Enhancing effective interpersonal interactions through soft skills: perceptions of nurse educators

Abstract

Background

Student nurses come across various complex interpersonal spheres that require them to show their soft skills. Nursing education pays more attention to developing hard skills but focuses less on the soft skills that contribute to the success of healthcare establishments and the nurses themselves. Thus, the purpose of the study was to explore and describe nurse educators’ perceptions of soft skills that enhance effective interpersonal interactions and to develop recommendations to facilitate the incorporation of soft skills in nursing education.

Methods

A qualitative, exploratory, descriptive, and contextual research design was used for this study. A purposive sampling method was applied, and 12 online semi-structured individual interviews were conducted with nurse educators from the Higher Education in Johannesburg. Tesch’s open coding method was employed for data analysis. The measures of trustworthiness were adhered to throughout the research process, along with the ethical principles.

Results

Majority of the nurse educators perceive that teaching soft skills strengthens personal capacity to interact and relate better with others. The analysis of the study revealed five themes (1) Soft skills teaching is perceived by nurse educators as enhancing effective interpersonal interactions. (2) effective communication, (3) teamwork (4) emotional intelligence, and (5) critical thinking.

Conclusion

Facilitating soft skills in nursing education is essential in preparing nurse graduates who can foster effective interpersonal interactions with patients and other professionals.

Background

Soft skills are vital for the successful execution of professional skills in the nursing profession. Soft skills are described as a combination of personal habits, attitudes, attributes and social abilities that improve an individual’s interactions and job performance [1]. These skills are interchangeably referred to as non-technical skills [2], service skills [3], social and personal skills [4], people skills [5], life skills [6] or interpersonal skills [7]. Teaching refers to the organized transfer of knowledge through the provision of stimulus to the psychological and intellectual growth of a person by another person [8]. In addition to facilitating knowledge acquisition and technical competency, ways of cultivating student nurses’ soft skills should be identified and implemented to enhance the quality of nursing care provided to patients [3]. However, it is still a challenge for nurse educators to teach soft skills to student nurses [9]. Nurse educators are persons who are qualified and competent to independently practice comprehensive nursing in the manner and to the level prescribed with accountability for such practice. These persons have an additional qualification in nursing education [10]. Nursing education pays more attention to developing hard skills but focuses less on the soft skills that contribute to the success of healthcare establishments and the nurses themselves [11].

Public complaints about inadequate nursing care in clinical practice are on the rise [12]. Some of the complaints state that nurses do not communicate effectively with the patient and relatives; there is no patient advocacy, and the nurses project uncaring behaviour. According to Jack et al. [13]. there is poor communication, patient mistreatment and uncompassionate behaviour shown by nurses when rendering nursing care. According to Barnard [14] most interactions that nurses have with other individuals need a certain level of soft skills to interact effectively. Student nurses come across various complex interpersonal spheres that require them to show their soft skills [15]. These skills form the central part of the interpersonal therapeutic nurse-patient relationship [16], and impact how one interacts with others [17]. Interpersonal interaction refers to how the individuals relate to each other verbally and non-verbally [18]. The current work environment faces additional pressures due to rapid technological advancements, globalization, and shifting patient preferences. Consequently, it is essential to develop soft skills among student nurses to help them adapt to these emerging challenges [19]. While considerable research has focused on improving the technical and psychomotor of student nurses there is a noticeable gap in research on nurse educators’ perceptions of teaching soft skills [19, 20]. Hence the the purpose of the study was to explore and describe nurse educators’ perceptions of soft skills that enhance effective interpersonal interactions and to develop recommendations to facilitate the incorporation of soft skills in nursing education.

Methods

Design

The study has a qualitative, exploratory, descriptive, and contextual research design [21] to gain an in-depth understanding of the nurse educators’ perceptions of teaching soft skills at a higher education institution.

Participants and procedure

Participants were purposely selected and were recruited via email by the first author. All the participants were nurse educators employed at a higher education institution in Johannesburg. The inclusion criteria for the study were as follows: (1) being nurse educators at an institution of higher education (2) registered with the South African Nursing Council as nurse educators (3) nurse educators who are willing to participate in the study.

The sample of the study consisted of 12 nurse educators who lectured at both undergraduate and postgraduate levels. All the participants were female aged between 35 and 50 years. Their level of experience ranged between 3 and 28 years, five of them have a PhD qualification, five have a master’s degree, and one have an honour bachelor’s degree in nursing.

