Nursing Students’ Relational Skills with Elders Improve through Humanitude Care Methodology
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Sample Characterization
3.2. Students’ Difficulties in Interacting with Elders
Comparison of the Difficulties Identified by EG and CG Students
- At baseline, the EG identified fewer difficulties than the CG in “caring for agitated and confused elders” (χ2 = 7.630; p = 0.006) and “communicating with non-communicative elders” (χ2 = 4.655; p = 0.031). No inter-variable correlations were found in the remaining difficulties identified (p > 0.05)
- At follow-up, the EG identified fewer difficulties than the CG in “caring for agitated and confused elders” (χ2 = 6.637; p = 0.010), “communicating with elders with aphasia” (χ2= 6.877; p = 0.009), and “initiating communication with elders” (χ2= 8.748; p = 0.003).
3.3. Causes of the Difficulties Identified by Students during Their Clinical Training
3.3.1. Causes of Difficulties Associated with Inexperience
3.3.2. Causes of Difficulties Associated with the Deficit in Theoretical–Practical Teaching
3.3.3. Causes of Difficulties Associated with the Clinical Training Context
3.3.4. Causes of Difficulties Associated with Personality Traits
3.4. Strategies Used by Students to Reduce Difficulties in Interacting with Elders
3.4.1. Strategies Used by EG Students to Reduce Difficulties in Interacting with Elders
- In the category “application of the HCM”, the following subcategories emerged: knowledge of the elders, Humanitude pillars, and technical–relational procedures. Knowledge of the elders, their life history, and the words that calm them down prevent agitation, according to this statement: ”…knowing the elders’ past, as well as the words that calm them down or the negative words that agitate them and that should be avoided” (S14). The proper use of the Humanitude pillars such as gaze, speech, and touch, as well as availability and active listening, were also emphasized: “…adequately using gaze, speech, and touch, making them company, taking the time to listen to them…” (S5); “…in elders who cannot communicate verbally, the strategy used was self-feedback, using both a predictive speech and a descriptive speech that allowed us to overcome the embarrassing silence” (S27).
- In the category “training/education”, the following subcategories emerged: training in “Caring with Humanitude”, self-training, relational techniques training, and practical context. Attendance at the optional course unit “Caring with Humanitude” was emphasized by these students: “…the optional course unit ’Caring with Humanitude’ taught me how to initiate communication, how to look patients in the eye, how to speak and touch them” (S18); “…it taught me how to speak calmly and encourage the patient to communicate, how, when and where to touch the elders…” (S1). The need for self-training, relational techniques training, and knowledge of the HCM was also mentioned: “We need to continue the HCM training on our own and to train more the relational techniques that we’ve learned” (S13); “Improve and train verbal and non-verbal communication” (S20). In the practical context, the need for nurses to have HCM training and not to follow bad examples was also evidenced: “Teaching HCM techniques to nurses so that we can apply what we have learned, so that there are ‘good examples’ in care” (S2), “…and we can avoid learning from the ‘bad examples’ that we observe in daily practice…” (S19).
- In the category “development of personal skills”, the following subcategories emerged: self-confidence, emotional management, and persistence. In this category, the importance of improving communication was emphasized as a means of increasing students’ self-confidence, emotional management, and acceptance of the patient: “…I must learn how to communicate so that the client accepts me and so that I can feel more confident manage my anxiety and the fear of interacting better” (S12); “Have a smile on my face and keep calm” (S15); “Should be persistent and not give up on the client” (S51).
3.4.2. Strategies Used by CG Students to Reduce Difficulties in Interacting with Elders
- In the category “training/education”, the following subcategories emerged: self-training, relational techniques training, and practical context. The need for self-training as a strategy to reduce difficulties was mentioned: “Reading articles about therapeutic communication” (S78). Students also emphasized the importance of relational techniques training: “Acquiring experience and skills that allow me to be better…” (S79). Regarding practical context, students identified that following a practical role model was valuable “Using nurses’ strategies…” (S72).
