Communicative and emotional skills as essential elements of humanised care

Numerous studies confirm the importance that the improvement of communication in care processes has for the establishment of a nurse-patient relationship⁵. The type of relationship and the type of care established between the nursing professional and the user may have therapeutic effects, resulting in increased adherence to and tolerance of medical treatment and nursing procedures³.

This can be observed in the results of the recent qualitative study carried out by Michelan and Spiri⁶, which concludes that holistic care is necessary and has a positive impact on the patients' recovery, since dialogue and listening can be compared to drug treatment.

When individuals feel well cared for, listened to, and respected, and when they maintain a bond of trust, their adherence to treatment tends to be higher. Similarly, some studies relate nurses' entrance into the patients' emotional spheres and favouring the expression of emotional experiences with improved satisfaction and recovery. Some studies even consider this to be decisive in the healing process^6,7. Furthermore, we found that ineffective communication on the part of healthcare professionals may lead to depression, increased anxiety, helplessness, hopelessness, and impaired quality of life for patients.

Thus, Pott et al.³identify as factors that impair the quality of care, on the one hand, any form of ineffective communication and/or lack of communication during care actions, neglecting the emotional and social aspects of the individual requiring care. On the other hand, other factors identified were the mechanisation and routinisation of daily care, showing that many professionals focus on treating and curing the sick body, without taking into consideration the other humanistic aspects that make up each being. However, the review of the literature on the subject reveals that users are increasingly demanding more human treatment and not merely seeking treatment. Users perceive that interpersonal relationships and the type of rapport established between the nurse and the patient are the most valued characteristics, even over effectiveness. Emotional intelligence should be one of the objectives in health training and practice, and should be recognised as one of the indicators of improvement in the quality of health services, since individuals with high levels of emotional intelligence are more capable of empathising with others and are more likely to help, cooperate, and establish more satisfying interpersonal relationships. Also noteworthy is the recent study by Sharon and Griberg⁸, which focuses on reviewing the relationship between the level of emotional intelligence and the degree of success of nursing students. Their results point to a positive correlation between these variables, arguing that emotional intelligence should be considered as a criterion for the admission of students to undergraduate nursing programs.

The above highlights the importance of emotional care and good rapport which, by establishing interpersonal relationships of trust, with special emphasis on the type of communication, can become a therapeutic element that influences the well-being, health, and/or recovery process of individuals in need of care.

Other factors contributing to humanised care: attention, reflection, and self-awareness

There are other factors that contribute to developing humanised care which depend directly on professionals. The individual's personality and character directly influence how they treat patients, the way they address patients and their families, as well as their behaviours, thus promoting or neglecting a more or less humanised practice⁹.

This is why reflecting on nursing practice in daily care is essential. According to these authors, in order to attain the humanisation of care, it is necessary to engage in a permanent reflective process that allows us to keep in mind the values and principles that govern professional practice, since nursing, in and of itself, is a humanised practice.

Jean Watson's theory of Human Caring may be considered here. This theory attaches special importance to reflection on the self, on personal introspection, and/or self-awareness as factors in the care process. Watson¹⁰claims that individuals who fail to recognise their own feelings will find it hard to understand someone else's feelings. Similarly, accepting the expression of one's own and others' feelings (both positive and negative) leads to a form of empathy that transcends one's own self and favours the process of human caring¹¹. Hence, self-awareness, reflective practice on the care that is being provided, and the ability to self-motivate are all elements that need to be incorporated into the professionalisation and training of nursing staff¹².

Another issue considered to be essential for humanised care is “attention to detail”. The study by Beltrán-Salazar¹³, whose purpose was to understand the meaning of humanised care as experienced by inpatients, their families, and nurses, points to the importance of details and how details can be perceived by individuals in need of care. This author concludes that, although it may not be important for nurses to perform certain actions or paying attention to certain details, the following may be crucial for individuals in need of care: being greeted, being addressed by their name, complicit looks, nurses knowing their interests, body contact and caresses, etc. These are important elements of interaction, in the establishment of trust-based interpersonal relationships from the humanised care perspective.

Thus, attention to detail, reflective practice, and self-awareness are considered to be factors that contribute to humanising care.

