N ur s e Ed uc a ti on T od ay 5 9 ( 20 1 7) 3 3 –37

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Nurse Education Today

journal homepage: www.elsevier.com/locate/nedt

A qualitative study on communication between nursing students and the

family members of patients
Zenobia C.Y. Chan
Sc hool o f Nu rsi ng , T he H ong Ko ng P ol yt ec hn i c U ni v e rsi t y, H un g H om , Ko wl oon , H on g Kong

ARTICLE INFO ABSTRACT

Ke ywor ds: Background: When caring for a family as a unit, it is as crucial to communicate with the family members of a
C omm u ni c ati o n patient as it is with the patient. However, there is a lack of research on the views of nursing students on
Nu rs i ng st ud en ts communicating with the family members of patients, and little has been mentioned in the nursing curriculum on
Fam i l y-c en tred c ar e
Qu al i tat iv e s tud y this topic.
Aim: The aim of this study was to explore nursing students' experiences of communicating with the family
members of patients.
Design: A qualitative descriptive study.
Methods: A total of 42 nursing students (21 undergraduate year-two students and 21 were master's year-one
students) from one school of nursing in Hong Kong participated in in-depth individual interviews. Content
analysis was adopted. The trustworthiness of this study was ensured by enhancing its credibility, con rmability,
and dependability.
Results: Two main themes were discerned. The rst, “inspirations gained from nursing student-family commu-
nication”, included the following sub-themes: (a) responding to enquiries clearly, (b) avoiding sensitive topics,
(c) listening to the patient's family, and (d) sharing one's own experiences. The second, “emotions aroused from
nursing student-family communication”, had the following sub-themes:(a) happiness, (b) anger, (c) sadness, and
(d) anxiety.
Conclusions: More studies on the perspectives of nursing students on communicating with family members
should be conducted, to strengthen the contents and learning outcomes of nursing student-family communica-
tion in the existing nursing curriculum.

1. Background Nurse-family and nurse-patient communications are undoubtedly of

equal importance. Family members rated the subjective and emotional
Nurses care for a family as a unit, and the quality of nursing care is elements of the caring process more highly than did the patients
(He ernan et al., 2010; Henoch et al., 2012). Regarding the di erence
facilitated if family members understand the care plan and participate
between nurse-patient and nurse-family communications, Marshall
in supporting the client/patient during the course of health assessment,
et al. (2010) put forward the concept of “relation su ering”, revealing
treatment, and rehabilitation. More attention is now being paid to
that family members often su er more than the patient. Since the
communication in the context of family-centred nursing care in order to
emotions of a patient's family may in turn a ect that patient's emotions
build rapport between nurses and patients and their family members.
and recovery, it is essential to draw attention to the speci c need to
For instance, family-centred care underpins paediatric nursing globally
relieve the emotional and relational burdens on a patient's family. Fa-
(Alabdulaziz et al., 2017). Indeed, in interdisciplinary rounds in the
milies should be provided with detailed information and compassionate
paediatric intensive care unit, families are regarded as playing a pivotal
support to reduce their uncertainty, stress, spiritual su ering, and
role (Bogue and Mohr, 2017). Furthermore, e ective family-centred
practical costs (Regis et al., 2011; Yorke and Cameron-Traub, 2008).
communication has been advocated in nephrology nursing (Harvey and
One e ective approach is to improve nurse-family communication.
Ahmann, 2016). There is still room to improve nurse-family member
E ective nurse-family communication is positively related to patient
communication in various healthcare settings, such as in hospital set-
outcomes and safe practices (Lin et al., 2017). E ective communication
tings focusing on older persons (Bélanger et al., 2017) and in intensive
can lessen the emotional burden of both nurses and families
care units (Adams et al., 2017; Loeslie et al., 2017).

