Artcle
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Received: 17 August 2018 | Revised: 25 March 2019 | Accepted: 30 March 2019
DOI: 10.1111/ppc.12381
OR I G I NA L AR T I C L E
Relationship between communication skills and care behaviors of nurses
Nurcan Kirca PhD, RN1 | Kerime Bademli PhD, RN2
1Department of Obstetrics & Gynecological
Nursing, Faculty of Nursing, Akdeniz
University, Antalya, Turkey
2Department of Psychiatric Nursing, Faculty
of Nursing, Akdeniz University, Antalya,
Turkey
Correspondence
Nurcan Kirca, PhD, RN, Department of
Obstetrics & Gynecological Nursing, Faculty of
Nursing, Akdeniz University, Dumlupinar Blvd,
07058 Antalya, Turkey.
Email: [email protected]
Abstract
Purpose: In this study, we aimed to determine the relationship between commu-
nication competence and patient care behaviors of nurses.
Design and Methods: The study was designed as a descriptive relational study and
conducted in Akdeniz University Hospital between March 2018 and May 2018. Data
of this study were collected from clinical nurses working in Akdeniz University
Hospital. The study was carried out with 262 nurses who accepted to agreed
participate in the study.
Findings: Of all nurses, 97% were college graduates, 63% were married, and 35% had
working experience between 5 and 9 years. There was a moderate positive
correlation between communicative competence and care behaviors of nurses
(r = 0.5, P < 0.01).
Practice Implications: More training can be implemented to educate nurses about
communication barriers to equip them with effective communication skills and
strategies. The nursing process is a scientific method of exercising and implementing
of nursing care, this is only achieved through dialogue, interpersonal environment,
and specific verbal and nonverbal communication skills. In service training of nurses
on effective communicative techniques will inevitably have a positive impact rather
than reflection on patient care.
K E YWORD S
care, care behaviors, communication, communication competence, nurses
1 | INTRODUCTION
The primary duty of nurses is to know and meet physical,
psychological, and social needs of individuals.1 Efficient communica-
tion is considered as one of the primary duties of a nurse.2
Communication is an essential component of nursing and has critical
importance in nursing practice.3 Efficient communication is an
inseparable part of quality care.4,5 Effective communication increases
the satisfaction of patients. In a study on this subject, it was stated
that patients expected nurses to have empathy, ability and good
communication skills.6 In another study carried out with nurses,
participants reported that they could increase care quality by using
communication skills.7 In a systematic review regarding the percep-
tion of nurses about care quality, it was revealed that patients
perceived communicative competence of nurses as a dimension of
care.8
Good communication between nurses and patients is essential for
the successful outcome of individualized nursing care of each patient.
To achieve this, however, nurses must understand and help their
patients and demonstrate courtesy, kindness, and sincerity. They
should also devote time to the patient to communicate in necessary
confidentiality, and they should not forget that this communication
includes the people who surround the sick person, therefore, the
language of communication should be understood by all those
Perspect Psychiatr Care. 2019;55:624-631.wileyonlinelibrary.com/journal/ppc624 | © 2019 Wiley Periodicals, Inc.
involved in it. Good communication is also based on education and
experience.9 Communication is an indicator of health care quality.8
Effective communication is an important component to be included in
patient care.10 In this case, the communicative competence of nurses
influences care behavior. Nurses should take into account the
expectations of patients, and deliver care in a manner that will meet
these expectations. Effective communication strategies together with
care environment are important determinants of positive nurse‐ patient relationships.11
Communication intervention of nurses usually includes asking
open‐end questions, intervening with patients, determining expecta-
tions and fears of patients and responding to these, and controlling to
facilitating patients' understanding of diagnosis and treatment
recommendations. Although such patient‐nurse relationship is
designed for increasing the quality of knowledge exchange, it also
produces richer interpersonal interactions. Any intervention de-
signed to improve communication will enhance the quality of
interpersonal relationship and quality of care delivered to the
patient.12 Determination of nurses' communicative competence and
the relationship between communicative competence and care
behaviors will guide communication training to be given to nurses.
The development of communicative skills of nurses will also provide
increased quality of patient care. In this context, this study aimed to
determine the relationship between communicative competence and
patient care behavior of nurses.
2 | PARTICIPANTS AND METHODS
2.1 | Design
This study was designed as a descriptive relational study.
