Traditionally, institutions of higher learning have been quite inner-directed in determining the educational needs of their graduates. Persons in higher education have made most of the assumptions and decisions in regard to the knowledge and skills students should possess when they leave college and begin their careers. Institutions have exercised minimal effort toward discovering what practitioners believe students should know or be able to do coming out of college.
Fortunately, there are tangible signs that communication faculty in higher education are becoming more responsive to demands from without our sacred walls. For example, Kennicott and Schuelke (1972) suggest that educators identify what communication skills are necessary in various careers and then develop courses which will teach these skills. McBath and Burhans (1975) say that we should systematically increase and refine our knowledge of the competencies called for in a host of careers. Jamieson and Wolvin (1976) exhort departments of Speech Communication to respond to needs of potential employers in their geographical areas by surveying them to determine what competencies are required in various positions.
Indeed, in recent years, several studies have been made to discover essential communication skills in some segments of the work world, particularly in business settings. DiSaI vo (1980) summarized 25 such studies concluding that the communication skills which were identified most frequently are: listening; written communication (letters, memos, written reports, proposals and requests for information); oral reporting (usually one-on-one or in small groups within the organization); motivating/persuading (in order to get people to do their job, selling one's ideas to others in the organization); interpersonal skills (being able to get along with people, with one's work group, dealing with people's problems); informational interviewing; and small group problem solving.
While applauding the work which is being done to identify essential oral communication behaviors in business, we have to recognize that communication by nurses is unique in many respects. Even the decision to communicate or not to communicate can be critical. There have been court decisions ruling that nurses are legally responsible to communicate information believed necessary for the life of patients (Cushing, 1982). On the other hand, nurses are often in a position where by providing patients with important information can be seen as harmful as withholding it (Harris, Schrigen-Krebs, Dericks & Donavan, 1983).
Much of the literature on nurse communication stresses the importance of listening. One author called listening "the most effective therapeutic communication technique available" and referred to it as an active process that requires a nurse's complete attention and a great deal of energy (Sundeen, Stuart & Cohen, 1981).
The nonverbal dimension of nurses' communication is emphasized by numerous authors. Smitherman (1981) gives very specific suggestions for visual and tactile communication, complete with sample encounters with various types of individuals with whom a nurse typically communicates. Blondis and Jackson (1977) authored a book dealing exclusively with nurses' nonverbal communication with patients.
Much has been written in recent years on the topic of the necessity for the nurse to speak assertively. Smythe (1984) included a chapter on how a nurse can develop assertive skills in her book Surviving Nursing. Among the number of complete books devoted to assertiveness for nurses is Assertive Skills for Nurses (Clark, 1978) and Developing the New Assertive Nurse (Angel & Petronke, 1983). The American Journal of Nursing ran a series on assertiveness in nursing beginning in March 1983 (Cohen, 1983).
In looking at surveys of communication skills needed for success, both before and after DiSalvo's summary, as well as the literature in communication for nurses, I made two observations: (1) Most surveys identified essential communication skills in general terms, as opposed to specific terms; and (2) Although there is an abundance of literature on communication for nurses, none of the surveys encountered dealt specifically with communication skills needed by practicing nurses. These two observations served to focus this study upon four specific questions as follows:
1. What are the specific oral communication skills necessary for success in nursing?
2. How often do Directors of Nursing note the use of undesirable oral communication behaviors by their employees?
3. When specific undesirable oral communication behaviors are used by nurses, how detrimental is the use of these behaviors to the success of the user?
4. What are the oral communication skills in greatest need or improvement by nurses according to the importance of the skills to the nurses success, the frequency with which opposite and undesirable behaviors are used, and the detriment to the nurse's success when she/he uses the undesirable behavior?
