Relational skills: needs experienced by nursing students

Rosa Cristina Correia Lopes Zaida de Aguiar Sá Azeredo Rogério Manuel Clemente Rodrigues About the authors

Abstracts

OBJECTIVE: to identify the needs of nursing students in the field of relational competencies. METHOD: qualitative study with an exploratory-descriptive nature. The random sample included 62 students in the 2nd year of the nursing undergraduate program of a school located in the central region of Portugal. The inclusion criterion was the nonexistence of clinical teaching. Data were collected through a form designed to assess relational needs; content analysis was used to analyze data. RESULTS: the results indicated that the students' concept of nursing care at this stage of their education is focused on the performance of nursing tasks and techniques instead of on scientific knowledge. Overall, they are aware that greater personal development and better self-knowledge are determinant for their personal and social well-being and for them to become good professionals. CONCLUSION: these results will support the improvement of an intervention program to be developed with these students.

Students, Nursing; Interpersonal Relations; Clinical Competence; Competency-Based Education; Nursing Education Research


OBJETIVO: identificar as necessidades manifestadas pelos estudantes de enfermagem na área das competências relacionais. MÉTODO: estudo, qualitativo com características exploratório-descritivas, a amostra aleatória incluiu 62 estudantes do 2º ano do Curso de Licenciatura em Enfermagem (Escola da Região Centro de Portugal). Considerou-se como critério de selecção a inexistência de realização de Ensino Clínico. Coleta de dados realizada por meio da Ficha de Avaliação de Necessidades Relacionais com análise de conteúdo dos dados. RESULTADOS: indicaram que nesta fase da formação, os estudantes detêm um conceito de cuidar em Enfermagem centrado na execução de tarefas e técnicas de enfermagem em vez de na cientificidade do saber em Enfermagem e, que globalmente estão cientes que um maior desenvolvimento pessoal, um melhor conhecimento de si será determinante para o bem-estar pessoal e social e ser um bom profissional. CONCLUSÃO: as evidências permitirão aprimorar o programa de intervenção a desenvolver com estes estudantes.

Estudantes de Enfermagem; Relações Interpessoais; Competência Clínica; Educação Baseada em Competências; Pesquisa em Educação de Enfermagem


OBJETIVO: identificar las necesidades manifestadas por los estudiantes de enfermería en el área de las habilidades relacionales. MÉTODO: estudio, cualitativo con características exploratorio-descriptivas, la muestra aleatoria incluyó 62 estudiantes del 2º año del Curso de Licenciatura en Enfermería (Escuela de la Región Centro de Portugal). Se consideró como criterio de selección la inexistencia de realización de Enseño Clínico. Recogida de datos realizada por medio de la Ficha de Evaluación de Necesidades Relacionales con análisis de contenido de los datos. RESULTADOS: indicaron que en esta fase de la formación, los estudiantes detienen un concepto de cuidar en Enfermería centrado en la ejecución de tareas y técnicas de enfermería en vez de en la cientificidad del saber en Enfermería y, que globalmente saben que un mayor desarrollo personal, un mejor conocimiento de sí será determinante para el bienestar personal y social y serán buenos profesionales. CONCLUSIÓN: las evidencias permitirán apurar el programa de intervención a desarrollar con estos estudiantes.

Estudiantes de Enfermería; Relaciones Interpersonales; Competencia Clínica; Educación Basada en Competencias; Investigación en Educación de Enfermería


ORIGINAL ARTICLE

Relational skills: needs experienced by nursing students1 1 Paper extracted from Doctoral Dissertation "Competências pessoais e sociais em estudantes de enfermagem: Implicações da implementação de um programa de intervenção no Saber Fazer Relacional", presented to Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal. Supported by Fundação para a Ciência e Tecnologia - Ministério da Ciência, Tecnologia e Ensino Superior, Portugal, - PEst-OE/SAU/UI0742/2011

Rosa Cristina Correia LopesI; Zaida de Aguiar Sá AzeredoII; Rogério Manuel Clemente RodriguesIII

IDoctoral Student, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal. Adjunct Professor, Escola Superior de Enfermagem de Coimbra, Portugal

IIPhD, Assistant Professor, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal

IIIPhD, Adjunct Professor, Escola Superior de Enfermagem de Coimbra, Portugal

Corresponding Author

ABSTRACT

OBJECTIVE: to identify the needs of nursing students in the field of relational competencies.

