CNA’s and why soft skills are needed and essential in the CNA training process
Introduction
The need for healthcare and more CNAs is growing continually. This study looks at CNA’s and examines why soft skills are needed and essential in the CNA training process. Certified Nursing Assistants (CNAs) are required to assist patients with their medical needs. McKay (2017) notes that RNs not only treats patients but also provide emotional support and advice to them as well as their families. RNs also educate patients along with the public about medical conditions (McKay, 2017). According to Aiken et al. (2016), a Licensed Practical Nurse (LPN) or Registered Nurse (RN) is responsible for CNA. At no time has was there a high need for healthcare providers and particularly CNAs to provide health services. A CNA needs to have strong soft skills to be effective. In this study, the researcher will look into the roles of the CAN and how to role-play affects their training. As part of this examination, a brief aspect of RNs and how they relate to CNAs discussed.
In the theoretical framework, the Caring Leadership theory explains about soft skills behaviors and work ethics. The framework is important because it provides guidelines that ensure the success of CAN students. Among the skills obtained is the use of body language when communicating to patients. Communication hereby involves both verbal and non-verbal forms. Body language is a non-verbal form of communication that is expressed through gestures, use of personal space, eye contact and body postures. The verbal forms entails speaking to patients directly and the skill here is presentation and negotiation. Professionalism is also a skill that regulate the conduct of nursing students. The skill demands for critical thinking and ethical and sound decision making when attending to patients. How to cope with stress is another skill that enables nursing students to moderate on pressure, anxiety, deadlines, death of a patient or failure. Don't use plagiarised sources.Get your custom essay just from $11/page
Needs and desires of CAN’s are influenced by the skill of motivation whereby informed decision making is met through working with peers and other superiors. The most important skill that also works in other successful health institutions and organizations is team work. The challenge of handling both personal and work issues is figured out in the skill of personal habits. It is also important that the nurses get enriched by cultural awareness by understanding diversity values and attitudes between patients. Above everything in nursing work ethics and problem solving skills are applied when working with superiors, patients and peers as well. The Model was formed after an evaluation of other two leadership theories called the Carting and simply the leadership theory. The combination of the theories focused on how leadership portrays caring which thereafter led to the Caring Leadership Model. The model incorporates competencies that depict the ability to interact with other people in this case the patients and co- health practitioners.
There are many quality traits and skills the model emphasizes on that are beneficial to health facilities and individual nurses as well. Some of the traits include, innovations, creativity and the ability to become invested in successful outcomes. Caring principles blend well with leadership principles because they transform ones thinking into positive thinking that brings out results that are positive. The model is important to healthcare system because nursing is a profession that deals with handling lives of many people and requires a humanitarian level of thinking at times that are always very vulnerable. The model also envisions values and intrinsic motivational aspects that make a working environment healthier. The values envisioned are five according to the model and are regarded essential to any environment and they trigger success. The five values are enlisted as;
- Leading with compassion, equality and kindness.
- Aim to generate faith and hope through co-creation.
- Be creative, innovative and wise.
- Purposely be bound by caring through mutual respect.
- Create an environment of self-care and for others.
Caring and leadership model also emphasizes on transpersonal self and spiritual practices that require one to go beyond their ego, become more aware of themselves and offer kindness and love even to situations or things we love or dislike. As a caring leader it is easy to build up an authentic relationship by being compassionate and minding other peoples dilemma. The aspect of dilemma is a concern within a healthcare set up that requires skills of the Caring and Leadership model. Through the model nurses are able to create an environment that encourages healing at every level either non-physical or physical.
Definition of Soft Skills
In their study, Matteson, Anderson, and Boyden (2016) define soft skills as the capacity to gain knowledge from a knowledge base that is domain-specific and employ this knowledge to carry out a task or perform a function. This definition is well applicable to the nursing profession since it’s essential for them to have the ability to acquire theoretical knowledge and apply it in all practical along with real-life scenarios. The effectiveness of the healthcare services offered CNAs and RNs depends on how they work, so they are required to have soft skills such as efficient communication (Aebersold & Tschannen, 2013).
This study will examine communication, work ethics, and trust and honesty as the vital soft skills needed by CNAs. Apart from these skills, some of the often-neglected abilities are following the hospital’s internal rules like dress code, timings, and other policies (Aubry, Etheridge & Couturier, 2012). Developing these skills creates a productive work environment for the CNAs and other medical staff. It also creates a situation where patients would feel positive about their environment.
The Role of CNAs
The role of CNAs is essential in providing patient care (Robert et al., 2015). CNAs operate in a wide variety of places like hospitals, nursing homes, adult care centers, and personal homes (Aebersold & Tschannen, 2013). CNAs provide an essential contribution to patient care seeing as they support nurses and physicians. They have daily contact with the patients and gather vital information about the condition of patients, which they convey, to their supervisors (Aebersold & Tschannen, 2013). Nursing care would be significantly affected if the nurse assistants were eliminated (Aiken et al., 2014). In many healthcare facilities, there are fewer RNs than CNAs, which adds to the workload of the RNs and leads to more patient and CNA interaction. Certified Nursing Assistants act as an essential group in covering for the large nurse to patient ration. They are, however, not allowed to perform specific medical procedures (Aiken et al., 2016).
The CNAs are important in the whole process of care since they have direct contact with the patients and they are highly efficient in offering their services (Aubrey et al., 2012). The CNAs, unlike the RNs and doctors, have the responsibility to care for the patients along with their personal needs. Foster, Idossa, Mau & Murphy (2016) observe that appropriate guidance of CNAs under experienced senior nurses and doctors can enable the nurse assistants to provide the vital care required to critical patients. Due to the scarcity of the trained RNs, they do not give much attention to every patient.
CNA Job Functions
Certified Nursing Assistants are required to help patients with their various needs. CNAs are responsible for maintaining patients with disabilities to stay comfortably within the healthcare facilities by assisting them to perform their routine activities (Foster et al., 2016). As the RNs provide the patients the medical and treatments needs, the nurse assistants offer the patients both emotional and spiritual support needed (Sulehria, 2015). Nurse assistants are also responsible for the general well being of the patients by ensuring that they have their meals at the appropriate time and assist them with their hygiene as well (Foster et al., 2016). Therefore, the CNAs are an integral part of the nursing since they offer patients the opportunity to have a good experience in their hospital beds.
CNA Responsibilities
A study of missed care by Maloney, Fenci, and Hardin (2015) discusses missed care from nurses as a result of various reasons and its effects on patient outcomes as well as the quality of care. Sulehria (2015) in his article Untrained Healthcare Assistants throws light on how untrained hospital support workers have been left in a general word with 30 to 40 patients and are frequently asked to perform roles of nurses. Nursing assistants are an essential part of patient healthcare and support in hospitals and long-term care centers (Sulehria, 2015). CNAs are under increased scrutiny, along with other medical professions, to provide safe and effective care (Porter & Lee 2013). The nursing education programs gave also undergone considerable changes to produce more efficient nursing staff. Any deficiency in skills can sometimes lead unfavorable result in unfavorable outcomes for the patient as well as the healthcare facility. In his article, Adams (2015) indicates how unqualified nurses affect the patient care in many hospitals and is a threat to the patient lives.