- In the category “development of personal skills”, the following subcategories emerged: self-confidence, emotional management, and persistence. Students identified the importance of self-confidence as a strategy to reduce difficulties at the beginning and end of clinical training: “Have more confidence in what I do, remain calm, and not give up” (S79). At baseline, emotional management was also mentioned: “…communicate more with the clients to overcome difficulties…” (S77). One student identified persistence as a strategy used to reduce difficulties at follow up: “...try to develop strategies because I feel like I need to be more relaxed to perform a more complex technical procedure, (...) keep calm and concentrated during the procedures…” (S76).
3.5. Importance Attributed to the SSHCP Dimensions
3.6. Impact of the HCM on the Development of Interaction Skills
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- Lopes, R.C.C.; Azeredo, Z.A.S.; Rodrigues, R.M.C. Relational skills: Needs experienced by nursing students. Rev. Latino-Am. Enfermagem. 2012, 20, 1081–1090. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Özdemir, Ö.; Bilgili, N. Attitudes of Turkish nursing students related to ageism. J. Nurs. Res. 2016, 24, 211–216. [Google Scholar] [CrossRef] [PubMed]
- Hovey, S.; Dyck, M.J.; Reese, C.; Kim, M. Nursing students’ attitudes toward persons who are aged: An integrative review. Nurse Educ. Today 2017, 49, 145–152. [Google Scholar] [CrossRef] [PubMed]
- Delaney, J.L. Patient-centred care as an approach to improving health care in Australia. Collegian 2018, 25, 119–123. [Google Scholar] [CrossRef]
- Freitas, R.J.M.; Moura, N.A.; Feitosa, R.M.M.; Guedes, M.V.C.; Freitas, M.C.; Silva, L.F.; Monteiro, A.R.M. Nursing process based on the Joyce Travelbee model proceso de enfermería fundamentado en el modelo de Joyce Travelbee. Rev. Enferm. UFPE 2018, 12, 3287–3294. [Google Scholar] [CrossRef]
- Franzoi, M.A.H.; Lemos, K.C.; Jesus, C.A.C.; Pinho, D.L.M.; Kamada, I.; Reis, P.E.D. Peplau’s interpersonal relations theory: An evaluation based on fawcett’s criteria. Rev. Enferm. UFPE 2016, 10, 3653–3661. [Google Scholar] [CrossRef]
- Wood, J.H.; Alushi, L.; Hammond, J.A. Communication and respect for people with dementia: Student learning (CARDS)—The development and evaluation of a pilot of an education intervention for pre-qualifying healthcare students. Int. Psychogeriatr. 2016, 28, 647–656. [Google Scholar] [CrossRef] [PubMed]
- Melo, R.C.P.; Queirós, P.J.P.; Tanaka, L.H.; Costa, P.J.; Bogalho, C.I.D.; Oliveira, P.I.S.F. Undergraduate nursing students’ difficulties during clinical training: Perception of the main causes. Rev. Enferm. Ref. 2017, 4, 55–63. [Google Scholar] [CrossRef]
- Mattos, M.K.; Jiang, Y.; Seaman, J.B.; Nilsen, M.L.; Chasens, E.R.; Novosel, L.M. Baccalaureate nursing students’ knowledge of and attitudes toward older adults. J. Gerontol. Nurs. 2015, 41, 46–56. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lea, E.; Marlow, A.; Bramble, M.; Andrews, S.; Eccleston, C.; McInerney, F.; Robinson, A. Improving student nurses’ aged care understandings through a supported placement. Int. Nurs. Rev. 2015, 62, 28–35. [Google Scholar] [CrossRef] [PubMed]