The first step was to design a questionnaire specifically for this study. It was composed of two lists of communication behaviors. The first list was composed of 37 behaviors which appeared to be desirable by virtue of the frequency with which they are treated as such in literature and in basic oral communication courses. Directors of Nursing were asked to indicate the importance of each behavior according to its necessity for success of nurses by one of the following: 5 - Very important; 4 - Quite important; 3 - Somewhat important; 2 - Not very important; and 1 - Unimportant. The second list was composed of 40 behaviors which roughly repeated the behaviors on the first list, except the wording was reversed to make them read as undesirable, rather than desirable, behaviors. The second list appeared twice. One time, respondents were asked to respond to each undesirable behavior according to the frequency it was noted among employees by one of the following: 5 - Very often; 4 - Often; 3 - Sometimes; 2 - Rarely; and 1 - Practically never. The second time, respondents were asked to respond to the undesirable behaviors according to the degree of detriment, when used, to the success of employees by one of the following: 5 - Very detrimental; 4 - Quite detrimental; 3 - Somewhat detrimental; 2 - Not very detrimental; and 1 - Practically of no detriment.
To facilitate talking about groups of specific behaviors in somewhat more general terms, the author then identified what appeared to be seven general types of behaviors on the list, labeling them as listening variables, message variables, language variables, vocal variables, physical variables, emotional variables, and style variables. Each specific behavior was then placed under the variable which seemed most appropriate.
After field testing and subsequent revision, the questionnaire was sent to a total of 36 Directors of Nursing believed to supervise graduates of UW-Oshkosh. Twenty-nine (81%) questionnaires were returned.
1. The responses to the first question asking what specific oral communication skills are necessary for success show that all 37 skills are perceived as important to the success of nurses, and most of them are considered either "quite important" or "very important." The mean score for the 37 behaviors is 4.33 which falls on the "quite important" portion of the five-point scale. The mean ratings for the seven communication variables studied are as follows, listening, 4.83; emotional, 4.68; message, 4.46; style, 4.34; language, 4.32; vocal, 3.95; and physical, 3.75.
Of the highest rated behaviors, five are listening variables ("understanding what others are saying," 4.90; "paying attention to what others are saying," 4.90; "giving accurate and sufficient feedback to others," 4.86; "listening to others without frequent interruption," 4.76; and "spending time listening to others," 4.72). Four are emotional variables ("establishing credibility with others," 4.83; "dealing with others in an objective and fair manner," 4.79; "dealing with others tactfully," 4.76; and "empathizing or 'feeling with' others," 4.48). One is a language variable ("giving directions clearly," 4.79).
2. The responses to the question asking the frequency with which supervisors observe the use of less-thandesirable communication behaviors cluster primarily around the "rarely" and "sometimes" areas of the scale as opposed to "often," or "practically never." The mean score of 2.54 for all behaviors falls almost directly midway between "rarely" and "sometimes" on the scale.
Of the ten most frequently observed undesirable behaviors, four are listening variables ("giving insufficient, or inaccurate, feedback to others," 3.14; "not paying close attention to what others are saying," 3.14; "not understanding what others are saying," 2.93; and "interrupting others," 2.79). Two are language variables ("using many words to say very little," 3.28 and "giving unclear directions," 2.86). Two are message variables ("deviating too often to insignificant subjects," 2.97 and "unable to get points across clearly," 2.86). One is a vocal variable ("using vocal distractors like 'y°u know,' 'ah,' 'urn' "). One is a physical variable ("using inadequate eye contact when speaking," 2.79).
3. The responses to the third question asking how detrimental is the use of the undesirable oral communication behaviors are mainly in the "somewhat detrimental" and "quite detrimental" area of the scale. The mean score is 3.98 which falls almost directly on the "quite detrimental" portion of the scale.
Of the ten most detrimental behaviors, four of them are emotional variables ("showing bias or unfairness in dealing with others," 4.86; "unable to gain credibility with others," 4.69; "showing tactlessness in dealing with others," 4.66; and "unable to resolve differences with others," 4.66). Three are listening variables ("unwilling to listen to others," 4.72; "giving insufficient, or inaccurate, feedback to others," 4.59; and "not understanding what others are saying," 4.55). One is a language variable ("giving unclear directions," 4.66). One is a message variable ("having insufficient grasp of subject matter," 4.52). One is a style variable ("showing close-mindedness toward the ideas of others," 4.62).