American Association of College of Nursing points out that there is an increase in the percentage of RNs in acute care hospitals and a decrease in the recruitment of associate degree nurses or CNAs (Porter & Lee, 2013). Employers are now recognizing that education in the nursing industry makes a tremendous impact in-patient care and hence, they are hiring the most-educated nurses at the entry-level. Nurses with a baccalaureate degree are now strongly preferred by more than 79% of employers (Porter & Lee, 2013). Semi-skilled or unskilled RNs can hurt patient care since they can assist doctors and surgeons poorly (Porter & Lee, 2013). A lot of published studies and researchers mention a variety of assessment scales or a tool to measure the knowledge of nurses which indicates the efficiency of their nursing of the nursing staff to the hospitals and adult care homes (Aiken, 2014).
Karacsony et al. (2015) in their literature review uses the Palliative Care quiz for Nurses (PCQN), which was formulated by nursing students who were undergraduates to test their knowledge and stimulate discussions. Specifically, the PCQN established palliative care nursing misconceptions, to assess the skills, education, and attitudes of nurses towards palliative care. These instruments have been used in measuring abilities as well as knowledge of nurses, which in turn helps in assessing the current nursing staff and aids in recruiting prospective qualified nurses (Karacsony et al., 2015). Blegen et al. (2013) established that hospitals having a higher percentage of RNs with baccalaureate or higher degrees had decubitus ulcers, lower congestive heart failure mortality, shorter length of stay and postoperative deep vein thrombosis or pulmonary embolism, and failure to rescue. In their cross-sectional study association with mortality Aiken, Sloane and Griffiths (2013) indicated that the using lower-skilled nursing assistants in place of registered nurses raise patient death’s risk. This study is in support of the need for the enhancement of CNAs’ training with the aim of ensuring that the nursing assistants acquire relevant skills to offer competent services.
Even with the passage of Nurses Registration in 1919, only a small percentage of nurses registered with the General Nursing Council. Illustrated by the statistics indicating that in 2015, there were 23 066 GP practice nurses providing care within the NHS, 25 418 midwives, and 3, 14,966 qualified nursing staff and health visitors (“NHS Confederation,” 2016). A conclusion drawn from various literature reviews that unskilled, semi-skilled nurses or lack of certification among nurses are not a favorable situation for hospitals and long-term care organizations (Aiken, 2014). With the technological advancement in the medical field, it is imperative for all the medical staff including doctors, surgeons, nurses, and pharmacists CNAs to have all the required theoretical knowledge, certifications, practical and soft skills training (Bach & Grant, 2009). These set of skills are also affected by the way hospital operates as well as the weight given to the regular training of the CNAs. Similar to other professionals, CNAs and RNs also have to be trained from time to time on emerging trends, innovations in medicine and technology associated with medical instruments (Porter & Lee, 2013).
CNA/Patient Relationship
Kourkouta and Papathanasiou (2014) opine that the nurse who is intent on creating the most effective relationship with the patient must make a good first impression with the patient. This is possible if the conversation is held appropriately, such that, courtesy and kindness emphasized as part of the CNA requirements (Fakhr-Movahedi, Negarandeh & Salsali, 2012). There are various instances, which are beyond a CNA’s control when the conditions are not most favorable. These include patient workload, long work hours, and emergency cases. These challenges notwithstanding, communication skill is the most critical aspect of a CNAs control. Communications skills, along with technical skill training, are of utmost importance for the nursing profession. They are required to communicate with patients, other nursing staff, and doctors effectively to provide better care and services (Matteson et al., 2016).
Soft Skills
Communication
Effective communication constitutes a significant part of patient care given that it enables the CNA to be more sympathetic, enhances the relationship between CNAs and patient and has an intense effect on the treatment outcomes and perceptions of the patient’s on health care quality (Tay, Ang & Hegney, 2012). A CNA needs to separately learn communication and interpersonal to be useful in the nursing practice and raise the ladder. Successful contact can also have a significant impact on a patient’s treatment outcome and long-term care (Kourkouta & Papathanasiou, 2014). Communication skills involve the way CNAs communication with their superiors (RNs in most of the cases), with their juniors (newly recruited trainee nurses) and with doctors. It’s unfavorable and unethical for a patient to suffer as a result of lack of communication or ineffective communication among nurses and doctors or between the healthcare providers and the patients (Aiken, 2014). In the ICU, contact with patients along with families can be approached successfully in an interdisciplinary way. Role-play is found to be an effective method to foster these skills among nursing students across the globe.
Interpersonal conflicts can ruin the relationship between CNAs and patients. Providing the appropriate communication tools to CNA’s, allows communicating with patients and families can be beneficial. Empowerment and support can aid CNAs better handle patient concerns and problem as well as provide accurate and timely information about their health (Norouzinia, Aghabarari, Shiri, Karimi, & Samami, 2016). A two -way communication with the patient along with their relatives or custodians is of great importance in therapeutic practice. As a healthcare science, nursing concentrate on serving human needs both as a bio-psychosocial as well as spiritual being. The nursing profession requires scientific knowledge as well as skills such as technical abilities, intellectual capabilities and interpersonal relations (Kourkouta & Papathanasiou, 2014). Acquiring useful communication skills requires proper education and experience. Communication involves an exchange of relevant information with the right recipient and conveying thoughts and feeling in a manner that is gained by anyone (Kourkouta & Papathanasiou, 2014). The results of a study conducted by Khodadadi et al. (2013) shows that by providing training in communication skills, the quality of nursing care improved. As a result, the study recommends that communication skills taught as a separate course in nursing education are more effective.
Work Ethics
Work ethics is another essential soft skill essential for CNAs and medical staff. In their research, Ramos et al. (2013) describe ethics, and bioethics as discourses that manifest productivity in the healthcare setting by impacting on medical work and training in multi-directional and varied ways as well as by participating in the different definition of boundaries, responsibilities and roles of professional performance. CNAs are required to have honesty and integrity while working with the patient. This involves not lying to the patient about something important, taking care of work even during long hours, and emergency situations. Above all, being faithful to the profession is essential (Ramos et al., 2013). The Council of South African Nursing states that it’s a requirement for nurses to do well and opt for the best alternative of care under given circumstances in addition to always acting with kindness (Ramos et al., 2013).
Honesty and trust
Honesty and trust between the patient and healthcare providers are critical if patient care is to be effective (Murray & McCrone, 2015). Mostly, the patient has to trust the CNA to convey all the pertinent information on their medical condition, medical history, any reservations with regards to the treatments, and other relevant details transparently so that the CNA can efficiently comprehend it and take appropriate actions. Ferguson et al. (2013) point out that a critical concern in nursing education is honesty, trusts, and respect in the professional setting. More specifically, Rutherford (2014) observes that the soft skill “Trust” should be taught by nursing educators as they prepare up and coming CNA students. Using role-play as a teaching tool can open the door to numerous “Trust” situations.
