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339
Patients’ satisfaction about nurses’ competency in practicing communication skills
1Ayman M. Hamdan-Mansour RN, MS.N, PhD, 2Ahmad E. Aboshaiqah, BSHA, BSN, MS, MHHA, PhD, 3Imad N.
Thultheen, 4Wisam M. Salim RN, CNS, 5Saleh N. AzzeghaibyPhD, 6Muna A. Anani RN, PhD
1 Professor, Head of Department of Community Health Nursing. Faculty of Nursing-The University of Jordan.
Amman 11942, Jordan. Al Farabi College, Riyadh, 11514, KSA. Tel:( 962 6) 5355000/ 23108, 23183, (962 79)
6383002, Email: a.mansour@ju.edu.jo,
2Assistant professor, Nursing Administration and Education Department. College of nursing –King Saud University
Riyadh 11492, KSA. Tel: 00966503154993. Email: aaboshaiqah@ksu.edu.sa
3 Lecturer, Department of Medical
Surgical Nursing. College of Nursing-King Saud University. Riyadh 11421, Saudi Arabia. Tel:( 966 1) 4693618.
Cell: 00966 559010410. Email : ithultheen@ksu.edu.sa
4Lecturer, Department of Medical Surgical Nursing. College of Nursing-King Saud University. Riyadh 11421, KSA.
Tel:( 966 1) 4693618. Email : wsalim@ksu.edu.sa
5 Director of Al-Farabi College for Dentistry and Nursing, Al-Farabi College, Riyadh, 11514, KSA, Tel:
(00966)556456666, E-mail: talal5656@yahoo.com
6 Education Coordinator Research. King Faisal Specialist Hospital & Research Center. MBC 63. Po. Box: 3354
Riyadh: 11211, KSA. Telephone: 00966-1- 4423036. Fax: 00966-1-4423075. Email: manani@kfshrc.edu.sa
Abstract: Background: Nurses’ communication skills are considered a mean to provide and improve quality of
nursing care. The purpose of this study was to patient’s satisfaction about nurses’ communication skills. Methods:
comparative study utilizing correlational design utilized a sample of 193 nurses and 160 patients from two major
hospitals in Saudi Arabia. Data collected from nurses and patients in regards to therapeutic communication skills
used by nurses. Results: patients had higher levels of perception of effectiveness in practicing communication skills
(
M=4.3,
SD=.23) than their nurses (
M= 4.1,
SD = .20) and this difference was statistically significant (
t = - 5.99,
p <
.05). No statistical differences were found between patients and nurses in regards to personal and demographic
characteristics (
p > .05).Conclusion: Nurses and health care professionals need to improve their communication
skills and have to use their patients’ feedback and evaluation as indicators for their performance.
[Ayman M. Hamdan-Mansour, Ahmad E. Aboshaiqah, Imad N. Thultheen, Wisam M. Salim, Saleh N. Azzeghaiby,
Muna A. Anani.
Patients’ satisfaction about nurses’ competency in practicing communication skills. Life Sci J
2014;11(3):339-345]. (ISSN:1097-8135). http://www.lifesciencesite.com. 49
Keywords: Communication skills, nurses, patients’ satisfaction, Saudi Arabia.
Introduction
Effective communications skills are necessary in
each area of life, but of particular importance in the
field of nursing. Nurses, if communicate effectively;
optimal health outcomes can be easily reached. Nkeng
(2009) defined nurse communication as the effective
exchange of information, ideas, and feeling to achieve
desirable interpersonal relationships which will be
beneficial to the patient. Previous studies showed that
practicing effective communication among nurses
contributed to safe and high quality nursing care
(Fleischer et al., 2009). However, the successful
healing process requires that health care professionals,
particularly nurses, feel and practice effective
therapeutic relationship with their patients and
enhance patients control and involvement in health
care plans. Therefore, effective communication skills
are the key to quality of patient care, and considered
the essence of patients’ recovery (Kettunen et al.,
2000). Communicating effectively with patients also
has been considered the heart of all patients’ care
aspects
(Fakhr-Movahedi
et
al.,
2011).