2.2 | Sampling and setting
This study was conducted between March 2018 and May 2018 in
Antalya province located on the Mediterranean coast of Turkey.
Nurses working at internal medicine clinics, surgical clinics,
intensive care units, and pediatric units of Akdeniz University
Hospital were included in the study. The data were collected by
face‐to‐face interview technique. A total of 300 questionnaires were
delivered to nurses for determining the final sample size. Two
hundred sixty‐two nurses returned their questionnaires, which is a
response rate of 87.6%. Nine nurses did not fully complete their
questionnaires. Thus, the study was carried out with a sample size of
262. Filling of the personal information form, Communicative
Competence Scale (CCS) and Care Behaviors Inventory (CBI) lasted
for 10 to 15minutes.
2.3 | Measures
2.3.1 | The personal information form
Personal Information Form consisted of eight questions related to
sociodemographic data and three questions related to communica-
tion. Questions about sociodemographic features included age,
educational status, type of family, status of having children, year of
working, unit of working, and status of preferring this profession
willingly. Questions on communication were as follows: Have you
received any training on communication? If the answer is “Yes,”
please specify the content of the training you have received and in
which cases do you have difficulty in communication with your
patient? (When receiving history/data, when giving bad, sad or hard
news, when caring, when informing the patient, when performing the
physical examination, and when conducting the introductory
interview).
2.3.2 | Communicative Competence Scale
CCS scale developed by Wiemann13 consists of 30 items and 5
subdimensions. These subdimensions include General Communica-
tion Competence (seven items), Empathy (seven items), Affiliation/
Support (six items), Behavioral Flexibility (five items), and Social
Relaxation (five items). Validity and reliability of the CCS was studied
by Koca and Erigüç.14 Internal consistency coefficient of the scale
was found as 0.87. In this study, the Cronbach's α reliability
coefficient of the CCS was 0.86.
2.3.3 | Care Behaviors Inventory
This scale was developed by Wu et al15 and is the short form of
Caring Behaviors Inventory‐42, which was a 42‐item scale
developed by Wolf et al,16 and allows for bidirectional measure-
ment by patients and nurses. The scale was designed to assess the
nursing care process. CBI‐24 is used to compare the self‐ assessment of nurses and patients' perceptions. In addition, the
scale can also be used to evaluate nursing care (care behaviors
involving listening, education, and including the patient in
decision making) delivered in the preoperative and postoperative
periods. The scale consists of 24 items and four subdimensions.
These four subdimensions include assurance (eight items),
knowledge and skill (five items), respectful deference to others
(six items) and connectedness (five items). Turkish validity and
reliability study of the Care Behaviors Scale‐24 (CBS‐24) was
performed by Kurşun and Kanan.17 Cronbach's α was found as
0.96 for the total scale and between 0.81 and 0.94 for the
subdimensions. In this study, the Cronbach's α reliability
coefficient of the CBI was 0.96.
2.4 | Ethical considerations
Ethics committee approval was received for this study from the
ethics committee of Akdeniz University (decision number:
70904504/83). The participants were verbally informed about the
study before giving the forms. They had the right to withdraw from
the study at any time. Nurses assured that they voluntarily agreed to
participate in the study.
KIRCA AND BADEMLI | 625
2.5 | Data analysis
Statistical analyses were conducted using the IBM SPSS Statistics for
Windows (SPSS Statistics Base v23; IBM). In the case of normally
distributed data, independent samples t test was used to compare
sociodemographic data and scales, and Pearson's correlation analysis
was used in the evaluation of correlation between the scales. In
addition, data were expressed with mean, standard deviation and
percentage. Cronbach's coefficients (for internal consistency of the
scale items) were used to assess the data. The level of statistical
significance was P < 0.05.
3 | RESULTS
3.1 | Characteristics of the participants
Of the participant nurses, 97% were college graduates, 63% were
married, and 35% had a working experience between 5 and 9 years.
Of the nurses, 72.1% reported that they willingly chose this
profession, 63% stated that they had not been trained on commu-
nication, and 78.4% had difficulty in communication when they
conveyed bad or sad news to a patient or healthy person (Table 1).
