Skill Enhancement Lab for Nursing Assistants


Basic communication skills and cultural awareness are the most important learning experience of a nursing assistant’s internship in order to comprehend their role in the health care faculty. Besides, nursing assistants are significant members of the nursing team (one part of the interdisciplinary health care team that plans and provides care to clients). Nursing assistants also make important contributions to the nursing practice that the professional nurse follows in estimating or determining the nature, value, quality, ability, extent, or significance of the client’s needs, planning interventions, implementing care, and evaluating outcomes.

Nursing assistants must be assisted to see the essential role their exact observations, communication skills, reporting skills, and cautious attention to training play in the general success of nursing care. Only then can they be acquainted with their full importance as members of the nursing team. Thus, enabling them to cope with the requirement that is desirable to the patient by providing a high level of reassurance, recuperation, and the state of good health and ensuring adequate clients’ rights as healthcare consumers.

Nature of the Problem

As we all know, communication in the nursing home requires full use of cultural abilities or resources. Regularly people in a nursing home, regardless of their normal or customary activity, experience a state of mental or emotional strain or suspense, which results in ineffective communication.

As a result, communication may be a problem, but nurse assistants must be conscious that learning is often culturally based and take this into account. Although, new nursing assistants frequently go through difficulty in communication more acutely than other nurses, however, if they suffer severe physical strain or distress, their ability to learn suffers. They want to learn the new short theatrical performance that is part of a longer program, master all the skills and fit in all at the same time. They may be uncertain about how to do something but are too afraid to ask for help. This could be even harder if they don’t feel they can communicate effectively.

As regards this, Communication within the Culture Change Committee and Council Leader Group meetings are critical at Veteran Affairs Medical Center and the Community Living Center. Miscommunication does occur occasionally, even when people have good intentions. Consequently, it is important to know how to show sincerity and warmth to the veterans, family members, and staff, which is a core principle of the Culture Change transformation. It is worth noting that miscommunications, staff attitudes, and communication techniques directly affect resident care as well as the living and working environment of the Community Living Center (Hoffart &Woods, 1996).

Training and interactive evaluations of competency in communication techniques will ensure a nursing assistant’s readiness for patient care. This training will enable the assistants to recognize the importance of effective communication skills and stellar attitudes to the delivery of health care services within the Community Living Center. A structured educational program that entails interactive methods is required to educate and empower frontline nursing assistants. The Skill Enhancement Lab will help to determine their competency and advancement with regard to communication and relationships (MIT, 2006).

With the increased quick and penetrating intelligence of nursing home residents and the consequent complexity of care needed today, some present reasons and arguments that training should be significantly improved and, especially, ties to the clinical problems identified in nursing homes (Burgio and Burgio, 1990). Training for nursing assistants in an institution where people are cared for should incorporate communication skills, clinical care of the aged and disabled, occupational health, and safety measures.

Nursing assistants themselves are reported to say they need more training and experience, mostly in the management of residents with dementia, depression, and aggression, and ineffective communication (Mercer et al., 1993). Most preferably, training programs should be structured to include career development for nursing assistants. Increased levels of training are considered likely to increase the essential and distinguishing attributes of care in nursing services. Regrettably, research is deficient on the consequence of diverse levels and kind of training on the quality of care provided in an institution where people are cared for.

There is some agreement among experts, however, that there is a relationship between the level and type of training and the quality of care that nursing assistants provide.

Lessons learned from effective communication in nursing

In the program for effective communication in nursing, it was understood that nursing assistants were found to concentrate on the technical aspect of care which prevented the development of supportive relationships with patients. It was also researched that effective communication in nursing is an important aspect of patient care in ensuring patients’ well-being; it also must be clear and be easily understood.

The information must be relayed with very few unnecessary details. Moreover, timelines for giving information is important for it portrays a true sense of urgency.

