Understanding communication skills learning, behavior and ...

cnssciedupresscom Clinical Nursing Studies 2019 Vol 7 No 2

ORIGINAL ARTICLE

Understanding communication skills learningbehavior and attitude among students in three nursingcolleges in Qassim region Saudi Arabia

Hanan MM Tork12 Areej S Alatrashlowast3 Asma R Alharbi4 Mona A Almansour4 Rawan S Alolayqi4

1College of Nursing Qassim University Saudi Arabia2Facuty of Nursing Zagazig University Egypt3Albukayreah General Hospital Saudi Arabia4King Fahad Specialist Hospital Saudi Arabia

Received September 17 2018 Accepted October 22 2018 Online Published December 29 2018DOI 105430cnsv7n2p19 URL httpsdoiorg105430cnsv7n2p19

ABSTRACT

Background Effective communication is one of the many skills that nursing students should master to be good at their jobNursing students have to understand different kinds of communication styles to know how to deal with different situations as anaspect of nursing professional education Poor communication is a barrier to effective nursing practice and this leaves the nurse tobe isolated feeling more stress and dissatisfiedObjective The aim of the present study is to evaluate the communication skills learning behavior and attitude among nursingstudents and their thoughts about the role of communication in three colleges in Qassim KSAMethods A descriptive study was applied using a convenience sample of 116 female students from three nursing colleges inQassim region Saudi Arabia Attitude toward the learning of communication skills was evaluated by Communication SkillsAttitudes Scale (CSAS)Results All participants were female and most of them 3rd year students The majority of nursing students at Qassim University(951) had hospital training for three semesters and more compared to 618 from Al-Ghad College and 429 from BuraydahColleges Statistically significant differences were detected among the three colleges regarding most of the items of communicationskills behavior Communication Skills Attitudes Scale revealed a moderate score in the positive attitudes and the average scorefor negative attitudinal scoreConclusions Moderate positive attitudes toward communication skills learning among nursing students of the three collegesThe results provide an important base for improving the content of the current communication curriculum in nursing studyprograms

Key Words Communication skills behavior Attitude Nursing college Qassim region

1 INTRODUCTIONEffective communication cans influence a patientrsquos healthsuch as symptom resolution decreasing of blood pressurereported pain and decrease of drug use Nurses have an op-

portunity to promote relationships and patient care in everypoint of communication[1] Many studies emphasized thatcommunication between health care providers and patientsaffects patient outcomes[2 3] Researches indicate that the

lowastCorrespondence Areej S Alatrash Email areej_556icloudcom Address Albukayreah General Hospital Saudi Arabia

Published by Sciedu Press 19


primary cause of medical errors and associated mortalityand morbidity is communication breakdowns in health caresettings[4 5] Communication is a process of exchanging in-formation either in the verbal or nonverbal way and creatingrelationships with others[1] In other words communicationis not just saying words it is a meaningful conversationwith people to influence and exchange information or ideaswith them The effective communication shows knowledgethoughts and feelings of people besides showing who theyare and what they know Full communication includes trustactive listening and time control In addition it shows em-pathy and conveys feelings in words give a sense of caringsharing ideas clearly and much more[6] By contrast inef-fective communication leads to an increased frequency ofmedical errors and this causes stress makes nursing tasksdifficult hinders pain control distances the patient impedesthe correct assessment of the patient and fulfillment of theirneeds and decreases the quality of patient care[7] The waysto conduct message is developed like words signs letterspictures colors signals body language and gestures and itdivided by experts into two categories Verbal and nonverbalcommunication[8] The clinical communication skills areall communications process with patients family membersand all the health care providers Communication behaviorsof treatment are providing information supporting givinghope and helping them to alleviate their anxiety[9] thereforethe quality of care is a combination of attitudes values andbeliefs of health care providers In health services caring isan important part and nursing care is more essential amonghealth team in health agencies[10] Moreover clarity of clari-fication is key for an effective communication data shouldbe essential and the content must be linear with receiversrsquocultural level[11]

2 LITERATURE REVIEW

The most important components of a quality healthcare es-tablishment are quality nurses Since nurses are taking careof patients during their entire stay Thus it is important fornursing students to be prepared and assessed on communica-tion competency prior to exiting their program of study[12]

Principles in nursing communication which helps to performnursing work in ease consistent and accurate way to en-sure patient satisfaction and health professional protectionCommunication is multidirectional and it represents the inter-action between sender and receiver every receiver gets to bethe sender and vice versa[13] Besides communication princi-ples the communication has specified process involves threekey parts a sender (encoder) receiver (decoder) and the mes-sage itself To effectively contact with patients nurses haveto be able to decode information successfully after receiv-

ing it offering different kinds of communication in variouscontexts of nursing through kinesthetic visual and auditorymodes to ensure addressing the patientsrsquo concerns[14]

Nursing students have to understand different kinds of com-munication styles to know how to deal with different situa-tions as an aspect of nursing professional education[15] toclarify nurse has different goals to communicate each goalrequires certain behavior of communication such as creatinga relationship assessing patient problems making decisionabout nursing care exchanging information providing carein physical and psychological aspects[16]

There are skills that prove listening such as reflecting sum-marizing paraphrasing checking acknowledging empathiz-ing and creating educated guesses[1] According to the RoyalChildrenrsquos Hospital Melbourne in 2015 there are sometasks the nurse needs to be a good communicator to performsuch as handover the patients formulating a care plan giv-ing appropriate care communicating with other health caremembers about patient condition and documenting in patientrecord[17] The Nurse may face barriers in reaching effec-tive communication some barriers related to communicationwith the patient such as noise environment lack of privacyand patient anxiety Other barriers to communication withhealth care providers such as lack of time staff conflict andhigh workload[1] Poor communication is a barrier to effec-tive nursing practice the new nurse is vulnerable to isolatefeel more stress and dissatisfied The communication diffi-culties are not only at the same organizational level but alsoamong different organizational levels especially betweennurses and physicians[18]

According to the Australian Commission on Safety and Qual-ity in Health Care the increasing number of patients whohave chronic diseases causes the increase of communicationdemand which in turn causes the rising of care complexityand rising of unexpected errors and problems which needadvanced communication skills to resolve it[19] Moreovernursesrsquo workload does not give nurses enough time to makemeaningful discussion with their patients they only completemeasurable duties[20] In General without good communi-cation skills teachers or practitioners will fail in doing theirresponsibilities[6] These failings in doing effective workmay have resulted from inadequate training of communi-cation skills[1] Therefore the use of proper communica-tion styles has advantages in the delivering of healthcare[13]

Nursing has various roles and every role has general andspecific accountability in professional nurses the importantduty is maintaining and promoting health care This canbe achieved by using many of scientific principles one ofthem is establishing proper communication with clients it

20 ISSN 2324-7940 E-ISSN 2324-7959


is clearly fundamental in nursing practice quality It is alsoessential in nursing to maintain a sensitive and effective re-lationship with patients and health care providers[9] Thisstudy sought to investigate and describe the effect of clini-cal settings with the communication skills of undergraduatenursing students in the Qassim region through three aspectstheir knowledge their behavior and their attitude towardscommunication skills amp and role of communication in thenursing field