METHOD: qualitative study with an exploratory-descriptive nature. The random sample included 62 students in the 2nd year of the nursing undergraduate program of a school located in the central region of Portugal. The inclusion criterion was the nonexistence of clinical teaching. Data were collected through a form designed to assess relational needs; content analysis was used to analyze data.

RESULTS: the results indicated that the students' concept of nursing care at this stage of their education is focused on the performance of nursing tasks and techniques instead of on scientific knowledge. Overall, they are aware that greater personal development and better self-knowledge are determinant for their personal and social well-being and for them to become good professionals.

CONCLUSION: these results will support the improvement of an intervention program to be developed with these students.

Descriptors: Students, Nursing; Interpersonal Relations; Clinical Competence; Competency-Based Education; Nursing Education Research.

Introduction

Relational and interpersonal relationship skills are considered to be the backbone of nursing care and are recognized as the competencies that differentiate excellent nursing care(1). The acquisition of these skills is considered a progressive process, developed according to various stages: beginning, advanced beginning, competent, proficient, and expert(2). Admittedly, professional competence in nursing includes clinical and technical aspects, but relational aspects complement it. The development of professional competence is achieved only after personal competence is developed(1). There is no doubt about the relevance of personal competence for one's personal and professional realization or of its usefulness in training or inclusion in school programs(3).

We assert that professional competence in nursing is primarily based on the nurses' personal qualities, on their personality, which determines the acquisition of education and experience. Competence in nursing comprises two essential aspects: the mobilization of personal competencies and the mobilization of different types of knowledge and know-how applied to nursing care(1).

The more self-knowledge a caregiver has and the more complete it is, the better the care provided(4). Self-knowledge (recognition of one's own limitations, emotions, being able to work with one's own emotions), respect for others, relational distance, open-mindedness, professional attitudes and behavior, attentive listening, invention, and creativity are competencies essential to the quality of nursing interventions(5).

In a clinical-reflective approach of an ecological matrix(6), professional competence is a result of a set of micro-interactions: with oneself (intrapersonal interaction), with others (interpersonal interaction), and with knowledge in interactive relationships (multidisciplinary interaction). Considering that people are the essence of an organization, their full involvement enables their competence to be fully used to the benefit of the organization itself, also benefiting the implementation of intervention programs(7).

It is also important to note that the quality of care is strongly marked by the attitudes and behaviors of those providing care. Competent professional performance requires knowledge able to mobilize, integrate, and transmit knowledge acquired during the educational process(8), which may be enabled by the development of competencies from new pedagogical opportunities provided during initial stages of education(9).

Specifically, nursing know-how incorporates in itself the relational know-how(8,10), while nursing care, considered to be the special attention provided to a person requiring help, is essentially developed via an interpersonal relationship, which requires complex competencies from nurses, competencies focused on humanist principles (unity, the tendency to update one's knowledge, autonomy, progress) and on supportive relationship (acceptance, authenticity, empathy, warm respect, congruence, attentive listening)(11).

Objective

To identify the needs manifested by nursing students in the field of relational competencies.

Method

Qualitative and longitudinal study with an exploratory-descriptive approach, quasi-experimental design and triangulation of quantitative and qualitative methods, to assess the efficiency of an intervention program.

The studied population included 2nd year students from an undergraduate nursing program taking the theoretical course in the 3rd quarter of 2009-2010 in a college of nursing in the center region of Portugal. There were 166 students distributed into three classes. Considering the randomization of students distributed per class, the random sample was composed of 62 students. The inclusion criterion "non-existence of clinical teaching" was considered in the sample selection.

A self-reported qualitative form addressing relational needs was used to collect data. It was composed of five open questions designed to identify relational needs expressed by the nursing students in their interpersonal and professional relationships and also their needs concerning education.

According to ethical principles, the school's president authorized this investigation and the participation of students was voluntary and confirmed by their signatures on free and informed consent forms. This study was also approved by the Ethics Research Committee (Process No. 14-12/2010) at the Research Unit in Health Sciences-Nursing (UICISA-E) of the Escola Superior de Enfermagem de Coimbra.

Data were analyzed through content analysis as a set of analytical communication techniques(12). We note that the development of categories followed the rules: homogeneity, exhaustiveness, uniqueness, objectivity, and relevance(12-14). The process of content analysis began with a pre-analysis of the material though skimming the answers provided to each question. The material was then explored and coded with the identification and delimitation of units, organizing categories and subcategories, through an inductive process. A panel of experts ensured the validity and reliability of content analysis.

