A 24-year-old woman scheduled an appointment to have a lump in her breast examined. After her sonogram came back normal, the radiology technician and nurse supervisor agreed that she didn’t need a mammogram. They added that the woman was "too young" to have breast cancer.
They were wrong.
By the time she was correctly diagnosed over a year later, her cancer had advanced to Stage IIIB.
Stories like these are not uncommon in the medical field. After investigating 23,000 malpractice lawsuits, CRICO Strategies found that 30% resulted from communication failures, resulting in nearly 2,000 preventable deaths and $1.7 billion in malpractice costs (HIPAA Journal, 2023).
The tragic outcome of the young woman's case underscores why the American Association of Colleges of Nursing (AACN) has identified communication as a core nursing value and woven it throughout all 10 domains of the AACN Essentials.
The AACN Essentials and Communication Competency
The AACN Essentials outline the foundational elements necessary for professional nursing education at the baccalaureate, master's, and Doctor of Nursing levels. These competencies emphasize a holistic approach to patient care, integrate knowledge from various disciplines, foster leadership and communication skills, and underscore evidence-based practice.
Joy Goldsmith, Ph.D., and Elaine Wittenberg, Ph.D., FACH, provided their expertise on the integration of communication into AACN Essentials at the 2023 Lippincott® Nursing Education Summit. During their presentation, they emphasized the importance of weaving communication through the ten domains:
- Knowledge for Nursing Practice
- Person-Centered Care
- Population Health
- Scholarship for the Nursing Discipline
- Quality and Safety
- Interprofessional Partnerships
- Systems-Based Practice
- Informatics and Healthcare Technologies
- Professionalism
- Personal, Professional, and Leadership Development
“It's about employing evidence-based practices that have shown to be effective with patients and families and are comfortable for nurses."
Elaine Wittenberg
Ph.D., FACH
The example of the 24-year-old woman whose breast cancer went undiagnosed due to poor communication highlights the importance of effective communication in nursing.
If the nurse had taken time to listen to the patient's concerns, build trust, and provide reassurance and clarity, the patient's cancer may have been detected early, leading to a more optimistic prognosis. The incident could have been avoided by adhering to the AACN Communication Guidelines, specifically by "demonstrating relationship-centered care:”
- Quality and Safety: Thoroughly investigating the patient's initial concerns would have ensured a comprehensive evaluation, regardless of her age.
- Professionalism: A detailed discussion about risks and decisions based on thorough medical evaluations would have shown a commitment to best practices and patient care.
- Person-Centered Care: Taking the time to discuss symptoms and outline possible next steps would have built trust and provided reassurance.
The chart below outlines the communication skills you can cultivate in your nursing students, as stated in the AACN Essentials guidelines.
"There are a lot of subdomains under the larger heading of communication. We're interested in helping to map those ideas, attitudes, and skills onto the domains."
Joy Goldsmith
Ph.D.