Research questions(1) Does the undergraduate nursing students understand

the role of communication skills in clinical settings(2) Does the communication skills learning behavior

and attitude affect the undergraduate nursing studentsrsquothoughts regarding the role of communication

3 RESEARCH METHODOLOGY

31 Design amp settingA descriptive study used a convenience sample from threenursing colleges in the Qassim region Saudi Arabia TheNursing College Qassim University Buraydah private Nurs-ing College and Al-Ghad private Nursing College

Figure 1 Nursing Professional Practice Model adopted from Hoffart amp Woods (1996)[23]

32 Participants

Participants were 116 female nursing students they partic-ipated from different colleges in the Qassim region Sixty-one participants from Nursing College Qassim Universitytwenty participants from Buraydah private Nursing Collegeand thirty-five participants from Al-Ghad private NursingCollege The total male and female nursing students in thesecolleges are 536 and this leads to a few numbers of partic-ipants from these colleges Participants were female onlybecause in Qassim region male and female students study-ing in two separate buildings and it is not allowed for onegender to access the building of another gender The nurs-ing students from the last four semesters were recruited to

participate because they have more opportunities for commu-nication skills experience with colleagues andor health careproviders

33 Research instrumentsThe communication skills of participants were evaluated bya standardized tool which was developed by Steckler[21] in2012 The tool is divided into three questionnairersquos sectionsthe first section concerning demographic data which includecollege name academic level age if the student has trainedbefore in a hospital or not and if yes the duration of trainingand the source of studentrsquos knowledge regarding communi-cation skills The second section focused on communicationskills learning which includes 22 statements the third sec-



tion dwelt on communication skills behavior which includeseight statements Attitudes towards communication skillswere measured using the Communication Skills AttitudesScale (CSAS) This scale was originally developed by Reeset al[22] for the purposes of measuring attitudes toward com-munication among medical students CSAS consists of 26items but based on the pilot study which was carried outdone the authors the CSAS items were reduced to 18 itemsto avoid repetition and studentsrsquo confusion These 18 itemswere divided into two subscales 9 items are written in theform of positive statements (positive attitudes subscale) and9 items were formulated as negative statements about com-munication skills learning (negative attitudes subscale) Eachitem is accompanied by a 5-point Likert scale ranging from1 (strongly disagree) to 5 (strongly agree) The total scorein each subscale ranged from 9 to 45 A higher score indi-cates higher positive attitudes towards communication skillslearning

34 Data collection procedureAfter getting approval from three aforementioned collegesthe researchers scheduled two days for obtaining participantsanswers On the first day in Buraydah college the instructorinformed the students and took time at the end of classes togather them to fill the questionnaires the researchers werethere to clarify any unclear statements and the filling tookone hour for all students On the second day the researchers

divided themselves into two colleges in Qassim Universitythe instructor gathered students in break time to fill ques-tionnaires and these took 15 minutes of time for filling andtwo researchers stood by in clarifying any ambiguous itemAt the same time two of the researchers were in Al-GhadCollege the instructor took an oral excuse from the lecturerin each class The convenient sampling method was usedThe Rresponse rate for this study was 843 Hard copies ofthe questionnaires were distributed among students in the 3rdand 4th year of their studies After all participants filled-outthe questionnaires and data collection has had been finisheddata entry and analysis were carried out (see Figure 1)

35 Ethical issues and statistical analysis

Prior to data collection the approval was obtained from theDean of University Studies Center female section of Qas-sim University as well as the deans of participating collegesParticipation in this study was voluntary and all participantswere informed of their right to withdraw from the study Allparticipants were given an explanation of the aim of thisstudy and assured of privacy and confidentiality where theprinciple of anonymity was strictly adhered to Data wereentered and analyzed using the Statistical Package SocialSciences (SPSS) software program version 230 Qualita-tive variables were presented by using frequency table andpercentages and p-value lt 05 was taken as significant

Table 1 Characteristics of participants

Items Qassim University Al-Ghad Colleges Buraydah Colleges

n = 61 n = 35 n = 20

Level

5-6 44 (721) 14 (40) 7 (35)

7-8 17 (279) 21 (60) 13 (65)

Age

le 21 Years 20 (328) 5 (143) 2 (10)

22-26 Years 41 (672) 30 (857) 17 (85)

gt 27 Years 0 (0) 0 (0) 1 (5)

Hospital Training

Yes 60 (984) 34 (971) 14 (70)

No 1 (16) 1 (29) 6 (30)

Duration of Training

One Semester 0 (0) 5 (143) 1 (71)

Two Semesters 1 (16) 8 (235) 7 (50)

Three Semesters amp more 58 (951) 21 (618) 6 (429)

Summer Training 2 (33) 0 (0) 0 (0)

Source of Knowledge about Communication Skills

Course 50 (82) 21 (60) 1 (59)

Subject 9 (148) 8 (229) 13 (765)

Article 2 (33) 5 (143) 3 (176)

Did not know about it 0 (0) 1 (29) 0 (0)

4 RESULTSA total of 116 female nursing students from three nursing col-leges (Qassim Al-Ghad College and Buraydah Colleges) inthe Qassim region Saudi Arabia participated in the present

study and more than half of them were from the QassimCollege (525) Regarding the academic level 721 ofQassim University participants were at 5-6 and 279 wereat 7-8 From Al-Ghad and Buraydah College it was 40

22 ISSN 2324-7940 E-ISSN 2324-7959


and 35 were at 5-6 respectively For level 7-8 there were60 of participants from Al-Ghad College and 65 of par-ticipants from Buraydah College Most of the participants ofQassim Al-Ghad and Buraydah Colleges had their age rang-ing from 22-26 years (672 857 amp 85 respectively)The majority of participants from Qassim University (984)Al-Ghad Colleges (971) and Buraydah College (70) hadhospital training Most of nursing students at Qassim Uni-versity (951) had hospital training for three semesters and

more compared to 618 from Al-Ghad College and 429from Buraydah Colleges Only the participants from Qas-sim University (33) had summer training Regarding thesource of knowledge about communication skills most ofthe participants from Qassim University (82) and Al-GhadCollege 60 received their knowledge from a course while765 of Buraydah College students received a subject oncommunication skills (see Table 1)

Table 2 Communications skills learning and role of communication

Question (Communication Skills

learning)

Qassim University (n = 61)

Al-Ghad Colleges (n = 35)

Buraydah Colleges (n = 20)

p-value N () N () N ()

Agree Neutral Disagree Agree Neutral Disagree Agree Neutral Disagree

In order to be a good nurse I must have

good communication 60 (984) 1 (16) 0 (0) 35 (100) 0 (0) 0 (0) 17 (85) 3 (15) 0 (0) 007

Nobody is going to fail their nursing

program for having poor communication

skills

10 (169) 29 (492) 20 (339) 13 (371) 18 (514) 4 (114) 10 (50) 9 (45) 1 (5) 004

Developing my communication skills is

just as important as developing my

knowledge of nursing

45 (738) 10 (164) 6 (98) 29 (829) 4 (114) 2 (57) 16 (80) 3 (15) 1 (5) 852

Learning communication skills will help

me to respect patients 54 (885) 6 (98) 1 (16) 33 (943) 2 (57) 0 (0) 16 (80) 4 (20) 0 (0) 443