3.2 | The mean scores of CCS, CBI, and subdimensions
When the mean scores of nurses in CCS and CBI were examined, the
mean score of CCS was the highest in personal aspects subdimension
(23.95 ± 2.62). Although mean scores of the CBI were close to each
other, the highest mean score was found in the assurance
subdimension (39.42 ± 5.55) (Table 2).
3.3 | Sociodemographic characteristics of nurses and CCS and CBI mean scores
When nurse's sociodemographic characteristics of nurses and CCS
and CBI mean scores were examined, while CCS social behavior
TABLE 1 Sociodemographic characteristics of partici- pants (n = 262)
Demographic features n %
Education
High School 8 3.1
University 254 96.9
Marital status
Married 164 62.6
Single 98 37.4
Family type
Nuclear 257 98.1
Extended 5 1.9
Years of work, y
<5 83 31.7
5‐9 92 35.1
10‐14 47 17.9
15‐19 40 15.3
Having children
Yes 127 48.5
No 135 51.5
Willingness to select this occupation
Yes 189 72.1
No 73 27.9
Having communication training
Yes 98 37.5
No 163 62.5
Communication difficulty
When introducing
Yes 68 32.2
No 143 67.8
When informing
Yes 73 34.9
No 136 65.1
When caring
Yes 84 37.7
No 139 62.3
When giving bad, sad news
Yes 192 78.4
No 53 21.6
TABLE 2 Distribution of the mean scores that participants received from the scales (n = 262)
Variables Min‐max Mean ± SD
Communicative Competence Scale
Social Relaxation 3.794‐4.023 15.60 ± 2.170
General Communication Competence 3.992‐4.137 23.95 ± 2.624
Empathy Competence 3.973‐4.111 16.19 ± 1.926
Behavioral Flexibility 4.049‐4.198 12.47 ± 1.400
Affiliation/Support 3.901‐4.103 12.01 ± 1.669
Care Behaviors Scale
Reassurance 4.756‐5.103 39.42 ± 5.556
Knowledge‐Skills 4.973‐5.141 25.26 ± 3.604
Respect 4.748‐4.962 28.90 ± 4.276
Connectedness 4.725‐4.847 23.82 ± 35.77
626 | KIRCA AND BADEMLI
adequacy subdimension showed a statistically significant difference
according to marital status, willing choice of profession, and receiving
communication training (P < 0.05), there was no significant difference
in the subdimensions of CBI (P > 0.05). Furthermore,a significant
difference was found according to marital status having children in
the compliance adequacy subdimension of CCS (P < 0.05), there was
no significant difference in the subdimensions of CBI (P > 0.05)
(Table 3).
3.4 | Nurses' difficulty with communication and the mean CCS and CBI scores
When the mean CCS and CBI subdimension scores were evaluated
according to the nurses' having or no difficulty with communica-
tion, behavioral flexibility subdimension showed a significant
difference in nurses who had no difficulty when introducing
themselves (P < 0.05). The subdimensions of the CBI scale showed
a significant difference in nurses who had no difficulty when
introducing themselves (P < 0.05). CCS behavioral flexibility sub-
dimension and CBI subdimensions were statistically significant in
nurses who had no difficulty when giving information and care
(P < 0.05). The behavioral flexibility subdimension of the CCS was
statistically significant in nurses who had no difficulty when giving
bad, sad news (P < 0.05), while CBI subdimensions were not
statistically significant (P > 0.05) (Table 4).
3.5 | The correlation between communicative competence and care behaviors of nurses
When the correlation between communicative competence and care
behaviors of nurses was examined, there was a moderate positive
correlation between communicative competence and care behaviors
of nurses (r = 0.5, P < 0.01) (Table 5).18
4 | DISCUSSION
Communication is an essential component of nursing and has a
critical importance in nursing practice.3 Communication between
nurses and patients is of importance to deliver a quality care.
Communication with patients and families is an essential compo-
nent of high‐quality care in serious illness. Nurses and patients
stated that they had experienced apprehension and disappoint-
ment when communication was not sufficient.19 Communication
skills are needed to allow the person's voice to be heard and to
maintain the persons' dignity.20 Although the importance of
communication in nursing profession is known, more than half of
the participant nurses had not received any training on commu-
nication. This indicates the need for supporting nurses with in
service training on communication. In a study carried out by Bays
et al,21 communicative skills training given to the nurses provided
positive behavioral changes in healthcare professionals. The
difficulty healthcare professionals experienced when giving bad
or sad news was significantly decreased and empathic response
skills were increased in healthcare personnel who received
communicative skills training.21 This indicates that communicative
skills training that will be given to nurses can both increase the
quality of care and prevent difficulties that they will have with
communication.