4. The final question sought to discover the oral communication skills in greatest need of improvement among nurses. This was done by assigning a weighted score to each desirable behavior on the questionnaire. The weighted score was determined by adding the means of the responses to three corresponding questions. For example, the importance score for "giving accurate and sufficient feedback to others" is 4.86, the frequency score for "giving insufficient, or inaccurate, feedback to others" is 3.14, and the detriment score for "giving insufficient, or inaccurate, feedback to others" is 4.59. Thus, the weighted score is 4.86 + 3.14 + 4.59 = 12.59. The rationale for determining this score rests upon the assumption that the degree to which educators/ trainers need to give attention to a given communication behavior is the sum of its importance to success, the observed frequency of the use of its negative counterpart, and the degree of detriment, when used, of its negative counterpart. The Table shows oral communication behaviors listed in order of their weighted scores.
The most obvious conclusion which can be drawn from this study is that Directors of Nursing consider the kinds of oral communication skills under consideration in this study to be important to the success of practicing nurses. This is seen both in their answers to the questions in reference to the "importance" of using desirable communication behaviors and to the "detriment" of using undesirable behaviors. Given this finding, institutions of higher education are served notice that they should re-examine their curricula. If oral communication does not appear prominently in the curricula, it should be put in; if it is already there, efforts should be made to check the quality of the instruction.
This study does not show that poor communication by nurses is running rampant, but it does show room for improvement. Note for example, that while "Giving insufficient, or inaccurate feedback to others," when noted, is "very detrimental" to the success of nurses, it is only "sometimes" observed. The significance of this finding is that given the fact that this behavior is rated "very important" to the nurse's success and "very detrimental" when not used, an employer may not be willing to accept the failure to use this positive behavior even "rarely" or "sometimes."
ORAL COMMUNICATION BEHAVIOR WEIGHTED ACCORDING TO NEED TO BE TAUGHT MORE EFFECTIVELY TO STUDENTS IN NURSING
Of the communication variables studied, listening behaviors stand out as the most important to success; poor listening is the most detrimental of the seven variables to success. This finding is consistent with literature in nurse communication. But curiously, listening instruction is still somewhat of a rarity in the preparation of nurses. Consideration should be given to the systematic teaching of listening skills.
The two variables which perhaps occupy most of the instructional time in basic communication courses (vocal and physical) are not considered as vital as the others: listening, message, language, emotional, and style. Teachers of oral communication for nurses should match course objectives and time spent on the development of various skills against the oral communication behaviors weighted according to their need to be taught more effectively as seen in the Table.
- Angel, G., & Petronke, D.K. (1983). Developing the New Assertive Nurse. New York: Springer.
- Blondis, M.N., & Jackson, B.E. (1977). Nonverbal Communication With Patients: Back to the Human lbuch. New York: John Wiley & Sons.
- Clark, CC. (1978). Assertive Skills for Nurses. Wakefield, MA: Contemporary Publishers.
- Cohen, S. (1983). Assertiveness in nursing: Part I.American Journal of Nursing, 83(3), 417-434.
- Cohen, S. (1983). Assertiveness in nursing: Part II. American Journal of Nursing, 83(6), 911-929.
- Cushing, M. (1982). Failure to communicate. American Journal of Nursing, 82, 1597-1598.
- DiSalvo, V.S. (1980). A summary of current research identifying communication skills in various organizational contests. Communication Education, 26(7), 283.
- Harris, E., Schrigen-Krebs, M.J., Dericks, V., & Donovan, C. (1983). Nothing but the truth? American Journal of Nursing, 83, 121.
- Jamieson, K.M., & Wolvin, A.D. (1976). Non-teaching careers in communication: Implications for the speech communication curriculum. Communication Education, 25, 290.
- Kennicott, P.C., & Schuelke, LD. (1972). Career Communication: Directions for the Seventies. New York: Speech Communication Association.
- McBath, JH., & Burhans, D.T., Jr. (1975). Communication Education for Careers. Urbana, IL: ERIC Clearinghouse on Reading and Communication Skills.
- Smitherman, C. (1981). Nursing Actions for Health Promotion. Philadelphia: EA. Davis.
- Smythe, E.E.M. (1984). Surviving Nursing. Menlo Park, CA: Addison- Wesley.
- Sundeen, S.J., Stuart, G. W, & Cohen, S.A. (1981). Nurse-client Interaction. St. Louis: CV. Mosby.
ORAL COMMUNICATION BEHAVIOR WEIGHTED ACCORDING TO NEED TO BE TAUGHT MORE EFFECTIVELY TO STUDENTS IN NURSING