive manner by applying specific strategies and skills that each situation may require.	8.41	9	1	5.41
F.1.3. Cultural and social diversity. The student will be able to...
Recognise the patients’ cultural and social diversity (ethnicity, nationality, socio-economic status, language, religion, gender, values, sexuality...) and the communication difficulties that this entails.	8.5	9	1	5.41
Address the cultural and social diversity of the patient and family by applying specific strategies and skills that each may require.	8.45	9	1	4.05
F.1.4. Health promotion and behavioural change.
Identify the patient’s accessibility to adopt healthy behaviours.	8.43	9	1	5.41
Apply motivational and effective communication strategies to modify individual behaviours.	8.43	9	1	4.05
Promote the implementation of healthy behaviours through individual and group communication techniques.	8.43	9	1	5.41
Use group communication techniques to promote health and encourage the modification of healthy behaviours.	8.41	9	1	4.05
F.1.5. Specific clinical contexts.
Adapt communication skills and strategies to the different specific psychiatric contexts, patients with dementia, with sensory problems: auditory, visual, verbal expression.	8.62	9	1	1.35
F.1.6. Patients of different ages.
Adapt communication skills and strategies to different patients belonging to different age groups (children and parents, adolescents, elderly).	8.66	9	1	1.35

No.	Agreed items with mean scores > 8.306 (> percentile 75)	Mean
P2	Recognise the mechanisms through which clinical communication influences health care outcomes (Demonstrate kindness, empathy, interest, active listening, satisfaction, self-efficacy, self-perception, trust, increased adherence).	8.56
P3	Carry out a personalised clinical interview integrating the contents of the Nursing context with the communication and relationship skills.	8.60
P4	Establish a nurse-patient relationship in which the patient feels comfortable and listened to regarding his/her needs.	8.59
P5	Perceive the patient’s non-verbal language (mimic, kinaesthetic, proxemic, and tactile) and respond appropriately to the context.	8.43
P7	Apply social skills to receive patients which encourage the establishment of an effective relationship (greet, call the patient by their name, make them feel comfortable, smile...).	8.69
P8	Apply social skills to say goodbye to patients, which encourages an effective relationship to be maintained (say goodbye cordially, accompany, thank...).	8.63
P9	Recognise the patient’s emotions in different contexts, difficult situations and communication challenges (crying, strong emotions, interruptions, aggressions, anger, anxiety, sensitive or embarrassing issues, cognitive difficulties, bad news, first encounter...).	8.41
P10	Respond emphatically (explore the origin of emotions, understand them and communicate understanding) to the patient’s emotions in difficult situations and communication challenges.	8.45
P11	Establish a relationship with the patient based on respect and consideration of their rights, autonomy, beliefs, values and individuality as a human being.	8.63
P14	Use verbal and non-verbal techniques of active listening (paraphrasing, facilitating speech, showing low reactivity, capturing clues, summarising...).	8.33
P16	Establish an adequate accompaniment of the physical examination (asking for permission, explaining what you propose to do and why, sharing the findings with the patient...).	8.49
P18	Adequately communicate risks and discomforts to the patient, during Nursing care.	8.40
P20	Adapt communication to the patient’s level of comprehension and language, avoiding technical terms.	8.40
P22	Explain to the patient the benefits, risks and expected outcomes of interventions derived from the Nursing care process.	8.50
P23	Check that the patient has understood the information provided, facilitating the expression of doubts.	8.54
P25	Transmit information related to Nursing care, in a manner adapted to the patient’s degree of tolerance and needs.	8.34
P28	Explore the patient’s disposition and capacity (information, autonomy, trust, responsibility, psychological traits...) to facilitate their involvement in the care process.	8.34

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[1] Corresponding author
Ana María Pérez-Martín E-mail: a.perez@ufv.es