Setting

The study was conducted at a higher education institution (HEI) in Johannesburg, South Africa, a context in which nurse educators are directly involved in the teaching of student nurses at first-year level to fourth-year level, including at the post-graduate level. The undergraduate program at the HEI has an average of 200 students, 50 students at each program level. The Postgraduate degrees include master’s and PhD candidates of which each lecturer can be responsible for three to five students, depending on the intake for a given year.

Data collection

All the interviews were conducted between September 2020 and February 2021. Due to the COVID-19 pandemic and the lockdown, face-to-face interviews were not possible at the time; therefore, all the interviews were conducted online, using Microsoft Teams. The interviews were conducted by the first author and all the authors developed the interview guide.

The central research questions applied to guide the interviews were (1) “What are your perceptions of teaching soft skills at higher education institutions?” and (2) “How do you incorporate soft skills in your teaching?” During the interviews, the researcher used communication skills such as probing, active listening, clarifying, paraphrasing, and reflection to encourage descriptions and understanding of the phenomenon [22]. The interviews lasted between 45 and 60 min. Data were collected until no new information emerged; thus, data saturation [22] was reached by participant twelve. Interviews were audio recorded with the consent of the participants. Field notes were also documented by the researcher during the online interviews [23].

Data analysis

For the qualitative data analysis, the audio recordings of the individual interviews were transcribed verbatim by the first author, and this was verified by the other two authors (LM and AM).

Data was analysed using Tesch’s 8-step open coding method [22](1) The three authors went through the whole transcript to familiarise themselves with the data. (2) One case was selected to generate initial coding (3) All other remaining interviews were coded, and a list of themes was created. Similar topics were clustered together. (4) A list of themes was applied to all the data. Codes were assigned to the established topics on the list. The codes were written next to the applicable segments of the text to establish if any new categories or codes were emerging. (5) Descriptive words to the established categories were assigned. Lines were drawn between the categories to show interrelationships. Afterward, the topics were arranged according to the way they related to each other. Similar topics were grouped into main topics with related sub-topics. Reducing the total list of established categories. (6) Final abbreviations were assigned to each category, together with the corresponding alphabetized codes. (7) The first author grouped together the supportive data that belonged to the established different categories and, thereafter, performed preliminary analysis. (8) The data were to be re-coded in case new themes re-emerged. The three authors had a consensus meeting and agreed on the themes.

An independent coder with experience in qualitative research and data analysis was appointed. The Independent coder was provided with the collected data to analyze independently. A consensus meeting between the first author and the independent coder was held to finalize the established themes and sub-themes.

Ethical considerations

This study was conducted by following the ethical guidelines stipulated in the Declaration of Helsinki. The study obtained approval from the Faculty of Health Sciences at the University of Johannesburg approval number (REC-646-2020). At the time of the study, there was no relationship between the researcher and the nurse educators. Verbal and written consent was obtained from the participants prior to data collection. All the participants were informed of their right to withdraw from the study at any time without suffering any consequences or providing a reason for withdrawal. Confidentiality was assured to the participants in the study. Code names were used when transcribing and discussing data. The independent coder signed a confidentiality agreement to ensure the participants’ confidentiality was not breached. The collected data is kept safe in a password-protected file for two years, and will only be accessible to the three authors.

Trustworthiness

Trustworthiness was achieved by applying the criteria of trustworthiness, namely; credibility, transferability, dependability, confirmability, and authenticity according to Lincoln and Guba [23]. The credibility of the study was maintained by recording and transcribing the data, documenting field notes after each interview, and coding the data accordingly. The researcher got back with the nurse educators to discuss and confirm if the data collected, interpretations, and conclusions were a true and fair reflection of the participants’ perspectives. Transferability and authenticity were enhanced by ensuring a thick description of data and participant experiences [23]. Dependability was ensured by using the same central question for all the interviews, and by coding the data and assigning an independent coder who coded the data separately [24]. Confirmability was enhanced by keeping an audit trail of the data collection, data analysis process, and coding process [23]. The researcher documented all the observations made during the online interviews with the participants, detailing the context under which the participants were providing the data. The researcher kept the chain of evidence inclusive of the field notes, audio recordings, and transcriptions.

Findings

The data analysis revealed five themes. An overview of the themes is presented in Table 1. The related subthemes will be presented with supporting quotes from participants.

Table 1 Theme and subthemes

Theme 1: soft skills teaching is perceived by nurse educators as enhancing effective interpersonal interactions.

The findings indicate that teaching soft skills is perceived to strengthen the student nurses’ ability to interact and relate better with other individuals. most interactions we have with other individuals need a certain level of soft skills to interact effectively.