Communication skills provide pathway for
transmitting important patient’s information to other
healthcare providers and for obtaining and sharing
necessary information with patient’s family members
(Granados- Gamez, 2009).
According to Parburry (2000) the most integral
part of nursing is caring. However, the nurse-patient
relationship is considered the foundation of nursing
care (Hagerty and Patusky, 2003). Theorists like
Fawcett (2005) described the nurse-patient
relationship as a critical element in the delivery of
nursing care, while others (Peplau, 1952) previously
maintained that nurse-patient interaction influences
the health care outcome. Thus, nurse-patient
relationship is a core element in the nurses'
competency while delivery nursing care. Therefore
effective communication between the nurse and
patient is vital in establishing the therapeutic
relationship that provides the foundation of quality of
patient care (Finch, 2005).
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340
Nowadays, nurses are providing care to more
acutely and chronically ill patients with increased
workloads and fewer resources; thus, interfering with
the ability to develop a successful relationship with
their patients (Ronayne, 2001). It has been found that
the effective nursing communication influenced the
rate of patients' recovery, controlled pain effectively,
enhanced patients' adherence to treatment regimens,
and improved patients' psychological functioning
(Fallowfield and Jenkins 1999). In a previous
Jordanian study, it has been reported that nurses and
patients were different in their perception regarding
the effective communication skills (Marmash, et al.,
2012). The Joint Commission on Accreditation of
Healthcare
Organizations
found
that
poor
communication can affect patient’s safety, satisfaction
and quality of care, and has adverse effects on
patient’s compliance with recommended treatment
regimes (Marshelle, 2007). This indicates that poor
communication and lack of use of therapeutic
communication skills may influence patients’
participation in his treatment plans that will inversely
affect the nurses’ ability to manage patients’ needs
effectively. This will also expect to lowers the
patients’ perception of quality of care provided by
nurses as patients and nurses are not developing a
therapeutic relationship which is the core of nursing
care as described by Peplua (1952) and Fawcett
(2005). Shattell (2004) made an effort to review all
studies in the literature related to nurse–patient
interaction and concluded that most studies focused
entirely on the nurse’s competency in communication
neglecting the patients’ perception of the nurses’
competency. However, Wilkinson (2002) previously
maintained that although nurses had the clinical
competencies, their patients had complaints of failure
communication and nurses' inability to adequately
convey a sense of care. The literature propose some
factors that may contribute to poor nursing
communication such as heavy nursing workload, hard
nursing tasks, lack of welfare facilities for nurses,
unfamiliarity of nurses with dialect, and sex
differences between nurses and patients (Anoosheh et
al., 2009).
The literature proposed evidence that further
research is needed to examine patients’ perception of
nurses’ communication skills and abilities.
Understanding the patients’ perception of what is
effective communication mean should be considered
to achieve satisfactory communication and
collaboration (Park and Song, 2005). The
measurement of patients’ satisfaction with nursing
care is a significant indicator to quality of nursing care
(Lui and Wang, 2007). There is currently a gap in
knowledge regarding the availability of information
relative to patient satisfaction related to nursing
communication skills. Therefore, this study came to
address this issue and further to extend our knowledge
among patients in the Saudi culture. The purpose of
this study was to examine patient’s level of
satisfaction about nurses’ communication skills.
The specific aims were:
• To examine the patient’s satisfaction about
nurses’ communication skills.
• To examine the differences between patients
and nurses in regards patient’s satisfaction about
nurses’ communication skills.
• To identify personal and demographic factors
that influence patient’s satisfaction about nurses’
communication skills.
Methods
Design: this is a comparative study utilizing
correlational design. Data collected using self-report
questionnaires from general nurses and their patients
in general wards in different health care agencies in
Riyadh, Saudi Arabia. Data collected from nurses and
patients in regards to therapeutic communication skills
used by nurses.
Sample and Setting: This study used a convenience
sample from nurses and patients in general care
settings in Saudi Arabia. A total of 193 nurses and 160
patients completed and returned the questionnaires.