Also, nursing assistants are often treated as if their jobs require few skills. However, they shoulder tremendous responsibilities, since they are responsible for the daily health and well-being of the residents. This requires a complex set of technical, social, problem-solving, and communication skills. In short, all the skills required of a professional. Until now, few nursing assistants have been offered professional jobs, instead, they are offered locked-in, no-growth jobs which almost ensures that they will move on to do something else. Skill enhancement lab in establishing communication competency in culture change, on the other hand, offers them a sense of pride and feeling of expertise in their position.

The program also offers nursing assistants the skills; encouragement, and confidence that will help them develop into quality health care professionals. This will lead towards knitting the nursing assistants into a smoothly, functioning caregiving team.

In an ideal world, all nursing assistants would have clinical learning activities in all settings, with all client groups, and in all professional nursing roles. In addition to preparation for the challenges of nursing practice today, students would be prepared to adapt to the challenges of nursing practice, students would be prepared to adapt to change as clients, health issues, care locations, and approaches to care evolve. Nursing assistants would have opportunities to work with clients from cultures other than their own and implement care that recognizes the global influences on both health and illness.

Purpose of the Internship

The purpose of the internship is to learn skills in setting up and constructing a skill lab as a venue to an innovative approach to learning how to empower direct care providers through competencies and effective communication skills that are needed for mandated cultural change in long-term care units.

Effective communication skills are critical to nursing assistants and the culture of change for health care. Nevertheless, proficiency in these skills is not instinctive. Communication proficiency must be trained in a way that is comparable to how other psychomotor abilities are trained. This is particularly important when “communicating with residents about awareness of the aging process and treating residents as people, not just bodies” (Inspector General Office, 2002, p. 4).

In addition, a lack of continuing education for nursing assistants has been well documented in the literature. Findings from a 2002 Inspector General Report stated that nursing assistant training has not kept pace with the needs of the nursing home industry. In addition, evidence suggests that the method of delivery of education is extremely important. For example, studies consistently show that a lecture-type delivery is least effective, and an interactive method seems to be more effective (Costa, Van Rensburg, & Rushton, 2007). Enhancement of communication skills among nursing assistants can significantly improve service delivery to the community as well as interaction among peers.

Review of Literature

Communicating with others is a necessary element of the nursing assistant’s daily life (Husband and Torry, 2004). The essence of communicating expresses itself in several ways. Communication satisfies numerous purposes that are important for our comfort and welfare. It assists us in setting up relationships, exchanging information and ideas, and attaching value in our daily endeavors (Costa, Van Rensburg, & Rushton, 2007). In the health care line of work, communication plays a major role in indicating a helpful and therapeutic method. Failure to provide precise and simply comprehended information, for instance, can lead to concern and may have grave effects where treatments are concerned. Communication is a vibrant and intricate procedure.

However, Miscommunication can contribute to differences and misunderstandings, and generally, can endanger patient wellbeing (Kruijver, Kerkstra, Francke, & Bensing, 2000). When a social encounter is being measured, a nursing assistant may turn out to be aware of the many evident and unseen characteristics of communication (Kruijver, Kerkstra, Francke, & Bensing, 2000).

Similarly, these characteristics are components of expressing acknowledgment and appreciation of the communication. In successful communication, the mutual significance of the point is important to the result of the common meeting. Comprehension of the message being expressed can be realized through a similar understanding of language and linked silent signals and symbols (Costa, Van Rensburg, & Rushton, 2007).

Nurses’ most important communication assignments are not only to enlighten the patient about their ailment and treatment, but also to fashion a therapeutically successful rapport by considering patients’ anxiety, presenting understanding, sympathy, and the provision of comfort and support (Kruijver, Kerkstra, Francke, & Bensing, 2000).

Nursing assistants make up the main percentage of caregiving workers in nursing homes. They offer the majority of the direct attention and use the most moment with inhabitants, but they have modest education for embarking on care in a nursing home. The healthcare institute, employment, and teaching of nursing assistants create a significant distinction in the care, comfort, and physical condition of residents in the healthcare environment, as well as in the state of individual psychological well-being based upon a sense of confidence and usefulness and purpose and wellbeing of the nursing assistants.