Emotional and communicative training in nursing education for humanised care

At present, educational curricula in the Spanish context include emotional and communication skills within the set of competencies that nursing students must attain to obtain a degree in Nursing⁴. Clinical communication has been embraced as an important component of nursing curricula and has been acknowledged as an essential competency by accreditation bodies and international organisations¹⁴.

In spite of this, it has been reported that training in communication and emotional skills in nursing has stagnated. It is even nursing professionals themselves who stress that learning to listen to, manage, and convey emotions are skills that should be taught during basic training across the board. It has also been pointed out that this type of training must be developed from new approaches and more participatory and experiential methods that ensure significant learning¹⁵.

According to Santos et al.¹⁶, dehumanisation begins during nursing training, where emphasis is placed on the mastery of knowledge, scientific evidence, and the development of technical skills, to the detriment of patient-centred skills and competencies from a holistic perspective, while ignoring the critical, creative, and sensitive-affective approach inherent in care. Lee et al.¹¹draw similar conclusions and stress the need to introduce specific training in emotional aspects using methods that encourage and promote more reflective learning in order to attain the competencies necessary for comprehensive caring. As a result, these authors state that the training of students should privilege communication with the individual rather than the performance of their technical role, so that students are able to clarify the needs and feelings of each individual being cared for (p. 40).

It is also worth highlighting the current educational interest in studying the presence of family members and how they are cared for, as this aspect is essential for the humanisation of care and directly influences the recovery and improvement of individuals in need of care¹⁷. The results obtained by Gomes et al.¹⁸also show that the presence of relatives is an element that promotes the physical and emotional recovery of the individual being cared for, especially when it comes to child care. It is apparent that, among the meanings of humanisation, the inclusion of the family in patient care must be acknowledged as a practice inherent in the nursing profession in order to provide more comprehensive, holistic and humane care¹⁹. As a result, it has been suggested that family should be included in nursing training programmes to help trainees acquire skills and competencies to work with family members, and above all, to understand the importance of including families in the care plan²⁰.

However, it is not sufficient to incorporate this type of training in academic degrees. It should also be provided as continued professional development throughout the nursing profession. In this regard, Tejada et al.¹⁵stress the need for continuous educational and professional updates to contribute to the integration of innovative strategies for meaningful learning. Similarly, Guerrero-Ramírez, Meneses-La Riva and De la Cruz-Ruiz²¹conclude that it is necessary to implement strategies, improvement plans, and continuous training in order to raise awareness among nursing professionals and humanise patient care, while placing utmost importance on communication, support, patient-family relations, and empathy.

Universities must be as sensitive as they are scientific²²and must bring about the changes necessary to ensure that university graduates acquire the competencies and skills necessary to provide humane care. In this sense, in accordance with Ruiz-Moral et al.¹⁴, it is worth noting the curricular modifications made in the Faculty of Medicine of the Francisco de Vitoria University (Spain), where certain new organisational particularities have facilitated the integration of communication and care skills across the board.

The results of the study by Hernández et al.²³are particularly noteworthy. In this study, an educational intervention was implemented with the aim of improving the use of the indicator dignified treatmentin inpatient nurses. The purpose of the study was to analyse whether their training was reflected in their relationships with patients and patient care. Regarding the results of the pre- and post-intervention evaluations, the means increased significantly. In conclusion, the educational intervention had a significant impact on the acquisition of knowledge by nurses, as well as on the improvement of the implementation of the indicator.

The above shows that making changes and improvements in the treatment and training of communication and emotional skills is a need that must be prioritised by scholars, researchers, and professionals alike, as they are instrumental in achieving good quality of care.