Inclusion criteria for nurses were 1) has working
experience in the health field for at least 6 months. No
exclusion criteria included. For patients, the inclusion
criteria were: 1) above the age of 18 years, 2) admitted
to general words, and 3) able to read and write in
Arabic. Exclusion criteria in clued: 1) had cognitive or
physical disability that may contribute to understand
or fill out the survey. The sample included nurses and
patients from health care settings representing the
public and private sectors. A simple random technique
used to select the targeted hospitals.
Procedure: after obtaining approval from the ethical
committees at each targeted institution, a package of
two self-report questionnaires and an author-
developed demographic survey distributed to nurses
and patients in the targeted settings. The heads of units
served as liaisons to facilitate approaching patients
and nurses. Research assistants were available during
distributing and receiving the packages, thus; nurses
and patients returned the surveys directly to research
assistants. The questionnaires arranged in packages
and only those who expressed interest in participation
asked to fill out the questionnaires. The package
included a cover letter that includes information about
the purpose of the study, its significance and what is
expected from subjects, and that the study is
anonymous. In addition, the cover letter included
contact information of the principal investigator and
co-investigators for any further information and for
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answering the questions related to the study. The
cover later included a statement informing the subjects
that returning the questionnaire considered an
approval to participate in the study, and that their
participation in the study is voluntarily and their
decision to participate is of their own choice without
any direct or indirect influence. Data kept in a closed
cabinet at the College of Nursing at King Saud
University where no one but the research team has the
access to the files, and electronic files were saved at
the personal computer of the principal investigator.
Instrumentation: data collected using the
Communication Assessment Tool (CAT)
(Makoul et
al., 2007). In this study the Arabic version of CAT
(Marmash et al., 2012) has been used. CAT measures
patient perception of communication with the health
team. CAT is a validated instrument developed to
assess communication across different specialties and
environments. The CAT includes 15 items and a 5-
point response scale (1 = poor, 2 = fair, 3 = good, 4 =
very good, 5 = excellent). It was originally designed to
assess patient perceptions of an individual physician’s
communication effectiveness. The CAT was field
tested with 950 patients and 38 physicians across
multiple specialties (dermatology, family medicine,
neurosurgery, ophthalmology, orthopaedic surgery,
physical medicine and rehabilitation)
(Makoul et al.,
2007). The Arabic version of CAT is adapted for
nurses’ environments by making minor changes in the
instructions and item-stems to broaden the focus of
assessment from a single doctor to the nurses. First,
references in the original CAT to ‘‘your doctor’’ or
‘‘the doctor’’ was changed ‘‘your nurse’’. Second, the
stem of item 15 focused on ‘‘the doctor’s staff’’ in the
original CAT and changed to ‘‘nurses staff. Consistent
with previous research on the CAT, results are
reported as percentages of ‘‘excellent’’ responses.
This scoring is based on the original CAT where
patients’ percent excellent (scores of 5) correspond to
a ‘‘yes’’ answer while percents non-excellent (scores
of 1–4) correspond to a ‘‘no’’ answer
(Makoul et al.,
2007). The scale has good reliability with
Chronbach’s alpha of .83.
Covariates:
A. For nurses: Personal details obtained on
participants’ age, gender, details about their nursing
education, years in nursing, and job titles, length of
employment on current ward, length of employment in
the nursing profession.
B. For patients information collected on age,
gender, medical diagnosis, length of stay at the
hospital, number of admission to hospitals in the last
12 months, level of education, marital status, and type
of education.
Analysis Plan:
1). Descriptive statistics in terms of mean scores and
standard deviation used to describe the data variables.
Nurses’ perception of practicing therapeutic
communication skills and patients’ perception of
nurses’ effectiveness in perception of nurses
therapeutic communication skills described using the
central tendency measures (means, and medians) and
the dispersion measures (standard deviation and
ranges). The main variables of the study; nurses’
therapeutic communication skills described among
each group, and then compared.
