Knowledge, applicability and importance attributed by nursing undergraduates to communicative strategies

Dermani, Dantielen Bezerra; Garbuio, Danielle Cristina; Carvalho, Emília Campos de

doi:10.1590/0034-7167-2019-0411

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (6) • 2020 • https://doi.org/10.1590/0034-7167-2019-0411 copy

Knowledge, applicability and importance attributed by nursing undergraduates to communicative strategies

Conocimiento, aplicabilidad e importancia atribuidos por graduandos de enfermería a las técnicas comunicativas

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

To evaluate the knowledge, applicability and importance that nursing students attribute to therapeutic communicative strategies.

Methods:

This is a quantitative study (survey) with nursing undergraduates from a public institution. The online questionnaire by the SurveyMonkey tool, comprising the informed consent form and six questions, had its relevance, clarity and operability assessed by experts.

Results:

Of the 104 graduates, 50 participated in the study; the most well-known and applied strategy was Therapeutic Communication, followed by Ask-Tell-Ask, NURSE and Tell Me More; the least were PACIENTE and SPIKES. Most use the strategies they know best; all were considered important by at least 82% of the students.

Conclusions:

The partial knowledge and application of these strategies by the students contributes to reflect on the complexity of their teaching-learning process.

Descriptors:
Nursing; Teaching; Communication; Strategies; Health Communication

Communication strategies	Objectives
Ask-Tell-Ask	Approach to emotion 8.89%	Clarification of the information obtained 71.11%	-
Tell Me More	Approach to emotion 28.89%	Clarification of the information obtained 31.11%	-
NURSE	Approach to emotion 25.64%	-	-
SPIKES	Communicating difficult news 66.67%	-	-
PACIENTE	Communicating difficult news 13.79%	-	-
Therapeutic communication	Clarification of the information obtained 28.26%	Encourage feelings and thoughts expression 67.39%	Validation of the information obtained 26.09%

Questions	Item	Original Version	Experts' suggestions	Students' suggestions
Question 2	Content	Mark, in the appropriate column, your knowledge (I know, I do not know) of the intervention techniques (listed in the left column) used by nurse's when talking to patients.	Mark, in the appropriate column, your knowledge (I know, I do not know) of the intervention techniques, listed in the left column, used by nurse's when talking to patients.
Question 2	Alternatives	Ask tell ask, Tell me more, Nurse, Spikes, Paciente, Therapeutic communication.	Ask Tell Ask, Tell Me More, NURSE, SPIKES, PACIENTE, Therapeutic communication.
Question 3	Content	Regarding the communication techniques mentioned, mark the frequency you use each one (not used, less used, used moderately, used frequently).		Regarding the communication techniques mentioned below, mark the frequency you use each one (not used, less used, used moderately, used frequently).
	Alternatives	Ask tell ask, Tell me more, Nurse, Spikes, Paciente, Therapeutic communication.	Ask Tell Ask, Tell Me More, NURSE, SPIKES, PACIENTE, Therapeutic communication.
	Other changes	There was misspelling: frequently.	Frequently
Question 4	Content	Mark the techniques according to their respective objectives (right columns). There may be identical objectives in different techniques; in this case, you must tick the columns corresponding to each technique.	Mark the respective objectives in the communication techniques (right columns). There may be identical objectives in different techniques; in this case, you must tick the columns corresponding to each technique.	Indicate for each communication technique described below their respective objectives (right columns). There may be identical objectives for more than one technique. In this case, you must tick the columns corresponding to each technique.
Question 4	Alternatives	Ask tell ask, Tell me more, Nurse, Spikes, Paciente, Therapeutic communication.	Ask Tell Ask, Tell Me More, NURSE, SPIKES, PACIENTE, Therapeutic communication.
Question 5	Content	Mark all the steps listed in the left column belonging to each of the techniques mentioned	Mark, for each of the communication techniques mentioned, all the relevant steps listed in the left column.
	Alternatives	Ask tell ask, Tell me more, Nurse, Spikes, Paciente, Therapeutic communication.	Ask Tell Ask, Tell Me More, NURSE, SPIKES, PACIENTE, Therapeutic communication.
	Strategy steps	Item 9: Identify a problem in the patient's speech. Item 10: Encourage the patient to speak more on the problem Item 19: Uses silence therapeutically. Item 21: Verbalize interest in the focus of interaction. Item 27: Allow them to choose the subject Item 32: Use humor therapeutically Item 35: Ask to specify the agent of action	Identify a concern/emotion in the patient's speech. Encourage the patient to speak more on the problem Use silence therapeutically. Verbalize interest in the main objective of the interaction. Allow the patient to choose the subject. Use humor therapeutically. Ask to specify the agent of action.
	Other changes			Layout revision
Question 6	Content	Mark the level of importance (unimportant, less important, moderately important, relatively important, important) that you assign to each technique mentioned. Only one alternative for each technique must be checked.
	Alternatives	Ask tell ask, Tell me more, Nurse, Spikes, Paciente, Therapeutic communication.	Ask Tell Ask, Tell Me More, NURSE, SPIKES, PACIENTE, Therapeutic communication.
	Gradation of alternatives	Unimportant, less important, moderately important, relatively important, important.	Unimportant, less important, moderately important, very important.
Question 7	Content	Mark the order of importance you assign to each technique. Consider 1 for more important and 6 for less important.		Mark the order of importance you assign to each technique. Consider 6 for the most important and 1 for the least important. The same order of importance cannot be assigned to more than one technique
Question 7	Alternatives	Ask tell ask, Tell me more, Nurse, Spikes, Paciente, Therapeutic communication.	Ask Tell Ask, Tell Me More, NURSE, SPIKES, PACIENTE, Therapeutic communication.