Furthermore, Nursing Assistants work under the supervision of nurses and handle much of the personal care needs of the patients. Nurse assistants assist in changing patients’ location and help the patient in exerting the muscles in different methods to keep fit and in the nutrition that needs to be eaten to sustain patient’s body needs, and watch and direct patients’ individual cleanliness (Ryan-flynn, 2008, 179).

The job of a nursing assistant can be characterized by or performed with much energy or force, necessitating the raising and motivating of the person who requires medical care. The task of nursing assistants requires teamwork. All these tasks of direct contact with the patients and enable them to develop a meaningful relationship with the patients, thus gaining their trust and friendship (Ryan-flynn, 2008, 245).

According to Winchester (2003), more patients suffering from fatal illnesses are being placed into nursing homes, because, an institution where people are cared for offers special care for residents. For this reason, most medical attention in nursing services is rendered by skilled nursing assistants, not by an experienced nurse. It is estimated that on average 40 certified nursing assistants are attached to 100 resident beds (Winchester, 2003, 178-81).

On account of the higher number of nursing assistants, excellent care calls for exceptional communication abilities; nursing assistants who have the responsibility of caring for these patients are often insufficiently skilled. The report on nursing assistants’ communicative skills further asserts that nursing assistants “receive little education in communication during training programs or as in-services in the nursing home” (Winchester, 2003, p.178). Lyons, Specht, Karlman, and Maas (2004, p. 5) acknowledge the following: “effective communication and teamwork are essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm” (Rahman & Schnelle, 2008, p. 6).

Since Communication is the nursing assistant’s arm. It should have the capacity to lead residents to accept service and to help nursing assistants through the accomplishment of the service. In the provision of an effective communication role, the nursing assistants provide services to any residents by making good use of communication skills. The nursing assistants need to ask questions about the degree of customer satisfaction, and also encourage the residents to ask for more services in case of needs. The nursing assistants need to keep on engaging the residents until he/she is satisfied.

The guiding principle to aid in the process of culture change in nursing homes has been developed by Quality Partners of Rhode Island, the “Holistic Approach to Transformational Change (HATCH) model” (Quality Partners of Rhode Island, 2010, p. 7). These guidelines consist of six closely-related domains that lead “to individual, organizational, community and systems changes” (p.8): workforce, care practices, environment, leadership, family/community, and regulatory/government. The “HATCH model considers these six inter-related domains necessary for a transformation from institutional to individual care” (Quality Partners of Rhode Island, 2010, p xx). Workforce practice, care practice, and environment overlap and are surrounded by leadership, while long-term care units are encircled by family and community, and then by regulatory/government domains.

Of these six domains, the workforce is the ultimate purpose of the Skill Enhancement Lab. “Workforce” refers to all the activities, procedures, and individuals whose labor and efforts impact residents. This domain is critical because of the correlation between good jobs and good care.

The domain of workplace practice offers possible changes in establishing relationships as the foremost organizational priority, supporting the necessary changes and adjustments that will allow relationships to flourish personally: organizationally and environmentally; the inclusion of elders, caregivers, and families in developing avenues for relationship building; the use and promotion of learning circles; welcome and hospitality committees; red carpet orientation programs; new ways of welcoming new families, staff, and residents (Compas, Hopkins, and Townsley, 2008).

Various issues in front of the education of a nursing assistant consist of the increased quick and penetrating intelligent intensity of patients, the shortage of nursing assistants, and the irregular character of the nursing assistants.

Quality and wellbeing of the patient have turned out to be the main common center of attention having the power of driving or impelling the improved answerability of the nursing module and students to grant secure, valuable ability to perform attached duties in an exceedingly complex health care environment. Nursing assistants are required and expected to display leadership ability that has been acquired by training in the synchronization of patient care and safety and at the same time keeping an eye on multi-corrective “cooperative” units supplying multifarious attention. Progressively, nurses are considered likely to employ their cognition to change the system of health care.

