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Teaching and Evaluating Communicative Techniques
Critical Conversations and the Academy
A National Symposium
November 22-23, 2019
University of Miami
Kathleen Haspel, Fairleigh Dickinson University
Patricia Tooker, Wagner College
Aleksandra Zagorin, Wagner College
The nursing profession, like all professions, has a code of ethics that enumerates the expectations of members of the profession and the personal performance standards that specifically spells out the role of the nurse with individual patients and with society as a whole with regard to health care needs. It also defines the appropriate behavioral expectations and practices of members of the nursing profession. The American Nurses Association (ANA) and the State Board of Professional Programs are the bodies that establish a strong foundation in ethical theory and principles within nursing education and practice, and in so doing, maintain a culture of virtue and value in the profession.
Nursing programs traditionally engage students in learning and understanding the obligations of their profession upon entry. Students are informed that as they venture into nursing for the first time, they must be familiar with the standards and the nursing code of ethics, which will help them interpret their responsibilities as professionals and as nurses. It is important that students understand that they are entering a profession that carries with it great privilege and responsibility. Faculty want them to feel proud of the profession they are preparing to enter and work to ensure that students uphold the values and standards expected of nurses. Attention to personal behavior, language use, and social interaction are critical to achieving professional character and representing the nursing profession. In short, professional communication is essential to teaching and learning about what it takes to be a nurse.
In the new era of nursing, with an ever-changing profession and a new generation of students, it has become more essential for educators to emphasize the importance of communication and professional behavior. The American Nursing Association (ANA) and the National Council of State Boards of Nursing (NCSBN) have advocated for appropriate behavioral expectations and practices in the nursing profession and have endorsed new guidelines for upholding these practices in the new environment of social networking (Spector & Kappel, 2012). Nursing students today require reinforcement about what constitutes professionalism in both clinical and academic environments. It is essential that they understand that communicating face to face is as important as, if not more important than, electronic communication when it comes to producing high-quality nursing care.
What constitutes professional communication? How do we teach it productively? How do we make sure that the generation of nurses who have been socialized through social media abides by the professional Code of Ethics and Guidelines set forth by the ANA and NCSBN (Stokes, 2016). Social media provide a space for connection, identity exploration, the expression of ideas (Denecke et. al., 2015), but they can impede development of the communication skills that are the essence of patient-centered and empathetic approaches to care.
Communication strategies and techniques are an essential component of the nursing curriculum. They are threaded throughout our nursing curriculum and communication is considered one of the core competencies of nursing. Emphasis is placed on the how and the what of communication, acknowledging that how a nurse communicates can be life-changing for patients. Students are instructed that communication is not just about ‘transmitting’ or ‘sharing’ information with others. Human communication is about understanding emotions, feelings, suggestions, ideas, and instructions. It entails managing stress and asserting oneself in a respectful way. Empathy and the ability to listen are taught as essential to maximizing communication skills. We emphasize these communication techniques further by defining the nursing environment as a context that fosters communication, and in turn, the communication used in that environment creates a context of professional care. An emphasis on human communication skills can counter assumptions that nursing practice in a high-tech environment is especially task-centered. Manojlovich (2005) notes that “[n]urses may practice more professionally when the environment provides opportunities and power through resources [and] support” that foster self-efficacy through therapeutic relationships with patients and collaborative relationships with doctors and other healthcare professionals (p. 41). In sum, learning how to integrate task-oriented with relationship-oriented behaviors through communication with a variety of others can build professional nursing practice behaviors (Manojlovich, 2005).
Nursing students study communication techniques in the classroom setting with a chapter on communication in the foundation courses: Dimensions of Health Promotion in the Community and Physical Assessment. We continue emphasizing communication strategies with different population groups, cultures, religions, age, and sexual orientation in Maternal-Child and Medical Surgical Nursing courses in the clinical settings. Our Senior Learning Community courses: Nursing Leadership and Management, Community Health Nursing, Holistic Nursing, and Reflective Tutorial-Senior Practicum teach communication and collaboration with health care professionals in a variety of clinical settings. During this time students have an opportunity to showcase their techniques with patients, families, other nurses, and peers and collaborate with other healthcare professionals. The Reflective Tutorial-Senior Practicum helps cultivate the development of the professional role with a preceptor-nurse experience. The students are evaluated in the clinical setting particularly, looking at their leadership abilities in order to become productive members of the healthcare team, patient advocates, and coordinators of care. Students reflect upon their experiences in a seminar utilizing their oral and written communication skills.