2) Inferential statistics: Pearson correlation
Coefficient (Pearson r) used to test the correlation
between mean item scores of patients and nurses. The
t-test for two-independent samples used to test for
difference in perception of therapeutic communication
skills between nurses and patients. Also t-test for two-
independent samples used to examine the differences
among groups in relation to selected demographic and
personal factors.
Results
Descriptive characteristics
A total of 193 nurses and 160 patients completed
and returned the questionnaire. For nurses (see table
1), the age of nurses ranged from 21 to 61 years with
mean age of 36.7 (
SD = 7.8). About 50% of them were
between the ages of 28 to 48years. There were 27
male nurses (13.4%) and 166 female nurses (82.2%).
About 65.5% (n = 132 nurse) received special course
in therapeutic relationship, and 12.9% (n = 26) have a
degree in therapeutic communication. Regarding
patients, patients’ age ranged from 18 to 100 years
with mean of 44.9 (
SD= 18.8). About 50% of the
patients were between the ages of 30-56 years. There
were 71 male patients (44.4%) and 89 female patients
(55.6%). Patients’ length of stay at the hospital ranged
from 1 to 630 days with mean of 17.2 days (
SD =
61.0) and about 50% of them had length of stay
ranging from 2 to 10 days.
Nurses’ communication skills
Regarding nurses’ perception of their
communication skills, the analysis (see table 2)
showed that the items mean score ranged from 3.9 (
SD
= 0.89) for item 11 “I involved patient in decision as
much as he wants” to 4.5 (
SD =0.63) for item 3 “I am
treat with respect”. The analysis in general shows that
nurses had moderate to high level of satisfaction about
practicing communication skills as their total mean
score of the scale was 4.1 (
SD = 0.20).
Regarding patients’ satisfaction about nurses’
communication skills, the analysis (see table 2)
showed that the items mean score ranged from 4.0 (
SD
= 1.24) “Participate in decision making” for item 11 to
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342
4.7 (
SD =0.76) for item 2 “Treat me with respect”.
The analysis shows that patients had high level of
satisfaction about nurses’ communication skills as the
mean score for the total scale was 4.3 (
SD = .23)
compared to nurses mean score that was 4.1 (
SD =
0.20). This indicates that patients had higher level of
confidences that nurses are practicing therapeutic
communications
skills,
and
that
nurses’
communication skills were highly recognized and
satisfactory to their patients.
Table 1. Demographic characteristics of nurses (N = 193) and patients (160)
Variable
M
SD Min Max
n
%
Nurses
Age in years
36.7 7.8
21
61
Years of experience
13.2 8.5
.5
37
Gender
Male
Female
27
166
13.9
86.1
Marital status
Single
Married
Divorced
54
135
4
27.2
69.9
2.1
Level of education
Diploma
Undergraduate
Graduate
110
82
3
56.9
42.5
1.5
Special course in
therapeutic
relationship
Yes
No
132
61
68.4
31.6
Patients
Age in years
44.9 18.8
18
100
Period of diagnosed
in months
4.4
7.4
1
50
Number of
admissions
2.5
2.5
1
14
Length of stay in
days
17.2 61.0
1
630
Gender
Male
Female
71
89
44.4
55.6
Marital status
Single
Married
Divorced
widow
29
113
7
11
18.1
70.6
4.4
6.9
Level of education
< high school
High school Diploma
Undergraduate
Graduate
67
43
14
31
4
42.1
27.0
8.8
19.5
2.5
Working status
Unemployed
86 53.8
full time job
44 27.5
Part-time job
11
6.9
Retired
19 11.9
Medical Diagnoses
CVD
30 18.8
Cancer
9
5.6
Orthopedic
23 14.4
Renal
17 10.8
Maternal
25 15.6
Pulmonary
11
6.9
Others
47 28.2
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Table 2. Mean item scores of nurses (N = 193) and patients (160)
Items
Nurses
Patients
Diff in Mean
Test statistics
M
SD
M
SD
t- test
p -value
1
Greeting patient
4.3 .75
4.6
.82
-.30
-5.99
< .05
2
Treating patient with respect
4.5 .63
4.7
.76
-.20
3
Showing interest in patient idea about health
4.2 .67
4.3 1.02
-.10
4
Understanding patients main health concern
4.2 .69
4.4
.96
-.20
5
Paying attention to patient
4.4 .71
4.5 1.02
-.10
6
Letting patient talk without interruption
4.2 .71
4.5
.93
-.30
7
Giving patient as much information as he want
3.9 .83
4.3 1.08
-.40
8
Talking in term that patient understand every
thing
3.9 .88
4.2 1.11
-.30
9
Checking to be sure patient understand every
thing
4.1 .79
4.2 1.05
-.10
10 Encouraging patient to ask question
4.0 .87
4.0 1.21
.00
11 Involving patient in decision as much as he want
3.9 .89
4.0 1.24
-.10
12
Discussing with patient next step including any
