THE IMPACT OF CLINICAL DUTY IN THE DEVELOPMENT OF

COMMUNICATION SKILLS AMONG 3RD NURSING STUDENTS OF PALAWAN

POLYTECHNIC COLLEGE INC.

Alvarez, Hazel

Condesa, Deborah Hazzel C.

Igloso, Joannie L.

Magdadaro, Charlie Jr.

Manlavi Dianne Jane C.

Yangson, Jude Ann

An Undergraduate Title Thesis Proposal Presented

To the Faculty of the School of Nursing of Palawan Polytechnic College Inc. in

partial fulfillment of the requirements for the degree

Bachelor of Science

In

Nursing.

November 2024
 Chapter I

Background of the Study

Nursing as a health care science, focuses on serving the needs of human as a

biopsychsocial and spiritual being. Its practice requires not only scientific knowledge, but also

interpersonal, intellectual, and technical abilities and skills. This means composition of

knowledge, clinical work, and interpersonal communication (Kourkouta & Papathanasiou,

2014).

According to Farahani, development of communication skills in nursing students is

important because strong communication skills are essential for providing safe, quality patient

care. Nursing students need to be able to establish therapeutic relationships with patients and

family members to address their needs and concerns. Strong communication skills are essential

to provide safe, quality, patient-centered care. Nurses develop therapeutic relationships with

patients and family members each day to ensure that health care concerns and needs are

addressed. If communication breaks down, information exchange stops and needs go

unidentified effective communication not only address the real need of patients but also is the

basis of nurses’ task in patient’s care. Most studies consider the psychological distance in the

nurse-patient relationship as one of the foundations in understanding the patient needs.

Accordingly, nurses’ ignorance of the values, beliefs, and experiences of the patient and his or

her family forms a negative attitude towards the patient’s behavior (Farahani et al. 2006).

Communication skills are taught to nurses in educational environments; however, they

disregard consistently these skills in clinical settings. Although learning communication skills is
an important part of the students’ curriculum, there are many issues over their poor

communication. The weakness of medical staff, including nurses, in communication is so

prominent that it has become one of the most frequent complaints in health care department

centers of the countries such as England (Heaven et al. 2006). Proper communication not only

satisfies an important need of the patient but also is a major aspect of nursing care, which besides

informing the patient’s illness and its treatment, helps to understand his/her concerns, develops

understanding; empathy; psychological support; and leads to recovery from physical,

psychological, and behavioral problems; and welfare of the patient (Gibson-Mee et al. 2011).

As noted by Gurdogan et al. (2016), when nursing students feel more confident, they are

able to communicate more effectively. As students, we have seen personally how difficult it has

been for our peers to speak clearly in a clinical setting. Organizing and effectively

communicating patient information to other healthcare practitioners, as well as starting and

continuing conversations with patients, are common challenges. These issues are frequently

made worse by the presence of other people, including family members, visitors, and other

medical personnel. Fortunately, nursing educators can quickly put a few interventions into place

to help students start gaining confidence before they join the clinical situation. Students should

be able to interact with patients, guests, and other caregivers more successfully once their

confidence has grown.

The purpose of this study was to determine the impact of clinical duty in the development

of communication skills among third year nursing student of Palawan Polytechnic College

Incorporated. This study aim to identify the specific aspects of clinical duty that contribute to

enhancing these skills, understand the challenges faced by students in effective communication

during clinical practice, and determine the overall significance of hands-on experience in
preparing nursing students for professional interactions with patients, families, and heathcare

teams.

By assessing the impact of clinical duty, the research could provide insights on educational

strategies and curriculum for nursing programs, ultimately aiming to improve the quality of

nurse-patient communication and patient care outcomes.

Statement of the study

This study aims to determine the impact of clinical duty in the communication skills of 3rd

year nursing student in Palawan Polytechnic College Inc. Specifically, this study seeks to answer

the following questions:

1. What is the demographic profile of the nursing students in terms of:

a. age;

b. gender;

c. ethnicity;

d. clinical duty experience;

e. type of clinical setting;

2. What specific communication skills do nursing students demonstrate most frequently during

clinical duty?