- Reitmaier, A.; Davies, S.; Reveling, S.L.; Mangan-Danckwart, D.; Hongerholt, K.; Klinkner, J. Discovering intergenerativity: An evaluation of learning partnerships between student nurses and older adults. Int. J. Older People Nurs. 2015, 10, 115–126. [Google Scholar] [CrossRef] [PubMed]
- Redfield, C.S.; McGuire, A.P.; Lin, T.-C.; Orton, V.J.; Aust, M.; Erickson, T.M. Shifts in attitudes, knowledge, and social goals in nursing students following structured contact with community-dwelling older adults. J. Nurs. Educ. 2016, 55, 569–573. [Google Scholar] [CrossRef] [PubMed]
- Simões, M.M.M.; Salgueiro, N.R.; Rodrigues, M.A. Caring in humanitude: Study applied to a continuum of care. Rev. Enferm. Ref. 2012, 3, 81–93. [Google Scholar] [CrossRef]
- Melo, R.C.C.P.; Pereira, A.C.Ô.; Fernandes, S.E.M.; Freitas, N.V.M.; Melo, A.S.P. Prevention of skin tears in the dependent older person: Contribution of the humanitude care methodology. Rev. Mill. 2017, 2, 45–51. [Google Scholar] [CrossRef]
- Melo, R.C.C.P.; Queirós, P.J.P.; Tanaka, L.H.; Salgueiro, N.R.; Alves, R.E.; Araújo, J.P.; Rodrigues, M.A. State of-the-art in the implementation of the humanitude care methodology in Portugal. Rev. Enferm. Ref. 2017, 4, 53–62. [Google Scholar] [CrossRef] [Green Version]
- Honda, M.; Ito, M.; Ishikawa, S.; Takebayashi, Y.; Tierney, L. Reduction of behavioral psychological symptoms of dementia by multimodal comprehensive care for vulnerable geriatric patients in an acute care hospital: A case series. Case Rep. Med. 2016, 1–4. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Melo, R.C.C.P.; Soares, I.F.F.; Manso, M.S.C.; Gaspar, F.P.; Melo, A.S.P. Reduction of agitation in people with dementia during hygiene care: Contribution of the methodology of care humanitude. Rev. Mill. 2017, 2, 57–63. [Google Scholar]
- Figueiredo, A.M.G.; Melo, R.C.C.P.; Ribeiro, O.P. Humanitude care methodology: Difficulties and benefits from its implementation in clinical practice. Rev. Enferm. Ref. 2018, 4, 53–62. [Google Scholar] [CrossRef]
- Calegari, R.C.; Massarollo, M.C.K.B.; Santos, M. Humanization of health care in the perception of nurses and physicians of a private hospital. Rev. Esc. Enferm. USP 2015, 49, 42–47. [Google Scholar] [CrossRef] [Green Version]
- Humanitude. Le Réseau IGM. Available online: http://www.humanitude.fr/le-reseau-igm/ (accessed on 15 August 2020).
- Melo, R.C.; Oliveira, P.I.; Bogalho, C.I.; Santos-Costa, P.J.; Henriques, L.V. Interacting difficulties: Strategies used by nursing students in clinical learning. Rev. Iberoam. Educ. Investi. Enferm. 2019, 9, 30–38. [Google Scholar]
- Campos, C.J.G. Content analysis: A qualitative data analysis tool in health care. Rev. Bras. Enferm. 2004, 57, 611–614. [Google Scholar] [CrossRef] [PubMed]
- Fontanella, B.J.B.; Luchesi, B.M.; Saidel, M.G.B.; Ricas, J.; Turato, E.R.; Melo, D.G. Sampling in qualitative research: A proposal for procedures to detect theoretical saturation. Cad. Saúde Pública 2011, 27, 389–394. [Google Scholar] [CrossRef] [Green Version]
- World Medical Association. Declaration of Taipei on Ethical Considerations Regarding Health Databases and Biobanks. Ferney-Voltaire: World Medical Association. 2016. Available online: http://www.wma.net/en/30publications/10policies/d1/index.html (accessed on 15 August 2020).
