NAGLAA A. MOHAMED, D.N.Sc. and NADIA A. ABD EL HAMMED, D.N.Sc.

Transcription

1 Med. J. Cairo Univ., Vol. 80, No. 1, March: 7-12, Effectiveness of Communication Skills Training Program on Improving Burnout and Self-Esteem Among Nursing Staff in Psychiatric Hospital at Assiut Governorate NAGLAA A. MOHAMED, D.N.Sc. and NADIA A. ABD EL HAMMED, D.N.Sc. The Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Assiut University Abstract Communication is an essential component of palliative care; communication difficulties are recognized stress factor among health professionals especially nurses. This study aimed to investigate the relationship between burnout and self-esteem and evaluate the effectiveness of communication skills training among nurses working in psychiatric hospital at Assiut. The study was carried out at Assiut psychiatric mental health Hospital, Ministry of health. The study sample comprised of 30 nurses (14 males and 16 females), five tools were used for data collection, namely: Sociodemographic Data Structured Interview schedules, Burnout rating scale, Self-esteem inventory, Communication skills checklist (Cslist), and Educational program evaluation sheet. The main results yielded by the study proved that, the highest percentage among nurses aged from 30 or more than 30 years, females than males, and single, more than 2 /3 (73.3%) of the studied group lived in rural area. The study recommended continuous education provided for all working nursing personnel and make nurses updated of new knowledge and technology. Key Words: Effective communication skills Burnout Selfesteem Training program. Introduction PSYCHIATRIC mental health nurses are confronted with the daily responsibilities of assessing, intervening and evaluating client responses to stress and client reactions [1]. Communication is an essential component of palliative care; communication difficulties are recognized stress factor among health professionals especially nurses [2]. A communication skill is the ability to use language (receptive) and express (expressive) information, which is the set of skills that enables person to covey information so that it is received and understood [3]. Correspondence to: Prof. Naglaa Abdel Megied, The Department of Psychiatric & Mental Health Nursing, Faculty of Nursing, Assiut University The communication enables nurses to explore in detail the concept of interpersonal communication and to assist nurses to identifying, practicing and applying arrange of communication skills that will enable them to develop helpful, caring relationships with patients care. Communication training activities such as establishing relationships with adults and patients using concept of warmth, respect, genuineness, empathy and trust, practicing active listening, observation and responding, improving communication and professional presenting skills and practicing communication strategies with people who have specific communication needs due to mental health problems [4]. The communication is most evident in the areas of patients care, interpersonal skills and professionalism, so effective communication skills are also critical for demonstrating individual skill sets in medical knowledge and systems-based practice [2]. They need to identify the meaning of their own stress and develop strategies that increase personal and professional growth. They need to be aware of themselves in relation to others and to explore issues that affect them in the workplace [5]. The ability to manage stressful situations is determined by self-esteem, confidence and sense of power [6]. Burnout of human service workers especially nurses has been a major concern in the field of mental health. Nurses have considerable job stress because they have long working hours, a wide range of tasks and complicated relationships with patients, their families, doctors and other medical coworkers [7]. Many studies have indicated that the prevalence of burnout is higher among nurses who work in especially stressful settings, such as oncology, mental health, emergency medicine, and critical care [8]. 7