3. Does clinical duty experience significantly improve nursing students’ communication skills?
Research hypothesis

Clinical duty positively influences the development of communication skills among third-

year nursing students, enhancing their ability to effectively interact with patient, families, and

healthcare teams. Through consistent exposure to patient care scenarios, students will improve

their verbal and non-verbal communication abilities, thereby increasing their competence in

establishing rapport, demonstrating empathy, and delivering patient- centered care, which in turn

contributes to their overall professional development and preparedness for future nursing roles.

Scope and limitations of the study

This study “ The impact of clinical duty in the development of communication skills

among 3rd year nursing student of Palawan Polytechnic College Inc.’’ will only limited to the

2024-2025 third year nursing students. This study will be conducted at the Palawan Polytechnic

College Inc.

Significance of the Study

This study will be conducted to determine the impact of clinical duty in the

communication skills of 3rd year nursing student in Palawan Polytechnic College Inc. This

research seeks to provide valuable insights into how clinical duties contribute to the development

communication skills of the students in the said institution. Also, this will be beneficial in the

following areas:

Nursing Department Faculty, the result and findings will guide as a reference to provide

valuable insights into how clinical duties help improved the student’s communication skills.

Results from the study can provide evidence for aligning nursing programs with accreditation
standards that emphasize communication skills in nursing practice. This can help nursing

departments maintain accreditation status and demonstrate their commitment to producing

competent graduates.

Students, the findings of this study can help students become more confident to communicate

and provide care for their patient. Furthermore, students can learn how to communicate more

effectively to their patient. One of the best way to gain the patients’ trust is through effective and

appropriate communication it provides high quality of services that leads to satisfaction and

better health.

Parents/Guardians. The awareness of the parents of the results of this study will help them in

understanding correlation between clinical experiences and the enhancement of their children’s

communication abilities can provide reassurance regarding their education and preparedness for

real-world healthcare setting. It underscores the importance of supporting their involvement in

clinical practices, which serve as a foundational experience that fosters confidence, empathy, and

the capacity to interact effectively with patients and colleagues. Furthermore, this study can

guide parents in recognizing the value of encouraging their learning and professional growth.

Future researchers The related literature and the results of this study may motivate them to

conduct further related studies that would explore the specific aspects of clinical duty that most

influence communication skill enhancement, such as interactions with patients, collaboration

with fellow healthcare professionals, and exposure to diverse clinical scenarios.

 Chapter II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter deals with the relevant and significant literature and studies obtained from

references such as articles, published research, and websites, both foreign and local. It also

contains the theoretical framework and research paradigm.

Related Literature

According to Saputro et.al 2020, communication is the transmission of a message.

Communication is not only an ability differing from person to person, but also it is a skill

that can be obtained with necessary training and experience. Communication is an essential

component of nursing and has critical importance in nursing practiced and it’s an inseparable

part of quality care. Effective communication increases the satisfaction of patients. (Bademli,

2019). One of the many abilities that nursing students need to develop in order to succeed in their

industry is excellent communication. The nursing students would become more confident about

their communication knowledge and skills through the modeling and interactive adaptive

learning exercises. (Steckler ,2012)

The Bachelor of Science in Nursing (BSN) program has clinical components providing

nursing students rich and varied opportunities for practice experience to care for patients across

the continuum of care. An effective and supportive clinical learning environment (CLE) is

essential to achieving student learning outcomes resulting in the development of necessary skills,

knowledge and behavior required to provide safe and quality patient care. (Inocian,2022).

Clinical rotations give students a working environment that simulates patient encounters and
confrontation requiring an individual to interact with patients, families, and colleagues. Padagas

2020, notes that students who participate in clinical practices not only gain technical knowledge

and skills but also interpersonal skills such as compassions, effective listening, and effective

communication. These are important skills in establishing rapport and ensuring patients

comprehension of medical directions, hence the importance of clinical exposure in creating the

upcoming healthcare professional’s communication generalship.