I havenrsquot got time to learn communication

skills 11 (18) 16 (262) 34 (557) 11 (314) 10 (286) 14 (40) 3 (15) 11 (55) 6 (30) 061

Learning communication skills is

interesting 41 (672) 16 (262) 4 (6 6) 28 (80) 6 (171) 1 (29) 17 (85) 3 (15) 0 (0) 412

Learning communication skills has helped

me or will help merespect my colleagues 59 (967) 1 (16) 1 (16) 30 (857) 5 (143) 0 (0) 16 (80) 4 (20) 0 (0) 055

Learning communication skills has

improved my ability to communicate with

patients

60 (984) 0 (0) 1 (16) 30 (857) 5 (143) 0 (0) 16 (80) 4 (20) 0 (0) 016

Communication skills teaching states the

obvious and then complicates it 29 (483) 21 (35) 10 (167) 20 (571) 6 (171) 9 (257) 15 (75) 5 (25) 0 (0) 047

Learning communication skills is too easy 14 (23) 33 (541) 14 (23) 22 (629) 9 (257) 4 (114) 12 (60) 8 (40) 0 (0) 000


me or will help me to facilitate

team-working skills

51 (836) 91 (148) 1 (16) 31 (886) 2 (57) 2 (57) 15 (75) 4 (20) 1 (5) 425

I find it difficult to trust information about

communication skills given to me by

non-clinical lecturers

16 (262) 28 (459) 17(279) 19 (543) 7 (20) 9 (257) 6 (30) 9 (45) 5 (25) 050


or will help me recognize patientsrsquo rights 48 (787) 10 (164) 3 (49) 30 (857) 4 (114) 1 (29) 17 (85) 3 (15) 0 (0) 801

Communication skills teaching would have

a better image if it sounded more like a

science subject

34 (557) 22 (361) 5 (82) 26 (743) 6 (171) 3 (86) 15 (75) 5 (25) 0 (0) 188

When applying for nursing I thought it

was a really good idea to learn

communication skills

48 (787) 12 (197) 1 (16) 30 (857) 4 (114) 1 (29) 14 (70) 4 (20) 2 (10) 344

I find it hard to admit to having some

problems with my communication skills 17 (288) 28 (475) 14 (237) 10 (286) 20 (571) 5 (143) 8 (40) 8 (40) 4 (20) 647

I think itrsquos really useful learning

communication skills in the nursing

program

49 (803) 11 (18) 1 (16) 30 (857) 5 (143) 0 (0) 16 (80) 4 (20) 0 (0) 865

My ability to pass exams will get me

through my nursing rather than my ability

to communicate

24 (40) 30 (50) 6 (10) 22 (629) 8 (229) 5 (143) 16 (80) 4 (20) 0 (0) 007


applicable to learning nursing 46 (754) 14 (23) 1 (16) 26 (743) 4 (114) 5 (143) 11 (55) 6 (30) 3 (15) 048

I find it difficult to take communication

skills learning seriously 15 (246) 18 (295) 28 (459) 14 (40) 9 (257) 12 (343) 10 (50) 10 (50) 0 (0) 004


important because my ability to

communicate is a lifelong skill

55 (902) 5 (82) 1 (16) 33 (943) 2 (57) 0 (0) 16 (80) 4 (20) 0 (0) 385

Communication skills learning should be

left to psychology students not nursing

students

10 (164) 13 (213) 38 (623) 16 (457) 8 (229) 11 (314) 7 (35) 4 (20) 9 (45) 022

Note p-value le 05 Chi-Square test was used to calculated p-value



Questions from communication skills learning domainshowed the statistically significant difference in the responsefor Q1 Q2 Q7 Q8 Q9 Q10 Q12 Q18 Q19 Q20 andQ22 for Qassim University Al-Ghad College and BuraydahCollege participantsrsquo response (see Table 2)

Regarding communication skills behavior and Role of Com-munication Table 3 illustrates that higher significant num-bers of students at Buraydah College agreed with the state-ment ldquochecking for patientrsquos understanding is generally un-necessaryrdquo (Qassim University 197 Al-Ghad College

286 amp Buraydah College 70) From Buraydah Collegesignificantly higher numbers of participants agreed with thestatement ldquocommunication address patientrsquos emotions andpsychological issues absolutely essential in nursing todayrdquo(Qassim University 115 Al-Ghad College 40 amp Buray-dah College 50) High numbers of participants on agreedwith the statement that addressing patientrsquos emotions andpsychological issues is an essential part of the role of com-munication (Qassim University 881 Al-Ghad College543 amp Buraydah College 85)

Table 3 Communications skills behavior and the role of communication

Question (Communication Skills learning)

Qassim University

Al-Ghad Colleges

Buraydah Colleges



1 Communication is important to clarify

the treatment plan with patients 57 (934) 4 (66) 0 (0) 30 (857) 4 (114) 1 (29) 16 (80) 4 (20) 0 (0) 252

2 Checking for patient understanding is

generally unnecessary 12 (197) 8 (131) 41 (672) 10 (286) 4 (114) 21 (60) 14 (70) 6 (30) 0 (0) 000

3 Nurses and other health professionals

must work to collaborate more

effectively

56 (919) 5 (82) 0 (0) 31 (886) 3 (86) 1 (29) 14 (70) 5 (25) 1 (5) 112

4 Acknowledging the patientrsquos experience

is not necessary in nurse- patient

relationships

16 (262) 12 (197) 33 (541) 11 (314) 12 (343) 12 (343) 8 (40) 5 (25) 7 (35) 254

5 Dealing with the emotional problems of

patients is the responsibility of

psychiatrists psychologists and social

workers not nurses

7 (115) 15 (246) 39 (639) 14 (40) 11 (314) 10 (286) 10 (50) 5 (25) 5 (25) 000

6 Communication address patientrsquos

emotions and psychological issues

absolutely essential in nursing today

52 (881) 7 (119) 0 (0) 19 (543) 14 (40) 2 (57) 17 (85) 3 (15) 0 (0) 002

7 Patients are generally unaffected by

nurses non-verbal responses 10 (164) 21 (344) 30 (492) 15 (429) 12 (343) 8 (229) 9 (45) 3 (15) 8 (40) 010

8 Nurses need to be aware of their body

language and use of personal space when

talking with patients

54 (885) 4 (66) 3 (49) 31 (886) 3 (86) 1 (29) 12 (60) 4 (20) 4 (20) 030


Figure 2 Percentage distribution of studentsrsquo response toward statement ldquoGood nurse-patient communication improvespatientrsquos healthrdquo

24 ISSN 2324-7940 E-ISSN 2324-7959


Figure 3 Percentage distribution of studentsrsquo response toward the statement ldquoGood communication is a core clinical skillrdquo

The majority of participating students agreed regarding thestatement ldquoGood nurse-patient communication improves pa-tientrsquos healthrdquo (902 of Qassim University 914 fromAl-Ghad College and 80 from Buraydah college) and thisdifference was not statistically significant (p-value = 235)(see Figure 2)