2 8 Effectiveness of Communication Skills Training Program on Improving Tao and Kubo, [9] indicated that burnout consisted of three dimensions such as emotional exhaustion, depersonalization, and reduced personal accomplishment, emotional exhaustion refers to being emotionally overwhelmed by the job demands and depleted of emotional resources. Depersonalization refers to the development of negative feelings and callous attitudes toward, or excessively detached response to, one's clients. Many studies have investigated the burnout of nurses. They indicated that there were personal factors (authoritative or perfectible tendency, selfesteem, purpose in life, work commitment and satisfaction with supports) and environmental factors (Conflicting role, supportive network, high work pressure, excessive workload, work schedule and poor human resources) which contribute to burnout [10]. Self-esteem is a state of appreciation which emerges from the approval of the self concept that the individual reaches after self-evaluation [11]. Self-esteem refers to whether one accepts oneself, respects oneself, and considers oneself a person of worth, and is an important factor in mediating the process between stressors and stress reaction in the model of job stress and health [12]. So nurses need to be good communicator in the clinical setting and confident in the necessary competencies and skills. Helping and caring for others are the essential core of professional nursing, often this care is viewed to be in conflicts when goals are achieved through direct and effective communication of ones needs, desire and wishes, however communication skills is essential to nursing in that nurse acts as communicator, advocate for and consultant to the client and to others. Also, improve nurse patient communication to give more effective caring for the psychiatric patients in psychiatric setup. The aim of the study was to investigate the relationship between burnout and self-esteem and explore the effectiveness of communication skills training among nurses working in psychiatric hospital at Assiut governorate. Material and Methods Research design: The design followed for this study is a pre testpost test quasi experimental study. Setting: The study was conducted on nurses at Assiut psychiatric mental health Hospital, Ministry of health. The hospital is serving Assiut City and all Upper Egypt governorates. Participants: Subjects of the study comprised all the available nurses working in mental health hospital at Assiut governerorate within a period of six months from March to August Both sexes and agree to participate in the study. The study subjects were 30 participants (14 male nurses and 16 female nurses). Tools of the study: - Sociodemographic Structured Interview questionnaire: This questionnaire developed by the researchers included the Sociodemographic data of the study subjects such as nurse's age, job type, marital status, education and years of experiences in psychiatric nursing field. - Burnout rating scale: It was developed by Shields K. [13], and composed of 10 statements used to assess and detect over stressed or burnout for individual. This is a 5 points, the rate in each question ranged from 0 (never) 1 (very rarely) 2 (rarely) 3 (sometimes) 4 (often). The following definition of severity levels: Not present burnout ranges from 0 to 10. Need for attention (mild) ranges from 16 to 25. Present burnout (moderate) ranges from 26 to 35. Severe burnout ranges from 36 to Self-esteem inventory: It was developed by Yusuf sayed [14], and consisted of 14 Items. The rate of points in each questions ranged from yes (2) or no (0). The degree of self-esteem categorized into: High self-esteem ranges from 22 to 30. Moderate self-esteem ranges from 19 to 21. Low self-esteem ranges from 15 to Communication skills checklist (cs-list): It was developed by Bowling, A [15] and consisted of fifteen items deemed necessary for communication skill. The answer for each item on the CS-list ranged from (1) unable to do at all to (6) able to do completely, the higher scores of the CSlist indicate higher communication skills. The levels of communication categorized into : <50% indicates low level of communication % indicate middle level of communication. >70% indicates high level of communication. - Educational program evaluation sheet: It was developed by the researcher to test the effective-

3 Naglaa A. Mohamed & Nadia A. Abd El Hammed 9 ness of communication skills training among nurses. The program distributed on "5" sessions, two sessions per week, each session ranged from one hour to two hours. Methods of data collection: - An official letter from the dean of the Faculty of Nursing-Assiut University directed to the head of psychiatric mental health hospital at Assiut governorate, ministry of health in order to get permission to conduct this study. - Collect data for all nurses through five tools prepared for the study. - Aim and nature of the study were explained to the nurses to participate in the study. - The study was carried out in "5" sessions. All sessions were divided as the following: Pre and post assessment of all nurses about burnout, self-esteem and communication as well as their knowledge of different communication skills were conducted before and after implementation of program. Another assessment evaluates the effectiveness of educational training program. Prepared scientific content of the educational training program of communication skills. Three months later a third assessment was conducted after the end of the program implementation among nurses. - Oral informed consents were obtained from all participants and they ensured about the confidentiality of the obtained information to avoid misunderstanding and providing privacy for them. Statistical analysis: The data were computerized and verified using the SPSS (statistical package for social science) version 11.5 to perform tabulation and statistical analysis. Qualitative variables were described in frequency and percentages, statistical significance was considered at p-value <0.05. Results In the present study, 60% of the studied group was in the age group <30 years, while 40% of them were less than or equal thirty ( 30 years). As regard sex, more than half of the studied group were women. 80% of the studied group were single, while 20% of them were married. According to residence, more than 2 /3 (73.3%) of the studied group were lived in rural area, while 26.7% of them lived in urban area. Concerning staff nurses, years of experience; more than half of the nurses (60%) had tenor more than ten years of experience, and the rest (40%) had less than ten years of experience. As regard place of work, about two thirty (70%) of the studied group were working at general ward, while 30% of them were at private ward. According to attending training courses about communication skills, most of the studied group (83.3%) did not attend training courses about communication skills, while only 16.7% of them were attending training courses about communication skills Table (1). Table (1): Socio-demographic characteristics of the studied group. Variables No. (n=30) % Age: (years) < Sex: Male Female Marital status: Married Single Residence: Rural Urban Experience: <10 y y Place of work: General Private Attending training courses about communication skills: Yes No Table (2) illustrates the comparison of mean score related to nurses knowledge about communication skills before and after educational training. Highly statistical significant difference was noticed between before and after training program regarding knowledge about communication skills (p=0.000*). Table (2): Comparison of mean score related to nurses' knowledge about communication skills before and after educational training program. Nurses' knowledge about Before training After training communication skills Mean±SD 4.73± ± 1.72 Range p-value 0.000*