Simulation offers an atmosphere for the instruction and knowledge of multiple disciplines of behavioral teamwork through situations entrenched by communication, wellbeing, passing on, analytical thinking, and other significant nursing curriculum results where novice nursing assistants are able to carry out their duties in a secure environment (Haskvitz & Koop, 2004; Jeffries, 2007; Radhakrishnan, Roche, & Cunningham, 2007).

Healthcare reforms in today’s society require nursing assistants who are committed to innovate clinical care through the evidence-based practitioner’s process. Through evidence-basedpractitioners innovations, healthcare quality can be improved to provide the best patient outcomes. A culture that supports nursing assistants to innovate improvements in patient care through evidence-based “practitioners” is essential to implementing and sustaining this gold standard paradigm.

Kanter’s Theory of Structural Power in Organizations provides the framework to help nursing assistants in their efforts to change the culture of patient care (Kanter, 1993), and Benner’s Novice to Expert Nursing Theory (1983) provides the venue for peer mentoring.

Individuals have the ability to empower those around them through communication and can therefore create an effective work unit within the organization. On the other hand, individuals in positions that limit their ability to acquire power and opportunity often perceive themselves to be powerless.

These individuals lack control over their practice and are dependent on those around them. According to Kanter (1993), powerless individuals are more rigid and rules-minded, and are less committed to the achievement of organizational goals. Kanter’s (1993) theoretical framework was the spark for developing the program known as Guided Growth Intervention to empower nursing assistants to effectively communicate with the residents in the long-term care setting.

Furthermore, Kanter’s theory of structural power in organizations was chosen to assess empowerment in mentoring relationships. Although its origins are in organizational environments, Kanter’s theory has recently been used to study empowerment structures in nursing education, and a good fit with educational practices has been demonstrated. Kanter proposes that access to empowerment structures (information, resources, opportunities, and support) leads to self-efficacy, motivation, commitment, and job satisfaction. In relation to this study, it is anticipated that the mentoring relationship will provide nursing assistants with access to these empowerment structures and that participants will be empowered as an outcome of the mentoring relationship (Kanter, 1993, p.266).

Benner’s classic works entails some levels of nursing competency. These levels represent progression in the aspects of skill performance:

  1. the nursing assistant moves from reliance on principles to the use of past experience.
  2. Assistant nurse moves from perception of equally relevant parts to the perception of the complete whole and discernment of relevance of the parts (Benner, 1984, p.80).

The assistant nurse is described as developing from rule based text-book guidelines and contextual variations within the setting to having some real experience and skilled performance.

As the assistant nurse progresses to the proficient level of practice a shift in perspective occurs. The proficient assistant nurse has advanced from viewing aspects of the patients situation to seeing the situation as whole and appreciating the long-term implications (Benner, 1984, p.27).

Nursing assistants in the proficient level also base their care on knowledge derived from past experiences. Past nursing-care experiences enables the proficient nurse to create a picture of what constitutes a normal, expected, patients care situation. The expected situation can then be compared to what is actually observed. Benner describes this stage as using maxims or subtle nuances to guide nursing care (p.29).

The final stage of skill proficiency is the expert nursing assistant who has many years of nursing experience in a specific specialty. The expert nursing assistant has progressed from using rules, guidelines, and maxims in providing patients care to using intuition (Benner, 1984, p.32). Benner further describes several unique characteristics of the expert nurse. Furthermore, he stated that nurses often have difficulty describing how they know that their interpretation of the situation is accurate or on what information a particular decision is based. Second, the clinical performance of expert nurses may not be easily captured by traditional performance evaluation criteria that value stepwise, analytical processes (p.34).

Factors of Communication

Several factors contribute to the problems of communication in intensive care. Many patients come to the intensive care unit as acute emergencies, having been previously well, with no apparent reason to consider their likely imminent morality (Kanter, 1993). The sudden nature of admissions means that intensivists rarely have established relationships with their patients, and patients in intensive care usually are unable to take part in discussions (Kanter, 1993). It is difficult to predict outcomes for individuals. A further barrier to good communication in the intensive care unit may be the physician’s own feelings of grief and inadequacy in dealing with dying patients.

