Journal of Nursing Education

The articles prior to January 2012 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here

A Comprehensive Interpersonal Skills Program for Nurses

Molly Anderson, RN, MSC; Brian Gerrard, PhD

Abstract

In a review of the literature by Gerrard (1979, p. 5), a relationship was found between health professionals' interpersonal skills and patient outcome. Twentyfour out of 27 studies reviewed (89%) had positive outcomes for the interpersonal skills treatment administered. The outcome measures included physiological, psychological and behavioral changes.

The review by Gerrard also revealed that health professionals value interpersonal skills although studies indicated that they lack them. A major study cited was conducted by Korsch and Negrete (1972). The investigators found that subjects had not told their physician of their chief concern because of lack of encouragement and opportunity. Truax and Millis (1971) found that registered nurses were low in empathy, nonpossessive warmth, and genuineness - qualities traditionally associated with therapeutic effectiveness in counselling.

Nurses value interpersonal skills and they support the concept of holistic care. Nursing education demonstrates this support by including communication and human behavior as important subjects in curricula. Many nursing textbooks and audiovisual resources are available to help the student develop the interpersonal skills which are essential for understanding patients and their responses to alterations in health. Yet the literature continues to indicate that relationships are less than satisfactory between patients, their families, and the health professionals who work with them (Rosenthal, Marshal, Macpherson, & French, 1980, pp. 132-135).

Rationale

Faculty in a baccalaureate nursing program faced the challenge of improving the interpersonal skills of their students. The interviewing skills of students were assessed at the end of the third year of the program, using simulated patients. The results indicated a need to increase the emphasis on communication skill development throughout the program, particularly in the earlier years.

Gerrard (1979) identified four types of interpersonal problems frequently encountered by health professionals. They are: 1. distressed patients, 2. aggressive patients, 3. team conflict, 4. evaluation anxiety.

The faculty felt it was desirable to provide the first year students with interpersonal skills training that would enable them to handle these important problem areas. Furthermore, there were specific methods recommended for handling these interpersonal problem situations.

Following a curriculum review it was decided to implement a new interpersonal skills program within the first year nursing course. To facilitate this, the Year I faculty were able to redistribute the time given to various components of the nursing course.

The Interpersonal Skills Program

Four faculty members who participated in the program as group leaders received approximately four hours of training. Course materials consisted of an instructor's manual, transparencies, and student exercises.

The program was designed to be experiential and many of the activities were carried out in pairs. In order to increase the degree of interest, participation and personal application, students were assigned to small groups of seven for the instructional periods of two hours weekly for six weeks. We selected an odd number to allow full participation of the faculty in the activities. Small rooms were used to enhance the development of interpersonal relationships and a relaxed climate. Groups were also encouraged to sit in a circle for the instruction period, rather than around a table. Our limited faculty resources made it necessary to run the program twice in order to give each student 12 hours of instruction. The majority of students completed the program in the first term of Year I.

Table

In comparison with students randomly assigned to a control group, students in the interpersonal skills course made empathy responses to a significantly higher proportion of scores on the BTIS. In addition, students in the interpersonal skills course made fewer "Don't Feel ________ _" responses. This indicates that the interpersonal skills course was successful in developing students' empathy…

In a review of the literature by Gerrard (1979, p. 5), a relationship was found between health professionals' interpersonal skills and patient outcome. Twentyfour out of 27 studies reviewed (89%) had positive outcomes for the interpersonal skills treatment administered. The outcome measures included physiological, psychological and behavioral changes.

The review by Gerrard also revealed that health professionals value interpersonal skills although studies indicated that they lack them. A major study cited was conducted by Korsch and Negrete (1972). The investigators found that subjects had not told their physician of their chief concern because of lack of encouragement and opportunity. Truax and Millis (1971) found that registered nurses were low in empathy, nonpossessive warmth, and genuineness - qualities traditionally associated with therapeutic effectiveness in counselling.

Nurses value interpersonal skills and they support the concept of holistic care. Nursing education demonstrates this support by including communication and human behavior as important subjects in curricula. Many nursing textbooks and audiovisual resources are available to help the student develop the interpersonal skills which are essential for understanding patients and their responses to alterations in health. Yet the literature continues to indicate that relationships are less than satisfactory between patients, their families, and the health professionals who work with them (Rosenthal, Marshal, Macpherson, & French, 1980, pp. 132-135).

Rationale

Faculty in a baccalaureate nursing program faced the challenge of improving the interpersonal skills of their students. The interviewing skills of students were assessed at the end of the third year of the program, using simulated patients. The results indicated a need to increase the emphasis on communication skill development throughout the program, particularly in the earlier years.