4 10 Effectiveness of Communication Skills Training Program on Improving Table (3) shows the comparison of mean score related to nurse's practice about Communication skills before and after educational training program. Highly statistical significant difference was found between before and after educational training program regarding practice about communication skills (p=0.000*). Table (3): Comparison of mean score related to nurses' practice about communication skills before and after educational training program. Nurses' practice about communication skills Before training After training Table (6) illustrates the effect of training program on burnout. A significant change was found after training program at (p=0.000*). Table (6): Distribution of the studied group in relation to their level of burnout before and after implementation of training program. Burnout Low Moderate High Before training After training No. % No. % p-value * Mean±SD 5.63± ± 1.64 Range p-value 0.000* Total score: 24. Table (4) shows the total score of communication skills level of the studied group were significant change was found in the level of communication skills at p=0.000 as 100% after educational training program. Table (4): Scores of communication skills before and after implementation of training program among nurses. Communication skills Before training After training No. % No. % Low Middle * 1 High Total score: 90. Table (5) illustrates the effect of educational training program on self-esteem. A significant change was found after the training program at (p=0.000*). Table (5): Distribution of the studied group in relation to their level of self-esteem before and after implementation of training program. Self-esteem Low 7 Moderate 8 High 15 Before training After training No. % No. % Total score: p-value p-value * 1 Discussion Communication is the most evident in the areas of patient care, interpersonal skills, and professionalism. Effective communication skills are also critical for demonstrating individual skill sets in medical knowledge and systems-based practice [2]. The present study aimed to estimate the effectiveness of communication skills training program on burnout and self-esteem among nurses working in psychiatric hospital at Assiut governorate. The highest percentage of the studied group aged from 30 to more than 30 years old, more than half of them were women, and lived in rural areas. As regards staff nurses years of experience, more than half of them had ten or more than ten years of experience. These results agreed with the result of Weert et al. [16] who stated that the majority of the nurses attended in the study were females with an average age of 41 years, while other studies do not go with these results, Zavertnik et al. [17] stated that the effects of gender, ethnicity and race differences were not significant among nurses. Also, Takashi et al. [12] found that there were no significant differences between the mean of age and working years of the intervention, which may be lack of connection between knowledge and practical skills. Related to nurses knowledge and practice about communication skills training program, the present study showed that there was a highly significant difference noticed after implementation of the training program regarding nurse's knowledge and practice about communication skills. This result supported by the findings of Wilkinson et al. [18] who stated that an overall statistically significant