Another important aspect of nurses’ ability to efficiently communicate is understanding the HIPAA (Health Insurance Portability and Accountability Act) process in the era of Electronic Medical Records (EMRs). The federal government mandates EMRs as a means of optimizing healthcare quality and safety. It has become a challenge for the new generation of healthcare providers to keep up with this and other innovations in patient-related care. Generation “Z” wants instant answers and may not pay enough attention to patient details. They may skip important aspects while taking a patient’s history or may “become frustrated” if they don’t get the information instantly (Hampton & Keys, 2017). Another challenge for Gen Z nursing students is managing to orient to the patient while reading a computer screen. Members of Gen Z claim to want more hands-on learning and face-to-face communication, yet they tend to spend more time engaging in on-screen communication than in face to face communication (Jiang, 2018; Denecke et al., 2015). And while they report proficiency in multi-tasking, the memory and cognitive efficiency of the latest generation of students may be adversely affected by their simultaneous use of multiple media (Nass, 2013). It is therefore the responsibility of educators to guide students of nursing (and other professions) to learn how to dually orient to screens and to people, as well as to tasks and relationships. We can engage students in such learning through role-modeling (Bussard & Lawrence, 2019) and through analysis of actual nurse-patient interaction (Pickering, Friginal, & Staples, 2016). The consequences of not doing so can be adverse for patients and nursing students alike, for “[t]here is a noticeable trend of poor patient outcomes with inefficient interpersonal and interprofessional communication techniques” (Scotten, Manos, Malicoat, & Paolo, 2015, p. 895). In conclusion, professional communication is critical to nursing education, nursing practice, and patient care.
Bussard, M. & Lawrence, N. (2019). Role modeling to teach communication and professionalism in prelicensure nursing students. Teaching and Learning in Nursing, 14, 219-223.
Denecke, K., Bamidis, P., Bond, C., Gabarron, E., Househ, M., Lau, A. Y., & Hansen, M. (2015). Ethical issues of social media usage in healthcare. Yearbook of medical informatics, 10:1, 137–147. doi:10.15265/IY-2015-001(https://www.thieme-connect.de/products/ejournals/abstract/10.15265/IY-2015-001)
Hampton, D.C. & Keys, Y. (2017). Generation Z students: Will they change our nursing classrooms? Journal of Nursing Education and Practice, 7:4, 111-115.
Jiang, Jing Jing. (August, 2018). How teens and parents navigate screen time and device distraction. Pew Research Center. Retrieved from https://www.pewresearch.org/internet/wp-content/uploads/sites/9/2018/08/PI_2018.08.22_teens-screentime_FINAL.pdf
Manojlovich, M. (2005). Predictors of professional nursing practice behaviors in hospital settings. Nursing Research, 54:1, 41-47.
Nass, C. (20 June, 2013). Are you multitasking your life away? TedxStanford talk. Available on YouTube at https://www.youtube.com/watch?v=PriSFBu5CLs
Pickering, L., Friginal, E., & Staples, S. (2016). Talking at work: Corpus-based explorations of workplace discourse. Communicating in Professions and Organizations Series. London: Palgrave Macmillan.
Scotten, M., Manos, E. L., Malicoat, A., Paolo, A. M. (2015). Minding the gap: Interprofessional communication during inpatient and post discharge chasm care, Patient Education and Counseling, 98:7, 895-900.
Spector, N. & Kappel, D. (30 September, 2012). Guidelines for using electronic and social media: The regulatory perspective. OJIN: The Online Journal of Issues in Nursing, 17:3 Manuscript 1.
Stokes, F. (2016). Use of Code of Ethics and Nurse Practice Act as resources for boards. Presentation at the NCSBN Annual Institute of Regulatory Excellence (IRE) Conference, Long Beach, CA. Retrieved from https://www.ncsbn.org/8989.htm