Communication strategies	Steps/techniques	Percentage frequency
Ask-Tell-Ask	1. Ask the patient their question, or reason for interaction	50.00
	2. Talk about the subject in question	16.67
	3. Ask what the patient understood about what was said	64.29
Tell Me More	1. Identify a concern/emotion in the patient's speech	14.29
	2. Encourage the patient to speak more on the problem	61.90
NURSE	1. Name the patient's emotion	17.50
	2. Explain whether or not the patient's feeling was understood	17.07
	3. Express respect for the patient	26.19
	4. Show patient support	12.50
	5. Show interest in the patient's focus of concern	4.88
SPIKES	1. Plan the interview	9.52
	2. Assess how much the patient knows about their problem	7.14
	3. Get the patient's request about what they want and how far they want to know about their problem	4.88
	4. Transmit information	14.29
	5. Welcome the patient's emotions	2.38
	6. Devise a treatment strategy	9.52
PACIENT	1. Plan the interview	7.14
	2. Assess how much the patient knows about their problem	9.52
	3. Get the patient's request about what they want and how far they want to know about their problem	9.76
	4. Transmit information	4.76
	5. Welcome the patient's emotions	4.76
	6. Devise a treatment strategy	4.76
	7. Do not abandon the patient	7.14
THERAPEUTIC COMMUNICATION	EXPRESSION CATEGORY
	1. Listen reflectively	57.14
	2. Use silence therapeutically	64.29
	3. Verbalize acceptance	43.90
	4. Verbalize interest in the main objective of the interaction.	38.10
	5. Use open or reticent phrases	28.57
	6. Repeat the patient's last words	14.29
	7. Ask questions	4.88
	8. Return the question to the patient	4.88
	9. Use descriptive phrases	17.07
	10. Allow the patient to choose the subject	30.95
	11. Focus on the main idea	14.63
	12. Verbalize questions	7.14
	13. Say no	28.57
	14. Encourage feelings and thoughts expression	38.10
	15. Use humor therapeutically	54.76
	CLARIFICATION CATEGORY
	16. Encourage comparisons	12.20
	17. Ask to clarify unusual terms	7.32
	18. Ask to specify the agent of action	11.90
	19. Describe events in logical sequence	9.76
	VALIDATION CATEGORY
	20. Repeat the patient's message	9.52
	21. Ask the patient to repeat what was said	9.52
	22. Summarize the content of the interaction	16.67

Strategy	Use n (%)
Strategy	No	Low	Moderately	Frequently	Total
THERAPEUTIC COMMUNICATION	0	3 (7.89)	12 (31.57)	23 (60.52)	38
ASK-TELL-ASK	2 (6.89)	3 (10.34)	13 (44.85)	11 (37.93)	29
TELL ME MORE	3 (13.63)	0	11 (50.00)	8 (25.00)	22
NURSE	3 (12.00)	7 (28%)	8 (32.00)	7 (28.00	25
SPIKES	4 (40%)	1 (10.00)	3 (30.00)	2 (20.00)	10
PACIENTE	1 (7.14)	3 (21.42)	3(21.42)	7 (50.00)	14

Strategy	Knowledge	Importance				p value
Strategy	Knowledge	None	Low	Moderately	High	p value
ASK-TELL-ASK	I know	0	1	2	22	0.001^* * p<0.05 Fisher's exact test
ASK-TELL-ASK	I don't know	0	0	6	2	0.001^* * p<0.05 Fisher's exact test
TELL ME MORE	I know	0	0	2	18	0.096
TELL ME MORE	I don't know	0	0	5	9	0.096
NURSE	I know	0	1	3	17	0.135
NURSE	I don't know	0	1	5	6	0.135
SPIKES	I know	0	0	1	6	0.303
SPIKES	I don't know	0	2	10	13	0.303
PACIENTE	I know	0	0	3	10	0.551
PACIENTE	I don't know	0	1	7	11	0.551
THERAPEUTIC COMMUNICATION	I know	0	0	2	33	1.000
THERAPEUTIC COMMUNICATION	I don't know	0	0	0	1	1.000

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[1] Corresponding author: Emília Campos de Carvalho E-mail: ecdcava@eerp.usp.br