Another finding of the present study is that the majority of nurses
(78.4%) had communication difficulty when giving bad, sad news to
patients or healthy persons. Giving bad news to patients or their
families is one of the most difficult duties that should be performed
by health care professionals. Nurses may play an important role in
informing patients or their relatives, and therefore they should be
trained for clinical and communication skills necessary for perform-
ing this duty.22 Similarly, studies have demonstrated that commu-
nicative skills training is effective in coping with difficulties in giving
bad or sad news.23–25 Within this context, evidence‐based commu-
nication skills interventions for nurses are urgently needed.
According to the results of this study, personal characteristics
highly affect communication competence of nurses (23.95 ± 2.624).
Effective communication skills of healthcare professionals have
positive effect on the health and recovery rate of patient's. Nurses
should take into account the expectations of patients about this
nurse‐patient relationship and should arrange their own behaviors to
meet patients' expectations. Nurses should be aware of their own
personal communication skills. Effective communication strategies
together with care environment are important determinants of
positive nurse‐patient relationships.11 Establishing a trusting rela-
tionship is identified as central to the patient‐centered care
independent of the professional group.26 Effective nursing is based
on relationships and the ability of the nurse to establish a relation-
ship with the patient. The evidence demonstrated that patients judge
the quality of the relationship through the alignment of the explicit
and implicit values demonstrated around caring behaviors and
attitudes displayed by the nurse. Effective communication strategies
together with the context or care environment were also important
determinants of positive nurse‐patient relationships.11 Most patient
complaints in developed health care systems result from ineffective
communication, including inadequate information provision, no
feeling of being listened, failure to value patients concerns, and
patients not feeling involved in care decisions.27 Effective inter-
personal and communication skills between health care providers
and patients are among the most significant factors for improving
patients' satisfaction, compliance, and overall health outcome.
It was found that nurses without communication difficulty when
delivering care had no problem in all subdimension of care behaviors.
When the correlation between mean scores of communication
competences and care behaviors of nurses was examined, a
moderate positive correlation was found between communication
competences and care behaviors. These results can be interpreted as
establishing sufficient communication positively affects care beha-
vior. Communication has effects in all areas of nursing, and all
interventions such as protection, treatment, rehabilitation, education,