Gerrard (1979) identified four types of interpersonal problems frequently encountered by health professionals. They are: 1. distressed patients, 2. aggressive patients, 3. team conflict, 4. evaluation anxiety.

The faculty felt it was desirable to provide the first year students with interpersonal skills training that would enable them to handle these important problem areas. Furthermore, there were specific methods recommended for handling these interpersonal problem situations.

Following a curriculum review it was decided to implement a new interpersonal skills program within the first year nursing course. To facilitate this, the Year I faculty were able to redistribute the time given to various components of the nursing course.

The Interpersonal Skills Program

Four faculty members who participated in the program as group leaders received approximately four hours of training. Course materials consisted of an instructor's manual, transparencies, and student exercises.

The program was designed to be experiential and many of the activities were carried out in pairs. In order to increase the degree of interest, participation and personal application, students were assigned to small groups of seven for the instructional periods of two hours weekly for six weeks. We selected an odd number to allow full participation of the faculty in the activities. Small rooms were used to enhance the development of interpersonal relationships and a relaxed climate. Groups were also encouraged to sit in a circle for the instruction period, rather than around a table. Our limited faculty resources made it necessary to run the program twice in order to give each student 12 hours of instruction. The majority of students completed the program in the first term of Year I.

Table

TABLE 1COMMON INTERPERSONAL PROBLEMS EXPERIENCED BY HEALTH PROFESSIONALS AND TRAINING MODALITIES RECOMMENDED FOR HANDLING THESE INTERPERSONAL PROBLEMS

TABLE 1

COMMON INTERPERSONAL PROBLEMS EXPERIENCED BY HEALTH PROFESSIONALS AND TRAINING MODALITIES RECOMMENDED FOR HANDLING THESE INTERPERSONAL PROBLEMS

FIGUREEXERCISE - WRITING AN T CONFRONTATION

FIGURE

EXERCISE - WRITING AN T CONFRONTATION

Activities or practice exercises were an integral part of each week's instruction. A homework assignment was given each week because of its importance for reinforcement and personal application. In general, the instructional format for each session was: A. debriefing of homework assignments, B. mini-lecture by instructor, C. skill-building activity.

A limitation of other interpersonal skills programs is the tendency to teach facilitation skills only. Through our experience with this program we identified clearly that instruction given to students in a combination of three sets of interpersonal skills was much more effective for dealing with the interpersonal problem areas commonly encountered by nurses. Table 1 shows the three skills of facilitation, assertion and desensitization/cognitive reappraisal and the health care problem situations for which they are particularly useful.

Facilitation skills are used by the health professional to develop a trusting relationship with the patient. Subskills of facilitation are empathy, warmth and respect. The facilitation responses included in our instruction were:

1. inviting requests, or encouraging questions;

2. responding with information;

3. responding with action (e.g. to requests);

4. warmth, or demonstrating caring;

5. active listening, or communicating empathy (by making an effective helping response).

Because the first three are behaviors commonly practiced by most nurses, a major emphasis in our program was placed on the last two skills. Active listening is the skill of understanding what the patient is saying and feeling, and communicating to him in your own words what you think he is saying and feeling.

Assertion skills training helps the health professional to handle complex team relationships and conflict situations. Students in our program were taught constructive responses, such as an "I" confrontation (Figure) for use in problem situations (e.g., with aggressive colleagues or patients, or in response to urn easonable requests). Students also were helped to recognize their own non-assertive, aggressive, and assertive behaviors.

Desensitization and cognitive reappraisal skills are particularly useful for handling stressful situations. Training in these skills was different from the others because the students were not taught communication responses. Instead they were taught how to cope with their interpersonal stressors (e.g., an angry patient) by reducing their level of anxiety through a process of relaxation, rational analysis of the situation, and repetition of positive coping statements. By having students mentally picture their stressor repeatedly and for increasing lengths of time, (in association with a pleasant scene of their choice), they became desensitized or habituated to the stressor. In other words, they learned to reassess its significance so that it no longer appeared threatening.

The students were made aware of the effect of their irrational beliefs in precipitating interpersonal stress. For example, two health professionals may respond quite differently to an angry outburst from a patient. One of them may be able to respond objectively and effectively while the other may experience feelings of anxiety and tension, or stress, because of his beliefs and thoughts about the patient's behavior (e.g., Mr. L. does not like me.) His irrational beliefs will block his ability to communicate effectively with the patient. Helping students to analyze their beliefs rationally removes the blocks to effective communication.