Most of the participants agreed that ldquoGood communicationis a core clinical skillrdquo (852 of participants from Qassim857 of participants from Al-Ghad College and 70 of par-ticipants from Buraydah) and this difference was statisticallyinsignificant (p-value = 225) (see Figure 3)

Table 4 Attitude scores of the CSAS questionnaire regarding learning communication skills

No Items of CSAS

Qassim

University

Al-Ghad

Colleges

Buraydah

Colleges

Mean SD Mean SD Mean SD

Items of positive attitudes scores

1 In order to be a good nurse I must have good communication skills 301 013 200 039 215 037

4 Developing my communication skills is just as important as developing my knowledge of nursing 296 096 123 055 125 055

5 Learning communication skills has helped or will help me respect patients 313 039 206 024 120 041

7 Learning communication skills is interesting 239 061 122 049 115 037

9 Learning communication skills has helped or will help facilitate my team-working skills 400 083 260 089 200 097

10 Learning communication skills has or will improve my ability to communicate with patients 413 089 204 024 127 049

12 Learning communication skills is fun 310 085 253 075 210 057

14 Learning communication skills has helped or will help me respect my colleagues 313 039 300 024 120 041

18 When applying for nursing I thought it was a really good idea to learn communication skills 411 059 224 050 169 040

Items of negative attitude scores

2 I do not feel confident in my ability to express a sense of caring for my patients 221 076 191 090 206 094

3 I have difficulty in suspending my personal beliefs and biases in order to hear and accept a

clientpatient as a person 220 075 165 081 150 069

6 I feel if I talk to clientspatients on an individual personal basis things might get out of control 179 076 165 077 155 069

8 I dont feel strong enough to listen to the fears and concerns of my clientpatient 290 079 203 087 155 060

11 I often find it difficult to express empathy with clientspatients 190 083 153 075 130 057

13 If I find it hard to relate to a clientpatient Ill stop trying to work 180 079 143 089 165 069

15 I often find it hard to relate to clients patients from a different culture than mine 382 092 291 106 150 079

16 I dont need good communication skills to be a nurse 100 072 231 156 250 099

17 I dont use creative or unusual ways to express caring for my clientspatients 313 089 104 024 129 046



Regarding attitude toward learning communication skillsTable 4 shows that among the positive items the highestpositive attitudes were found in item 10 ldquoLearning commu-nication skills has or will improve my ability to communi-cate with patientsrdquo and item 18 ldquoWhen applying for nursingI thought it was a really good idea to learn communicationskillsrdquo The lowest positive attitudes were expressed in item7 ldquoLearning communication skills is interestingrdquo and item 4ldquoDeveloping my communication skills is just as important asdeveloping my knowledge of nursingrdquo Among the negativeitems the highest negative attitudes were found in item 15ldquoI often find it hard to relate to clientspatients from a differ-ent culture than minerdquo and item 11 ldquoI often find it difficultto express empathy with clientspatientsrdquo The lowest neg-ative attitudes were expressed in item 6 ldquoI feel if I talk toclientspatients on an individual personal basis things mightget out of controlrdquo and item 13 ldquoIf I find it hard to relate to aclientpatient Irsquoll stop trying to workrdquo

5 DISCUSSION

Effective communication is one of the most important skillsthat nursing students should master to be good in their job[21]

In the hospital environment most time of communicationwith the patient occurred by nurses[24] A quality nurse is themost important component of a quality healthcare establish-ment not only are nurses the first to interact with patients in aclinical setting but they also take care of patients during theirentire stay[25] The goal of the present study is to evaluate thecommunication skills learning behaviour and attitude of un-dergraduate nursing students at the three colleges of nursingand their thoughts on the role of communication One studyin 2012 of 312 nursing students at the beginning of prac-tice sessions showed that 881 of nursing students had poorskills in clinical treatment and interpersonal communicationand they need extra training[26] On the contrary our resultsrevealed that most of nursing students in the Qassim regionhad trained in hospitals for three semesters or more whichsubsequently exhibit an understanding of communication Inaccordance with this finding Zamanzadeh et al emphasizedthat nurses have to receive training of communication skillsin a regular manner to gain more competence and confidencein their role because they will face challenges resulting fromthe nature of the environmental work which is often givenlittle time to communicate and have stressful situations[27]

Regarding learning of communication skills the majority ofnursing students agreed that learning communication skillsis applicable to learning nursing and that clinical commu-nication skills are important in the practice of nursing care(see Table 2) They agreed that their knowledge about com-munication skills come from studying course These results

are similar to those achieved by Leite[28] in this study moststudents felt prepared in the area of communication skillsalthough some have negatively assessed the preparation theygot in that field and stated that there was some room forimprovement

Data analysis showed that nursing students are aware of theimportance of acquiring good communication skills and in-terpersonal relationships as shown in Table 3 This confirmsthe principle that the help function is an important area forany health care professional In our participantsrsquo opinion oncommunications skills behavior they reported that nursesneed to be aware of their body language and use of personalspace when talking with patients This is in accordance withPatriacutecio (2012) who mentioned that nursing professionalsshould know how to approach the patients how to listen tothem they should learn to say the right words at the righttime know how to encourage communication through ex-pressions like gazing gestures and how to make the act ofasking questions[29]

Part of our study objective was to examine the attitudestoward learning communication skills the present resultsshows moderate positive attitudes score of the CSAS ques-tionnaire towards learning communication skills among nurs-ing students of the three colleges especially those from Qas-sim University It may be due to their studying of communica-tion skills as a complete course Moderate positive attitudestowards learning communication skills among nursing stu-dents is supported by a study conducted recently among 227University nursing students in Martin[30] In addition strongdisagreement with the statement ldquoI donrsquot need good commu-nication skills to be a nurserdquo indicate a positive perceptionof the importance of communication skills in the practiceamong students These results are in accordance with theresearch study of Busch et al[31] where low negative atti-tudes towards communication skills and moderate positiveattitudes were found among medical students in Germany

This study had a number of limitations the study was carriedout with students in three colleges in urban centers and theinclusion of other centers could have resulted in differentresults The sample size may not have been large enough todetect significant differences among the three colleges andthis was because of a studentsrsquo number in Buraidah and Al-Ghad colleges This study depended on self-report measuresand self-report data have been criticized for their potential re-sponse bias However in this study all of the questionnaireswere anonymously filled and accordingly this strategy maylead to increase in the accuracy of the questionnaires andreduce the bias Further studies with a larger sample size andthe comparison group are necessary Male students are not

26 ISSN 2324-7940 E-ISSN 2324-7959


included in this study since it was difficult to communicatewith them Finally we cannot rule out the possibility thatour findings are due to other extraneous variables thereforefuture studies would be beneficial

ACKNOWLEDGEMENTSThe authors like to express deep gratitude to all the deansand administrators of the three participant colleges of nurs-ing Qassim Buraidah and Al-Ghad We also express ourprofound appreciation to all the nursing students who partici-pated in this study

AUTHORSrsquo CONTRIBUTIONSHT AA AR MA and RA designed and implemented thestudy AA AR MA and RA were involved in the data gath-ering and analysis and helpedto draft the manuscript Ad-ministrative technical or logistic supports were contributedto AA AR MA and RA Critical revision of the article forimportant intellectual content was done by HT All authorsread and approved the final manuscript