Results

Most of the sample is composed of single (98.38%) women (90.32%), aged between 18 and 35 years old, though 61 participants were aged between 18 and 22 years and only one participant was 35 years old. The average age was 19.55 years old and the standard deviation was 2.163 years.

When the 62 students were asked about the skills they considered essential for the quality of nursing care, 188 units were obtained. These units were organized into two categories: professional competence, and personal and social competencies; the first is presented in subcategories and indicators.

The results presented in Table 1 show that the competencies the students considered to be essential to the quality of care delivery were: in the first place, the techniques and procedures (18.62%), in the second place, supportive relationships (18.08%), in the third place, personal and social competence (15.43%), and only after these does scientific knowledge come (11.70%).

A more detailed analysis shows that professional competence was organized by the subcategories Knowledge, Know-How, and Relational Know-How. The subcategory Knowledge, which includes scientific knowledge and ethics, revealed that 11.7% of the units refer to scientific knowledge and 5.85% to ethical aspects. Know-How units refer to techniques and procedures (18.62%) and to meeting peoples' needs (6.38%). Relational Know-How essentially refers to supportive relationships (18.08%), to humanistic principles (11.17%) and to communication (9.04%) (Table 1). Personal and social competencies comprise aspects related to assertiveness, self-esteem, and the ability to adapt, among others. It represents 15.43% of the units.

Table 2 shows the results of the analysis concerning the 318 units expressed by the students. They support the opinion that personal characteristics facilitate nurses' competence, especially communication skills (12.89%), followed by sympathy (8.81%), tolerance (6.92%), professionalism (6.60%), and self-esteem/self-confidence (5.66%).

The students were also asked what professional competencies the program should enable them to acquire and 220 units were found. The units were organized into two categories (professional competence, and personal and social competence), as presented in Table 3. The results from a global analysis reveal that their opinion is that the program should enable them to perform techniques and procedures (21.36%), enable the development of personal and social skills (16.82%), to establish supportive relationships (15.91%), to develop communication skills (15.00%), and to acquire scientific knowledge (12.27%).

It is worth noting that the results concerning the students' opinions of the professional competencies the program should enable them to acquire are related to their opinion concerning the competencies that they considered to be essential for quality nursing care previously presented in Table 1.

Table 4 presents the results concerning the analysis of units reported by the students regarding the characteristics and personal competencies students need to target and change in order to become good nurses. A total of 172 units were found and reveal that the main characteristics that they need to change were communication skills (29.07%), self-esteem (15.12%), including aspects concerning self-esteem and self-assurance. Students also highlighted personal and social competence, and assertiveness (13.37%).

Units concerning the development of professionalism (8.14%), understanding (5.81%), knowing to listen (5.23%) and emotional competence (5.23%), were also equally expressed by the participants; less frequently mentioned were tolerance, anxiety, and respect for others and teamwork.

When the students were asked about the characteristics and the personal competencies they needed to develop to improve their personal and social well-being, they reported self-esteem in 29.55% of the 132 studied units, communication skills (23.48%), assertiveness (15.91%) and emotional competence (12.12%) (Table 5). Tolerance, knowing to listen and sense of responsibility were less frequently reported.

Discussion

Highlighting the most significant results achieved in this study through the assessment of relational needs, the following conclusions were reached. Based on what the students reported as being competencies essential to the quality of nursing care, we verified that the categories (professional competence, and personal and social competence) illustrate the importance the students assign to the professional dimension (85%) and to the intra- and interpersonal dimensions (15%). Such findings allow us to infer that the students, at this stage of their education, do not integrate concepts advocated by some theorists, for whom the quality of nursing care is marked by the nurses' behavior(8) and that professional competence is only achieved after personal competence is developed(1).

Meanwhile, another piece of evidence related to the subcategories of Professional Competence is related to a greater appreciation of Know-How, due to the over-valorization of techniques and procedures at the expense of the subcategory Knowledge, especially scientific knowledge. This notion of nursing care is focused on the performance of nursing tasks and techniques instead of on scientific knowledge in nursing, essential for nurses' autonomy(15). On the other hand, the students assigned significant value to the subcategory Relational Know-How (42%), recognizing the importance of supportive relationships, humanistic principles and communication for the quality of nursing care(10-11,16).

