International Journal of Africa Nursing Sciences 14 (2021) 100310

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International Journal of Africa Nursing Sciences

journal homepage: www.elsevier.com/locate/ijans

Nurses’ communication skills and determinant factors in Amhara Region

Referral Hospitals, Northwest Ethiopia, 2019
Kassahun Gebeyehu Yazew a, *, Mignote Hailu Gebrie b, Zewdu Bishaw Aynalem c
a
Department of Medical Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
b
Department of Surgical Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
c
Department of Nursing, Bahir Dar Health Science College, Bahir Dar, Ethiopia

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Nurses are critical in the delivery of essential health services and are core in strengthening the health
Communication skills system. Therefore, the aim of this article was to assess the prevalence of the nurses’ communication skills and
Nurses determinant factors in Amhara Region Referral Hospitals, Ethiopia, 2019.
Patients
Methods: An institution-based cross-sectional study was conducted from March 18 to April 16, 2019 in Amhara
Ethiopia
Region Referral Hospitals. A simple random sampling technique was used to select 678participants. Data were
collected using pretested and self-administered questionnaires. The collected data were entered into Epi Info
version 7.1.2.0 and exported to SPSS version 25.0 for analysis. Primarily, bivariate analysis was used and var­
iables with p-values ≤ 0.2 were further examined using a multivariable logistic regression model to control for
confounders. Then, variables with p-values <0.05 with 95% CIs were used to determine associated factors.
Results: Out of 678 study participants, 403 (61.4%) of them had effective communication skills with 96.76% of
the response rate. <5 years of working experience [AOR = 2.77; 95% CI: (1.28, 5.99)], workload [AOR = 1.52;
95% CI: (1.09, 2.12)], and poor evidence-based utilization [AOR = 2.00; 95% CI: (1.40, 2.85)] were associated
with the nurse’s ineffective communication skill to patients.
Conclusions: More than half (61.4%) of the participants had effective communication skills. Year of working
experience, workload, and poor evidence-based utilization were the main contributing factors of communication
skills.

1. Introduction Rahnavard, 2011). The desirable outcome of a verbal interaction process

is effective communication, where the receiver understands the sender’s
The delivery of essential health services and solidification of the message as it was intended (Lunenburg, 2010).
health system are the main roles of nurses (WHO, 2016). Communica­ The nature of the interpersonal relationships between nurses and
tion skills are an important element in nursing care. Nurses have paid patients, as well as its effect on patient care, is critical in health care
much consideration to communication and interaction in nursing since service delivery to ensure that the patients’ expectations are met or
the 19th century at the time of Florence Nightingale (Fleischer, Berg, exceeded (Kourkouta & Papathanasiou, 2014). Healthy communication
Zimmermann, Wüste, & Behrens, 2009). Appropriate communication is between providers and patients may predispose patients to release
one of the patient’s critical needs and the basis for nursing care relevant information and to obey to prescribed treatment (Doyle, Len­
(Aghabarari, Mohammadi, & Varvani, 2009), and effective communi­ nox, & Bell, 2013). In the health care setting, effective communication
cation is again the most important factor in maintaining the quality of assures a healthier psychological position by managing the disease,
nursing care (Mullan & Kothe, 2010). It plays the most important role controlling the pain, recalling the history of the disease and improving
between nurses and clients (Itri, Yacob, & Mithqal, 2017). the satisfaction of the clients (Marhamati, Amini, Mousavinezhad, &
Ineffective communication is usually a potential barrier to providing Nabeiei, 2016). A health professional must therefore continuously try to
services in caring settings (Fakhr-Movahedi, Salsali, Negarandeh, & advance his/her communication skills, as ineffective messages can be

Abbreviations: AOR, adjusted odds ratio; COR, crude odds ratio; CI, confidence interval; EBP, evidence-based practice; SD, standard deviation.
* Corresponding author.
E-mail address: [email protected] (K. Gebeyehu Yazew).