and health development. Effective communication is the key for
KIRCA AND BADEMLI | 627
T A B L E
3 So
ci o d em
o gr ap
h ic
fe at u re s an
d m ea
n sc o re s b et w ee
n C C S an
d C B I sc al es
(n = 2 6 2 )
C o m m u n ic at iv e C o m p et en
ce Sc
al e
C ar e B eh
av io rs
In ve
n to ry
So ci o d em
o gr ap
h ic s
So ci al
R el ax
at io n
G en
er al
C o m m u n ic at io n
C o m p et en
ce
E m p at h y
C o m p et en
ce
B eh
av io ra l
F le xi b ili ty
A ff ili at io n /
Su p p o rt
R ea
ss u ra n ce
K n o w le d ge
‐ Sk
ill s
R es p ec
t A d h er en
ce
M ar it al
st at u s
M ar ri ed
3 .9 ± 0 .4 8
4 .0 ± 0 .3 9
4 .0 ± 0 .4 9
4 .2 ± 0 .4 3
4 .0 ± 0 .5 7
4 .8 ± 0 .6 8
5 .0 ± 0 .7 0
4 .8 ± 0 .6 9
4 .7 ± 0 .6 9
Si n gl e
3 .7 ± 0 .6 0
3 .9 ± 0 .4 9
4 .0 ± 0 .4 5
4 .0 ± 0 .4 9
3 .9 ± 0 .5 1
4 .9 7 ± 0 .7 0
5 .0 ± 0 .7 4
4 .8 ± 0 .7 4
4 .7 ± 0 .7 4
T es t va
lu e
2 .3 9 6
1 .6 8 5
1 .1 3 0
2 .5 2 3
1 .3 1 2
1 .9 1 6
1 .3 2 0
1 .0 4 9
1 .5 1 4
P va
lu e
0 .0 1 7
0 .0 9 3
0 .2 6 0
0 .0 1 2
0 .1 9 1
0 .3 6
0 .7 4
0 .9 6
0 .6 0
H av
in g ch
ild re n
Y es
3 .9 ± 0 .5 3
4 .0 ± 0 .3 9
4 .0 ± 0 .4 8
4 .2 ± 0 .4 5
4 .0 ± 0 .5 6
4 .9 ± 0 .7 0
5 .0 ± 0 .7 6
4 .8 ± 0 .7 1
4 .8 ± 0 .7 2
N o
3 .8 ± 0 .5 4
3 .9 ± 0 .4 6
4 .0 ± 0 .4 7
4 .0 ± 0 .4 7
3 .9 ± 0 .5 4
4 .9 ± 0 .6 8
5 .0 ± 0 .6 8
4 .8 ± 0 .7 1
4 .7 ± 0 .7 0
T es t va
lu e
1 .5 6 4
1 .8 3 7
1 .3 3 4
2 .5 8 3
1 .3 0 1
1 .0 1 5
1 .1 8 9
1 .2 9 2
1 .0 9 9
P va
lu e
0 .1 1 9
0 .0 6 7
0 .1 8 3
0 .0 1
0 .1 9 4
0 .9 8 8
0 .8 5 0
0 .7 7 1
0 .2 7 3
W ill in gn
es s to
se le ct
th is
o cc u p at io n
Y es
3 .9 ± 0 .5 0
3 .9 ± 0 .4 3
4 .0 ± 0 .4 9
4 .1 ± 0 .4 9
4 .0 ± 0 .5 8
4 .9 ± 0 .7 0
5 .0 ± 0 .7 1
4 .8 ± 0 .6 9
4 .7 ± 0 .6 9
N o
3 .7 ± 0 .6 2
4 .0 ± 0 .4 3
4 .0 ± 0 .4 5
4 .1 ± 0 .3 8
3 .9 ± 0 .4 8
4 .9 ± 0 .6 8
5 .0 ± 0 .7 5
4 .8 ± 0 .7 6
4 .7 ± 0 .7 6
T es t va
lu e
2 .2 7 0
1 .1 7 5
1 .0 0 5
1 .2 5 1
1 .3 9 9
1 .3 5 5
1 . 0 5 1
1 .8
5 1 .0
4
P va
lu e
0 .0 2 4
0 .8 6 1
0 .9 9 6
0 .8 0 2
0 .6 9 0
0 .7 2 3
0 .9 5 9
0 .7 0 1
0 .9 9 7
C o m m u n ic at io n ed
u ca ti o n
Y es
3 .8 ± 0 .5 7
3 .9 ± 0 .4 5
4 .0 ± 0 .5 1
4 .1 ± 0 .4 6
3 .9 ± 0 .5 5
4 .9 ± 0 .6 8
5 .1 ± 0 .6 8
4 .8 ± 0 .7 4
4 .7 ± 0 .7 3
N o
3 .9 ± 0 .5 1
4 .0 ± 0 .4 2
4 .0 ± 0 .4 6
4 .1 ± 0 .4 7
4 .0 ± 0 .5 5
4 .8 ± 0 .7 0
5 .0 ± 0 .7 4
4 .7 ± 0 .6 9
4 .7 ± 0 .7 0
T es t va
lu e
− 2 .0 8 3
− 1 .3 3 9
0 .6 1 0
− 0 .5 0 6
− 0 .9 .2 9
1 .8 5 1
1 .0 2 1
1 .7 6 8
1 .1 7 7
P va
lu e
0 .0 3 8
0 .1 8 2
0 .5 4 2
0 .6 1 3
0 .3 5 4
0 .3 9 6
0 .3 0 8
0 .4 4 3
0 .8 5 9
628 | KIRCA AND BADEMLI
delivering sufficient care for the needs of patients.9 Lack of
establishing a professional communication leads to failure in care.28
Jones, Hamilton, and Murray29 stated that in their study, there is
insufficient communication between the nurse and patient due to
insufficient number of nurse and too much number of the patient.
The results of our study and the other studies indicate that
effective communication influences patient care outcomes. In
conclusion, effective communication skill of nurses is a precondition
for the ability to provide care to meet the needs of patients.