CONFLICTS OF INTEREST DISCLOSUREThe authors declare they have no conflicts of interest

REFERENCES[1] Bramhall E Effective communication skills in nursing practice

Nursing Standard 2014 29(14) 53-59 PMid 25467362 httpsdoiorg107748ns291453e9355

[2] Cronenwett L Sherwood G Barnsteiner J et al Quality andsafety education for nurses Nursing Outlook 2007 55 122-131PMid 17524799 httpsdoiorg101016joutlook200702006

[3] Sheldon LK Hilaire DM Development of communication skills inhealthcare Perspectives of new graduates of undergraduate nursingeducation Journal of Nursing Education and Practice 2015 5(7)30-37 httpsdoiorg105430jnepv5n7p30

[4] Sentinel event data summary The Joint Commission Accessed on30th June 2017 Available from httpswwwjointcommissionorgsentinel_event_statistics_quarterly

[5] Communication during handoffs root cause of error Medscape Ac-cessed on 14th April 2016 Available from httpwwwmedscapecomviewarticle746070_2

[6] Jason H Communication skills are vital in all we do aseducators andClinicians Education for Health Change in Learning amp Practice2000 13(2) 156-160 PMid 14742074

[7] Thomas CM Bertram E Johnson D The SBAR communicationtechnique Teaching nursing studentrsquos professional communicationskills Nurse Educator 2009 34(4) 176-180 PMid 19574858httpsdoiorg101097NNE0b013e3181aaba54

[8] Rehman AU Communication skills and cultural awareness-modelcourse World Maritime University Dissertations 2007

[9] Shafakhah M Zarshenas L Sharif F et al Evaluation of NursingStudentsrsquo Communication Abilities in Clinical Courses in Hospi-tals Global Journal of Health Science 2015 7(4) 323-8 PMid25946924 httpsdoiorg105539gjhsv7n4p323

[10] Khodadadi E Ebrahimi H Moghaddasian S et al The Effect of Com-munication Skills Training on Quality of Care Self-Efficacy JobSatisfaction and Communication Skills Rate of Nurses in Hospitalsof Tabriz Iran Journal Caring Sciences 2013 2(1) 27-37 PMid25276707

[11] Piazza O Cersosimo G Communication as a basic skill in criticalcare J Anaesthesiol Clin Pharmacol 2015 31(3) 382-383 PMid26330721

[12] Krautscheid LC Improving Communication among HealthcareProviders Preparing Student Nurses for Practice International Jour-nal of Nursing 2008 5(1) 1-11

[13] Kourkouta L Papathanasiou IV Communication in Nursing Prac-tice Mater Sociomed 2014 26(1) 65-67 PMid 24757408 httpsdoiorg105455msm20142665-67

[14] McKenna L Brown T Boyle M et al Listening and communicationstyles in nursing students Journal of Nursing Education and Practice2014 4(11) 50-58 httpsdoiorg105430jnepv4n11p50

[15] Caris-Verhallen W Kerkstra A Bensing J The role of commu-nications in nursing care for elderly people a review of theliterature Journal of Advanced Nursing 1997 25(5) 915-933PMid 9147197 httpsdoiorg101046j1365-264819971997025915x

[16] 2015 Undergraduate Nursing Students Scope of Practice Availablefrom httpwwwrchorgauuploadedFilesMainContentmcpcnursing_education2015_Scopeofpracticepdf

[17] Kutzin JM Communication and Teamwork Focused Simulation-Based Education for Nursing Students Doctor of Nursing Practice(DNP) Capstone Projects Paper 4 2010

[18] Iedema R Manidis M ldquoPatient-Clinician Communication AnOverview of Relevant Research and Policy Literaturesrdquo Sydney Aus-tralian Commission on Safetyand Quality in Health Care and UTSCentre for Health Communication 2013

[19] Patterson P Nursing 619 ndash Communication Barriers InNursing Accessed on August 11 2016 Available fromhttpssspattersonwordpresscomscholarly-workscommunication-barriers-in-nursing-nursing-622

[20] Stickley T Freshwater D The art of listening in the therapeuticrelationship Mental Health Practice 2006 9(5) 12-18 httpsdoiorg107748mhp2006029512c1899

[21] Steckler R Improving communication skills among nursing studentsassessing the comfort curriculum as an intervention 2012 Accessedon 14th April 2016 Available from httpuknowledgeukyeducomm_etds7

[22] Rees C Sheard C Davies S The development of a scale to measuremedical studentsrsquo attitudes towards communication skills learningThe Communication Skills Attitude Scale (CSAS) Med Educ 200236(2) 141-7 PMid 11869441 httpsdoiorg101046j1365-2923200201072x

[23] Hoffart N Woods CQ Elements of a nursing professional practicemodel J Prof Nurs 1996 12 354-364 httpsdoiorg101016S8755-7223(96)80083-4

[24] Higazee MZ Types and Levels of Conflicts Experienced by Nursesin the Hospital Settings Health Science Journal 2015 9(6) 7



[25] Mitchell PH Defining Patient Safety and Quality Care InHughes R (ed) Patient Safety and Quality An Evidence-BasedHandbook for Nurses Accessed on 20th April 2016 Availablefrom httpsarchiveahrqgovprofessionalsclinicians-providersresourcesnursingresourcesnurse-shdbknurseshdbkpdf

[26] Xie J Ding S Wang C et al An evaluation of nurs-ing studentsrsquo communication ability during practical clinicaltraining 2012 Accessed on 11th August 2016 Availablefrom httpwwwnurseeducationtodaycomarticleS0260-6917(12)00055-Xabstract

[27] Zamanzadeh V Rassouli M Abbaszadeh A et al Factors InfluencingCommunication Between the Patients with Cancer and their Nursesin Oncology Wards Indian J Palliat Care Jan-Apr 2014 20(1) 12-20 PMid 24600177 httpsdoiorg1041030973-1075125549

[28] Leite RA Competecircncias essenciais de comunicaccedilatildeo cliacutenicano curso de Medicina da UBI avaliaccedilatildeo e revisatildeo curricu-

lar Dissertaccedilatildeo para a obtenccedilatildeo do grau de Mestre em Medic-inaUniversidade da Beira Interior Covilhatilde 2013 Availablefrom httpubibliorumubiptbitstream10400616131DissertaC3A7C3A3o20Rita20Leitepdf

[29] Patriacutecio MS Competecircncias comunicacionais em estudantes do cursode licenciatura emenfermagem apoacutes a primeira experiecircncia de ensinocliacutenico [Communication skills in undergraduate nursing students af-ter the first clinical teaching experience] Dissertaccedilatildeo de MestradoEscolaSuperior de Enfermagem de Coimbra 2012

[30] Škodovaacute Z Baacutenovcinovaacute L Baacutenovcinovaacute A Attitudes towardscommunication skills among nursing students and its associationwith sense of coherence Kontakt 2018 20 e17-e22 httpsdoiorg101016jkontakt201709014