Tulabut et al. (2019) assert that learning in clinical environment entails note-taking, group

discussions and presentation of reports thus help improve the communication skills in getting

across information. Clinical practice to mitigate the effects of first impressions on public

speaking or miscommunication and how the practical interactions assist learners in conquering

pre-employment anxieties. Through participation in multidisciplinary team meetings and

associated collaborative problem solving, the students gain clarity, precision and flexibility in

their communication important values and skills in professional context. Clinical exposures put

the students in contact with the patients, fellow health care team members as well as the

lecturers, which creates an environment that enhances the growth of appropriate interaction skills

(Tulabut et al. 2019) . According to Fernandez et al. (2024), self-observed clinical

communication could be reasonably adequate, but only slightly so since nursing students are

found to have moderate communication skills, although higher semester students reported better

skills because they have more opportunity to practice in clinical context. Nonverbal

communication also plays a vital role in nursing since not only is it an important component of

patient management, but also since the majority of medical errors are said to be as a result of

ineffective communication.
 The clinical setting is an essential factor in strengthening and exercising these skills using

practical experience and practice .Furthermore, the teaching and preparation of students can be

attributed to the high significance of involvement of clinical instructors as far as communication

is concerned. Clinical experience interactions can be followed by debriefing led by the instructor,

which enable the instructors to give constructive criticism to the students and make them

consider certain aspects of their behavior. (Acosta et al., 2023).

According to Magpile et al. (2023), the fact that students gained support in learning

environment increase the students’ communication openness, thus making them more competent

in clinical practice. The use of effective instructional practices in clinical training can enhance

students’ interpersonal communication as they practice as expected in nursing. Developing

communication competencies with patients and coworkers is necessary for today. The first steps

for getting students ready to become good communicators are knowledge and principles of

practical interpersonal communication skills and extending these skills in communication with

patients and coworkers. Still, attitudes toward using these skills in daily practice are undeniably

crucial. Forming attitudes towards the importance of learning and using communications skills is

a multifactorial entity.

Communication skills training program for nursing students, utilizing phenomenology as a

foundation. Nurses struggle to prioritize communication with patients because of time

constraints, as well as organizational and cultural elements. Similar to other healthcare providers,

nurses may face challenges in communicating with patients because of their own insecurities and

limitations. The curriculum for communication training, which is grounded in phenomenology, is

designed to teach students how to consistently pay attention to the stories of patients and their

families. This enables them to think critically and gain a deeper understanding of the present
circumstances. This method of communication can be used in any medical scenario where it is

crucial to make room for the patients’ experiences. The program includes both the theoretical

principles and the practical steps of the training. The strategy is evaluated against other typical

communication techniques utilized in nursing such as motivational interviewing, caring

conversations, and empathy training. This method can be improved, evaluated, and adjusted in

upcoming studies and could potentially serve as a motivational example for developing a

universal communicative skillset for nurse(Söderlund,2019)

Related Studies

Communication is a universal word with many meanings. Many definitions describe it as a

transfer of information between a source and a receiver. In nursing, communication is a sharing

of health-related information between a patient and a nurse, with both participants as sources and

receiver of information. Communication occurs in many ways and may be verbal or nonverbal,

written or spoken, personal or impersonal, issue specific, or even relationship oriented. It can

pertain in a larger sense to public health campaigns and policy issues, or it can relate to one

patient's personal experience with a health issue. Human communication is a continuous and

dynamic process, with the nurse and patient developing a relationship not only to share

information but also to facilitate growth and healing.(Sheldon,2009).