Patient’s hospital experiences enabled with positive trust experiences between CNAs and patients, (Rutherford, 2014). According to Kourkouta and Papathanasiou (2014), inefficient communication among CNAs, RNs, and doctors can hurt building trust. CNAs have to be honest with patients to create the trust (Kleebaur, 2014). Trust and honesty rely on each other. According to Rutherford, belief shapes the way patients perceive their healthcare. As a result of the potential impact, trust and honesty could have on patient care; the Midwifery and Nursing Council changed the nursing code to include honesty (Kleebaur, 2014).
A Unique Population
For CNAs, the nursing profession created a premise for helping those in need at all times (Park, Kjervik, Crandell & Oermann, 2012). Sometimes, during emergencies, it boils down to a CNA’s ethics and integrity to give treatment to those in need. In their study, Park et al. (2012) observed that training in work ethics has intensified to help nurses improve their work ethics and hence assisting patients in their recovery journey. Discrimination, racial, cultural, and economic or gender is also a dissuading factor when it comes to work ethics (Aubry et al., 2012). CNAs should not discriminate against the patients based on their background and should not hold back any treatment due to this reason.
CNA Education
The American Association of Colleges of Nursing (2014), new AACN data on BSN-prepared hiring reports that there is a mortality of about 30% in hospitals where 60 % of nurses cared for six patients on average and had bachelor’s degrees (Aubry et al., 2012). This is lower mortality compared to hospitals where 30% of nurses cared for eight patients on average and had bachelor’s degrees (Aubry et al., 2012). Some recent researches prove that baccalaureate and graduate degree levels nurses have helped bring down mortality rates, medication errors and have indicated positive outcomes (Tay, Ang & Hegney, 2011). ACCN suggests that education strongly influences nurse’s ability to practice and that the most educated nursing personnel possible is what patients deserve (American Association of College of Nursing, 2015). This connection between lower mortality rates and baccalaureate education will interact with a growing body of research (American Association of College of Nursing, 2015).
As per the findings by Aiken (2014), an increase in a nurses’ workload by one patient raised the possibility of an inpatient’s death within 30 days following admission by 7 percent and every 1 % increase in nurses with bachelor’s degree was linked to a decline in this possibility by 7%. The qualifications of nursing staff are considerably related to patient outcomes, and at least baccalaureate level nurses have proved to be more effective in caring for patients with cancer (Porter & Lee, 2013).
Karacsony et al. (2015), in their literature review, used the Palliative Care quiz for Nurses (PCQN). The PCQN was developed by qualified RNs along with undergraduate nursing students to test knowledge, stimulate discussions and identify palliative care nursing misconceptions, to assess the skills, education, and attitudes on nurses towards palliative care (Karacsony et al., 2015). These instruments have been successful in measuring the skills and expertise of nurses, which in turn helps in assessing the current CNA staff and helps in hiring qualified CNAs in future.
Skill Deficit
The rise in mortality rates among hospitalized patients across the country increases the concerns about proficiency among the medical staff (Aubry et al., 2012). Nursing determines the overall efficiency of any hospital or medical organization and thus a critical factor. In most of the cases, a CNA provides initial or emergency care to the patient that could prove to be most effective in the overall treatment of the patient (Porter & Lee, 2013). In situations like natural disaster and crises, CNAs can play a role of an RN or doctor to provide critical care to the patients since there is often a shortage of medical staff as well as medical equipment during such instances. A CNA can also provide human touch and sympathy to patients, which has been found to have a positive effect on the patients’ ailments (Aiken, 2014).
The quality of care given by CNAs to a patient is a primarily influenced by the knowledge and experience of the CNA along with soft skills such as the ability to handle pressure, work long hours and deal with severe patients (Porter & Lee, 2013). The power of active listening and taking notes required in ensuring that CNAs take down all the necessary information about a patient condition and convey it to all levels, wherever and whenever needed.
Impact of Role Play
Role-playing techniques in the problem-based learning have, for a long time, been created (Bach & Grant, 2009). There are tremendous changes made in the CNA training programs as well as the trainers responsible for preparing them, and the focus is now shifting to the training process as well (Bach & Grant, 2009). Bach & Grant (2009) point out that establishing a more evolving, competent and equipped workforce, through education has focused on the need to improve nurses, and CNA on a personal level and interventions have thus created.
One of the most effective components of these interventions is the use of role-playing to help improve the personal standards and qualities of CNA students. Woodhouse (2014) defines role-play as a type of communication involves simulation rather than reality, and this simulation involves people interacting with one another. Role-Play has been adapted into the education curriculum for nursing with the aim of trying to give CNA students the kind of first-hand experience that could gain from practice (Aiken, 2014).
Role-Play As A Training Strategy
Role-play as a training strategy has proven to be one of the most affecting learning techniques for nursing staff. Role-playing prepares students to deal with real clinical conditions that need the intervention of psychiatric nursing more efficiently, competently and empathetically (Dawood, 2013). With the advancement of medical science as a field, there has been a paradigm shift in learning-centered instruction (Kamerer, Brophy & Corvino, 2011). The guidelines have shifted from teacher-centered to learner-centered. Many medical universities are adapting to the needs of dynamically changing and demanding expectations from medical staff, especially the nursing staff. Educational psychologists suggest that to have sufficient and long-lasting learning, the involvement of the student in the teaching process is essential (Kamerer et al., 2011).
At the stage when the nursing students have gained most of the theoretical knowledge, they are ready to apply that knowledge to practical situations (Aiken, 2014). This is the stage when they require to be provided with capacities to face circumstances requiring interactions and communication with patients and other CNAs as well as doctors (Kamerer et al., 2011). They are needed to deal with situations where managing human relationships and decision-making are of utmost significance. Through role-playing, students go through a new and vital experience which helps them recognize the importance of theoretical knowledge, which they have learned in their educational institution, and the necessity of effective communication, human interaction, empathy and sympathy (Aiken, 2014). Role-playing gives them an opportunity to improve their skills and work on their weaknesses and further enhance their secure areas.
Kamerer et al. (2011) observe that the best way to prepare students for a simulation session is through the development of simulation learning interactive modules (SLIMs). The teacher plays the role of a link between the students and critical learning information in a role-play scenario (Aiken, 2014). Giving feedback is crucial as it shows the strengths and weaknesses of each student and where they need to focus more on becoming successful CNAs (Kamerer et al., 2011). Interdisciplinary cases benefit from role-playing as they allow students to gain knowledge about various disciplines and departments within a medical institution or hospital, thereby broadening their horizon in the field of healthcare. Role-play has some benefits that include enabling the student to be more creative, sharpening perspective and helping the students gain confidence, reducing anxiety and assisting students to understand group dynamics (Kamerer et al., 2011).