Physicians own religious and cultural differences profoundly affect attitudes towards withdrawal of life support. In a questionnaire study of Vincent, it was found that physicians with strong religious beliefs were less likely to withdraw life support (Husband and Torry, 2004). Many intensive care units, particularly in the inner city areas, serve multiethnic and multicultural communities whose diverse values must be appreciated (Husband and Torry, 2004).

One consistent research finding in North America is the importance that families place on communication. In a meta-analysis addressing needs of family members who have loved one in the intensive care, eight out of 10 needs identified were related to communication with nursing assistants (Husband and Torry, 2004). Nursing assistants usually have had little training discussing dying in or out of the intensive care unit, so it is not surprising that the quality of such discussions is poor (Husband and Torry, 2004). Effective communication depends on the clinician being able to recognise that a problematic situation exists and then to address it promptly and appropriately. If this discussion takes place too late, if it is inadequate to meet the family’s needs or end abruptly, families may feel betrayed and abandoned leading to conflict between families and physicians.

Theoretical Framework for Mentoring

Benner’s (1984) theory describes how nurses perceive their clinical expertise or skill through five stages:

  1. Novice: No background knowledge to critically analyze cases.
  2. Advanced Beginner: Begins to grasp situations with assistance from mentor/preceptors.
  3. Competent: Able to analyze the situation and change approach to care based on the resident’s situation and needs.
  4. Proficient: Sees the total picture, has background and understanding, is aware of the needs of the residents; able to understand nonverbal cues.
  5. Expert: Has significant background and vast experiences; identifies the problem and takes action by changing or supporting practice.
  6. This perceived level of expertise will guide in the matching of mentors and mentee.

Methods and Procedures


Mentor and Preceptor: Daisy Galindo-Ciocon, Ph.D., ARNP

She is the nurse researcher of long-term care unit and directly involves in the Guided Growth program of the long-term care nursing staff in the culture change journey. This includes peer mentoring program and research on the road. She has taught nursing research to the nursing staff, and directing the creation of the Skill Lab as part of developing and evaluation competency. She involves the nursing staff in research studies and evidence based practice.


This internship will take place at the Veterans Affairs Medical Center (VAMC) in the long-term care unit. It is a 360-bed hospital with other health services provided in the outpatient clinics. It has a 24-hour emergency room. The hospital offers minor and major health care procedures for veterans. The long-term care unit comprises 4 units with 80 beds, and care is provided for residents with multiple medical conditions.

Culture change is the most important building block in the foundation of successful long-term delivery. As the field of long-term care evolves, so must the profession transform itself to keep pace. Nursing assistance is required now more than ever to continuously look for ways to maintain or bolster organizational creativity and innovation.

Communication skills

Communication with the elderly requires special skills apart from speaking, listening, writing, and presentation skills. Particular attention must be paid to language use with older adults. Use of technical jargons is commonplace among nursing home associates, but such jargon should be avoided when communicating with clients and their families. For example, associates should use the term food service instead of dietary. Simple and straight forward language is is the most effective method of verbal communication.

A hand shake or touch adds warmth to the communication process. Sitting in close proximity to an older client aids understanding of what is being said and is also taken as a sign of acceptance. Active listening, repeating, and feedback are essential techniques for communicating with the elderly to ensure understanding. Because hearing impairment is a common problem among nursing clients, use of clear diction and a slow pace of talking are important. Another good strategy is to use the patients’ names frequently, so they know that they are being addressed.


The skill lab will be created for the nursing staff in Long Term Care Units, to help improve their communication skill. Additionally the initial activities will be for nursing assistants’ education and training needed for culture change journey.