Educational strategies and resources for the communicative training of lecturers, students, and healthcare professionals

Students report feeling underprepared or not at all prepared to cope with communicative and emotional demands. The evidence provided by the studies consulted also supports the ideas we have been proposing. The scientific results suggest that it is necessary to improve the training of future nursing professionals with regard to communicative and emotional skills. However, it has also been observed that both the acquisition and the development of these skills require special work. Simply providing knowledge in an explanatory manner, following the masterclass model, and offering occasional lectures or seminars on these competencies may not suffice to help the student body develop the empathy and communication skills necessary to provide efficient and affective education and care¹⁴. According to the literature consulted, there is a call for incorporating new methodological approaches to replace the insufficiency of explanatory lectures and contribute to generating significant learning processes²⁴. In this regard, Tejada et al.¹⁵point to the need to incorporate learning processes based on participatory, reflective, and dialogical methods that respect students' autonomy and teamwork in order to build, rebuild, and exchange knowledge. The results of their study highlight that pedagogical practices play an essential role in the teaching-learning processes of care in future nursing professionals, by contributing to the development of a special human sensitivity and by awakening affective, creative, and critical approaches. Similar results were obtained by Oliveira et al.⁹. The objective of their study was to understand, from the lecturers' perspective, what are the facilitating and hindering factors in the development of communicative skills in nursing students. The following factors were found to contribute to learning: the use of practical activities, students' individual characteristics, use of active methods²⁵, relationship of proximity between student and lecturer, and organisation in small groups.

In consonance with the above, the recent contributions of Rojas and Gonzáles²²stand out. These authors indicate that the participatory teaching-learning process acquires an added value when it is intended for the development of communicative skills, as their acquisition requires educational scenarios in which exchanges, reflections, and mutual influences are the dynamic driving force of educational practice. As emphasised by these authors, pedagogical spaces and environments where personal reflection, exchange of opinions, and open and respectful discussion predominate must be stimulated, thus promoting meaningful learning and personal and collective development linked to the communication process.

Interdisciplinary work is another element indicated in the literature to be incorporated into the learning processes with a view to improving emotional and communication skills and competencies. The results of a recent study indicate that 90% of studies show that interprofessional training is vital for health students²². So much so that, in 2016, the United Nations, in collaboration with the World Health Organization and other agencies, proposed interprofessional and interdisciplinary education in basic health training, aimed at promoting good quality transformative education and integrated skills from all fields.

Recent studies suggest that interdisciplinary work can offer a multiplicity of approaches and alternatives to understand the aspects involved in patient care, thus contributing to the creation of a new culture of nursing care, which must be translated into the educational sphere²⁶.

Narration is another of the resources proposed to contribute to a change in nursing care practice towards the humanisation of care. Narration improves training in communicative and emotional skills centred on individuals and their families, with autobiographical narratives being especially relevant²⁷.

Self-ethnography may be mentioned at this point. Writing one's own history as a way of understanding one's own vital processes and those of our patients allows us to reflect, create, and learn as individuals and as nursing professionals. A self-ethnographic process requires conscious observation, while focusing on connecting with patients, how we relate to patients, how we interact with them and bond in interpersonal relationships, and whether we put into practice experiences, skills, and teachings in which effective and affective communication is the driving force of our interaction with others. Self-ethnography is thus used as a resource to work on our feelings, on our ways of communicating and relating to others, starting from our own history and that of others, so that we are able to understand them and come closer to understanding others²⁸.

When nursing professionals use this method on patients and their own experiences of illness, patients are able to express their feelings and emotions with others. As a result, nursing professionals contribute directly to improving the self-care of patients while becoming aware of the position of the individual in need of care.

Considering the above, it is safe to say that qualitative, narrative, and interpretative methods force us to constantly (re)question our views of human beings, our personal, social, physical, mental, and spiritual problems, which directly influences our stance in relation to one another²⁹.

Finally, it should be noted that, despite the positive influence of these methods on health research, their subjective nature and the expression of feelings in contact with the most rigorous science is also pointed out as an obstacle. However, as argued by Siles²⁸, sociopoetics has arisen in an attempt to address this obstacle, as it allows the expression of feelings to be studied in an intersubjective way, thus attaining certain objectivity. Several authors have described the utility of poetry in nursing.

The possibility of conducting self-narratives that are shallow on the interpretative plane has also been mentioned, which can be counterproductive, as they neglect the main goal, which is to link the personal side of self-ethnography with its social side.

Hence, some authors have put their efforts into trying to provide guidelines for placing this research method within the framework of sound social research by suggesting the creation of an Educational Model Based on Narration (EBN)^28,30, which is meant to serve as a bridge between the qualitative subjectivity of this research method and the scientific objectivity of EBE (Evidence-Based Education).