One participant said:

“It is those (soft) skills that enable someone to be able to relate better with other individuals. These are skills that are based on interpersonal relations, they just ensure smooth running of a day-to-day interaction with anyone”. (Participant 11)

Another participant believes that through teaching soft skills, the student nurses are taught how to relate with other individuals within the personal and professional spheres. The participant stated:

“It’s how to relate with other people, whether it is a patient or other professionals. So, it’s teaching them how to relate basically.” (Participant 1).

Another participant added:

“That is looking at personal attributes that enable one to interact within the environment of teaching and learning”. (Participant 5)

The participants perceive strengthening the student nurses’ personal capacity to interact and relate better with others can be achieved through the incorporation of soft skill teaching during lessons and by having a program about soft skill. This is reflected in the participants’ statements below:

“I would say all the lessons; all the practical lessons that are offered should incorporate soft skills”. (Participant 2)

The sub-themes to the above theme describe the soft skills linked to strengthening the students’ ability to interact and relate better with patients and with each other.

Theme 2: effective communication

The findings convey that student nurses need to be developed in the area of effective communication in order to cultivate their ability to effectively interact with patients and other healthcare personnel. A participant voiced:

“It is very important we (nurse educators) teach student nurses like how to communicate. We can communicate effectively without being rude” (Participant 9).

Another participant expressed:

“They (student nurses) must learn communication skills. They must learn principles of communication and the listening skills”. (Participant 8)

A participant suggested that communication skills for patient relationships.:

“You need to have good communication skills to communicate with your patients”. (Participant 12)

The findings identified demonstration of effective communication by nurse educators and opportunities of practicing communication skills by student nurses to be effective in enhancing communication skills of the student nurses. While one participant said:

“You (nurse educator) need to have demonstrated communication skills”. (Participant 6)

Another explained also the importance nurse educator has in training of students’ communication skills and in demonstrating different communication skills:

“So, they (students) would practice with each other and take roles and get to evaluate themselves you know and see where sometimes we go wrong in our conversations when talking to patients. So, you are letting them see their own mistakes in communication and how they relate to other people” (Participant 1).

Theme 3: teamwork

Participants’ views on the importance of teaching soft skills as an aspect of teamwork are reflected in the following statement:

“It is important that we teach proper team ship, as it is a South African Qualifications Authority critical cross-field outcome” (Participant 10).

Another participant said:

“Teamwork is another skill that I think is important to learn.” (Participant 11).

Teamwork communication and collaboration as a soft skill in nursing allows one to work effectively with others and promote one’s accountability. Another participant stated:

“Teamwork is one of those skills you know; especially in the work environment you need to be able to have teamwork” (Participant 2).

The participants acknowledged the importance of incorporating the students’ existing experience on teamwork and the use of team-based learning activities by nurse educators to cultivate the skill of teamwork among the students. Two of the participants said:

“In a group assignment that fosters teamwork, they are supposed to delegate themselves in terms of who will take the role of the leader, resource coordinator or the presenter. They have different roles in that assignment as team members” (Participant 11).

“I teach students the most important things about teamwork, such as there is no way you can resuscitate alone. I ask them to share with me their experiences about teamwork. This is very important because students have seen and heard things in the wards” (Participant 10).

Theme 4: emotional intelligence

Participants expressed that teaching the soft skill of emotional intelligence should be intensified during training, to acclimatise the students to the habit of recognizing emotions. A participant said:

“We’re talking about recognising the emotions because by teaching these students to understand and recognise emotions, they are going to be able to understand their patients” (Participant 4).

Another participant stated:

“Soft skills teach a student emotional intelligence more than anything, to know when to act, not to act, and how to act”. (Participant 9)

Emotional intelligence allows one to thrive in areas of self-awareness, self-management, social awareness, and relationship management. One of the participants said:

“One other skill that I was thinking is emotional intelligence, so that you are able to respond to other people. With emotional intelligence, you will learn to work with yourself, there is self-awareness” (Participant 10).

The findings reveal that participants perceive it as necessary for nurse educators to attend workshops to develop their emotional intelligence for themselves, and to be in a better position to impart the skill to the student nurses. Further shows that the participants recommend more effort should be put into developing student assessments that incorporate emotional skills. The participants said:

“As a nursing educator, you need to work towards obtaining this particular soft skill before you can teach it to a student. So, there are workshops that are available for us to go and build our emotional intelligence and it has nothing to do with a once-off workshop. It’s something that you work on it on a daily basis, you work on it from one workshop to the other, from year on and the next year, because you cannot just attend one workshop and then oh, now I’m emotionally intelligent. It doesn’t work like that. And emotional intelligence then assists in the role of maintaining good proper relationships irrespective of person you are engaged with.” (Participant 10).