Role-playing created in such a way that it analyzes the behavior of patients and nurses on the job thus providing solutions to medical and interpersonal problems and developing empathy towards the patients (Aiken, 2014). It also provides the CNA with an opportunity to practice since they can communicate with patients, discover their emotions, observe various behaviors along the way, and apply their theoretical learning on similar situations (Kamerer et al., 2011). The successes of role-playing largely depend on the quality of a job created its practice and most importantly, its post-completion analysis. Chan (2012) considered role-playing as an active learning strategy that facilitates independent learning and is hoped to be employed by nursing teachers.
Role-play mostly develops empathy, along with other on the job skills, in the nursing staff by stimulating emotions and behavior (Aiken, 2014). Some of the behavioral outcomes of role-playing include facing reality, learning from others, self-assessment, overcoming the fear of participation, coping up with anxiety, gaining self-confidence and clinical practice (Babatsiko & Gerogianni, 2012). Innovative ideas and new strategies are encouraged to provide learning needs and meet the demands of constantly changing and developing healthcare system (Chan, 2012). Nursing education can maintain this dynamic nature by moving towards innovation and modern methods of teaching and learning (Aiken, 2014). Students also need to be provided with specific abilities that facilitate better human relationships which are highly significant. In addition to gaining knowledge pertinent to their field of study, role-play helps develop communication abilities, collaboration, empathy and ethics of care (Babatsiko & Gerogianni, 2012). In her article on Role-playing in Problem Based learning class, Chan (2012) observes that nursing education has widely adopted problem-based learning, with a variety of positive impact on student’s learning including critical thinking, problem-solving skills, teamwork, and motivated knowledge. Role-play has been a successful learning strategy which involves an experimental and active feature that enhances student’s autonomy in their medical training. Many similar studies have been done to compare the impacts of traditional study methods versus role-playing on nursing students (Chan, 2012).
Unlike traditional training methods which have followed since time immemorial, innovative training strategies like simulation and role-play help the students gain practical knowledge and skills which are needed in this profession once they join a medical institution as a CNA (Aiken, 2014). Correct use of role-playing as a training strategy can increase student interest in the class, improve the involvement of students in activities and give them an opportunity to showcase their abilities (Dawood, 2013).
Because of the dynamic nature of the healthcare profession, it’s a requirement that teaching plans used by teachers should be up to date (Pourghaznein, Sabeghi & Shariatinejad, 2015). Role-play is considered by Babatsiko and Gerogianni (2012) as the vast and one that emphasized some interpersonal social aspects which have been an essential part of the success of the healthcare system over the years, and it has also been responsible for the development of some character traits like trust and self-disclosure. A learning method that is problem-based for the combination of practice and theory in the classroom and clinical background is a suitable approach to tackle these issues. Both aspects are essential in the creation of a relationship between the patient and the nurses or any other healthcare service provider (Dawood, 2013). They also help to create a relationship based on the information that is shared between the patient and the healthcare practitioners as well as create confidentiality. Other aspects of role-playing include giving truthful information to the patients along with relatives and solving conflicts, which heavily relies on effective communication (Aiken, 2014). Role-play teaching has been found to make the learning experience more grounded in reality and increase the efficacy (Bhattacharjee, 2014).
Dawood (2013) observes that role-play may be a useful teaching method in psychiatric nursing if was adequately formulated and structured based on meeting the objectives of the course. Role-play involves a schematic approach where observers observe, analyze and interpret the actions of participants (Dawood, 2013). These observers can be the teachers, experts in healthcare domain or experienced CNAs. This method stimulates CNAs’ thinking and problem-solving ability and lets them show a presence of mind in emergency situations, which is one of the most important skills for CNAs (Dawood, 2013). The participants are given instant feedback so that they can improve their performance and learn from their mistakes. Students have a chance to express their thoughts and concerns, making it a two-way communication which boosts their confidence they build their communication skills. In their study on reflective thinking, Hanya, Yonei, Kurono, and Kamei (2014) describe the effectiveness of video-based reviews of the role-play activity and creation of transcripts of the videos to show how each step in the process affects students’ awareness of their communication skills.
Why Role Play Is important
Active and active learning achieved through the use of appropriate strategies (Gillespie, Brown, Grubb, Shay, & Montoya, 2015; Alluri, Tsing, Lee, & Napolitano, 2016). Role-playing which is incorporated to teach many clinical and theoretical nursing courses as well as courses in the medical discipline (Gillespie, Brown, Grubb, Shay, & Montoya, 2015; Alluri, Tsing, Lee, & Napolitano, 2016). Role-playing subdivided into four categories which include; instructor preparing and explaining the activity, students preparing for the event, carrying out the role-plays, and debriefing following the completion of the operation. According to an empirical study conducted by Vizeshfar, Dehghanrad, Magharei, & Sobhani (2016), role-playing as a collaborating approach enhances the learning of students more than the lecture approach, and their findings showed that students significantly scored more in role-playing method than in lecture method. Using role-play approach in courses from problem-solving amplifies student’s innovation and enhances critical thinking (Chan, 2012).
Understanding is a skill CNAs have to use to develop excellent listening skills to identify with patients’ problems and situations (Rao & Stupans, 2012). Understanding the patients’ condition is important as it gives the nurse a clear idea of what kind of help that patient requires and the nurse can decide if any preliminary treatment is to be given (Aiken, 2014). Understanding also helps CNAs convey information on the patient’s the condition to the doctor and other medical staff handling that patient. This leads to a better CNA-patient relationship.
Role-play activities can be customized and designed according to the department that the CNAs will be working. For example, nurses working in the psychiatric department require unique communication skills, interviewing skills, listening skills, assessment and intervention skills (Dawood, 2013). Psychiatric nurses also need to sympathize with their patients. Putting themselves in the patients’ shoes and assessing the situation from their perspective can achieve this.
Role-Playing In Critical Thinking
Critical thinking involves becoming a better thinker when it comes to all-important aspects of life. Development of critical thinking holds prime importance in professional education since it enhances the capabilities of nursing students (Hubbard, 2014). The teaching method of problem-based learning was first developed in 1969 by McMaster University in Canada with the aim of improving motivation for student’s education and enabling them to act as peer teachers and decide their learning objective (Chan, 2013). Apart from getting trained in nursing curriculum and getting hands-on practice in real situations, soft skills such as critical thinking also play an essential role in the overall skill development of a CNA. Dawood opines that role-playing is recognized as a valid instructional strategy in nursing education which improves critical thinking capacity of students, enhances communication skills and prepares nursing students to put nursing skills into practice.
Manzoor, Mukhtar, and Hashmi (2012) found out from their research that 37.5 percent of their subjects supported the incorporation of role-plays in both primary and clinical topics, 7.8 percent supported the integration of role plays into primary education, and 54.7% endorsed the inclusion of role-plays into clinical subjects. These numbers indicate that the students who are involved in role play activities have welcomed this approach and have benefitted from it to a great extent (Manzoor, Mukhtar & Hashmi, 2012). Students are thus open to the idea of incorporating this technique into their curriculum as they feel it gives them the practical exposure they need when they start working in that environment.