4.1 | Limitations
The study was conducted only in a single center. No comparison was
made with other hospitals. Therefore, the results of this study may be
limited only to the center of the study and should not be generalized.
5 | CONCLUSION
Communication is not only an ability differing from person to
person, but also it is a skill that can be obtained with necessary
training and experience. Communication training in nursing is an
important component to deliver more beneficial care for the needs
of patients. As it is shown in this study, good communication in
nursing increases the quality of care. In addition, this is an
inevitable precondition for establishing a real and meaningful
communication among patients, nurses, and other health care
professionals. Providing nurses with education, and continuous in
service training will enable them to sufficiently meet the
expectations of patients.
5.1 | Implications for nursing practice
More training can be implemented to educate nurses about
communication barriers to equip them with effective communica-
tion skills and strategies. Communication is important in health
care to encounter with patients, in particular, to understand each
patient's needs and to support health and well‐being. This goal can be achieved by shortening the working hours and workload by
recruiting more nurses or practical nurses, this will reduce stress
and allow for more time to thoughtfully communicate more
professionally. More training can be implemented to educate
nurses about communication barriers to equip them with effective
communication skills and strategies. Communication is important
TABLE 4 Communication challenge by mean scores of CCS and CBI scales (n = 262)
Communication Competence Scale Care Behaviors Inventory
Communication difficulty
Social relaxation
General
communication competence
Empathy competence
Behavioral flexibility
Affiliation/ support Reassurance
Knowledge‐ skills Respect Adherence
When introducing
Yes 3.8 ± 0.43 3.9 ± 0.50 4.0 ± 0.45 3.9 ± 0.50 3.9 ± 0.61 4.8 ± 0.67 4.8 ± 0.69 4.5 ± 0.67 4.5 ± 0.69
No 3.8 ± 0.61 4.0 ± 0.43 4.0 ± 0.49 4.2 ± 0.44 3.9 ± 0.52 5.0 ± 0.71 5.1 ± 0.71 4.9 ± 0.70 4.8 ± 0.72
Test value −0.046 −1.323 −0.313 −3.885 −1.079 −3.804 −2.015 −3.429 −3.629
P value 0.964 0.187 0.755 0.000 0.282 0.001 0.045 0.001 0.000
When informing
Yes 3.8 ± 0.47 3.9 ± 0.47 4.0 ± 0.46 3.9 ± 0.48 3.9 ± 0.58 4.7 ± 0.70 4.8 ± 0.70 4.5 ± 0.63 4.5 ± 0.67
No 3.8 ± 0.60 3.9 ± 0.44 4.0 ± 0.49 4.2 ± 0.43 3.9 ± 0.54 3.9 ± 0.38 5.0 ± 0.69 5.1 ± 0.72 4.9 ± 0.71
Test value −0.208 −0.361 −1.212 −5.090 −0.516 −4.210 −2.851 −3.730 −4.640
P value 0.835 0.718 0.227 0.000 0.607 0.000 0.005 0.000 0.000
When caring
Yes 3.8 ± 0.54 4.0 ± 0.46 3.9 ± 0.48 3.9 ± 0.47 4.0 ± 0.60 4.7 ± 0.71 4.7 ± 0.67 4.5 ± 0.68 4.5 ± 0.69
No 3.8 ± 0.55 3.9 ± 0.43 4.0 ± 0.49 4.2 ± 0.43 3.9 ± 0.53 5.0 ± 0.67 5.2 ± 0.71 4.9 ± 0.70 4.8 ± 0.71
Test value 0.136 0.848 −1.5 7 −3.9 53 0.543 −3.443 −4.718 −3.994 −3. 476
P value 0.892 0.397 0.117 0.000 0.587 0.001 0.000 0.000 0.001
When giving bad news
Yes 3.9 ± 0.55 4.0 ± 0.44 4.0 ± 0.46 4.1 ± 0.46 4.0 ± 0.55 4.9 ± 0.69 5.0 ± 0.71 4.7 ± 0.69 4.7 ± 0.71
No 3.8 ± 0.48 3.9 ± 0.44 4.0 ± 0.48 4.2 ± 0.47 3.9 ± 0.54 4.8 ± 0.70 5.0 ± 0.76 4.8 ± 0.73 4.7 ± 0.73
Test value 0.745 0.595 0.631 −2.203 0.341 0.871 −0.315 −0.956 −0.411
P value 0.457 0.552 0.529 0.029 0.734 0.385 0.753 0.340 0.682
TABLE 5 Correlation between communicative competence and care behavior scales of nurses (n = 262)
Communicative Competence Scale
Care Behaviors Inventory
Communicative
Competence Scale
1.00 1.00
Care Behaviors
Inventory
r = 0.5
P < 0.01
KIRCA AND BADEMLI | 629
in health care to encounter with patients, in particular, to
understand each patient's needs and to support health and well‐ being. Development of an effective relationship is important for
patient‐centered care. Nurses should know the importance of
communicative skills for a quality nursing care. Nurses should take
into account the expectations of patients about caring needs.