- World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. Ferney-Voltaire: World Medical Association. 2013. Available online: http://www.wma.net/en/30publications/10policies/b3/index.html (accessed on 15 August 2020).
- Henriques, L.V.L.; Dourado, M.A.R.F.; Melo, R.C.C.P.; Tanaka, L.H. Implementation of the humanitude care methodology: Contribution to the quality of health care. Rev. Latino-Am. Enferm. 2019, 27, 1–10. [Google Scholar] [CrossRef] [PubMed]
- Nolet, K.; Roberts, T.; Gilmore-Bykovskyi, A.; Roiland, R.; Gullickson, C.; Ryther, B.; Bowers, B.J. Preparing tomorrow’s nursing home nurses: The wisconsin long term care clinical scholars program. Gerontol. Geriatr. Educ. 2015, 36, 396–415. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sun, F.-K.; Long, A.; Tseng, Y.S.; Huang, H.-M.; You, J.-H.; Chiang, C.-Y. Undergraduate student nurses’ lived experiences of anxiety during their first clinical practicum: A phenomenological study. Nurse Educ. Today 2016, 37, 21–26. [Google Scholar] [CrossRef]
- Lea, E.; Marlow, A.; Bramble, M.; Andrews, S.; Crisp, E.; Eccleston, C.; Mason, R.; Robinson, A. Learning opportunities in a residential aged care facility: The role of supported placements for first-year nursing students. J. Nurs. Educ. 2014, 53, 410–414. [Google Scholar] [CrossRef]
- Casate, J.C.; Corrêa, A.K. The humanization of care in the education of health professionals in undergraduate courses. Rev. Esc. Enferm. USP 2012, 46, 219–226. [Google Scholar] [CrossRef] [Green Version]
- Chan, Z.C.Y.; Lai, C.K.Y. The nurse-patient communication: Voices from nursing students. Int. J. Adolesc. Med. Health 2016, 29, 363–371. [Google Scholar] [CrossRef]
- Melo, R.; Costa, P.; Henriques, L.; Tanaka, L.; Queirós, P.; Araújo, J. Humanitude in the humanization of elderly care: Experience reports in a health service. Rev. Bras. Enferm. 2019, 72, 825–829. [Google Scholar] [CrossRef] [Green Version]
- Sheldon, L.; Hilaire, D. Development of communication skills in healthcare: Perspectives of new graduates of undergraduate nursing education. J. Nurs. Educ. Pract. 2015, 5, 30–37. [Google Scholar] [CrossRef] [Green Version]
- Shafakhah, M.; Zarshenas, L.; Sharif, F.; Sarvestani, R. Evaluation of nursing students’ communication abilities in clinical courses in hospitals. Glob. J. Health Sci. 2015, 7, 323–328. [Google Scholar] [CrossRef] [PubMed]
Students’ Difficulties | Moment of Assessment | EG | CG | Total | χ2 | p | ||||
---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | |||||
Initiating communication with elders | Baseline | Yes | 10 | 31.3 | 14 | 43.8 | 24 | 37.5 | 1.067 | 0.302 |
No | 22 | 68.8 | 18 | 56.3 | 40 | 62.5 | ||||
Follow-up | Yes | 2 | 6.5 | 11 | 37.9 | 13 | 21.7 | 8.748 | 0.003 | |