A role-play scenario is intended to mirror the relations between a patient and a care provider to put into practice the predictable therapeutic result (Babatsiko & Gerogianni, 2012). Gaining soft skills through role-playing prepares a CNA for situations where they need to apply their critical thinking and presence of mind rather than medical knowledge. During a role-play, patients also play an essential part where self-disclosure allows patients to trust nurses (Manzoor et al., 2012). A CNA has to respect the patient irrespective of their background or medical condition and also needs to recognize the emotions of the patient’s family members. Nurses have to be cautious with their words and behavior to avoid any interpersonal conflicts with the patients and their family members (Manzoor et al., 2012).
Role-play falls under the category of simulation, which also includes full mission simulation. Simulation is a technique, which replaces or amplifies real experiences with experiences guided by instructors. Aebersold and Tschannen (2013) point out that in the past 20 years, simulation has were incorporated into the nursing and other medical education. Some hospitals have also adopted simulation methods as an essential part of their nursing curriculum (Manzoor et al., 2012). Role-play has demonstrated its effectiveness as a method to train CNAs for clinical procedures, communication, critical thinking and soft skill development.
In their study on developing critical thinking skills in undergraduate nursing students, LaMartina and Ward-Smith (2014) mention that the American Association of Colleges of Nursing (AACN) summarizes vital skills for the recently graduated nurse which included professionalism, a working knowledge of health care policy, and scholarship. One critical competency highlighted is the ability to employ critical thinking to solve simple to complex conditions. Riera, Cibanal, and Mora (2010) have assessed nursing students and proved that role-playing is a useful tool that assists us to interpret real situations that students are afraid of and will have to face soon.
Theory Of Role Play
Communication, as well as other soft-skills, tends to constitute a large part of the role-playing technique used in the nursing curriculum (Bach & Grant, 2009). It is a crucial factor in providing high-quality healthcare services, which leads to overall health improvement and patients’ satisfaction. Norouzinia et al. (2016) describe useful communication skills of health professionals as crucial to the provision of successful healthcare and may have positive results such as reduced disease symptoms, pain, guilt, and anxiety. These skills can also increase patient satisfaction, acceptance, and co-operation throughout treatment and for any future healthcare needs (Aiken, 2014). Failure to use or lack of communication skills negatively impacts the services offered to patients. Downey and Hap (2013) describe the problems faced by hospitalized patients in all ages as the collective experience of complex communication needs including mobility, sensory, and cognitive needs as well as language barriers during their stay.
De Meester et al. (2013) have reiterated that the use of SBAR (situation, background, assessment, and recommendation the introduction) has increased the perception of effective communication and collaboration in nurses has increased the knowledge of effective communication and cooperation in nurses. This has also helped in developing the interface of nurses with other physicians assigned to the patients (De Meester et al., 2013). Hospitalization is usually stressful to patients along with their relatives, and if they don’t get proper communication from the nursing staff during their stay, then their visit can become even more unpleasant (Gausvik et al., 2015). These are the outcomes of lack of training in communication and negligence in paying attention to actual contact with the patients (Aiken, 2014). However, slightly different results were found by Norouzinia et al. (2016) in their study where the patients mostly emphasize the impact of gender differences on communication, and in reality, nurses are less affected by patients’ gender while performing their professional duties.
Basic knowledge of how to communicate and create relationships for the benefit of favorable healthcare outcomes provided in the role-playing approach (Redden, 2015). However, Babatsiko and Gerogianni (2012) suggest that there is a different approach that can be used to try and create an overall understanding of effective communication in the role-playing approach. While trying to evaluate how connection, amongst other soft skills, is improved in the role-playing approach, Babatsiko and Gerogianni (2012) introduce the intersystem model of communication which looks at an individual in different levels. These levels include spiritual, psychological and biological subsystems of individuals, in addition to the background affecting them, and support collaboration of nurse and patient in effective care provision (Babatsiko & Gerogianni, 2012). These levels of interpersonal communication depict the kind of soft skills that are required by nurses to ensure efficiency and effectiveness in the provision of healthcare to the patients. Contact with various age groups also has its challenges (Aiken, 2014). For instance, while attending to a toddler, child or a teenager the nurses have to behave and communicate differently with them to build an effective-CNA patient relationship.
With regards to the role-playing approach, Bach and Grant (2009) looked into the interpersonal values and skills that are somewhat intertwined with communication and the manner in which these values and skills continue to grow and develop with the improvement of communication skills. Communication patterns indicate that the creation of a relationship between patients and nurses helped to create a successful approach to providing healthcare (Bach & Grant, 2009). Charlton et al. introduced the two-major nursing and healthcare provision procedures which include bio-medical and bio-psychosocial and tried to compare them while considering the healthcare outcomes of each of these approaches (Charlton et al., 2008). The biopsychosocial approach focuses mainly on the patient and patient-nurse communication whereas the bio-medical approach focuses on the ailment and the patient’s illness. Comparison of the two showed a significant difference since the bio-psychosocial registered better outcomes than the bio-medical approach (Charlton et al., 2008). Creation of relationships through communication help to improve the response by nurses and CNA, enhance the outcome of healthcare and in turn improve the soft skills for nurses including CNAs.
Skills practiced in role-playing
Rao and Stupans (2012) consider role-playing to be efficient in accomplishing a wide range of learning outcomes and is also able to deal with psychomotor, productive, and cognitive domains of learning. Babatsiko and Gerogianni (2012) have described how understanding, trust, respect, honesty and respect issues between patients and CNAs strengthened through the analysis of role-play situations. Other skills practiced in role play include time management/punctuality, proper work attire, peer to peer communication skills, and critical thinking.
Communications skills
Practical communication skills for nursing assistants identified in small groups through the use of role-playing. Through various communication exercises, nursing assistants can learn many communication skills including listening skills, nonverbal communication, people skills, persuasion, verbal communication, public speaking, presentation, and writing skills.
Trust
Trust is a factor that allows patients to trust CNAs. This is of importance because it makes the patient feel safe while in the care of CNAs. Once there is trust between the patient and CNA, the patient can be more open about their medical or psychological condition, which helps them get appropriate treatment (Norouzinia et al., 2016). The patient can also convey their conditions time to time, and if they feel any discomfort, they can discuss this with the CNA and medical staff.
Respect
During a role-play and even after its completion, CNAs need to respect the patient. Respect helps the patients form better and long-lasting opinions about CNAs. The notion of respect is closely related to understanding, honesty, and trust (Aiken, 2014). In therapeutic communication, respect is of great importance. It is imperative for the CNAs to perceive attitudes and emotions of patients to create an active connection with them.
Truth-telling and honesty
Honesty affects the healthcare provider’s as well as the hospital’s credibility. It makes the patient trust the nurse and other medical staff. It can contribute to therapeutic communication, as it helps patients be informed about their condition (Aiken, 2014). Truthful information about one’s health can also reduce anxiety and improve the recovery process.