Nurses should improve their communicative skills to determine
patients' needs correctly. Nurses should understand the effects of
their communicative styles and skills on patients' care. There are
mutual interactions between the nurses and patients. Nurses are
affected by the patient and vice versa, thus nurses should assess
the effects of their behaviors on patients. This would improve the
patient‐nurse relationship, thus providing a quality care which
focuses on patients' needs. Communication between nurses and
patients is highly important to deliver quality care. If nurses are
trained for effective communication through in service training, its
positive reflections on care quality will be inevitable. It is
important to appropriately update training of nurses about
communication according to recent conditions. Regular commu-
nicative skills training for nurses can be organized in hospitals.
Although health professionals and students both warrant continu-
ing education in communication, the opportunity to correct this
problem lies within early education efforts.
CONFLICT OF INTERESTS
The authors declare that there are no conflict of interests.
ORCID
Kerime Bademli http://orcid.org/0000-0002-3969-9010
REFERENCES
1. Özcan A. Nurse‐Patient Relationship and Communication. 2nd ed.
Ankara: System Publishing; 2006.
2. Naish J. The route to effective nurse–patient communication. Nurs
Times. 1996;92:27‐30. 3. McCabe C. Nurse–patient communication: an exploration of patients'
experiences. J Clin Nurs. 2004;13:41‐49. 4. McGilton K, Robinson HI, Boscart V, Spanjevic L. Communication
enhancement: nurse and patient satisfaction outcomes in a complex
continuing care facility. J Adv Nurs. 2006;54:35‐44. 5. Anoosheh M, Zarkhah S, Faghihzadeh S, Vaismoradi M. Nurse–patient
communication barriers in Iranian nursing. Int Nurs Rev. 2009;56:243‐ 249. https://doi.org/10.1111/j.1466‐7657.2008.00697.x
6. Staniszewska S, Ahmed L. The concepts of expectation and satisfac-
tion: do they capture the way patient sevaluate their care? J Adv Nurs.
1999;29:364‐372. 7. Ross H, Tod AM, Clarke A. Understanding and achieving person‐
centred care: the nurse perspective. J Clin Nurs. 2015;24:1223‐1233. https://doi.org/10.1111/jocn.12662
8. Mohammed K, Nolan MB, Rajjo T, et al. Creating a patient‐centered healthcare delivery system: a systematic review of health care quality
from the patient perspective. Am J Med Qual. 2016;31:12‐21. https:// doi.org/10.1177/1062860614545124
9. Kourkouta L, Papathanasiou IV. Communication in nursing practice.
Mater Sociomed. 2014;26:65‐67. https://doi.org/10.5455/msm.2014.
26.65‐67 10. Tobiano G, Bucknall T, Marshall A, Guinane J, Chaboyer W. Nurses'
views of patient participation in nursing care. J Adv Nurs.
2015;71:2741‐2752. https://doi.org/10.1111/jan.12740 11. Wiechula R, Conroy T, Kitson AL, Marshall RJ, Whitaker N,
Rasmussen P. Umbrella review of the evidence: what factors
influence the caring relationship between a nurse and patient? J
Adv Nurs. 2016;72:723‐734. https://doi.org/10.1111/jan.12862 12. Kelley JM, Kraft‐Todd G, Schapira L, Kossowsky J, Riess H. The
influence of the patient‐clinician relationship on health care out-
comes: a systematic reviewand meta‐analysis of randomized con-
trolled trials. PLOS One. 2014;9:e94207. https://doi.org/10.1371/
journal.pone.0094207
13. Wiemann JM. Explication and test of a model of communicative
competence. Hum Commun Res. 1977;3:195‐213. https://doi.org/10. 1111/j.1468‐2958.1977.tb00518.x
14. Koca, GŞ, Erigüç, G. Validity and reliability of communicatıon
competence scale. Int. Journal of Management Economics and Business,
2017;13:789‐799. http://dx.doi.org/10.17130/ijmeb.2017433408
(in Turkish).