[31] Busch AK Rockenbauch K Schmutzer G et al Do medical studentslike communication Validation of the German CSAS (Communica-tion Skills Attitude Scale) GMS Z Med Ausbild 2015 32(1) PMid25699103

28 ISSN 2324-7940 E-ISSN 2324-7959

Introduction

Literature review

Research methodology

Design amp setting

Participants

Research instruments

Data collection procedure

Ethical issues and statistical analysis

Results

Discussion


primary cause of medical errors and associated mortalityand morbidity is communication breakdowns in health caresettings[4 5] Communication is a process of exchanging in-formation either in the verbal or nonverbal way and creatingrelationships with others[1] In other words communicationis not just saying words it is a meaningful conversationwith people to influence and exchange information or ideaswith them The effective communication shows knowledgethoughts and feelings of people besides showing who theyare and what they know Full communication includes trustactive listening and time control In addition it shows em-pathy and conveys feelings in words give a sense of caringsharing ideas clearly and much more[6] By contrast inef-fective communication leads to an increased frequency ofmedical errors and this causes stress makes nursing tasksdifficult hinders pain control distances the patient impedesthe correct assessment of the patient and fulfillment of theirneeds and decreases the quality of patient care[7] The waysto conduct message is developed like words signs letterspictures colors signals body language and gestures and itdivided by experts into two categories Verbal and nonverbalcommunication[8] The clinical communication skills areall communications process with patients family membersand all the health care providers Communication behaviorsof treatment are providing information supporting givinghope and helping them to alleviate their anxiety[9] thereforethe quality of care is a combination of attitudes values andbeliefs of health care providers In health services caring isan important part and nursing care is more essential amonghealth team in health agencies[10] Moreover clarity of clari-fication is key for an effective communication data shouldbe essential and the content must be linear with receiversrsquocultural level[11]

2 LITERATURE REVIEW

The most important components of a quality healthcare es-tablishment are quality nurses Since nurses are taking careof patients during their entire stay Thus it is important fornursing students to be prepared and assessed on communica-tion competency prior to exiting their program of study[12]

Principles in nursing communication which helps to performnursing work in ease consistent and accurate way to en-sure patient satisfaction and health professional protectionCommunication is multidirectional and it represents the inter-action between sender and receiver every receiver gets to bethe sender and vice versa[13] Besides communication princi-ples the communication has specified process involves threekey parts a sender (encoder) receiver (decoder) and the mes-sage itself To effectively contact with patients nurses haveto be able to decode information successfully after receiv-

ing it offering different kinds of communication in variouscontexts of nursing through kinesthetic visual and auditorymodes to ensure addressing the patientsrsquo concerns[14]

Nursing students have to understand different kinds of com-munication styles to know how to deal with different situa-tions as an aspect of nursing professional education[15] toclarify nurse has different goals to communicate each goalrequires certain behavior of communication such as creatinga relationship assessing patient problems making decisionabout nursing care exchanging information providing carein physical and psychological aspects[16]

There are skills that prove listening such as reflecting sum-marizing paraphrasing checking acknowledging empathiz-ing and creating educated guesses[1] According to the RoyalChildrenrsquos Hospital Melbourne in 2015 there are sometasks the nurse needs to be a good communicator to performsuch as handover the patients formulating a care plan giv-ing appropriate care communicating with other health caremembers about patient condition and documenting in patientrecord[17] The Nurse may face barriers in reaching effec-tive communication some barriers related to communicationwith the patient such as noise environment lack of privacyand patient anxiety Other barriers to communication withhealth care providers such as lack of time staff conflict andhigh workload[1] Poor communication is a barrier to effec-tive nursing practice the new nurse is vulnerable to isolatefeel more stress and dissatisfied The communication diffi-culties are not only at the same organizational level but alsoamong different organizational levels especially betweennurses and physicians[18]

According to the Australian Commission on Safety and Qual-ity in Health Care the increasing number of patients whohave chronic diseases causes the increase of communicationdemand which in turn causes the rising of care complexityand rising of unexpected errors and problems which needadvanced communication skills to resolve it[19] Moreovernursesrsquo workload does not give nurses enough time to makemeaningful discussion with their patients they only completemeasurable duties[20] In General without good communi-cation skills teachers or practitioners will fail in doing theirresponsibilities[6] These failings in doing effective workmay have resulted from inadequate training of communi-cation skills[1] Therefore the use of proper communica-tion styles has advantages in the delivering of healthcare[13]

Nursing has various roles and every role has general andspecific accountability in professional nurses the importantduty is maintaining and promoting health care This canbe achieved by using many of scientific principles one ofthem is establishing proper communication with clients it

20 ISSN 2324-7940 E-ISSN 2324-7959









32 Participants













n = 61 n = 35 n = 20

Level

5-6 44 (721) 14 (40) 7 (35)

7-8 17 (279) 21 (60) 13 (65)

Age

le 21 Years 20 (328) 5 (143) 2 (10)

22-26 Years 41 (672) 30 (857) 17 (85)

gt 27 Years 0 (0) 0 (0) 1 (5)

Hospital Training

Yes 60 (984) 34 (971) 14 (70)

No 1 (16) 1 (29) 6 (30)


One Semester 0 (0) 5 (143) 1 (71)

Two Semesters 1 (16) 8 (235) 7 (50)




Course 50 (82) 21 (60) 1 (59)

Subject 9 (148) 8 (229) 13 (765)

Article 2 (33) 5 (143) 3 (176)




22 ISSN 2324-7940 E-ISSN 2324-7959






learning)










skills

10 (169) 29 (492) 20 (339) 13 (371) 18 (514) 4 (114) 10 (50) 9 (45) 1 (5) 004




45 (738) 10 (164) 6 (98) 29 (829) 4 (114) 2 (57) 16 (80) 3 (15) 1 (5) 852




skills 11 (18) 16 (262) 34 (557) 11 (314) 10 (286) 14 (40) 3 (15) 11 (55) 6 (30) 061


interesting 41 (672) 16 (262) 4 (6 6) 28 (80) 6 (171) 1 (29) 17 (85) 3 (15) 0 (0) 412