Power and interpersonal conflicts
Interpersonal conflicts tend to ruin the relationship between the CNA and patients thus CNA’s need to be in charge of their temper at all times and mainly when dealing with the patient along with their family members (Kourkouta & Papathanasiou, 2014).
Empowerment and support
The nurse has to empower the patient to deal with their problem in a better way and provide accurate information about their health at the right time (Norouzinia et al., 2016).
Reflective thoughts
Reflective thoughts help CNAs to assist their patient’s by understanding and confronting their feelings and emotions, which, sometimes, can adversely affect the patients’ health (Dawood, 2013). They also help CNAs understand what the patients have to say and find a better way to interact with them.
Peer-to-peer communication
An exercise in peer-to-peer communication is a way of improving learning and enhancing student’s level of confidence as well as perceived competence in therapeutic communication and interviewing. A study by Mckenna and French (2011) showed that students who take part in a peer teaching project reported improved levels of confidence in teaching abilities and knowledge in addition to a higher perceived competence in therapeutic communication and interviewing.
Time management/ punctuality
Time management involves nursing assistant’s ability to plan daily activities so that so they can get to work on time (Randolph, 2016). It also ensures that scheduled activities finished on time, or work deadlines met.
Proper Work Attire
Nursing assistant’s appropriate attire along with their appearance earns them respect from patients who in turn learn from and follow their instruction. A nursing assistant recognized as a representative of a very noble profession, and thus proper work attire represents the seriousness of their call (Randolph, 2016).
Critical thinking
Taking part in role-playing simulation-based scenarios in which CAN students work together to solve potentially real situations is one way of enhancing essential thinking (Ertmer et al., 2010). Skills acquired about critical thinking include creativity, critical observation, flexibility, innovation, research, logical reasoning, and problem-solving (Randolph, 2016).
Benefits of role-play practice
In his study on customized role-play, Hubbard (2014) indicates that customized role-plays offer students an extra chance to attain entry-level competence as advanced practice nurses and close learning gaps. When students go through a supervised role-play activity with explicit feedback, they tend to appreciate the value of preparation (Aiken, 2014). Uniquely designed role-play activities can develop specific skills required for one particular department. Chan (2012) observes that through a variety of non-verbal and verbal activities of the students along with their cognitive process which understands, interprets and analyzes role-play meanings, role-play makes the classroom more dynamic. In addition to benefitting the students/participants, role-playing also improves group working morale, which in turn, improves the overall productivity of the team (Hubbard, 2014). This method can also be paired up with other teaching styles. According to several empirical studies, role-play, as a training method, has been found to be more effective than traditional learning methods (Aiken, 2014).
Co-ordination of services
The short time involved in contact between the professional nurses and the patients may lead to some condition details, and patient concerns overlooked by the CNAs (Aubry et al., 2012). CNAs have direct contact with the patients, and they spend most of their time with the patients (Aubry et al., 2012). They can observe them and learn the genuine patient concerns and communicate them to the professional CNAs and the doctors for the betterment of the whole treatment process. It is also important to note a CNA takes care of not only the patients but also their family members by giving them the hope and the emotional support they need. The CNAs remain with the patient along with their family for the most prolonged period, unlike the doctors and the professional nurses (Aubry et al., 2012). Their genuine concern about a patient in all conditions and the urge to offer exceptional services makes the CNA role an essential part of the nursing industry as well as the entire healthcare fraternity.
Summary
There is the growing need for a qualified workforce of Certified Nursing Assistants with each passing day. With the advancement of medical science as a field of study and growing innovations in medicines and medical equipment, nursing as a profession has become more and more competitive and demanding. To be competent in their work, Certified Nursing Assistants are required to have the latest knowledge about clinical studies and possess as well as display all necessary soft-skills to be more efficient in their services (Aubry et al., 2012). Since CNA is the role that precedes the stage of becoming a Registered Nurse, this role requires utmost sincerity regarding learning and applying the correct knowledge during critical and emergency situations along with regular day-to-day activities (Norouzinia et al., 2016). Critical thinking, communication skills, work ethics and technical know-how are some of the bare minimum skills needed for any student to become a Certified Nursing Assistant.
In their study on training nurses for interdisciplinary communication for Intensive Care Unit patients, Krimshtein et al. (2011) concluded that one of the crucial constituents of high-quality care in ICU is effective communication. Various methods have been diverse to try and meet the demand for a well-educated and equipped workforce, for example, hiring foreign nurses in place of native nurses (Cortes & Pan, 2014). All these endeavors were formed to try to improve the quality of healthcare for the patient. Patient outcomes about healthcare provision are essential, and these outcomes can only be enhanced with the creation of a highly qualified workforce (Norouzinia et al., 2016). Intervention methods were created, and many have worked, but the most significant of them has been the use of role-playing to try and improve the soft skills of nurses in the early stages of training and education.
Implementation of the role-playing approach has seen an improvement of nurses in given areas such as interpersonal communication, self-efficiency, and efficacy as well as the skills to handle patients better to facilitate improved care (Cortes & Pan, 2014). It is cardinal therefore to concentrate more on the improvement the healthcare system on the training level for CNAs. Adapting role-play and its results on soft skills such as communication into the training of nurses can be considered as a step forward towards achieving the creation of a well-equipped workforce (Ertmer et al., 2010).
Nursing students ought to be equipped with abilities to handle real-life conditions, consisting of emergency and critical care, where the application of interpersonal skills is highly significant (Norouzinia et al., 2016). They can be prepared to face these situations when shown to suitable role-play activities. Although it initially creates anxiety, because they meet a real medical condition and have to implement all their theoretical knowledge they have gained, it’s, in the end, effective in improving their soft skills and technical expertise required to handle similar and more complex situations in future. Enhancing the critical thinking and communication skills has a positive implication of the patient treatment and overall satisfaction from the healthcare provider. Some other factors that influence the development of critical thinking among nursing students are the teacher, education system, curriculum and learning atmosphere.
As an outcome of the increased need for evidence-based practice, patient-centered care, and tackling patients’ satisfaction in care along with issues on staff shifting, the health care setting has become more demanding and complex (Chan, 2012). Nursing, as a role, is considered to be a direct provider of health-care and any delay in providing the initial necessary care is considered as medical negligence. This delay can lead to various complications and may worsen the patients’ condition. Developing appropriate and effective communication is one of best ways of achieving patient satisfaction (Norouzinia et al., 2016).
CNAs are also required to have practical communication skills with patients to achieve the desired clinical outcomes. They also have to be right councilors as sometimes proper counseling is beneficial in the overall improvement of the patient. To get nursing students bet involved in their learning process as well as better integration of theoretical and practical knowledge, role- pay activities should be initiated at an early stage of their profession and maintained for future learning purposes. Lastly, role-play techniques prepare the CNAs to deal efficiently with all kinds of day-to-day and critical medical scenarios and give them a better understanding of how to deal with patients and other medical staff.