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0 26 0 -69 17 / © 2 01 7 E l s evi er Ltd . A l l r i gh ts res erv ed .
Z. C. Y. Chan
(Wittenberg et al., 2017). From the perspective of patients and their
family members, it enhances the relationship of trust that can be built
with nurses (Hemming, 2017). Such trust arising from e ective com-
munication has been shown to facilitate decision-making for residents
with dementia during end-of-life care (Rosemond et al., 2017).
Insu cient training in e ective nurse-family communication skills
has been reported in various specialties. For example, oncology nurses
perceived themselves as underprepared to communicate with the fa-
mily members of patients (Cronin and Finn, 2017). Nurses caring for
children with cancer have been found to experience various stressors
following pre-registration nurse education, one of these being com-
munication with families (Jestico and Finlay, 2017). Nursing students
have been found to experience emotional distress and a sense of in-
adequacy when communicating with families (Heise and Gilpin, 2016).
It has been suggested that nursing students undergo training to help
them retain their emotional equanimity when serving patients with
cancer and their families (Lin et al., 2017).
This present paper reports on the second set of data collected in a
major educational research study. The rst set of data concerned nur-
sing students' perspectives and experiences of communication between
nursing students and patients during their clinical placement (Chan and
Lai, 2016). This paper aims to explore nursing students' experiences of
communicating with the families of patients (referred to in this paper as
“families”).
2. Method
This study adopted a qualitative descriptive design, which makes
e ective descriptions of the data possible and allows for direct and
credible re ections on the views of the participants (Sandelowski,
2010). The two main research questions were:
1. What are the main contents of the communication between nursing
students and families?
2. What speci c experiences have nursing students had in commu-
nicating with families?
2.1. Participants
A total of 42 students from a university nursing school were pur-
posively recruited as the research participants. Of these, 21 were un-
dergraduate year-two students and the other 21 were master's year-one
students. The main criterion for inclusion in this study was prior clinical
experience with communicating with families.
2.2. Data Collection and Data Analysis
Ethical approval was obtained from the University prior to the
collecting of data. Forms giving their written consent to participate in
this study were collected from the participants. Participation in this
study was voluntary and all of the participants were informed of their
right to withdraw from the study. All of the participants were given an
explanation of the aim of this study and assured of privacy and con-
dentiality. Forty-two in-depth individual interviews were conducted
by the researcher and research assistant in a private room, with about
one to 2 h spent with each participant. All of the research data were
kept con dential and the principle of anonymity was strictly adhered
to. The interviews were audiotaped and then transcribed. Content
analysis was adopted: the transcripts were rst read and reread, the
signi cant narratives were underlined, meanings were drawn from each
transcription, and then the meanings from all of the transcriptions were
compared and contrasted. After peer checking was conducted between
the researcher and the research assistant, two core research themes
were discerned.
34
Nu rse E duc at i on To day 5 9 ( 20 1 7) 33 –3 7
2.3. Trustworthiness
The trustworthiness of this study was ensured by enhancing its
credibility, con rmability, and dependability. With regard to cred-
ibility, the interview questions were designed to collect descriptive data
that re ected real experiences. The interviewer would then paraphrase
the dialogues to ensure that the participants' views were accurately
interpreted. To enhance the con rmability of this study, peer checking
between the researcher and the research assistant was performed
throughout the study to reach a consensus. Finally, the dependability of
this study was upheld by performing audit trails throughout the process
of collecting, thematizing, and analysing the data.
3. Results
Two main themes were discerned: namely “inspirations gained from
nursing student-family communication” and “emotions aroused from
nursing student-family communication”. Each main theme consisted of
four sub-themes. The rst main theme, “inspirations gained from nur-
sing student-family communication”, included the following sub-
themes: (a) responding to enquiries clearly, (b) avoiding sensitive to-
pics, (c) listening to the patient's family, and (d) sharing one's own
experiences. The second main theme, “emotions aroused from nursing
student-family communication”, had the following sub-themes: (a)
happiness, (b) anger, (c) sadness, and (d) anxiety. Each master's/un-
dergraduate participant was coded arbitrarily with ascending numbers
from 1 to 21.
3.1. Inspiration Gained From Nursing Student-Family Communication
During their clinical placements, both the master's and under-
graduate nursing students acquired experience in communicating with
family members and gained inspiration from signi cant circumstances.
3.1.1. Responding to Enquiries Clearly
A majority of the participants stated that the most important task in
nursing student-family communication is to provide information about
the patient's condition to family members and to respond to their en-
quiries in detail.
“Since the patient's family usually asks about the patient's condition, you
have to tell them the truth, and answer them only when you are familiar
with the situation. I am just a nursing student, and I may not be able to
elaborate on the details of medical treatment, so I refer questions from
the patient's family to the corresponding medical sta or responsible
nurses. Also, you really have to provide a concrete response to them and
not waste their time; otherwise, you will be in trouble. I heard the family
members of some patients complain that nurses seldom answered their
questions satisfactorily . So don't mince words: whenever you don't know
how to answer, you should approach the responsible nurse or even doctor
immediately.” (Master's student no. 20)
“Once, due to an examination in aseptic technique, a patient's mealtime
was delayed until 4 pm. The patient's family members enquired as to why
their grandpa was fed so late. Since more than one nurse was serving this
patient and each nurse was responsible for di erent duties, perhaps that
nurse didn't know why the schedule was delayed, so she improvised and
said that suppertime had been moved back. But the family members
didn't believe it and checked with another nurse, only to receive a dif-
ferent response.” (Master's student no. 3)
The above excerpts show that it is essential for nurses to provide