https://doi.org/10.1016/j.ijans.2021.100310
Received 11 February 2020; Received in revised form 11 November 2020; Accepted 11 April 2021
Available online 16 April 2021
2214-1391/© 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
K. Gebeyehu Yazew et al. International Journal of Africa Nursing Sciences 14 (2021) 100310

challenging and lead to confusion. Therefore, to tackle those problems, 2.1.3. Sample size determination and sampling technique
nurses are confronted daily with excessive duties due to high patient The sample size was determined by using a single population pro­
numbers and the nature of the health care environment (MacPhee, portion formula with the assumption of nurses’ level of communication
Dahinten, & Havaei, 2017). Thus, this might lead to abortion of 65.5% (Wune et al., 2020) proportion, Z = standard normal distribution
communication during care giving. value at 95% confidence level of Za/2 = 1.96, and 5% margin of error for
From Canada, patients were dissatisfied due to nurses and ineffective the first objective. This gave 347.1 plus 35 non-response rates equal to
communication (Norouzinia, Aghabarari, Shiri, Karimi, & Samami, 382. The sample size for the second objective was determined by using
2016). the double population proportion formula for a cross-sectional study by
Care receivers with communication challenges were more likely to considering the following assumptions, taking two significant factors
manifest medical or clinical complications related to other receivers from the previous studies (Wune et al., 2020) (Table 1).
(Bartlett, Blais, Tamblyn, Clermont, & MacGibbon, 2008). Therefore, the largest sample size with power calculation was 678,
The communication problems among the general population were which is higher than the sample size calculated for the first objective in
5–10%, whereas over 15% were in hospital admissions (Downey & the above. Thus, the minimum adequate sample size for this study was
Happ, 2013; Ruiters, 2017). In a different study, the prevalence of 678.
nurses’ communication skills was 14.3% in Iran (Rostami, Mirzaei, & Of the 1465 nurses working in the Amhara Regional Referral Hos­
Golchin, 2012), 94.7% in Tabriz (Mogadasian, Firoziyan, Nikanafar, pitals, Northwest Ethiopia, 678 were recruited for the study at the time
Rahmani, & Abdolahzadeh, 2013), 41.3% in Greece (Peleki et al., 2015), of data collection. Study participants were included using a simple
75% in Korea (Park & Song, 2005), and 34.5% in Ethiopia (Wune, random sampling procedure.
Ayalew, Hailu, & Gebretensaye, 2020). Accordingly, poor quality of care
is prevalent due to such ineffective communication skills. Therefore, in 2.1.4. Data collection instrument and procedures
the United Kingdom, researchers have tried to improve communication Data were collected by five trained Bachelor of Science degree in
skills with inter professional team learning to maintain patient safety nursing who are facilitated the process of filling pretested self-
(Edwards & Siassakos, 2012). administered questionnaires and supervised by principal investigator
Several factors that influence communication skills between nurses and three Masters of Science degree in nursing. The data collection in­
and patients have been examined, such as job experience, environmental strument had different components: socio-demographic characteristics,
barriers, gender differences, work crowdedness, work load, insufficient working environment attributes and nurses’ communication skills dur­
time and evidence-based practice utilization (Aghabarari et al., 2009; ing patient care using a checklist that was adopted from prior similar
Aghamolaei & Hasani, 2011; Albagawi & Jones, 2017; Alotaibi, 2018; studies (Ayman et al., 2014; Wune et al., 2020). The validity of the tool
Mascherek & Schwappach, 2017; Van Kleef, 2012). on the nurses’ communication skills proved by previous study (Wune
A systematic review explained that nurses’ communication skills et al., 2020) and the tool was given to two experts for critiquing that
were negatively influenced by their excessive work during activities contained sixteen questions and each item had a 5-point Likert scale (1
(Andriyanto, 2019). = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree and 5 =
A cross-sectional study from Iran explained that a disorganized strongly agree) with a minimum score of 16 and a maximum score of 80.
environment was significantly associated with communication skills But, for the sake of contextualization, the reliability of the tool was
(Norouzinia et al., 2016). checked via Cronbach’s alpha. Using the data obtained from the pretest
Regardless of the strong emphasis on training and improving the the Cronbach’s alpha value was found to be reliable (0.95) on nurses’
nurses’ communication skills, there are still noticeable lacks, and communication skills with the patient.
therefore, effective communication is restricted by a number of orga­
nized factors (Fleischer et al., 2009). 3. Data quality control
To enhance health care and decrease patients’ dissatisfaction, the
factors that affect communication between nurses and patients must be The pre-test was conducted among 5% of participants at Debretabor
recognized and taken into account; also, response to all communication general Hospital before the scheduled data collection day. Data quality
needs of patients should be provided (Rodin et al., 2009). Therefore, this was checked at the time of the questionnaire filling during the pretest by
study aimed to assess the nurses’ communication skills and determinant examining the consistency of data. Two days of training had been given
factors at Amhara Region Referral Hospitals, Northwest Ethiopia, 2019. for the data collectors/facilitators who are working from Health centers
and district Hospital. The principal investigator and three Masters of
2. Main text Science in nursing closely supervised the performance of the data col­
lectors/facilitators daily. Collected data were checked for completeness
2.1. Materials and Methods and consistency.