15. Wu Y, Larrabee JH, Putman HP. Caring behaviors inventory: a
reduction of the 42‐item instrument. Nurs Res. 2006;55:18‐25. 16. Wolf ZR, Giardino ER, Osborne PA, Ambrose MS. Dimensions of
nurse caring. J Nurs Scholarsh. 1994;26:107‐112. https://doi.org/10. 1111/j.1547‐5069.1994.tb00927.x
17. Kurşun Ş, Kanan N. Validity and reliability study of the Turkish
version of caring behaviors inventory‐24. J Anatolia Nurs Health Sci.
2012;15:229‐235. 18. Mukaka MM. A guide to appropriate use of correlation coefficient in
medical research. Malawi Med J. 2012;24:69‐71. 19. Finke EH, Light J, Kitko L. A systematic review of the effectiveness of
nurse communication with patients with complex communication
needs with a focus on the use of augmentative and alternative
communication. J Clin Nurs. 2008;17:2102‐2115. https://doi.org/10. 1111/j.1365‐2702.2008.02373.x
20. Lindberg E, Hörberg U, Persson E, Ekebergh M. “It made me feel
human”—a phenomenological study of older patients' experiences of
participating in a team meeting. Int J Qual Stud Health Well‐Being. 2013;8:20714. https://doi.org/10.3402/qhw.v8i0.20714
21. Bays AM, Engelberg RA, Back AL, et al. Interprofessional commu-
nication skills training for serious illness: evaluation of a small‐group, simulated patient intervention. J Palliat Med. 2014;17:159‐166. https://doi.org/10.1089/jpm.2013.0318
22. Abbaszadeh A, Ehsani SR, Begjani J, et al. Nurses' perspectives on
breaking bad news to patients and their families: a qualitative
content analysis. J Med Ethics Hist Med. 2014;718:1‐7. 23. Arnold RM, Back AL, Barnato AE, et al. The critical care communica-
tion project: improving fellows' communication skills. J Crit Care.
2015;30:250‐254. https://doi.org/10.1016/j.jcrc.2014.11.016 24. Grudzen CR, Emlet LL, Kuntz J, et al. EM Talk: communication skills
training for emergency medicine patients with serious illness. BMJ
Support Palliat Care. 2016;6:219‐224. https://doi.org/10.1136/
bmjspcare‐2015‐000993 25. Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Commu-
nication skills training for healthcare professionals working with people
who have cancer. Cochrane Database Syst Rev. 2018;7:CD003751.
https://doi.org/10.1002/14651858.CD003751.pub4
26. Kitson A, Marshall A, Bassett K, Zeitz K. What are the core elements
of patient‐centred care? A narrative review and synthesis of the
literature from health policy, medicine and nursing. J Adv Nurs.
2013;69:4‐15. https://doi.org/10.1111/j.1365‐2648.2012.06064.x 27. Coad J, Smith J, Pontin D, Gibson F. Consult, negotiate, and involve:
evaluation of an advanced communication skills program for health
630 | KIRCA AND BADEMLI
care professionals. J Pediatr Oncol Nurs. 2018;35:296‐307. https://doi. org/10.1177/1043454218765136
28. Blackman I, Henderson J, Willis E, et al. Factors influencing why
nursing care is missed. J Clin Nurs. 2015;24:47‐56. https://doi.org/10. 1111/jocn.12688
29. Jones TL, Hamilton P, Murry N. Unfinished nursing care, missed care, and
implicitly rationed care: state of the science review. Int J Nurs Stud.
2015;52:1121‐1137. https://doi.org/10.1016/j.ijnurstu.2015.02.012
How to cite this article: Kirca N, Bademli K. Relationship
between communication skills and care behaviors of nurses.
Perspect Psychiatr Care. 2019;55:624‐631. https://doi.org/10.1111/ppc.12381
KIRCA AND BADEMLI | 631
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