In addition to acknowledging the need to teach students emotional intelligence, nurse educators also admit that their assessments lack the aspect of emotional intelligence.

“Most of our assessments really focus on like the psychomotor skills of the student and cognitive skills a lot but we don’t focus on the emotional component and that’s something we can also put effort towards”. (Participant 9)

Theme 5: critical thinking

The findings of the study demonstrate that participants perceive critical thinking as one of the soft skills that is necessary to enhance effective interpersonal interactions. A participant said:

“Most importantly the soft skills that you need to engage in critical thinking, because it promotes being open-minded, being able to tolerate other people”. (Participant 10)

Other participants added:

“Reinforce critical thinking, I mean, and those are the skills that we need to use when we are facilitating the technical skills”. (Participant 4)

“As an educator, you are supposed to have that analytic thinking; so, you will be able to broaden the students’ cognitive thinking skills”. (Participant 6)

. The participants perceive that in their teaching, nurse educators need to stimulate the students’ critical thinking skills.

Discussion of findings

This study aimed exploring and describing nurse educators’ perceptions of soft skills that enhance effective interpersonal interactions and to develop recommendations to facilitate the incorporation of soft skills in nursing education. The findings of the study revealed that nurse educators recognize the need to incorporate soft skills in teaching to develop holistic student nurses. The findings indicate that students who have been taught soft skills will possess the necessary attributes that will empower the student nurses to thrive as nurses and to interact with patients and with each other and with the multi-disciplinary team collaboratively. These attributes include effective communication, teamwork, emotional intelligence and critical thinking. In addition, the findings reveal that while acknowledging the need to incorporate soft skills in teaching, nurse educators admit that they do not include soft skills when teaching and when they assess student nurses.

Previous studies support these findings by stating that, teaching soft skills is considered to be necessary, as novice nurses are expected to use both their hard and soft skills attributes when transitioning to becoming professionals [25]. Another study reveals that commencing teaching of soft skills early helps students become aware of their lack of soft skills, and autonomously begin learning how to fill those knowledge gap [26, 27]Furthermore, the study’s findings are similar to findings from another study stating that in nursing practice, soft skills allow nurses to effectively interact with patients, co-workers, and the multidisciplinary team, thus ensuring quality care [27]. Developing competency necessitates numerous practice sessions [28]. Practicing affords the students an opportunity to improve their soft skills, an idea that is also conveyed in the current study.

Similar to our findings, effective communication plays an important role in establishing good interpersonal relationships [29]. Furthermore, Sibiya [30] perceives effective communication as a core element of interactions, co-operation and collaboration, which are necessary aspects of the professional practice. Training student nurses in the area of effective communication is an active way of growing confidence and skill application in different clinical scenarios [15]. Curtis [31] supports these sentiments by stating that, in nursing, effective communication ensures smooth communication of the patients’ diagnosis and treatment plans among the nurses and the health care multidisciplinary team [31].

Additionally, Novita [32] states that nurses are still demonstrating poor communication skills when they interact with their patients and other health care professionals hence the need to deliberately educate the student nurses through the use of soft skills. Taghizadeh et al. [33]. recommend incorporating communication skills into the teaching programmes of the student nurses, in order for students to acquire the necessary experience prior to becoming professionals, which support our findings. A study by Dalcol et al. [34]. found that the student nurses are likely to develop communication skills in a more autonomous manner during their practices encouraged by the student and teacher interactions. This idea is also mirrored in one of our findings, such as, Effective Communication. Pingue-Raguiniet al. [35] reported that student nurses indicated satisfaction in their experiences of learning through a demonstration of nursing communication skills. According to Oliveira and Braga [36] the nurse educator may influence the student nurses’ interactions with patients and healthcare teams by teaching and giving the students orientation about interpersonal communication.

Our findings indicate the need to develop teamwork in the student nurses, considering the fact that they will be working with different members of the disciplinary team (MDT) in the clinical setting. These findings are supported by previous research which indicates that teamwork fulfils the need for social interaction and association [37]. Additionally, studies show that in nursing, teamwork ensures that the goals of patient care, improved outcomes and patient safety are met [38]. If the student nurses work together in teams aligning the expected outcomes of different patients with that of the members of the MDT, there will be an increase in patient satisfaction. This will lead to short hospital stay due to coherence among the personnel. Furthermore, another study indicates that developing educational programmes for student nurses should include themes focusing on teamwork practices that will bring change and improvement of health outcomes [39].