2.1.1. Study design and setting 3.1. Operational definition

Institution-based cross-sectional study design was employed among
nurses’ working in Amhara Regional state Referral Hospitals, Ethiopia. Nurses’ Communication skills: in this study participants who
This region has five Referral Hospitals: Debre Birhan, Debre Markos, scored ≥ the median of nurses’ communication skill questions were
Felege Hiwot, Gondar University comprehensive and specialized considered had effective nurses’ communication skills and below the
Referral, and Dessie Referral Hospitals. Each of them serves 3.5–7 median was considered ineffective communication skills (Ayman et al.,
million people (Health, 2010). 2014).
Ever-married: is the merged name for married, divorced, and wid­
2.1.2. Source and study population owed nurses during data analysis time.
All nurses who were working in Amhara Region Referral Hospitals Workload: in this study participants who work >39 h per week were
and at list who had 6 months of working experience during the data considered as having “workload” otherwise “no workload” (Beshir,
collection period were included. Nurses who were on maternity or Woreta, & Kebede, 2017).
annual leave or those who were seriously ill during the data collection
period were excluded. 3.2. Data processing and analysis

The collected data were cleaned, checked for completeness,

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K. Gebeyehu Yazew et al. International Journal of Africa Nursing Sciences 14 (2021) 100310

Table 1
Sample size determination by determinant factors of nurses’ communication skills in Amhara Region Referral Hospitals, Northwest Ethiopia, 2019.
No Associated (Aghamolaei & Hasani, 2011; Alotaibi, Non- Exposed Confidence Power Odds Sample 10% non– Finalsample
2018; Aghabarari et al., 2009; Albagawi and Jones, exposed (p2) level (%) (%) ratio size response size
2017) factors (p1)

1. Lack of interest to work 44.2 55.8 95 80 1.59 616 62 678

2. Work load 29.9 70.1 95 80 5.50 622 56 62

categorized, coded, and entered into Epi Info version 7.2.1.0 software. nurse ratio was 8.79 ± 2.50, and more than half (56.4%) of them had a
Then, it was exported to Statistical Package for the Social Sciences ≥ 7 patient-to-nurse ratio. Out of the 656 participants, 358 (54.6%) and
(SPSS) version 25.0 for analysis. Bivariate analysis was performed to see 298 (45.4%) had good and poor evidence-based practice utilization
the association of each independent variable with the outcome variable respectively, with a mean and SD of 16.62 ± 6.04. The majority of the
at P ≤ 0.2. The AOR with 95% CI was calculated to determine the as­ participants 511 (77.9%) took training or courses on communication
sociation at P < 0.05 and considered statistically significant. Finally, the skills. Of the respondents, 357 (54.3%) had workloads, whereas 400
data are presented in tables and texts. (61%) lacked time to communicate effectively during their activities.