Goal and Objectives

  1. To acquire information or evidence of the best teaching method and evaluation tool appropriate to the educational level of the nursing assistant.
  2. To empower and enhance nurses assistants’ ability to access and mobilize support, information, resources, and opportunities from their position in the organization (Kanter, 1993).
  3. To set up mentorship support system to sustain the education in providing care reflective of the change in culture.
  4. To promote high quality resident centered care that is team based, compassionate, and evidence based.
  5. To gain knowledge in teaching and evaluating skills, and monitoring the competency of the health care providers.
  6. To apply this knowledge in creating an innovative approach to enhancing communication skills


  1. Learn how to set-up a Skill Enhancement Lab. To learn about interactive role playing,
  2. To learn the best mean of communication.
  3. Learn how to identify if there is any support system from other departments to enhance communication skills.
  4. To learn how to match mentor and mentees to improve communications, utilizing Benner’s classification of novice to experts.
  5. Learn what is the most effective techniques in a script.
  6. Understand the relationship between nursing assistance and culture change
  7. Discuss the role of nursing assistance in long-term care.
  8. Identify and distinguish the components of nursing assistance.
  9. Understand and explain the role of culture change in long-term care.
  10. Identify and differentiate the components of culture change and how it is implemented.

Skill Lab Program Information

This program will be a venue to meet the nursing assistants’ educational needs. This program also provides teaching opportunities. Other support is available from other disciplines and staff, such as the librarian. Resources included financial support for conferences and poster presentations. Information is provided through classes and group projects as direct application of communication skills is acquired. There is also the opportunity to participation in actual role playing and other skill enhancement opportunities. The Director who is also the mentor of this program will oversee these activities.

Design and implementation is based on a timeline that is being deployed in phases. During the first phase, a doctoral student preceptor, the Nurse Researcher, was identified as the architect for designing a skills lab for all long-term care staff with emphasis on relationship management. Also, during this phase, the Skills Lab will be branded as the “Nursing Assistant Culture Change Skill Enhancement Lab (NACCC-SEL)” (Misiorski, 2004, p. 3).

Schedule of Activities

Preceptor Daisy Galindo-Ciocon, PhD. ARNP.

Week Activity Hours
1 Meet with Preceptor: to learn how to brainstorm plan for SEL and to outline the activities, goals, and objectives 12
2 Meet with Preceptor: to learn how to assess the needs of the institution and learn how to use Literature review on the SEL, communications and competency. 10
3 Meet with Preceptor and nursing assistants to learn how to assess their perceived barriers in communication and in promoting culture change. (series of meetings) we will meet for 2 hours, four times for this semester. 8
4 Meet with Preceptor: Discuss the priority problem in communication that nursing assistants encounter almost daily. 8
5 Meet with Preceptor: Discuss the miscommunication script, and meet with the media in preparing a DVD of this scenario. 10
6 Meet with Preceptor: Planning for a dry run of the video for a small group of NA; let them identify what is wrong with the communication in the video and how they can improve the errors. 10
7 Meet with Preceptor: Evaluate the assistants’ perception of their level of effectiveness, from Novice to Expert. 8
8 Meet with Preceptor: Assist the mentor-mentee team in role playing effective communication. 8
9 Meet with Preceptor: Evaluating the experience and how the goals and objectives of this Preceptorship program have been met. 4
Total hours 80

Results: BASIC—Learning Outcomes

Learning this skill is important to advance and enhance knowledge in this new program of cultural change needed in the job as a Supervisor. I will be prepared for greater professional growth or promotion. Furthermore this will enhance the skills I need in using evidence-based practice in cultural change policies, in mentoring peers, in communication, in setting up a program for the nursing staff on cultural change to establish competencies, in evaluating the effectiveness of the program.

  • Provision of broad practical cultural knowledge. Participants of the skill enhancement programs enhance their practical levels with different skills.
  • Provision of an enhanced essential skills in nursing practice communication. – Evaluation and examination of healthcare approach and practice in a diverse scenery.