follow up
3.9 .85
4.4 1.16
-.50
13 Showing patient care and concern
4.3 .72
4.5
.84
-.20
14 Spending the right amount of time with patient
4.1 .89
4.2 1.05
-.10
15 The nursing staff treat patient with respect
4.4 .67
4.6
.90
-.20
Total scale
4.2 .20
4.4
.82
-.20
Differences between nurses and patients’
perception related to nurses’ communication skills
Using Pearson r test used to examine the
correlation magnitude between patients and nurses in
regard to nurses communication skills using mean
items of for both nurses and patients. The analysis
showed that there is a significant strong and positive
correlation (
r = 0.80,
p = < .001) between means of
items of nurses and means of items of patients.
However, this correlation was not significant using the
total score of nurses and patients as the correlation (
r)
was 0 .015, with p-value >.05. to examine if there is a
significant difference between patients’ and nurses
mean scores,
t-test (see table 2) was used and revealed
a significant difference between their scores (
t = -
5.99,
p < .05) The highest difference between nurses
and their patients have been observed in item 1
“Greeting the patient” (- 0.30) item 7 “Giving patient
as much information as he want” (- 0.40), and item 12
“Discussing with patient next step including any
follow up” (- 0.50). On the other hand, the lowest
difference in mean item score was observed in item 10
“Encouraging patient to ask question” (0.0).
Interestingly, in all mean item scores, patients had
higher mean than their nurses expect in one item (item
10; Encouraging patient to ask questions).
Differences in patients’ perception of nurses’
effectiveness in using communication skills related to
demographic characteristics
Regarding the differences in patients’ perception
in relation to demographic characteristics, the analysis
showed that there were no significance differences
between patients in regards to age, gender, marital
status, educational level, and working status (
p > .05).
Moreover, there was no significant association
between
patients’
perception
of
nursing
communication and their length of stay at the hospital
and number of times of admissions. This infers that
patients’ demographic and personal characteristics
have no contribution to patients’ perception.
Moreover, the analysis showed that there were
significant differences between patients’ in regards to
their medical diagnosis (
F 6, 141 = 2.62,
p = .019).
using post hoc comparison (Tukey HSD), the analysis
showed that patients diagnosed with cancer were
significantly different in their perception of nurses’
effectiveness in using communication skills than those
diagnosed with CVD (
p < .001), Maternal problems
(
p = .013) and Orthopedic problems (
p = .043).
In regards to differences in nurses’ perception
related to their personal and demographic
characteristics, the analysis showed that none of the
personal and demographic characteristics of the nurses
had a significant association with their perceptions;
age, gender, marital status, years of experience,
whether had a special course or holding an academic
degree in therapeutic communication. This infers that
nurses’ perception has not been influenced by their
demographic or personal characteristics. In summary,
demographic characteristics have no contribution in
both nurses and patients’ perception of nurses’
perceptions
of
effectiveness
of
practicing
communication skills.
Discussion
Successful healing process requires that health
care professionals, particularly nurses, feel and
practice effective therapeutic relationship with their
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344
patients. Fakhr-Movahedi and associates (2011)
maintained that ccommunicating effectively with
patients is considered the heart of all patients’ care
aspects. This requires that nurses and patients should
have an agreement on what and how communication
skills can be effective. One approach is through
obtaining patients’ satisfaction about nurses’
communication skills. This study explored patient’s
level of satisfaction about nurses’ competency in
practicing communication skills. The findings of this
study indicated that patients had high level of
satisfaction about nurses’ communications skills,
while nurses had moderate to high level of satisfaction
about their communication skills. This difference was
statistically significant and infers that nurses and
patients have different perception of what may
contribute to satisfactory communication skills.