4. Ethical considerations 5.3. Prevalence of nurses’ communication skills

Ethical clearance was obtained from School of Nursing ethical review The prevalence of nurses’ communication skills among participants
committee on behalf of University of Gondar. Before beginning data who had effective communication skills was 38.6%, whereas 61.4%
collection, permission letter was obtained from School of Nursing and were ineffective.
was submitted for each referral hospitals. From each participant a verbal
informed consent was obtained after clearly describing purpose and
5.4. Factors associated with nurses’ communication skills
benefits. Again, study participants were informed of their full right to
skip or ignore any questions or terminate their participation at any
All independent variables were entered in to the bivariate logistic
stage. Confidentiality was maintained by using anonymous
regression model, and seven variables, including age, job/working
questionnaires.
experience, presence of enough time, training on communication,
workload, utilization of the evidence-based practice, and patient-to-
5. Results nurse ratio with p ≤ 0.2, were entered into the multivariate analysis.
After controlling for possible confounding effects of other covariates, job
5.1. Socio-demographic characteristics experiences, workload, and utilization of the evidence-based practice
had a significant association at the 95% confidence level (Table 3).
A total of 656 nurses participated in this study from 678 sampled
participants with a 96.76% response rate. Out of the total participants,
6. Discussion
22 (3.24%) were non-respondents. The study consisted of 335 (51.1%)
males. The participants’ mean and standard deviation for age were
Effective communication between nurses and patients is one of the
31.22 ± 5.565 years, respectively. Among the study participants, 439
most essential components for raising patient satisfaction, treatment
(66.9%) and 217 (33.1%) were ever-married and single, respectively. Of
compliance and health products (Shukla, Yadav, & Kastury, 2010).
the nurses working in different units, 27.6%, 26.4%, 19.4%, 11.3%,
Hence, this study revealed that the proportion of the nurses’ effective
9.8%, and 5.5% were at Medicine, Surgical, Ambulatory, Pediatric,
communication skill was 61.4% with the 95% CI (57.6%, 65.2%). The
Emergency and critical units, respectively (Table 2).
finding of this study was lower than studies done in Korea 75% (Park &
Song, 2005). In contrast, the current finding was higher than studies
5.2. Organizational and other related factors done in Iran 14.3% (Rostami et al., 2012) and in other part of Ethiopia
34.5% (Wune et al., 2020). The variation might be due to the difference
In this study, the mean and standard deviation (SD) of the patient-to- in study design, data collection tool, and sample size in study
participants.
Table 2 The finding was also identified as different significant factors that
Socio-demographic characteristics of nurses’ working in Amhara Region had an association with nurses’ communication skills. With respect to
Referral Hospitals, Northwest Ethiopia, 2019 (n = 656). year of job experience, less than five years of job experience was
variables Categories Frequency Percentage significantly associated with nurses’ communication skills. Those with
job experience less than five years were 2.77 [AOR = 2.70 (95% CI =
Age 21–30 430 65.5
31–40 157 23.9 1.28, 5.99)] times more likely to be ineffective on communication than
41–50 57 8.7 those who had job experience more than ten years , which was similar to
51–60 12 1.9 the study done in Saudia Arabia (Albagawi & Jones, 2017). The possible
Educational level MSc Nurse 36 5.5 reason for this might be that frequently practicing or communicating
BSc Nurse 559 85.2
Diploma Nurse 61 9.3
with clients for a long period can predispose nurses to perform their
Place of education Government 584 89.0 duties effectively.
completion institutions The other factor that had a significant association with nurses’
Private institutions 72 11.0 communication skills was the workload. In this study, participants with
Jobexperience 319 48.6
<5
workload were approximately 1.52 [AOR = 1.52 (95% CI = 1.09, 2.12)]
5–10 213 32.5
>10 124 18.9 times more likely to have ineffective communication than those who had
Monthly salary <4650 168 25.6 no workload. This study was supported by studies performed in Iran.
4650–5294 168 25.6 Health professionals who had workloads showed ineffective communi­
5294–7111 196 29.9 cation with clients (Anoosheh, Zarkhah, Faghihzadeh, & Vaismoradi,
124 18.9
2009; Kingma, 2007). The possible justification for this high workload
>7111

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K. Gebeyehu Yazew et al. International Journal of Africa Nursing Sciences 14 (2021) 100310

Table 3
Bivariate and multivariate logistic regression output on determinant factors for nurses’ communication skills in Amhara Region Referral Hospitals, Northwest Ethiopia,
2019 (n = 656).
Variables Categories Communication skills AOR (95%CI) COR (95%CI) P-value

Effective Ineffective

Age 21–30 286 144 0.99(0.29, 3.35) 0.34(0.08,1.42) 0.14

31–40 88 69 0.64(0.18, 2.21) 0.45(0.12,1.71) 0.24
41–50 21 36 0.29(0.08, 1.09) 0.31(0.08,1.21) 0.09
51–60 8 4 1 1
Experience <5 224 95 3.06(1.99, 4.69) 2.77(1.28,5.99) 0.01
5–10 125 88 1.84 (1.18, 2.88) 1.58(0.81,3.08) 0.18
>10 54 70 1 1
Lack of time Yes 173 83 0.65(0.47, 0.90) 0.81(0.57,1.15) 0. 23
No 230 170 1
Communi cation training No 303 208 0.67(0.44, 0.97) 0.94(0.61,1.44) 0.77
Yes 100 45 1 1
Work load Yes 157 113 0.79(0.58, 1.09) 1.52(1.09,2.12) 0.01
No 246 140 1 1
EBP utilization Good 150 148 1 1
Poor 253 105 2.38(1.72, 3.28) 2.00(1.40,2.85) 0.00
Patient to nurse ratio ≤6 165 121 1 1 0.13
≥7 238 132 1.32(0.96, 1.81) 0.77(0.55,1.08)

might cause nurses to have a short time to communicate with clients and Appendix A. Supplementary data
cause negative interactions between nurses and clients.
The odds of nurses’ communication skills were approximately 2.00 Supplementary data to this article can be found online at https://doi.
[AOR = 1.90; (95% CI = 1.40, 2.85)] times ineffective among in­ org/10.1016/j.ijans.2021.100310.
dividuals who had poor evidence-based practice (EBP) utilization
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