Current trends in Communication Skills Training in UK schools of medicine.

BACKGROUND: Communication Skills Training (CST) is now mandatory for all students in UK Schools of Medicine. However, the extent to which all schools follow a similar curriculum is unclear. AIMS: This paper reports the findings of a survey of CST teaching in all UK Schools and compares the findings with an earlier survey. METHODS: A specially designed questionnaire survey was sent to all Schools, and this was supplemented by follow-up telephone interviews. RESULTS: There is a high level of consensus across Schools about the aims and objectives of CST, its location within the overall curriculum, and how it is assessed. There is also a dedicated staff member specifically responsible for CST delivery in all Schools. A wide number of different specialisms also contribute to training. However, wide variations remain in CST pedagogy. In addition, several problems were identified in relation to the integration and operation of CST. CONCLUSIONS: While the paper identifies and delineates a typical or 'modal' model of CST in UK Schools of Medicine, it also emphasizes the importance of flexibility in this part of the curriculum.

Cancer nurses narrating after conversations with cancer outpatients: how do nurses' roles and patients' perspectives appear in the nurses' narratives?

AIM: The aim of this study was to contribute to knowledge of nursing practice in the cancer care field by exploring cancer nurses' perceptions of conversations with cancer outpatients. BACKGROUND: Current practice at cancer outpatient clinics in Norway is that nurses have planned conversations with patients and relatives as a follow-up after patient-physician conversations about assessment and medical treatment. Little is known about nurses' experiences of conversations in the ambulatory context. This study reports the experiences of initial patient-nurse consultations. Data were collected in 2006-2007. DESIGN: A qualitative phenomenological hermeneutic study was performed. A purposive sample of 12 cancer nurses was selected for qualitative interviews where nurses were narrating about conversation experiences. Significance and meaning of conversation experiences were analysed within a hermeneutic perspective, inspired by Ricoeur. Anonymity and voluntary participation procedures were followed. Ethical approval for the study was obtained from the Regional Committee for Medical Research Ethics of the region. FINDINGS: There were plots of nurses experiencing conversations as hard work, routine work or artistry. The nurses' conceptualizations of their roles as an information provider, or patient-centred caring role were rooted in rules of the nursing community or in humanistic caring ethics. Differences of nurses' perceptions and experiences of conversations are explained by different attitudes and role appreciations. CONCLUSION: Cancer nurses' role appreciation and meaning horizons are guiding their perceptions of patient-nurse communication. Feeling free to act in interplay with patients' voices, the patients' perspectives become foreground. There is an educational challenge here in terms of developing methods to help nurses to discover how their mental work and meaning horizons guide conversational practice.

Assertiveness and caring: are they compatible?

BACKGROUND: Findings from numerous assertion studies suggest that nurses are generally non-assertive. This study examines the role of caring as an important determinant of adaptive assertive behaviour. AIM AND OBJECTIVES: The aim of the investigation was to explore the relationship between assertion and caring skills. Two study objectives sought to determine whether both positive and negative assertive behaviours were related to caring skills. DESIGN: Correlational and cross-sectional study. METHOD: The Caring Assessment Instrument (Care Q - Questionnaire Version) and the assertion inventory were used to collect self-report data from a convenience sample of 94 subjects. Behavioural data were obtained by directly sampling 50 nurses' responses within role-play situations. RESULTS: One significant result between the various assertion measurements and caring skill scores was noted, highlighting a relationship between negative assertion and the caring 'accessible' subscale. CONCLUSION: Overall the findings of the study suggest that positive and negative assertive behaviours are not related to caring skills. RELEVANCE TO CLINICAL PRACTICE: The current findings suggest that the presence of caring attributes cannot be offered as a possible reason for non-assertion in nurses.

Effects of nurses' sex-role orientation on positive and negative assertion.

The present paper examines how the sex-role orientation of the nurse can affect both positive and negative assertion. The Bem Sex-Role Inventory (BRSI) and the Assertion Inventory (AI) were used to collect self-reported data from a convenience sample of 94 subjects. Behavioral data were obtained by directly sampling 50 nurses' responses within role-play situations. Contrary to earlier studies, the findings of the investigation indicated that there was no significant relationship between assertion measurements and sex-role orientation. Following a discussion of the findings, recommendations relating to future research are made and the limitations of the study are identified.

Health professionals' perceptions of breaking bad news.

The growth of the "patient-centred" approach to health care has highlighted the importance of quality communication practices. One area that remains problematic, however, is the process of breaking bad new to patients and/or relatives. Hence, there have been calls for more research and training in this domain. Reports the findings of a study that used the critical incident technique to explore the breaking bad news encounter from the perspective of the health care practitioner. In total 33 senior medical and nursing staff reported on situations in which they described specific, vividly recalled, experiences of both "effective" and "ineffective" bad news delivery. These reported incidents were content analysed and a range of key dimensions was identified for both effective and ineffective experiences. Interpersonal communication skills emerged as particularly salient factors and these are discussed in detail, together with implications for future research and training.