Factors predicting emotional cue‐responding behaviors of nurses in Taiwan: An observational study

Abstract

Objective Responding to emotional cues is an essential element of therapeutic communication. The purpose of this study is to examine nurses' competence of responding to emotional cues (CRE) and related factors while interacting with standardized patients with cancer. Methods This is an exploratory and predictive correlational study. A convenience sample of registered nurses who have passed the probationary period in southern Taiwan was recruited to participate in 15‐minute videotaped interviews with standardized patients. The Medical Interview Aural Rating Scale was used to describe standardized patients' emotional cues and to measure nurses' CRE. The State‐Trait Anxiety Inventory was used to evaluate nurses' anxiety level before the conversation. We used descriptive statistics to describe the data and stepwise regression to examine the predictors of nurses' CRE. Results A total of 110 nurses participated in the study. Regardless of the emotional cue level, participants predominately responded to cues with inappropriate distancing strategies. Prior formal communication training, practice unit, length of nursing practice, and educational level together explain 36.3% variances of the nurses' CRE. Conclusions This study is the first to explore factors related to Taiwanese nurses' CRE. Compared to nurses in other countries, Taiwanese nurses tended to respond to patients' emotional cues with more inappropriate strategies. We also identified significant predictors of CRE that show the importance of communication training. Future research and education programs are needed to enhance nurses' CRE and to advocate for emotion‐focused communication.

Communication patterns in nurse-led chemotherapy clinics: A mixed-method study

“…This is worrying since all nurse participants reported completing advanced communication skills training. Evidence suggests that effective cue-responding can be learnt [9], however to what extent communication skills are maintained over time is unknown. Additional factors may also impact nurse-patient communication within nurse-led chemotherapy clinics [31], including the physical environment, organisational culture, and operational factors [3], which indicates the need for further research.…”

“…MIARS was specifically developed for oncology settings [18], and has been widely used [9]. In MIARS 'a turn' represents the basic unit of observation: what one person says before another speaks.…”

“…Zimmermann et al [8] defines a concern as "a clear and unambiguous expression of an unpleasant current or recent emotion that is explicitly verbalized with or without a stated issue of importance"; cues are described as verbal or nonverbal hints to underlying concerns, which require further exploration to identify the actual concern [8]. Many studies on communication frameworks focus on cue-responding behaviours, indicating the effectiveness of nurse-patient communication in oncology relies on addressing patients' psychosocial needs [9,10]. Patients often prefer to express emotional concerns to nurses [11], therefore nurses in nurse-led chemotherapy clinics should provide good psychosocial care.…”

“…However, evidence indicates that nurses may lack the ability and sensitivity to address patients' psychosocial needs [12]. Other cueresponding studies have shown that nurses use blocking behaviours 55-75% of the time, even when patients explicitly expressed concerns [9], which discourages patients from expressing concerns. The missing or avoidance of cues/concerns by nurses may cause psychosocial distress for patients with cancer if their needs are not addressed [13].…”