Comparación de dos estrategias educativas y sus efectos en el desarrollo de la competencia comunicativa básica en alumnos de enfermería

Abstract

Nursing is an important component of health care system and it encompasses health promotion care, disease prevention and disease treatment. In order to get a complete education, nurses have to receive specific theoretical and clinical training. In our country this education is framed within the European Higher Education Area which bet on a competency-based learning. Nursing is based on several essential competences among which communicative competence stands out. Communication seeks to create meaningful relationships with patients, as well as with healthcare professionals in order to provide a safe care. To that end, nurses must have sufficient knowledge, skills and confidence on communication. However, nursing students seem to experience difficulties communicating, and these problems arise when they become professional nurses. Thus, in order to promote a better learning on this competence, in recent years educational programs have applied methodologies that focus on the student, such as role-play and the use of standardized patients. Therefore, the main idea of this doctoral dissertation was to compare the effectiveness of these two educational strategies in achieving communicative competence. However, a literature review showed that there weren’t validated tools to measure this competence in all its domains. Because of that, the dissertation is structured in two sections: a section to present the development and validation of three assessment tools and a second section to present the application of educational interventions. For the first section, an observational and cross-sectional design was proposed with a sample of 365 nursing students from UAL and 17 university communication experts. For the validation of the knowledge tool, a content validation was carried out by experts and the validity of the items and the structure validity were assessed by students. For the selfefficacy tool, three steps were proposed: an expert content validation; a pilot validation to measure reliability; and a final validation by students to assess reliability and content, criteria and structure validity. The third tool was validated by experts who assessed the content validity and by students who evaluated the reliability, the content validity and the construct validity. The results obtained were positive in terms of reliability and validity for the three tools, so they had excellent psychometric characteristics for the assessment of communicative competence. For the second section, a randomized clinical trial design was used with 126 students randomly divided into two intervention groups: role-play and standardized patient. They received a theoretical training on communication with patients and other healthcare providers, and they visualized real interactions carried out by actors. After this, the roleplay group had to use this technique in small groups to solve practical cases. While in the standardized patient group, an interaction was developed with an actor who played a role as a patient or a doctor, in order to practice the theoretical training. The domains of knowledge, ability and attitude were evaluated at three different moments to assess the efficacy of both interventions. Thereby, the number of students achieving success rates was calculated and comparisons were made between the measurements, as well as between the results of the groups. The results showed that the success rates improved significantly after both interventions. However, no significant differences were found between the two groups. Therefore, it is not possible to determine which of the strategies used is the most appropriate for teaching the communicative competence.