No | 29 | 93.5 | 18 | 62.1 | 47 | 78.3 | ||||
Communicating with non-communicative elders | Baseline | Yes | 18 | 56.3 | 26 | 81.3 | 44 | 68.8 | 4.655 | 0.031 |
No | 14 | 43.8 | 6 | 18.8 | 20 | 31.3 | ||||
Follow-up | Yes | 12 | 38.7 | 18 | 62.1 | 30 | 50.0 | 3.270 | 0.071 | |
No | 19 | 61.3 | 11 | 37.9 | 30 | 50.0 | ||||
Communicating with elders with aphasia | Baseline | Yes | 11 | 34.4 | 18 | 56.3 | 29 | 45.3 | 3.090 | 0.079 |
No | 21 | 65.6 | 14 | 43.8 | 35 | 54.7 | ||||
Follow-up | Yes | 12 | 38.7 | 21 | 72.4 | 33 | 55.0 | 6.877 | 0.009 | |
No | 19 | 61.3 | 8 | 27.6 | 27 | 45.0 | ||||
Communicating with agitated and confused elders | Baseline | Yes | 12 | 37.5 | 23 | 71.9 | 35 | 54.7 | 7.630 | 0.006 |
No | 20 | 62.5 | 9 | 28.1 | 29 | 45.3 | ||||
Follow-up | Yes | 10 | 32.3 | 19 | 65.5 | 29 | 48.3 | 6.637 | 0.010 | |
No | 21 | 67.7 | 10 | 34.5 | 31 | 51.7 | ||||
Caring for elders who refuse care | Baseline | Yes | 7 | 21.9 | 8 | 25.0 | 15 | 23.4 | 0.087 | 0.768 |
No | 25 | 78.1 | 24 | 75.0 | 49 | 76.6 | ||||
Follow-up | Yes | 7 | 22.6 | 12 | 41.4 | 19 | 31.7 | 2.447 | 0.118 | |
No | 24 | 77.4 | 17 | 58.6 | 41 | 68,3 |
Categories | Subcategories | Moment of Assessment | Recording Units | |
---|---|---|---|---|
EG | CG | |||
Inexperience | Lack of experience | Baseline | 12 | 7 |
Follow-up | 11 | 9 | ||
First contact with reality | Baseline | 7 | 6 | |
Follow-up | 1 | 1 | ||
Deficit in theoretical–practical teaching | Deficit of knowledge about communication | Baseline | 3 | 4 |
Follow-up | 1 | 0 | ||
Difference between theory and practice | Baseline | 6 | 3 | |
Follow-up | 3 | 3 | ||
Deficit of relational techniques training | Baseline | 11 | 1 | |
Follow-up | 12 | 0 | ||
Procedure focused simulation | Baseline | 3 | 2 | |
Follow-up | 3 | 1 | ||
Clinical training context | Deficit of Humanitude in the professionals | Baseline | 5 | 0 |
Follow-up | 4 | 0 | ||
Lack of respect from the professionals | Baseline | 2 | 0 | |
Follow-up | 1 | 1 | ||
Understaffing | Baseline | 1 | 3 | |
Follow-up | 1 | 3 | ||
Personal traits | Shyness | Baseline | 3 | 1 |
Follow-up | 0 | 3 | ||
Lack of self-confidence | Baseline | 1 | 7 | |
Follow-up | 1 | 5 | ||
Anxiety | Baseline | 1 | 2 | |
Follow-up | 1 | 1 | ||
Fear | Baseline | 2 | 9 | |
Follow-up | 0 | 2 | ||
Total | 96 | 74 |
Categories | Subcategories | Moment of Assessment | Recording Units | |
---|---|---|---|---|
EG | CG | |||
Application of the HCM | Knowledge of the elders | Baseline | 3 | 0 |
Follow-up | 1 | 0 | ||
Humanitude Pillars | Baseline | 12 | 0 | |
Follow-up | 4 | 0 | ||
Technical–relational procedures | Baseline | 6 | 0 | |
Follow-up | 13 | 0 | ||
Training/education | Training in “Caring with Humanitude” | Baseline | 4 | 0 |
Follow-up | 6 | 0 | ||
Self-training | Baseline | 3 | 5 | |
