Iran Journal of Nursing

Background & Aims: The emergency department is one of the most important wards in a hospital, and its functions can have a great impact on the activities of other wards. In the emergency department, 24- hour emergency services are provided to patients, and there is a large number of patients in this ward, which shows the importance of good performance and effective communication of nurses to maintain patient safety and provide quality care. Effective communication is one of the pillars of nursing and having communication skills is a professional necessity required for all nurses especially those who work in the emergency wards to provide safe and quality care. Nurses’ competent performances in the emergency wards are also affected by their self-efficacy. Thus, this study was conducted to determine the communication s and self-efficacy competency of nurses.
Materials & Methods: This descriptive cross-sectional study was carried out in the emergency wards of hospitals affiliated to Iran University of Medical Sciences in 2020. In this study, 234 nurses were selected through census method and based on the inclusion criteria and were evaluated using Communication Competence and Self-Efficacy Scales. The Communication Competence Scale consisted of 35 questions on a five-point Likert scale, ranging from strongly agree (5) to strongly disagree (1). The overall score of the communication competence scale was 35-175, with the higher scores indicating high communicative competence. The Communication Self-Efficacy Scale consisted of 12 items on a 10- point scale ranging from not at all sure (1) to very clear (10). The overall scores of the communication self-efficacy scale were 12-120, with high values indicating higher communication self-efficacy. Data were analyzed using independent t-test, one-way ANOVA, Pearson's correlation-coefficient, and linear regression in SPSS version 16.
Results: In total, 234 nurses working in emergency departments participated in this study. The response rate of the participants was 100%. According to the results, the mean score of the nurses’ communication competency was 141.03 ± 15.09, which was higher than the average value (108). The highest average communication competencies related to "let others know that you understand them", "listen to what people say" and "support others" were 4.15 ± 0.70, 4.15 ± 57, and 4.15 ± 0.68. The lowest mean belonged to the item "you do not pay attention to meeting and talking with strangers" (2.32 ± 1.28). The mean score of emergency nurses’ communication self-efficacy was 86.24 ± 22.00 that was slightly higher than the average point (66). The highest average communication self-efficacy was related to "Have appropriate nonverbal behaviors (such as eye contact, facial expressions, and gestures) during conversation (7.84 ± 2.15). And the lowest average belonged to the item "Have a plan prepared in advance to talk to the patients. Based on the results of the regression model, 11% of communication competency among emergency nurses were explained by working hours per week (P=0.001), hospital type (P<0.001) and education level (P=0.023), and working hours per week with the standard coefficient of -0.249 had the most effect on nurses’ communication competencies. Based on the mean and standard deviation, the nurses' communication self-efficacy score was 86.24 ± 22.00, which was higher than the average (66). Also, only 12 percent of nurses’ communication self-efficacy was explained by independent variables (demographic variables) (P<0.001). There was a direct linear relationship between the variables of age (P=0.035) and nursing experience (P=0.043) with nurses' communication self-efficacy and there was a statistically significant inverse relationship with working hours per week (P<0.001). Only working hours per week (P<0.001) was significant in the regression model (standard coefficient=-0.37).
Conclusion: Although the levels of communication competencies and communication self-efficacies of the nurses in the emergency wards were approximately high, due to their activity and their role in the front line of the organization, higher levels of communication competency and self-efficacy are expected. Effective communication of health workers, especially nurses, is essential in improving the quality of care and maintaining patient safety. Due to their role, nurses should have extensive communication with patients and other health workers, so communication competence is an important principle in providing nursing care. Owing to the structure of the emergency department and the patients visiting this department, it is useful and necessary to find the cause and determine the appropriate solutions to increase the communication competency and self-efficacy of emergency nurses to the highest possible level and thus improve quality and safe care. According to the results of the present study, communication competence decreases by increasing working hours, which can be the result of fatigue and high work pressure after spending long hours in the stressful emergency department. The presence of patients in need of immediate and acute care increases fatigue, thereby leading to the low efficiency of nursing services and endangers the safety of patients. It is necessary to plan for employing experienced nurses as well as those with higher and specialized education in the emergency department. However, it will not diminish the importance of increasing the workforce in the emergency departments and reducing the workload of nurses in order to improve the quality of services and improve patient safety. Communication self-efficacy of nurses working in the emergency department was relatively high in this study. The highest communication self-efficacy of the studied nurses was related to having appropriate non-verbal behaviors during the conversation and the lowest communication self-efficacy of the nurses was related to planning to talk to the patients. Self-efficacy is considered an important indicator of a person's confidence in performance, including job performance. A strong sense of self-efficacy increases nurses' confidence in their performance and knowledge. Nurses who are confident in their abilities in all areas, including effective communication, define their goals and are committed to maintaining them.