Hence based on our findings, and in agreement with Speakman et al. [40]. student nurses should be prepared for their roles as effective members of the interprofessional team, nurse educators should provide student nurses with team-based learning opportunities such as meaningful inter-professional educational opportunities. Teamwork learning activities help the students to experience and learn dealing with different people as well as learning to respect and trust people within a team [41]. Similarly, a study by Allari [42] mentions that use of group assignments acclimatises the student nurses toward working effectively in a team. Group assignments are described as tasks allocated to a group of students with the purpose of working together to complete learning objectives [43].

Emotional intelligence is identified as a critical factor in maintaining strong relationship between individuals [44]. Emotional intelligence refers to “the ability to maintain control when situations, people and events make excessive demands” [45]. A previous study reveals that students need to be taught how to work and cope with the various challenges they encounter within the unpredictable and emotionally charged clinical area [46]. Holston and Taylor [47] likewise reported that the cultivation of student nurses’ soft skill of emotional intelligence promotes a wide range of coping skills for stress or any negative behaviour in both the academic and clinical environment. Similar to our findings, findings from a previous study demonstrate that emotional intelligence training is perceived to require multiple sessions of self-reflection and other personal growth activities [48]. To improve student nurses’ emotional intelligence, we agree with Monem et al. [49]. recommendation that there is a need to develop an in-service training program on emotional intelligence skills for the nurse educators, as this in return encourages the assertiveness of the student nurses.

In agreement with the findings, Loveland [50] states that as part of career preparation, students ought to retain critical thinking in their set of soft skills. Supporting this, Arli et al. [51]. reported that teaching critical thinking promotes development of the student nurses’ intellectual abilities to be independent critical thinkers. The teaching strategies utilised by the nurse educators’ impact the student nurses’ learning of critical thinking [52]. Similar to findings from another study [53], our findings revealed that student nurses are not adequately prepared with the necessary critical thinking skills that would be able to meet the demands of the dynamic health care environment. Knowing that, some nurse educators were receptive to incorporating critical thinking skills into their teaching. Makhene [54] adds that many nurse educators have found it difficult to successfully facilitate critical thinking, however, as our findings reveal, critical thinking is an important skill to train during nursing education.

Finally, the findings indicate that soft skills play an important role in steering effective interpersonal interactions. It is perceived that when nurse educators incorporate soft skills in their teaching, student nurses will progressively learn to develop effective interpersonal interactions with other individuals. However, some challenges are still being experienced by nurse educators in facilitating soft skills. As a result, necessitates the need to also empower nurse educators on their soft skills, to be in a better position to impart the soft skills to the student nurses. This will prepare the student nurses for their transition to their professional roles, in which they will be able to establish effective interpersonal interactions with their patients, co-workers, and the rest of the healthcare team to provide quality and efficient patient care.

Recommendations for future research

This study recommends incorporating the teaching of soft skills for nursing students in simulated learning environments and through theoretical instruction and integration into the bachelor’s nursing program curriculum. Furthermore, the study recommends developmental workshops for nurse educators to empower them to transfer their skills to student nurses. Future research should explore the experiences of student nurses regarding soft skills and the impact of teaching soft skills by employing quantitative data collection methods such surveys.

Strengths and limitations

The findings of this study led to the provision of recommendations that can help facilitate the incorporation of soft skills in nursing education and nursing practice. The study can also be used to pursue future nursing research on soft skills development for student nurses or in nursing education. The study was conducted at one higher education institution in Johannesburg. A broader range of perceptions may have been described by nurse educators from other nursing education institutions, if the researcher conducted the study in several other institutions. For this reason, the findings of this study cannot be generalised to other contexts.

Conclusion

Facilitating soft skills in nursing education is seen as preparing nurse graduates who can foster effective interpersonal interactions with patients and other professionals. The findings of this study can be applied in nursing education to facilitate the incorporation of soft skills in teaching of student nurses. Within the nursing practice, these study findings can be applied to empower nursing professionals to practice and role model soft skills in order to influence the professional and ethical conduct of the student nurses. Producing nurse graduates with soft skills will add enormous value to the nursing profession. The profession needs nursing professionals who are competent in their technical skills and still be able to relate better with patients and their families, colleagues, and members of the multidisciplinary healthcare team. This will lead to quality nursing care, improved health outcomes, and the success of healthcare establishments. Further research is still necessary for the development of evidence-based practices concerning soft skills in nursing education and practice.