patients

60 (984) 0 (0) 1 (16) 30 (857) 5 (143) 0 (0) 16 (80) 4 (20) 0 (0) 016






team-working skills

51 (836) 91 (148) 1 (16) 31 (886) 2 (57) 2 (57) 15 (75) 4 (20) 1 (5) 425




16 (262) 28 (459) 17(279) 19 (543) 7 (20) 9 (257) 6 (30) 9 (45) 5 (25) 050





science subject

34 (557) 22 (361) 5 (82) 26 (743) 6 (171) 3 (86) 15 (75) 5 (25) 0 (0) 188




48 (787) 12 (197) 1 (16) 30 (857) 4 (114) 1 (29) 14 (70) 4 (20) 2 (10) 344





program

49 (803) 11 (18) 1 (16) 30 (857) 5 (143) 0 (0) 16 (80) 4 (20) 0 (0) 865



to communicate

24 (40) 30 (50) 6 (10) 22 (629) 8 (229) 5 (143) 16 (80) 4 (20) 0 (0) 007








55 (902) 5 (82) 1 (16) 33 (943) 2 (57) 0 (0) 16 (80) 4 (20) 0 (0) 385



students

10 (164) 13 (213) 38 (623) 16 (457) 8 (229) 11 (314) 7 (35) 4 (20) 9 (45) 022









Qassim University

Al-Ghad Colleges

Buraydah Colleges









effectively

56 (919) 5 (82) 0 (0) 31 (886) 3 (86) 1 (29) 14 (70) 5 (25) 1 (5) 112



relationships

16 (262) 12 (197) 33 (541) 11 (314) 12 (343) 12 (343) 8 (40) 5 (25) 7 (35) 254




workers not nurses

7 (115) 15 (246) 39 (639) 14 (40) 11 (314) 10 (286) 10 (50) 5 (25) 5 (25) 000




52 (881) 7 (119) 0 (0) 19 (543) 14 (40) 2 (57) 17 (85) 3 (15) 0 (0) 002






54 (885) 4 (66) 3 (49) 31 (886) 3 (86) 1 (29) 12 (60) 4 (20) 4 (20) 030



24 ISSN 2324-7940 E-ISSN 2324-7959






No Items of CSAS

Qassim

University

Al-Ghad

Colleges

Buraydah

Colleges


























5 DISCUSSION








26 ISSN 2324-7940 E-ISSN 2324-7959









































28 ISSN 2324-7940 E-ISSN 2324-7959

Introduction

Literature review


Design amp setting

Participants




Results

Discussion









32 Participants













n = 61 n = 35 n = 20

Level

5-6 44 (721) 14 (40) 7 (35)

7-8 17 (279) 21 (60) 13 (65)

Age

le 21 Years 20 (328) 5 (143) 2 (10)

22-26 Years 41 (672) 30 (857) 17 (85)

gt 27 Years 0 (0) 0 (0) 1 (5)

Hospital Training

Yes 60 (984) 34 (971) 14 (70)

No 1 (16) 1 (29) 6 (30)


One Semester 0 (0) 5 (143) 1 (71)

Two Semesters 1 (16) 8 (235) 7 (50)




Course 50 (82) 21 (60) 1 (59)

Subject 9 (148) 8 (229) 13 (765)

Article 2 (33) 5 (143) 3 (176)




22 ISSN 2324-7940 E-ISSN 2324-7959






learning)










skills

10 (169) 29 (492) 20 (339) 13 (371) 18 (514) 4 (114) 10 (50) 9 (45) 1 (5) 004




45 (738) 10 (164) 6 (98) 29 (829) 4 (114) 2 (57) 16 (80) 3 (15) 1 (5) 852




skills 11 (18) 16 (262) 34 (557) 11 (314) 10 (286) 14 (40) 3 (15) 11 (55) 6 (30) 061


interesting 41 (672) 16 (262) 4 (6 6) 28 (80) 6 (171) 1 (29) 17 (85) 3 (15) 0 (0) 412





patients

60 (984) 0 (0) 1 (16) 30 (857) 5 (143) 0 (0) 16 (80) 4 (20) 0 (0) 016






team-working skills

51 (836) 91 (148) 1 (16) 31 (886) 2 (57) 2 (57) 15 (75) 4 (20) 1 (5) 425




16 (262) 28 (459) 17(279) 19 (543) 7 (20) 9 (257) 6 (30) 9 (45) 5 (25) 050





science subject

34 (557) 22 (361) 5 (82) 26 (743) 6 (171) 3 (86) 15 (75) 5 (25) 0 (0) 188




48 (787) 12 (197) 1 (16) 30 (857) 4 (114) 1 (29) 14 (70) 4 (20) 2 (10) 344





program

49 (803) 11 (18) 1 (16) 30 (857) 5 (143) 0 (0) 16 (80) 4 (20) 0 (0) 865



to communicate

24 (40) 30 (50) 6 (10) 22 (629) 8 (229) 5 (143) 16 (80) 4 (20) 0 (0) 007








55 (902) 5 (82) 1 (16) 33 (943) 2 (57) 0 (0) 16 (80) 4 (20) 0 (0) 385



students

10 (164) 13 (213) 38 (623) 16 (457) 8 (229) 11 (314) 7 (35) 4 (20) 9 (45) 022









Qassim University

Al-Ghad Colleges

Buraydah Colleges









effectively

56 (919) 5 (82) 0 (0) 31 (886) 3 (86) 1 (29) 14 (70) 5 (25) 1 (5) 112



relationships

16 (262) 12 (197) 33 (541) 11 (314) 12 (343) 12 (343) 8 (40) 5 (25) 7 (35) 254




workers not nurses

7 (115) 15 (246) 39 (639) 14 (40) 11 (314) 10 (286) 10 (50) 5 (25) 5 (25) 000




52 (881) 7 (119) 0 (0) 19 (543) 14 (40) 2 (57) 17 (85) 3 (15) 0 (0) 002






54 (885) 4 (66) 3 (49) 31 (886) 3 (86) 1 (29) 12 (60) 4 (20) 4 (20) 030



24 ISSN 2324-7940 E-ISSN 2324-7959






No Items of CSAS

Qassim

University

Al-Ghad

Colleges

Buraydah

Colleges


























5 DISCUSSION








26 ISSN 2324-7940 E-ISSN 2324-7959









































28 ISSN 2324-7940 E-ISSN 2324-7959

Introduction

Literature review


Design amp setting

Participants




Results

Discussion









n = 61 n = 35 n = 20

Level

5-6 44 (721) 14 (40) 7 (35)

7-8 17 (279) 21 (60) 13 (65)

Age

le 21 Years 20 (328) 5 (143) 2 (10)

22-26 Years 41 (672) 30 (857) 17 (85)

gt 27 Years 0 (0) 0 (0) 1 (5)

Hospital Training

Yes 60 (984) 34 (971) 14 (70)

No 1 (16) 1 (29) 6 (30)


One Semester 0 (0) 5 (143) 1 (71)

Two Semesters 1 (16) 8 (235) 7 (50)




Course 50 (82) 21 (60) 1 (59)

Subject 9 (148) 8 (229) 13 (765)

Article 2 (33) 5 (143) 3 (176)




22 ISSN 2324-7940 E-ISSN 2324-7959






learning)










skills

10 (169) 29 (492) 20 (339) 13 (371) 18 (514) 4 (114) 10 (50) 9 (45) 1 (5) 004




45 (738) 10 (164) 6 (98) 29 (829) 4 (114) 2 (57) 16 (80) 3 (15) 1 (5) 852




skills 11 (18) 16 (262) 34 (557) 11 (314) 10 (286) 14 (40) 3 (15) 11 (55) 6 (30) 061


interesting 41 (672) 16 (262) 4 (6 6) 28 (80) 6 (171) 1 (29) 17 (85) 3 (15) 0 (0) 412