Strength, Weakness, Opportunity, and Threats Analysis

The Miami VA has officially begun the culture change program and has established the NACCC. Also, all staff has had basic orientation and education about the culture change journey.

However the strengths are:

  1. Establishing and building relationship which is the core aim of all effective communication in a cross-cultural setting.
  2. Recognition of one’s cultural filters, including the values and stereotypes that shaped them.
  3. Work at understanding cultural preferences.
  4. Respecting the appropriate level of formality in other cultures.


There is no objective way to measure nursing staff competency in carrying out culture change.


The VA is part of a larger organization like a VISN and central office. Culture change is a mandate for all the units…to change. With this comes the opportunity for consultations with the experts in culture change. Sharing with other local VA is available through telephone conferencing. The director of the culture change program will intern with the educator of the long-term care unit will create, monitor, and evaluate a culture change skill lab.

The opportunity of familiarizing with cultural and communication skills.

Opportunities for doing the skills led the nursing assistants to higher level of competence with the skills such as accuracy, speed, patient comfort, and ability to evaluate and record outcomes.

Furthermore, motivation was achieved by the nursing assistants which helped to apply full scope of theory to their practice.

Positive organizational skills were used, enabling the opportunity for clinical competency and improved communication skills. Also, health teaching and health counseling skills improved as communication skills became more relaxed.

Additionally, evidence-based practice needs to be an integral component of the education and training of nursing assistants in a way that provides a common ground for professionals to integrate their skills and knowledge to ensure that palliative care is administered both effectively and sensitively. Education about evidence-based practice needs to be supported within the culture of an organization that delivers palliative care, whether it is in the community, nursing home, hospice or hospital. It is such an endorsement that encourages the free flow of best evidence in everyday practice.


Nursing homes are now facing combination of financial, workforce turnover, and liability issues that may destroy them in their current form.

The bottom line of skill enhancement lab was that nursing assistants scores improved and their capabilities developed. Specifically, nursing assistants reported an increase in self confidence and self-image. This lead to an improvement in skills and level of stress lowered tremendously. Learning objectives where achieved well in the lab settings. However, the combination of focus on the nursing process, and safety competency provided excellent opportunities for the interns to develop a high level of proficiency in their physical skills. All procedures were tested and approved in the skill laboratory.


An efficient and effective communication and cultural skill is the optimal model of delivery of palliative care, yet health care professionals’ education still tends to occur within single disciplines. It will be more appropriate to adopt a multi-disciplinary approach to the teaching of and training in ethics and communication skills, to reflect clinical practice (Keogh, Jeffrey and Flanagan, 1999).

Healthcare professionals and nursing assistants may feel inhibited about teaching ethics and communication skills for a number of reasons (Jeffrey, 2002). Some nursing assistants have little practical and communication experience and they also lack confidence in their ability to perform their duties, especially in a complex situation.

Moral values and communication are sensitive areas in the practice of healthcare. However, teaching and learning should take place in an environment in which everyone’s view is respected and where a positive approach is emphasized, whereby praise and constructive criticism are much more effective aspects in the learning of communicative skills.

As regards this learning situation, people feel confident to disclose areas of difficulty more easily. These promotes competent and compassionate nursing assistant who are inspired to continue developing more skills.

Recommendations and conclusion

Healthcare systems may become inefficient due to poor communication infrastructure in practice. However, lack of communication was the commonest cause of preventable death (Winchester, 2003). Communication mechanisms may be either synchronous or asynchronous. Furthermore effective communication is enhanced by the formation of good interpersonal relationships, in which nursing assistants feel able to communicate their feelings about their patients without fear of ridicule by medical colleagues.

Team members need instruction in the appropriate use of communication facilities. Also, nursing assistants should consider the consequences of communication action with regards to their colleagues and patients, and reflects on the effective use of communication skills.

An important objective of inter-professional education is the fostering of mutual respect, this means that if nurses and nursing assistants were to receive some aspects of their education together, this will help to remove barriers and develop mutual respect and cooperation thereby avoiding potential conflict in the profession.