| AACN Communication Guidelines | |
|---|---|
| Domain | Positive Real-World Demonstration of Domain |
| Demonstrate relationship-centered care | During rounds, a nurse notices a patient's anxiety and takes extra time to sit, listen, and reassure them, which helps build trust and improves the patient's willingness to engage in their care. |
| Consider individual beliefs, values, and personalized information | A patient from a strict religious background hesitates to accept a blood transfusion. Understanding this, the nurse discusses alternative treatments and respects their decision, ensuring culturally sensitive care. |
| Use a variety of communication modes appropriate for the context | After explaining a complex procedure verbally, the nurse provides a pamphlet and video link to a patient with limited English proficiency, ensuring they fully understand the upcoming surgery. |
| Demonstrate the ability to conduct sensitive or difficult conversations | A nurse sits with a terminally ill patient's family, explaining hospice care options with compassion and clarity, addressing their fears, and helping them make informed decisions about end-of-life care. |
| Use evidence-based patient teaching materials | A diabetic patient receives a colorful, easy-to-read brochure tailored to their low health literacy, which helps them better manage their blood sugar levels at home. |
| Demonstrate emotional intelligence in communication | Recognizing a patient's fear before surgery, the nurse provides comfort through empathetic conversation, addressing their emotional and informational needs to ease their anxiety. |
| Possess advanced communication skills and techniques | During a consultation, a nurse uses motivational interviewing to help a reluctant patient understand the benefits of quitting smoking, leading to the patient committing to a cessation program. |
| Design evidence-based, person-centered engagement materials | A nurse develops a personalized care plan for a patient with a rare genetic disorder, incorporating the latest research and the patient's specific lifestyle needs, improving treatment adherence. |
| Apply individualized information in personalized care | After pharmacogenetic testing reveals specific drug metabolism issues, the nurse adjusts the patient's medication plan, ensuring effective and safe treatment tailored to their genetic profile. |
| Facilitate difficult conversations and disclosure of sensitive information | When discussing a new chemotherapy drug, the nurse honestly explains potential side effects and supports the patient in making an informed decision about their treatment options. |
Integrating Communication Skills into Nursing Education
Teaching nursing students the precise steps required to administer a particular treatment is more straightforward than cultivating their communication skills. Fostering empathy, actively listening, and tailoring communication to individual patients require sensitivity and nuance. Here are some practical teaching techniques you can integrate into your curriculum:
Teaching Techniques
- Role-playing Scenarios: Simulate interactions with diverse patients and healthcare professionals, helping your students practice and refine their communication skills in a controlled environment.
- Simulation Exercises: Focus on communication challenges, allowing your students to navigate complex scenarios and receive immediate feedback on their performance.
- Debriefing Sessions: Analyze your students’ communication effectiveness post-simulation to identify strengths and areas for improvement, fostering continuous learning and development.
Curriculum Development
- Integrating Communication Modules: Ensure communication skills are a consistent focus throughout your nursing program, not just a standalone topic.
- Emphasizing Active Listening: Teach your students the importance of verbal and nonverbal communication skills, crucial for understanding patient needs and building rapport.
- Including Communication in Assessments: Evaluate your students' communication skills through presentations, simulations, and role-playing exercises, making it a core component of their competency evaluation.
Using UWorld to Build Communication Skills in Nursing Students
UWorld's Learning Platform for Nursing offers a wealth of resources to help you build your students' communication skills with hundreds of high-quality Next Generation NCLEX (NGN) case studies. Use our NGN case studies to facilitate:
Scenario-Based and Role-Playing Learning
- Rich Case Studies: Use UWorld's diverse patient scenarios for realistic role-playing exercises.
- Assigning Roles: Assign your students roles — such as nurse, patient, and family member — to practice tailored communication strategies.
- Scenario-Based Learning: Present scenarios that require students to use the clinical judgment measurement model: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes.
Reflective and Feedback-Driven Learning
- Feedback and Reflection: Conduct post-exercise debriefings using a reflection tool and provide detailed feedback on your students’ responses.
- Reflective Assignments: Assign exercises to explore how cultural perspectives impact patient care.
- Clinical Reasoning Exercises: Analyze complex situations, identify problems, and develop solutions.
Collaborative and Open Discussions
- Group Projects: Assign projects requiring collaborative clinical problem-solving, encouraging idea exchange.
- Interactive Learning Sessions: Pick a topic from the news and hold live or asynchronous sessions to debate various approaches to patient care.
- Discussion Forums: Provide a platform for your students to discuss case studies and share insights and experiences.
Additional Resources for Nurse Educators
The AACN Tool Kit provides comprehensive resources for integrating communication exercises into your nursing program. The Communication Concept within the toolkit offers valuable guidelines and activities to help you develop robust communication modules tailored to your curriculum.
By leveraging these resources, you can ensure your students graduate with the communication skills necessary to excel in their careers while providing high-quality, patient-centered care.
References
HIPAA Journal. (2023, June 30). Effects of poor communication in healthcare. HIPAA Journal. https://www.hipaajournal.com/effects-of-poor-communication-in-healthcare/