Nursing students entering their programme of study are already experts, as communication

is 'learned since birth'. While there is often excitement upon presentation of the range of clinical

skills and nursing care topics, lectures, tutorials and small-group teaching of communication

skills can be met with a certain reluctance, in so far as many students have been practising these
basic skills for at least 17 years. Thus imparting the basics of communication in a way that

engages students can be difficult. Additionally historical and popular rhetoric, emphasised more

recently in screening for 'compassion' among potential nursing students, lends credence to the

notion that a person has the 'personality' to be a nurse and by default may not need that much

input in communication theory and skills.(Riley 2015)

Catherine Mccabe et.al, 2013 made a study about the communication skills for nursing

practice. They argued that communication is not actually communication unless it is intentional.

When communicating, you need to consider and be aware of the effect your facial expression

and tone has on another person. Your behaviour whether verbal or non-verbal, will influence

how another person communicates with you because of the message that your tone and body

language sends out. (Mccabe et.al, 2013)

This study is concerned with interpersonal communication in nursing, regardless of the

medium through which it takes place. The emphasis is on the verbal and/or non-verbal language

required to deliver the message in a manner that is patient-centred, respectful, genuine and

therapeutic. This requires a level of awareness, not just of the specific nature and purpose of the

message but most importantly it requires knowledge of one's self. Communication is about

interacting with people and therefore is at the core of nursing. For nursing care to be effective

and therapeutic, the communication skills used by nurses need to be positive and patient-centred.

(Mccabe et.al, 2013)

According to Philippa Sully et.al, when caring for a patient therefore nurses may have to

emphasize the importance of sharing specific information; however they will have to be clear

themselves that what they are asking is necessary and relevant. This will also have an impact on
the group dynamics, particularly if the members of the team or seminar group have different

preferences with regard to self-disclosure. The facial expression of people from, for example,

Japanese and Filipino cultures may not portray the uncomfortable emotions they are

experiencing: nurses may therefore have to use their skills to elicit what the person may be

feeling and discover how to help.(Sully,2019)

While the tone of the nurse's first words to the patient sets the framework for future

conversations, it is often the missed communication that impacts the care that will follow. Each

time a nurse meets a new patient, a relationship begins for both the patient and the nurse.

However, this is a different type of relationship from the usual social roles because it involves

the nurse as a professional health- care provider working with a patient. These relationships often

develop at vulnerable points in patients' health, when they are seeking assessment, treatment,

information, and often reassurance. Gone are many of the social boundaries that define everyday

relationships. These are different relationships; ones that have the potential to affect both the

patient and the nurse.(Sully,2019 )

A study of Jenifer H. Alcorano 2023 entitled the extent of the therapeutic

communication skills of the medical and surgical nurses of the Philippine Public

Hospital conducted in Ospital ng Palawan. The researcher used a researcher-made

questionnaire to describe the respondent’s profile and the extent of therapeutic communications

skills, frequency counts, means, weighted means, and the rank was used. It reveals that the

nurses are competent in therapeutic communication skills at the hospital regarding the Acting-

Response Technique and Active Listening Response technique. It revealed that age, gender,

ethnic group, the native language spoken, religion, and educational attainment were not
significantly correlated to the acting response and acting listening-response techniques

regarding the stand, open, lean forward, eye contact, and relax. (Alcorano 2023 )

Based on this study's significant findings nurses should take graduate studies that will give

them in-depth knowledge and practical skills in their field. They should improve their therapeutic

communication skills, develop and maintain a healing relationship in which their patient will

experience security, and be optimistic that positive change is possible. Moreover, nurses should

always possess a good and caring attitude toward their patients. It must be based on mutual

agreement between nurses and patients as to what constitutes nurse caring behaviors (Alcorano

2023 ).

A study of Jamshidi et.al, 2016 entitled “The Challenges of Nursing Students in the

Clinical Learning Environment: A Qualitative Study’’. The study aimed to explore Iranian

nursing students’ challenges in the clinical learning environment.This is a qualitative study using

the content analysis approach. Nurses’ competence is based on the knowledge and skill taught to

them . Nursing training is a combination of theoretical and practical learning experiences that

enable nursing students to acquire the knowledge, skills, and attitudes for providing nursing care.