References
Adams, S. (2015). NHS Whistleblowers: Unqualified Foreign Nurses are Running Hospital Wards and Dishing out Drugs. Available Online: www.dailymail.co.uk/news/article-3367447/NHS-whistleblowers-Unqualified- foreign-nurses-running-hospital-wards-dishing-out-drugs.html (Retrieved January 31, 2017).
Aebersold, M., & Tschannen, D (2013). Simulation in nursing practice: The impact on patient care. Online Journal of Issues in Nursing, 18(2), 83. doi:10.3912/OJIN.Vol18No02Man06
Aiken, L. H. (2014). Baccalaureate nurses and hospital outcomes: More evidence.
doi: 10.1097/MLR.0000000000000222
Aiken, L. H., Sloane, D. M., McHugh, M. D., & Stimpfel, A. W. (2016). Hospitals known for nursing excellence associated with better hospital experience for patients. Health services research, 51(3), 1120-1134. https://doi.org/10.1111/1475-6773.12357
Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M.,& Sermeus, W. (2017). Nursing skill mix in European hospitals: the cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Qual Saf, 26(7), 559- 568. http://dx.doi.org/10.1136/bmjqs-2016-005567
Alluri, R. K., Tsing, P., Lee, E., & Napolitano, J. (2016). A randomized controlled trial of high- fidelity simulation versus lecture-based education in preclinical medical students. Medical Teacher, 38(4), 404-409. doi/abs/10.3109/0142159X.2015.1031734
American Association of Colleges of Nursing (AACN), (2015). Creating a More Qualified Nursing Workforce. AACN: Media Relations. Available Online: www.aacn.nche.edu/media-relations/fact-sheets/nursing-workforce (Retrieved January 23, 2017).
Aubry, F, Etheridge, F., & Couturier, Y. (2013). Facilitating change among nursing assistants in long-term care. Online Journal of Issues in Nursing, 18(1). DOI: 10.3912/OJIN.Vol18No01PPT01
Babatsiko, F. & Gerogianni, G (2012). The Importance of Role-Play in Nursing Practice. Health Science Journal, (6)1. http://www.hsj.gr/medicine/the-importance-of-roleplay-in-nursing- practice.pdf. (Retrieved March 22, 2018)
Bach, S., & Grant, A (2009). Communication and Interpersonal Skills for Nurses. Learning Matters: ISBN: 978-1-844-451-623. 8-23. doi:10.7748/nm.19.2.9.s3
Bhattacharjee, S. (2014). The effectiveness of role-playing as a pedagogical approach in construction education. In 50th ASC Annual International Conference Proceedings. http://www.ascpro.ascweb.org/chair/paper/CERT199002014.pdf. (Retrieved March 22, 2018)
Blegen, M. A., Goode, C. J., Park, S. H., Vaughn, T., & Spetz, J. (2013). Baccalaureate education in nursing and patient outcomes. Journal of Nursing Administration, 43(2), 89- 94. doi: 10.1097/NNA.0b013e31827f2028
Chan, Z. C. (2012). Role-playing in the problem-based learning class. Nurse Education in Practice, 12(1), 21-27. doi: 10.1016/j.nepr.2011.04.008
Charlton, C. R., Dearing, K. S., Berry, J. A. and Johnson, M. J. (2008). Nurse practitioners’ Communication styles and their impact on patient outcomes: an integrated literature Review. Journal of the American Academy of Nurse Practitioners, 20: 382–8. doi: 10.1111/j.1745-7599.2008.00336.x.
Choi, E., Lindquist, R., & Song, Y. (2014). Effects of problem-based learning vs. traditional lecture on Korean nursing students’ critical thinking, problem-solving, and self-directed learning. Nurse education today, 34(1), 52-56. doi: 10.1016/j.nedt.2013.02.012
Confederation, N. H. S. (2016). Key Statistics on the NHS. 2016. http://www.nhsconfed.org/resources/key-statistics-on-the-nhs. (Retrieved March 23, 2018)
Cooper, J. R., Martin, T., Fisher, W., Marks, J., & Harrington, M. (2013). Peer-to-peer teaching: improving communication techniques for students in an accelerated nursing program. Nursing education perspectives, 34(5), 349-350.
Cortes, P., Pan, J. (2014). Foreign Nurses Importation to the United States and the Supply of Native Registered Nurses. Federal Reserve Bank of Boston: Working Pg. 14-7. 3-18. https://www.bostonfed.org/publications/research-department-working- paper/2014/foreign-nurse-importation-to-the-united-states-and-the-supply-of-native- registered-nurses.aspx. (Retrieved March 23, 2018)
Dawood, E. (2013). Nursing Students’ Perspective about Role Play: Play as a Teaching Strategy in Psychiatric Nursing. Journal of Education and Practice. ISSN 2222-1735. Vol. 4(4). Pg. 38-48. https://www.researchgate.net/publication/262223022_Nursing_Students’_Perspective ab out_Role_-_Play_as_a_Teaching_Strategy_in_Psychiatric_Nursing. (Retrieved March 23, 2028)
De Meester, K., Verspuy, M., Monsieurs, K. G., & Van Bogaert, P. (2013). SBAR improves nurse-physician communication and reduces unexpected death: A pre and post- intervention study. Resuscitation, 84(9), 1192-1196. doi: 10.1016/j.resuscitation.2013.03.016
Downey, D., & Happ, M. B. (2013). The need for nurse training to promote improved patient- provider communication for patients with complex communication needs. Perspectives on Augmentative and Alternative Communication, 22(2), 112-119. doi:10.1044/aac22.2.112
Ertmer, P., Strobel, J., Cheng X, et al., (2010). Expression of Critical Thinking in Role- Playing Simulations: Comparisons across Roles. Springer Science and Business Media, LLC 2010. DOI 10.1007/s12528-010-9030-7. 1-22.
Fakhr-Movahedi, A., Negarandeh, R., & Salsali, M. (2013). Exploring nurse-patient communication strategies. Journal of Hayat, 18(4), 28-46.
February 2, 2017). http://ijn.iums.ac.ir/article-1-2389-en.pdf. (Retrieved March 23, 2018)
Ferguson, L. M., Ward, H., Card, S., Sheppard, S., & McMurtry, J. (2013). Putting the ‘patient’back into patient-centered care: An education perspective. Nurse education in practice, 13(4), 283-287. doi: 10.1016/j.nepr.2013.03.016
Foster, J., Idossa, L., Mau, L. W., & Murphy, E. (2016). Applying Health Literacy Principles: Strategies and Tools to Develop Easy-to-Read Patient Education Resources. Clinical journal of oncology nursing, 20(4).
Framework: Creating a Workforce that Works. SEMCOG, 4-20.
From: www.bbc.com/news/uk-england-31746583.
