Communication skills training

A report from the Royal College of Physicians (2014) on end of life care in hospitals in England found that the majority of discussions with families and friends took place less than two days before death. This finding may indicate some degree of reluctance to engage in these sensitive discussions earlier in the patient’s illness, not only by nursing staff but also by all members of the multi-professional team across health and social care, hospital and community settings. The report recommends that training in communication skills should be mandatory for all staff involved in caring for dying people. If healthcare professionals felt more confident and competent to engage in these sensitive discussions, more discussions would take place at a time when people who are dying and those close to them are better able to prepare and adjust to the situation.

Improving Supportive and Palliative Care for Adults with Cancer (National Institute for Health and Care Excellence (NICE) 2004) described a four-level model for providing psychological support to patients (Table 1). The guidance stated that psychological distress is common and these signs of distress are not readily recognised, with the result that people fail to receive the support they require. All healthcare professionals, regardless of grade, role or specialty, were noted as having a role in identifying and responding to the distress of patients and their relatives (NICE 2004). The core responsibility to be able to recognise distress and respond in a helpful and supportive way continues to be highlighted in the literature. However, healthcare professionals are failing in this core responsibility to recognise and respond to the needs of patients in distress (Francis 2013). These failings may in part be the result of inadequate formal, structured or consistent communication skills training in pre and post-registration nursing courses. Nurses learn much about communication in clinical practice from peers, senior staff and others, who may themselves have received little or no communication skills training. This informal approach can be effective for some, but it may offer little constancy or opportunity for feedback and development.

Table 1

Promoting effective communication in health care is demanding, complex and challenging because of the nature of the work environment, which is often stressful and pressurised, providing little time for communication. If nurses are to meet these challenges in the future they need to be supported by high quality, evidence-based training. Nurses should receive regular communication skills training if they are to feel confident and competent in their role. The benefits for patients, carers and healthcare professionals are clear – good communication influences patients’ emotional health, symptom resolution, function and physiological measures such as blood pressure, and it decreases reported pain and drug use (Stewart 1995). Most nurses should be able to remember a patient who had reduced pain as a result of feeling less anxious and frightened. Fear has the potential to increase pain, and in the labour ward it can impede the birthing progress (Otley 2011).

Healthcare professionals themselves benefit if they feel confident about managing communication situations such as breaking bad news, handling difficult questions and responding helpfully to strong emotions. Ramirez et al (1996) and Taylor et al (2005) found that healthcare professionals experience adverse psychological effects if they have not had sufficient training in effective communication skills to match the demands of their role.

The availability and quality of communication skills training is variable, but some workshops provide evidence that attendance and participation can have a positive effect on clinical practice. Two such workshops are Connected – National Advanced Communication Skills Training, previously part of the National Cancer Action Team Programme (The Royal Marsden 2014), and the foundation-level half-day SAGE & THYME course (Connolly et al 2010, 2014).

Evidence-based communication skills training workshops have similar core elements. These include theory and an evidence base; the participants decide the content of the workshop and receive supporting handouts and references. A presentation and/or demonstration is given of effective communication skills in practice and participants have the opportunity to practise skills and receive feedback in a structured format. The insight they gain leads to a greater awareness of the way people communicate with others, and their confidence and competence increase.

Complete time out activity 2

Working with a colleague, discuss and list the barriers to effective communication. One person could consider the barriers from the healthcare professional’s point of view and one from the patient and/or carer’s point of view.

Once completed your time out activity is saved and stored in "My Modules”.

Learning points

1. Promoting effective communication in health care is demanding, complex and challenging because of the nature of the work environment, which is often stressful and pressurised, providing little time for communication.
2. Good communication influences patients’ emotional health, symptom resolution, function and physiological measures such as blood pressure, and it decreases reported pain and medication use.
3. Evidence-based communication skills training workshops include theory and an evidence base; the participants decide the content of the workshop and receive supporting handouts and references.