Course Evaluation

The interpersonal skills course was evaluated in two ways. First, students who took the course rated it on five different dimensions on a Likert-type feedback form. The results of the student evaluation are shown in Table 2, The rating scale used to rate each questionnaire item was: Strongly Agree (5), Agree (4), In-between (3), Disagree (2), Strongly Disagree (1). The mean scores for all five items (for 28 nursing students) were all above 4.10. This indicates overall student satisfaction with the interpersonal skills course.

Second, students who took the interpersonal skills course had their interpersonal skills assessed before and after the course using the Behavioral Test of Interpersonal Skills for Health Professionals (BTIS). The BTIS is a 30-minute videotape containing 30 scenes, role played by actors, of common interpersonal problems encountered in health care (Gerrard & Buzzell, 1980). The nursing student whose interpersonal skills are being assessed is seated in front of a TV monitor. As the TV plays back each of the recorded problem situations (e.g., an angry patient), the student must make a verbal response as though she were speaking with a real person. The student's responses were videotaped and later scored using an interaction analysis coding method. Table 3 shows scores obtained by a sample of 14 nurses on the three facilitation skill dimensions: Reflects Feelings, Reflects Content, and "Don't Feel _____ " (e.g., makes statements like "Don't be sad"). Reflects Feelings and Reflects Content assess the two main components of empathy (feeling and content) and "Don't Feel ____" assesses student responses that detract from empathy.

Table

TABLE 2MEAN STUDENT COURSE EVALUATION SCORES FOR COMPREHENSIVE INTERPERSONAL SKILLS COURSE

TABLE 2

MEAN STUDENT COURSE EVALUATION SCORES FOR COMPREHENSIVE INTERPERSONAL SKILLS COURSE

Table

TABLE 3A COMPARISON OF MEAN SCORES ON INTERPERSONAL SKiLL AND CONTROL GROUPS IN THE BTIS CATEGORIES: REFLECTS FEELING, REFLECTS CONTENT, AND "DON'T FEEL ______ ".

TABLE 3

A COMPARISON OF MEAN SCORES ON INTERPERSONAL SKiLL AND CONTROL GROUPS IN THE BTIS CATEGORIES: REFLECTS FEELING, REFLECTS CONTENT, AND "DON'T FEEL ______ ".

In comparison with students randomly assigned to a control group, students in the interpersonal skills course made empathy responses to a significantly higher proportion of scores on the BTIS. In addition, students in the interpersonal skills course made fewer "Don't Feel ________ _" responses. This indicates that the interpersonal skills course was successful in developing students' empathy skills as measured in the BTIS.

A detailed description of this comprehensive interpersonal skills program is contained in Interpersonal Skills for Health Professionals by Gerrard, Boniface, and Love (1979).

One of the major goals of our BScN program is that students will demonstrate sensitivity and skill in human relationships and communication. At the Year I level our objective has been that students demonstrate awareness of their own feelings and behavior and sensitivity to the feelings and behavior of others. We believe that this program of interpersonal skill training helped students gain knowledge and skill well beyond the traditional year level.

References

  • Gerrard, B., Boniface, W., & Love, B. (1979). Interpersonal skills for health professionals. Reston, VA: Reston Publishing Co., Inc.
  • Gerrard, B., & Buzzell, M. (1980). Behavioral test of interpersonal skills for health professionals (BTIS, videocassette). Reston, VA: Reston Publishing Co., Inc.
  • Korsch, B., & Negrete, V. (1972). Doctor-patient communication. Scientific American, 227:66-74.
  • Rosenthal, C, Marshall V., Macphersoo, A. S., & French, S. (1980). Nurses, patients and families. New York: Springer Publishing Co.
  • Truax, C.B., & Millie, J. Perceived therapeutic conditions offered by contrasting occupations, 1971. Unpublished manuscript quoted by Peitchinis, JA. (1972, March-April). Review of the literature on therapeutic effectiveness of counseling by nursing personnel. Nursing Research, 2i:138-148.

TABLE 1

COMMON INTERPERSONAL PROBLEMS EXPERIENCED BY HEALTH PROFESSIONALS AND TRAINING MODALITIES RECOMMENDED FOR HANDLING THESE INTERPERSONAL PROBLEMS

TABLE 2

MEAN STUDENT COURSE EVALUATION SCORES FOR COMPREHENSIVE INTERPERSONAL SKILLS COURSE

TABLE 3

A COMPARISON OF MEAN SCORES ON INTERPERSONAL SKiLL AND CONTROL GROUPS IN THE BTIS CATEGORIES: REFLECTS FEELING, REFLECTS CONTENT, AND "DON'T FEEL ______ ".

10.3928/0148-4834-19841001-11

Sign up to receive

Journal E-contents