Gillespie, G. L., Brown, K., Grubb, P., Shay, A., & Montoya, K. (2015). Qualitative evaluation of a role play bullying simulation. Journal of nursing education and practice, 5(7), 73. doi:10.5430/jnep.v5n6p73
Glasper, A. (2017). Nurse education and the development of the nursing associate role. British Journal of Nursing, 26(1), 56-57. doi: 10.12968/bjon.2017.26.1.56
Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary healthcare, 8, 33. doi:10.2147/JMDH.S72623
Hanya, M., Yonei, H., Kurono, S., & Kamei, H. (2014). Development of reflective thinking in pharmacy students to improve their communication with patients through a process of role-playing, video reviews, and transcript creation. Currents in Pharmacy Teaching and Learning, 6(1), 122-129. doi/abs/10.5688/ajpe80465
Hubbard, G. B. (2014). Customized role play: Strategy for development of psychiatric mental health nurse practitioner competencies. Perspectives in psychiatric care, 50(2), 132-138. https://doi.org/10.1111/ppc.12031
Kamerer, J. L. (2011). Massive Transfusion Protocol Simulation: Compound Femur Fracture and Hypovolemic Shock. Simulation in Healthcare, 7(3), 196-200. doi: 10.1097/SIH.0b013e318228a5dc
Karacsony, S., Chang, E., Johnson, A., Good, A., & Edenborough, M. (2015). Measuring nursing assistants’ knowledge, skills and attitudes in a palliative approach: A literature review. Nurse education today, 35(12), 1232-1239. https://doi.org/10.1016/j.nedt.2015.05.008
Khodadadi, E., Ebrahimi, H., Moghaddasian, S., & Babapour, J. (2013). The effect of communication skills training on quality of care, self-efficacy, job satisfaction and communication skills rate of nurses in hospitals of Tabriz, Iran. Journal of caring sciences, 2(1), 27. doi: 10.5681/jcs.2013.004
Kleebauer, A. (2014). Nurses trial ‘huddle’technique that aims to improve communication. Nursing Standard, 29(5). doi: 10.7748/ns.29.5.10.s9
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Material socio-media, 26(1), 65. doi:10.5455/msm.2014.26.65-67
Krimshtein, N. S., Luhrs, C. A., Puntillo, K. A., Cortez, T. B., Livote, E. E., Penrod, J. D., & Nelson, J. E. (2011). Training nurses for interdisciplinary communication with families in the intensive care unit: an intervention. Journal of palliative medicine, 14(12), 1325-1332. doi: 10.1089/jpm.2011.0225
LaMartina, K., & Ward-Smith, P. (2014). Developing critical thinking skills in undergraduate nursing students: The potential for strategic management simulations. Journal of Nursing Education and Practice, 4(9), 155. https://doi.org/10.5430/jnep.v4n9p155.
Maloney, S., Fenci, J. and Hardin, S. (2015). Is Nursing Care Missed? A Comparative Study of Three North Carolina Hospitals. Research Gate. 2-6.
Manzoor, I., Mukhtar, F., & Hashmi, N. R. (2012). Medical students’ perspective about the role- plays as a teaching strategy in community medicine. J Coll Physicians Surg Pak, 22(4), 222-5. doi: 04.2012/JCPSP.222225
Matteson, M., Anderson, L., Boyden, C. (2015). “Soft Skills”: A Phrase in Search of Meaning. John Hopkins University Press, Baltimore. Libraries and the Academy, Vol. 16(1). 71-88. doi: 10.1353/pla.2016.0009
McKay, D.R. (2017). What is an RN: Job Description of a Registered Nurse. The Balance, Retrieved from https://www.thebalance.com/registered-nurse- 526062?utm_source=emailshare&utm_medium=social&utm_campaign=s
Murray, B., & McCrone, S. (2015). An integrative review of promoting trust in the patient– primary care provider relationship. Journal of advanced nursing, 71(1), 3-23. doi: 10.1111/jan.12502
Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M., & Samami, E. (2016). Communication barriers perceived by nurses and patients. Global journal of health science, 8(6), 65. doi:10.5539/gjhs.v8n6p65
Park, M., Kjervik, D., Crandell, J., & Oermann, M. H. (2012). The relationship of ethics education to moral sensitivity and moral reasoning skills of nursing students. Nursing Ethics, 19(4), 568-580. doi:10.1177/0969733011433922
Porter, M. & Lee, T., October 2013. The Strategy That Will Fix Health Care. https://hbr.org/2013/10/the-strategy-that-will-fix-health-care. (Retrieved March 24, 2018)
Ramos, F. R. S., de Pires, D. E. P., de Farias Brehmer, L. C., Gelbcke, F. L., Schmoeller, S. D., & Lorenzetti, J. (2013). The discourse of ethics in nursing education: Experience and reflections of Brazilian teachers–Case study. Nurse education today, 33(10), 1124-1129.
https://doi.org/10.1016/j.nedt.2012.12.011
Randolph, M. L. (2016). The Need for Soft Skills in a Medical Assistant Program (Doctoral dissertation, Walden University). https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?referer=https://www.google.com/ &httpsredir=1&article=3857&context=dissertations. (Retrieved March 24, 2018)
Rao, D., Stupans, I., (2012). Exploring the potential of role-playing in higher education: development of a typology and teacher guidelines. Innovations in Education and Teaching, Vol. 49 (4). 427-436. https://doi.org/10.1080/14703297.2012.728879
Redden, S. (2015). The Effectiveness of Combining Simulation and Role Playing in Nursing Education. Walden University Scholar Works. 26-38. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?referer=https://www.google.com/ &httpsredir=1&article=2462&context=dissertations. (Retrieved March 24, 2018)
Riera, J. R. M., Cibanal, J. L., & Mora, M. J. P. (2010). Using role-playing in the integration of knowledge in the teaching-learning process in nursing: assessment of students. Texto & Contexto-Enfermagem, 19(4), 618-626. http://dx.doi.org/10.1590/S0104- 07072010000400003
Robert, G., Cornwell, J., Locock, L., Purushotham, A., Sturmey, G., & Gager, M. (2015). Patients and staff as codesigners of healthcare services. BMJ, 350, g7714. https://doi.org/10.1136/bmj.g7714
Rutherford, M. M. (2014). The value of trust to nursing. Nursing Economics, 32(6), 283. https://www.nursingeconomics.net/ce/2016/article3206283327.pdf. (Retrieved March 23, 2018)
Sulehria, S. (2015). ‘Untrained’ Healthcare Assistants ‘Put Patients at Risk.’ doi: 10.3399/bjgp08X277032
Tay, L. H., Hegney, D., & Ang, E. (2011). Factors affecting effective communication between registered nurses and adult cancer patients in an inpatient setting: a systematic review. International Journal of Evidence‐Based Healthcare, 9(2), 151-164.
Vizeshfar, F., Dehghanrad, F., Magharei, M., & Sobhani, S. M. J. (2016). Effects of Applying Role Playing Approach on Nursing Students’ Education. International Journal of Humanities and Cultural Studies (IJHCS) ISSN 2356-5926, 1772-1781. doi: 10.1111/j.1744-1609.2011.00212.x.
Woodhouse, J. (2014). Chapter 8. Role Play: A Stage of Learning. Research Gate; Strategies for Healthcare Education. 71-78.