Follow-up | 4 | 3 | ||
Relational techniques training | Baseline | 8 | 5 | |
Follow-up | 5 | 5 | ||
Practical context | Baseline | 2 | 1 | |
Follow-up | 0 | 0 | ||
Development of personal skills | Self-confidence | Baseline | 2 | 4 |
Follow-up | 3 | 1 | ||
Emotional management | Baseline | 1 | 2 | |
Follow-up | 1 | 0 | ||
Persistence | Baseline | 0 | 0 | |
Follow-up | 2 | 1 | ||
Total | 80 | 27 |
SSHCP Dimensions | Moment of Assessment | Groups | n | Mean | SD | t | p | ES | ES | |
---|---|---|---|---|---|---|---|---|---|---|
95% CI | ||||||||||
Pre-preliminaries | Baseline | EG | 32 | 3.59 | 0.42 | 3.384 a | 0.001 | 0.853 b | 0.333 | 1.366 |
CG | 31 | 3.20 | 0.49 | |||||||
Follow-up | EG | 30 | 3.68 | 0.38 | 1.483 a | 0.144 | 0.390 b | −0.132 | 0.908 | |
CG | 28 | 3.53 | 0.42 | |||||||
Preliminaries | Baseline | EG | 32 | 3.65 | 0.31 | 2.655 a | 0.010 | 0.669 b | 0.159 | 1.174 |
CG | 31 | 3.45 | 0.28 | |||||||
Follow-up | EG | 30 | 3.76 | 0.21 | 2.594 a | 0.012 | 0.682 b | 0.149 | 1.209 | |
CG | 28 | 3.60 | 0.27 | |||||||
Sensory circle | Baseline | EG | 30 | 3.64 | 0.36 | 1.028 a | 0.308 | 0.268 b | −0.246 | 0.779 |
CG | 29 | 3.54 | 0.38 | |||||||
Follow-up | EG | 29 | 3.72 | 0.28 | 1.798 a | 0.078 | 0.472 b | −0.052 | 0.992 | |
CG | 29 | 3.57 | 0.35 | |||||||
Emotional consolidation | Baseline | EG | 32 | 3.69 | 0.46 | 0.661 a | 0.511 | 0.167 b | −0.329 | 0.661 |
CG | 31 | 3.61 | 0.44 | |||||||
Follow-up | EG | 30 | 3.77 | 0.34 | 1.822 a | 0.074 | 0.474 b | −0.045 | 0.990 | |
CG | 29 | 3.60 | 0.37 | |||||||
Appointment | Baseline | EG | 32 | 3.70 | 0.42 | 3.034 a | 0.004 | 0.759 b | 0.248 | 1.263 |
CG | 32 | 3.35 | 0.49 | |||||||
Follow-up | EG | 30 | 3.80 | 0.30 | 2.460 a | 0.018 | 0.647 b | 0.121 | 1.169 | |
CG | 29 | 3.49 | 0.60 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Melo, R.C.C.P.; Queirós, P.J.P.; Tanaka, L.H.; Henriques, L.V.L.; Neves, H.L. Nursing Students’ Relational Skills with Elders Improve through Humanitude Care Methodology. Int. J. Environ. Res. Public Health 2020, 17, 8588. https://doi.org/10.3390/ijerph17228588
Melo RCCP, Queirós PJP, Tanaka LH, Henriques LVL, Neves HL. Nursing Students’ Relational Skills with Elders Improve through Humanitude Care Methodology. International Journal of Environmental Research and Public Health. 2020; 17(22):8588. https://doi.org/10.3390/ijerph17228588
Chicago/Turabian StyleMelo, Rosa Cândida Carvalho Pereira, Paulo Joaquim Pina Queirós, Luiza Hiromi Tanaka, Liliana Vanessa Lúcio Henriques, and Hugo Leiria Neves. 2020. "Nursing Students’ Relational Skills with Elders Improve through Humanitude Care Methodology" International Journal of Environmental Research and Public Health 17, no. 22: 8588. https://doi.org/10.3390/ijerph17228588