patients

60 (984) 0 (0) 1 (16) 30 (857) 5 (143) 0 (0) 16 (80) 4 (20) 0 (0) 016






team-working skills

51 (836) 91 (148) 1 (16) 31 (886) 2 (57) 2 (57) 15 (75) 4 (20) 1 (5) 425




16 (262) 28 (459) 17(279) 19 (543) 7 (20) 9 (257) 6 (30) 9 (45) 5 (25) 050





science subject

34 (557) 22 (361) 5 (82) 26 (743) 6 (171) 3 (86) 15 (75) 5 (25) 0 (0) 188




48 (787) 12 (197) 1 (16) 30 (857) 4 (114) 1 (29) 14 (70) 4 (20) 2 (10) 344





program

49 (803) 11 (18) 1 (16) 30 (857) 5 (143) 0 (0) 16 (80) 4 (20) 0 (0) 865



to communicate

24 (40) 30 (50) 6 (10) 22 (629) 8 (229) 5 (143) 16 (80) 4 (20) 0 (0) 007








55 (902) 5 (82) 1 (16) 33 (943) 2 (57) 0 (0) 16 (80) 4 (20) 0 (0) 385



students

10 (164) 13 (213) 38 (623) 16 (457) 8 (229) 11 (314) 7 (35) 4 (20) 9 (45) 022









Qassim University

Al-Ghad Colleges

Buraydah Colleges









effectively

56 (919) 5 (82) 0 (0) 31 (886) 3 (86) 1 (29) 14 (70) 5 (25) 1 (5) 112



relationships

16 (262) 12 (197) 33 (541) 11 (314) 12 (343) 12 (343) 8 (40) 5 (25) 7 (35) 254




workers not nurses

7 (115) 15 (246) 39 (639) 14 (40) 11 (314) 10 (286) 10 (50) 5 (25) 5 (25) 000




52 (881) 7 (119) 0 (0) 19 (543) 14 (40) 2 (57) 17 (85) 3 (15) 0 (0) 002






54 (885) 4 (66) 3 (49) 31 (886) 3 (86) 1 (29) 12 (60) 4 (20) 4 (20) 030



24 ISSN 2324-7940 E-ISSN 2324-7959






No Items of CSAS

Qassim

University

Al-Ghad

Colleges

Buraydah

Colleges


























5 DISCUSSION








26 ISSN 2324-7940 E-ISSN 2324-7959









































28 ISSN 2324-7940 E-ISSN 2324-7959

Introduction

Literature review


Design amp setting

Participants




Results

Discussion






learning)










skills

10 (169) 29 (492) 20 (339) 13 (371) 18 (514) 4 (114) 10 (50) 9 (45) 1 (5) 004




45 (738) 10 (164) 6 (98) 29 (829) 4 (114) 2 (57) 16 (80) 3 (15) 1 (5) 852




skills 11 (18) 16 (262) 34 (557) 11 (314) 10 (286) 14 (40) 3 (15) 11 (55) 6 (30) 061


interesting 41 (672) 16 (262) 4 (6 6) 28 (80) 6 (171) 1 (29) 17 (85) 3 (15) 0 (0) 412





patients

60 (984) 0 (0) 1 (16) 30 (857) 5 (143) 0 (0) 16 (80) 4 (20) 0 (0) 016






team-working skills

51 (836) 91 (148) 1 (16) 31 (886) 2 (57) 2 (57) 15 (75) 4 (20) 1 (5) 425




16 (262) 28 (459) 17(279) 19 (543) 7 (20) 9 (257) 6 (30) 9 (45) 5 (25) 050





science subject

34 (557) 22 (361) 5 (82) 26 (743) 6 (171) 3 (86) 15 (75) 5 (25) 0 (0) 188




48 (787) 12 (197) 1 (16) 30 (857) 4 (114) 1 (29) 14 (70) 4 (20) 2 (10) 344





program

49 (803) 11 (18) 1 (16) 30 (857) 5 (143) 0 (0) 16 (80) 4 (20) 0 (0) 865



to communicate

24 (40) 30 (50) 6 (10) 22 (629) 8 (229) 5 (143) 16 (80) 4 (20) 0 (0) 007








55 (902) 5 (82) 1 (16) 33 (943) 2 (57) 0 (0) 16 (80) 4 (20) 0 (0) 385



students

10 (164) 13 (213) 38 (623) 16 (457) 8 (229) 11 (314) 7 (35) 4 (20) 9 (45) 022









Qassim University

Al-Ghad Colleges

Buraydah Colleges









effectively

56 (919) 5 (82) 0 (0) 31 (886) 3 (86) 1 (29) 14 (70) 5 (25) 1 (5) 112



relationships

16 (262) 12 (197) 33 (541) 11 (314) 12 (343) 12 (343) 8 (40) 5 (25) 7 (35) 254




workers not nurses

7 (115) 15 (246) 39 (639) 14 (40) 11 (314) 10 (286) 10 (50) 5 (25) 5 (25) 000




52 (881) 7 (119) 0 (0) 19 (543) 14 (40) 2 (57) 17 (85) 3 (15) 0 (0) 002






54 (885) 4 (66) 3 (49) 31 (886) 3 (86) 1 (29) 12 (60) 4 (20) 4 (20) 030



24 ISSN 2324-7940 E-ISSN 2324-7959






No Items of CSAS

Qassim

University

Al-Ghad

Colleges

Buraydah

Colleges


























5 DISCUSSION








26 ISSN 2324-7940 E-ISSN 2324-7959









































28 ISSN 2324-7940 E-ISSN 2324-7959

Introduction

Literature review


Design amp setting

Participants




Results

Discussion







Qassim University

Al-Ghad Colleges

Buraydah Colleges









effectively

56 (919) 5 (82) 0 (0) 31 (886) 3 (86) 1 (29) 14 (70) 5 (25) 1 (5) 112



relationships

16 (262) 12 (197) 33 (541) 11 (314) 12 (343) 12 (343) 8 (40) 5 (25) 7 (35) 254




workers not nurses

7 (115) 15 (246) 39 (639) 14 (40) 11 (314) 10 (286) 10 (50) 5 (25) 5 (25) 000




52 (881) 7 (119) 0 (0) 19 (543) 14 (40) 2 (57) 17 (85) 3 (15) 0 (0) 002






54 (885) 4 (66) 3 (49) 31 (886) 3 (86) 1 (29) 12 (60) 4 (20) 4 (20) 030



24 ISSN 2324-7940 E-ISSN 2324-7959






No Items of CSAS

Qassim

University

Al-Ghad

Colleges

Buraydah

Colleges


























5 DISCUSSION








26 ISSN 2324-7940 E-ISSN 2324-7959









































28 ISSN 2324-7940 E-ISSN 2324-7959

Introduction

Literature review


Design amp setting

Participants




Results

Discussion






No Items of CSAS

Qassim

University

Al-Ghad

Colleges

Buraydah

Colleges


























5 DISCUSSION








26 ISSN 2324-7940 E-ISSN 2324-7959









































28 ISSN 2324-7940 E-ISSN 2324-7959

Introduction

Literature review


Design amp setting

Participants




Results

Discussion



5 DISCUSSION








26 ISSN 2324-7940 E-ISSN 2324-7959









































28 ISSN 2324-7940 E-ISSN 2324-7959

Introduction

Literature review


Design amp setting

Participants




Results

Discussion









































28 ISSN 2324-7940 E-ISSN 2324-7959

Introduction

Literature review


Design amp setting

Participants




Results

Discussion

Understanding communication skills learning, behavior and ...

Documents

Transcript of Understanding communication skills learning, behavior and ...