A large part of nursing education is carried out in clinical environments. In Iran and many other

countries, clinical education forms more than half of the formal educational courses in nursing.

Therefore, clinical education is considered to be an essential and integral part of the nursing

education program . Since nursing is a performance-based profession, clinical learning

environments play an important role in the acquisition of professional abilities and train the

nursing students to enter the nursing profession and become a registered nurse. Unlike

classroom education, clinical training in nursing occurs in a complex clinical learning

environment which is influenced by many factors.( Jamshidi et.al, 2016 et.al)

 Based on the results of the study, many students lack the communication skills necessary

for effective communication in the clinical environment. It is suggested that the effective

communication skills are taught to students before they enter the clinical environment with the

emphasis on the differences between the clinical environment and the classroom environment .

(Jamshidi et.al, 2016)

Furthermore, the educational institutions offering the nursing course should emphasize

their curriculum to improve the therapeutic communication skills of a student nurse. The journey

to becoming a nurse requires students to demonstrate effective communication skills with

patients, careers, and other healthcare professionals (Alcorano 2023 ).

To qualify as a nurse, therefore, students should be able to contribate to teamworking by

understanding their own role in the team, respecting the role of others, and managing the

resources available within the team for the benefit of their patients. Working with others from

different professional backgrounds and often with different priorities can be challenging, but it is

often the nurse who takes the lead in coordinating health-based care by using good

communication and management skills to provide a holistic care package for the patient. (Lucy

Web 2011). Numerous dilemmas, confusions, misunderstandings and anxieties arise as we try to

tease out what we bring to the game as individuals, what we encounter in our roles as students

and nurses, and what are complex aspects of the patients, relatives, professionals and

organisations we engage with.(Riley, 2015)

Nurses, like all human beings, are complex organisms with feelings, fears, hopes, and

needs. Like other humans, nurses are the product of their genetic makeup, family environment,

peer networks, cultural background, and previous experiences. Becoming an effective nurse
requires identifying the characteristics that make each person unique, including oneself. The

process of self-examination requires a more personal and honest reflection about the effect of

past and present influences on current behavior. Most nursing students want to develop into kind,

respectful, and effective professionals. They are motivated to understand and work with their

patients to promote comfort, understanding, and healing in a patient- centered manner. However,

to become a successful nurse requires understanding the wide variety of human responses to

stressful circumstances in the healthcare setting. Students need to develop into nurses who use

the knowledge and skills of nursing in a manner that allows for accurate assessments, mutual

goal setting, and timely interventions. Understanding human responses, both the nurse's and the

patient's, requires knowledge of the self. With time and experience, you will grow into the nurse

and communicator you want to be, given your personal strengths and professional goals. Each

nurse is a unique mixture of many qualities. The development of your communication style is up

to you. (Sheldon,2009)

Theoretical and Conceptual Framework

Research Paradigm
 Chapter III

RESEARCH DESIGN AND METHODOLOGY

This chapter presents a detailed discussion of the research design, including the study’s

setting, target respondents, sampling procedures, data gathering, instruments and validation

techniques utilized to ensure reliability and accuracy. Furthermore, this chapter explains the

administration of instruments and statistical treatment of data gathering employed to treat and

interpret the data.

Research Design

Research Population

The respondents of this study will be third-year nursing students who were Palawan Polytechnic

College Inc., selected through simple random sampling process, ensuring representative and

unbiased sample.

Research Locale

This research will be conducted at Palawan Polytechnic College Inc., a branch of Mats college of

Technology in Davao, located in Puerto Princesa city. This school offers a range of programs,

including elementary, secondary, and senior high school tracks. Specifically, this research will

focus on gathering data from third-year nursing students enrolled in college’s nursing program.

Research Instruments

Data Gathering Procedure

After the approval of the title of the research paper

Statistical Treatment

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