In relation to the professional competencies the program should enable students to acquire, the results are related to the competencies that are essential to the quality of nursing care previously discussed. The students, again, under-valued Scientific Knowledge and evidenced bias toward Techniques and Procedures.

These findings contradict some previous studies addressing students from different undergraduate programs where the aspect most valued is "acquisition of knowledge", indicating that teaching institutions transmit more knowledge from the knowledge scope than from the know-how, know-to-be, and know-coexist scopes(17).

Nonetheless, within Relational Know How, they exalt the development of competencies concerning supportive relationships and communication skills, while within the scope of Knowledge, they exalt personal and social competencies. These aspects are globally confirmed by conceptions that defend the view that competence in nursing comprises two essential aspects: the mobilization of personal competencies and the mobilization of knowledge and know-how applied to nursing care(1). These aspects also highlight the importance of nurses' self-knowledge that promotes skills and quality of care, that is, the better and the more complete one's self-knowledge, the better the quality of care provided(5).

The more self-knowledge a caregiver has and the more complete it is

In relation to the personal characteristics that facilitate the competence of nurses, the students highlight communication skills but also value the ability to be tolerant, rigorous, organized, professional, understanding, assertive, and having good self-esteem and self-confidence. Overall, these findings seem to be in agreement with the idea that investing in communication skills on the part of nurses is associated with higher levels of personal growth(18).

In regard to personal characteristics and competencies to which students need to pay greater attention in order to become good nurses, communication skills, self-esteem and assertiveness stand out. These results are consonant with those reported by studies that defend competence in interpersonal communication as an ability essential to be acquired by nurses, which enables them to provide conscientious, true and transforming care(19). Closely related to the previous issue are the personal characteristics and competencies that students are required to develop in order to improve their personal and social well-being; they highlighted self-esteem, communication skills, assertiveness and also emotional competence.

Considering that undergraduate education should enable personal development, dimensions concerning the development of responsibility, positive relationships and cooperation emerge as having considerable relevance in empirical investigations focused on the academic success of undergraduate students(17). In other studies that are focused on acquiring knowledge in Clinical Teaching, the students' personal characteristics and maturity demonstrated in interactions(6), self-knowledge and factors intrinsic to the individual stand out(20).

Conclusion

The content analysis concerning the opinion of students about what competencies are essential for the quality of nursing care and professional competencies the program should enable them to acquire showed a greater valorization of Know-How through an over-valorization of Techniques and Procedures at the expense of Knowledge, especially of Scientific Knowledge. The conclusion is that the concept of Nursing Care held by nursing students at this stage of their education is focused on the performance of nursing tasks and techniques instead of on scientific nursing knowledge, so essential for the autonomy of nurses and the science of nursing. It also became apparent that they attribute great value to the quality of Nursing Care and Relational Know How, especially through supportive relationships, humanistic principles and communication.

The students reported that personal characteristics are required to improve their well-being or for them to become good nurses or to facilitate nursing competencies: the development of communication skills, emotional competence, self-esteem, and assertive behavior. Finally, we conclude that the students are aware that personal development and better self-knowledge are determinant of their personal and social well-being, as well as for them to become good professionals.

  • Corresponding Author:
    Rosa Cristina Correia Lopes
    Escola Superior de Enfermagem de Coimbra
    Rua 5 de Outubro, Apartado 7001, 3001-901
    Coimbra, Portugal
    E-mail:
  • Received: Jan. 10th 2012

    Accepted: Oct. 5th 2012

  • 1
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    Corresponding Author: Rosa Cristina Correia Lopes Escola Superior de Enfermagem de Coimbra Rua 5 de Outubro, Apartado 7001, 3001-901 Coimbra, Portugal E-mail: rlopes@esenfc.pt 1 Paper extracted from Doctoral Dissertation "Competências pessoais e sociais em estudantes de enfermagem: Implicações da implementação de um programa de intervenção no Saber Fazer Relacional", presented to Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal. Supported by Fundação para a Ciência e Tecnologia - Ministério da Ciência, Tecnologia e Ensino Superior, Portugal, - PEst-OE/SAU/UI0742/2011

    Publication Dates

    • Publication in this collection
      17 Dec 2012
    • Date of issue
      Dec 2012

    History

    • Received
      10 Jan 2012
    • Accepted
      05 Oct 2012
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    E-mail: rlae@eerp.usp.br