Collaboration practice in the healthcare institution involves good communication within a team. Individuals and groups depend on each other for information and help, and their inter-dependence may result in either a competitive or a collaborative relationship. Inter-professional education results in improved understanding of professional roles in collaborative working. Patients and their families will benefit if nursing assistants are aware of their own skills and limitations and are ready to employ the skills of others. Continuity of care builds trust, and this facilitates the introduction of other healthcare professionals into patient’s care.

Nursing assistants who is involved with the patient over time is in the best position to initiate a team approach. A team of reliable nursing assistants provides patients with a sense of security, consistency and comfort. In an effective and efficient inter-disciplinary team, each member will have an understanding of the roles of other members.

Nevertheless, Communication skills can be taught using a variety of techniques that enable learners to practice these skills in situations that are as close to those encountered in real life as possible. Many participants feel inhibited about practicing their communication skills. One way of overcoming this difficulty is to use the communication skill ladder.

The first step involves interactive and experiential work that is non-threatening. At the next step the degrees of personal participation increases, as does the potential for the learner to feel threatened. If communication skills are to improve, it is necessary for the participants to feel confident enough to practice their skills.


Benner P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley.

Compas, C., Hopkins, K.A. & Townsley, E. (2008). Best practices in implementing and sustaining quality of care. Research in Gerontological Nursing, 1(3), 209-216.

Costa, M. L., Van Rensburg, L. and Rushton, N. (2007), Does teaching style matter? A randomised trial of group discussion versus lectures in orthopaedic undergraduate teaching. Medical Education, 41: 214–217.

Haskvitz, L. M., & Koop, E. C. (2004). Students struggling in clinical? A new role for the human patient simulator. Journal of Nursing Education, 43(4), 181–184.

Hoffart, N. & Woods, C.Q. (1996). Elements of a nursing professional practice Model. Journal of Professional Nursing, 12, 354-364.

Husband C, and Torry B. (2004). Transcultural Health Care Practice: An educational resource for nurses and health care practitioners. Published by the Royal College of Nursing. Web.

Inspector General Office. (2002). Nursing aide training report. Geneva, Switzerland: Moran William.

Jeffrey, D (ed.) (2002). Teaching Palliative Care: a practical guide. Radcliffe Medical Press, Oxford.

Jeffries, P. (2007). Simulation in nursing education. New York: National League for Nurses.

Kanter, R. (1993). Men and woman of the corporation. New York, NY: Basic Books.

Keogh, K, Jeffrey, D and Flanagan S. (1999) The Palliative Care Education Group for Gloucestershire (PEGG): an integrated model of multidisciplinary education in palliative care. Eur J cancer care. 8: 44-7.

Kruijver I, Kerkstra A, Francke A, Bensing J. (2000) Evaluation of communication training programs in nursing care: a review of the literature. Patient Education and Counseling Volume 39, Issue 1, Pages 129-145.

Misiorski, S. (2004). Getting started: A pioneering approach to culture change in Long-term care organizations. Rochester, New York: Pioneer Network.

MIT. (2006). MIT training delivery methods survey report. Geneva, Switzerland: Gerzon Jeannette.

Quality Partners of Rhode Island. (2010). Hatch model – individualized. New York, NY: Gail Patry. Web.

Radhakrishnan, K., Roche, J. P., & Cunningham, H. (2007). Measuring clinical practice parameters with human patient simulators: A pilot study. International Journal of Nursing Education Scholarship, 4(1), 1–10.

Rahman, A. N., & Schnelle, J. F. (2008). The nursing home culture-change movement: Recent past, present, and future directions for research. The Gerontologist, 48(2), 142-148.

Ryan-Flynn, M. S. (2008). The Top 100: The Fastest-growing Careers for the 21st Century. New York, NY: InfoBase Publishing.

Winchester, T. A. (2003). Teaching communication skills to nursing home certified nursing assistants. Geriatric Nursing, 24(3), 178-81.

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