5 Naglaa A. Mohamed & Nadia A. Abd El Hammed 11 improvement in assessment skills between pre-test and post-test scores of communication skills program, which allows nurses to explore their attitudes, raise self-awareness and develop knowledge and skills, is most effective in preparing them to communicate with patients. Also, in the study of Kruijver et al. [19] when using methods for communication training program as role playing exercise, group discussion, videotapes demonstrations of key communication skills, exchange of experiences among nurses, case study discussion, found that during combination of practical and theoretical communication training for nurses promote nurse's post-training communication skills. Concerning communication skills levels of the studied group, the present study revealed that the total score of communication skills level was significantly higher after training program. This finding consistent with Takashi et al. [12] who stated that communication skills levels were improved significantly after the training program. As regards the effect of educational training program on nurse's self-esteem and burnout, the present study showed that there were significant changes of nurse's self-esteem and burnout after implementation of training program. This result in accordance with Takashi et al. [12] who reported that only a few studies have investigated the relationship between communication skills and burnout of health professionals including nurses, which improve the mental health of human service workers. In the study of Takashi, [12,20] reported that the nurse's knowledge and practice after the first study (five month) changes in burnout and selfesteem and communication skills of Japanese nurses after educational training program. Also, Tao, and Kubo, [9] stated that previous studies suggested that interpersonal relationship skill was important to prevent burnout or to reduce job stress among nurses, and the communication skills training was considered to prevent burnout among them. In addition to that, Takashi, et al, [20] found that the nurse's self-esteem had improved at six months after the assertiveness training. This corresponded also, with the previous studies which indicated that assertiveness contributed to self-esteem among American firefighters (Hurrel and Mclaney, [21] ; and that assertiveness training reduced stress reaction among Taiwanese hospital nurses [22]. Conclusion: Based upon the study results, it is concluded that the educational training program affected communication skills among nurses which im- proved after the training, and also, improved their self-esteem and self-confidence, so that leading to reduced job stress at work. This revealed that the communication training helped nurses communicate effectively and be more tolerant to their patients. Recommendations: From the previous conclusion, the following recommendations are suggested: - Communication skills methods as a training program should be provided to all nurses at regular sessions by professional people in the field of mental health to train them on dealing with stressful situation. - Design, implementation and evaluation of an advanced communication skills module undertaken to final year undergraduate nursing students. - Before embarking on the psychiatric field, nurses should be prepared by self-awareness training to orient them with their actual or potential capabilities and limitations which will enhance proper coping in their reactions to stressors. - Development of stress management programs for nurses and suggestions of certain strategies as assertiveness training based on learning both verbal and non verbal aspects of assertiveness. - In service training and continuing education should be provided for all nursing personnel working in psychiatric hospitals to make them updated of new knowledge and technology. All nursing personnel should have planned learning program during their initial professional education, properly designed to help acquire the knowledge, attitude and skills in the field of mental health and psychiatric nursing. References 1- SULLIVAN P.J.: Occupational stress in psychiatric nursing. Advanced Nurse., 18: , KATZ L.: Communication skills training programs for I.M.Gs. Update in medical education/interpersonal and communication skills. Academic Internal Medicine Insight, pp: 5-3, Www. communication skills. Com. In DUBLIN: Communication and nursing practice, nursing school module. Http// contents. Ph.p, STWART G.W. and SUNDEEN I.J.: Principles and practice of psychiatric nursing. 5 Th ed. Boston. Mosby-Year Book, Inc., , OTING D.A. and KONGABLE G.: Psychiatric nursing, biological and behavioral concepts. Philadelphia: W.B Saunders co., 66-78, MIKI A.: Stress management in hospitals. San Eishi, in Japanese with Abstract, 44: , 2002.

6 12 Effectiveness of Communication Skills Training Program on Improving 8- PONCET M.C., TOULLIC P., PAPAZIAN L., et al.: Burnout syndrome in critical care nursing staff. Am. J. Respir. Crit. Care Med., 175 (7): , TAO M. and KUBO M.: Theory and researches of burnout (burnout no Riron to Zissai). Tokyo: Seishin-Shobo, (in Japanese), HIGASHIGUCHI K., MORIKAWA Y., MIURA K., NISHIJO M., TABATA M.M. and KAKAGAWA H.: Burnout and related factors among hospital nurses. J. Occup. Health, 41, , COSKUN ARSLAN1*, ERDAL HAMARTA1 and MUS- TAFA USLU2: Educational Research and Reviews Vol. 5(01), pp , January TAKASHI S., TETSUJA M. and SHINYA K.: Relationship between burnout and communication skill training among Japanese hospital nurses: A pilot study. J. Occup. Health, 45: , SHIELDS K.: Burnout rating scale. An empowerment guide for social action, Self Published, p. 130, YUSUF and SAYED,: Self-esteem inventory. Maktoobblog.Com/sayed Yusuf oo, BOWLING A.: Research methods in health. Philadelphia: open University press, , WEERT J.C.M. VAN, JANSEN J., SPREEUWENBERG P.M.M., et al.: Effects of communication skills training and a question prompt sheet to improve communication with older cancer patients: A randomized controlled trial. Critical Reviews in Oncology Hematology, ZAVERTNIK, TANYA A. and CINDY L.: Innovative approach to teaching communication skills to nursing students. Journal of Nursing Education. Vol. 49, No. 2, 65-71, WILKINSON, SUSIE, ROBERTS, et al.: Nurse-patient communication in palliative care: An evaluation of a communication skills programme. Palliative Medicine, 12 (1): 13-22, KRUIJVER, IRMA P.M., KERKSTRA, et al.: Evaluation of communication training programs in nursing care: A review of the literature. Patient Education and Counseling, 39: , TAKASHI S., SHINYA K., NORIO M. et al.: Relationship between self-esteem and assertiveness training among Japanese Hospital nurses. Journal of Occupational Health, 46: , HURRELL J.J. and MCLANEY M.A.: Exposure to job stress- Anew psychometric instrument. Scand J. Environ Health, 14, 27-28, SLEE and CROCKETT M.S.: Effects of assertiveness training on levels of stress and assertiveness experienced by nurses in Taiwan, Republic of China. Issues in Mental Health Nursing, 15: , 1994.