Although nurses and patients had almost satisfied
about nurses’ communication skills, the difference
between patients and nurses may raise questions about
the influence of this difference in managing patients’
needs. Peterneij and Yonge (2003) maintained that
communication skills are the mean through which
nurses are able to improve patients’ well-being, while
Parburry
(2002)
sustained
that
effective
communication skills contributed to a positive
experience of a health-ill cycle. Therefore, there
nurses and patients should entirely agree on be
satisfied about nurses communication skills at the
same level to avoid confusion and disagreement on
other element of care plan. Moreover, the results in
this study infer that patients were able to evaluate
nurses’ communication skills better than nurses do for
themselves. The results do not agree with previous
studies that found that nurses were reported as poor
communicators by their patients, and their
competency was not enough to adequately convey a
sense of care (Shattell, 2004; Wilkinson et al., 2002).
This can be related to the lack of feedback that nurses
might used to judge their communication skills, and to
their low level of satisfaction about their
communication skills. Another possible explanation is
that nurses and patients have different knowledge
background about communication skills in which
nurses might used their acquired knowledge and
patients used their personal experience which may
resulted in this difference in satisfaction. In addition,
the study is using Arabian patients who used to be
generous and extreme in their evaluation for any given
situation. According to Fenghali (1997), Arabs tend to
be indirect in their communication in which they have
high tendency to accommodate and go along with
their interactors. In this case, Arab patients tend to be
indirect for the purpose of satisfying their interactors
whom are the nurses.
Moreover, in this study, there were no significant
differences in patients’ satisfaction about nurses’
communication skills in regards to demographic
characteristics except for medical diagnoses in which
patients diagnosed with cancer had different
perception. The results agree with previous reports
that patients’ perception of nurses’ communication
skills is affection by patients’ demographics. Previous
studies (e.g., Bakhtiari et al., 2009) found that patients
diagnosed with cancer had different perception of
nurses’ communication skills. One possible
explanation is that patients in specialized care units
such as oncology and palliative care units may have
longer period of interaction and their disease process
also may have an influence on their satisfaction level
about nurses’ communication skills. On the other
hand, patients in general wards have less contact time
with their nurses that influence their level of
satisfaction about their nurses’ communication skills.
One limitation of this study is that the study used
the modified tool of CAT in which the modified tool
used in regards to nurses roles; while the original CAT
has been develop to examine effective communication
skills in regards to physicians’ roles.
Conclusion and implications
This study found that patients had high level of
satisfaction about their nurses’ communication skills.
Nurses, on the other hand, had moderate to high level
of perception of their effectiveness of practicing
communication skills. The difference between nurse
and patients was significant.
Consequently, there is a possibility that nurses
might be unable to adequately meet patients’ needs
and improve their patients’ wellbeing and provide a
quality of nursing care. The study has an implication
for nurses and health care providers at the Saudi
health care settings. Nurses and health care
professionals need to improve their communication
skills and have to use their patients’ feedback and
evaluation as indicators for their performance.
Communication is the mean inn which nurses know
the outcome of their care, thus; nurses need to
appropriately consider seriously their effective
practice of communication skills with their patients. It
is recommended that there should be nursing staff
development
programs
addressing
practicing
communication skills. Further research is needed also
focusing
on
evaluating
effectiveness
of
communication skills considering the Arabian culture
of communication. Further research is needed to
explore the perceptions, competencies, and
educational needs of nurses in the field of therapeutic
relationships and effective communication skills.
Health care administrators need to assist nurses to gain
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345
the necessary knowledge and skills in practicing
effective practice of communication skills.
Acknowledgement:
The authors acknowledge the
support provided by the Deanship of Scientific
Research at King Saud University, through Research
Center at College of Nursing.
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