concrete and accurate information to the family members. Since nur-
sing students do not have enough experience or knowledge to respond
to complicated medical enquiries, they should refer these enquiries to
the responsible medical sta or investigate the incident before giving an
answer to the family.
Z. C. Y. Chan
3.1.2. Avoiding Sensitive Topics
In apparent contrast to the previous sub-theme about providing
information to family members, some participants stated that nurses
should refrain from discussing sensitive topics with families, and that
the decision as to whether a particular piece of information should be
disclosed should be based on professional and ethical considerations.
“First, check the patient record and see if the patient is willing to disclose
his/her condition to family members. If you disclose it negligently, you
may have a lawsuit led against you. By contrast, if the family members
have been kept fully informed, then you can communicate with them
more freely. But you should still be aware of the family members' emo-
tions and avoid threatening them and making them feel unhappy.”
(Undergraduate student no. 16)
“If a patient's family members are present, we have to pay attention to
our conversations with other medical sta . Don't say, “This patient is
getting worse today”; otherwise, the patient's family members will become
nervous and ask what is happening to him/her. Of course we have to be
honest, but the wrong wording may intimidate them.” (Undergraduate
student no. 10)
The above participants mentioned that during their communica-
tions with the family members, they would consider the patient's desire
to disclose his/her condition to the family and the family members'
emotional competence to receive this information, since some family
members may become nervous or even feel a sense of hopelessness if
they hear bad news regarding the patient's condition.
3.1.3. Listening to the Patient's Family
The decision to disclose or avoid mentioning certain information
depends on the desires of the patient and his/her family; hence, it is
essential that nurses understand their perspectives.
“I think we should pay special attention to the family's attitude and body
language. If you go to the patient's bedside and his/her family takes no
heed of you, then you will realize that the family members are not de-
lighted, and you have to pay more attention to their words and attitude.
If they greet you instead, that means that they are willing to talk to you
and you may then share more information besides that related to the
patient's case.” (Undergraduate student no. 19)
The above narrative reveals that by taking notice of the body lan-
guage and attitudes of family members, nursing students can anticipate
the appropriate moment for communication. Another participant also
mentioned the importance of listening to the family members.
“In addition to mentioning necessary information, such as the details of a
healthcare procedure, I would try to be aware of the concerns of the patient's
family members, and ask them whether they have any queries or require
further clari cation. In other words, I wouldn't leave the ward right after
explaining the case; rather, I would listen to the patient's family and see if
they have anything to ask.” (Undergraduate student no. 9).
This excerpt suggests that nurses can proactively welcome further
enquiries from family members about a patient. The shortage of man-
power in global healthcare settings may prevent nurses from spending
time communicating with patients' families; therefore, there is a need to
revisit the issue of whether the existing supply of nurses in hospitals is
su cient.
3.1.4. Sharing One's Own Experiences
Apart from information about a patient's condition and care, the
participants sometimes shared information about their own learning
and work experiences with members of the patient's family, which
enhanced the relationship between the nurses and the family members.
“At the beginning, our conversation was related to the elder male patient,
then to the patient's family, and we discussed our working lives together. I
don't have any tips for communicating with a patient's family, but I think
you have to be willing to listen. Don't be too quick to leave when the
35
Nu rse E duc at i on To day 5 9 ( 20 1 7) 33 –3 7
conversation isn't nished.” (Master's student no. 18)
“Sometimes the patient's family members enquire about the charges of
this hospital or about the details of our practical training. Since many
students were given practical training in this hospital, they would be
concerned about the duration of our programme, or about the di erences
between us and our fellow students.” (Master's student no. 13)
The participants mentioned that the family members might be in-
terested in their learning and practical training. By sharing their lives,
the participants can relieve the atmosphere of stress and show their
willingness to communicate with the family.
3.2. Emotions Aroused by Nursing Student-Family Communication
Physical health and mental health are interrelated. When patients
are su ering from physical illnesses, they and their families shoulder a
heavy psychological burden, such as feelings of hopelessness and shock.
During conversations and caring, nurses are also touched by these
emotions. The following conversations were thematized into four kinds
of emotions, namely happiness, anger, sadness, and anxiety.
3.2.1. Happiness
Although the su ering brought about by illness usually leads to low
spirits, some participants shared accounts of enjoyable moments that
they had spent communicating with patients' families.
“The family members of patients were very nice and appreciated us. For
example, there was a patient su ering from abdominal cancer. After his
surgery, we needed to bathe him frequently, and his wife was very
grateful to us.” (Master's student no. 2)
This excerpt shows that the appreciation expressed by the patient's
family gave this participant considerable satisfaction. This is un-
doubtedly one of the most common sources of happiness from com-
munication, but the following narrative describes another happy mo-
ment in communication.
“There was an elderly male patient whose wife and daughter visited him
every day. He was a diabetic and preferred not to eat the meals provided
by the hospital. Sometimes I asked his wife whether she had brought any
food to the patient, and told her to let me know if he ate, so that I could
give him his injection. Several fellow students were working together in
the same ward, and we enjoyed talking with the patient's daughter. We
talked about her interests and grandchildren.” (Master's student no. 17)
This participant shared another source of happiness from commu-
nication. Just like talking with friends, merely sharing details of their
daily lives with family members could also be enjoyable.
3.2.2. Anger
Some participants pointed out that anger is another common emo-
tion arising from nurse-family communication.
“If the family members really care for the patient, then I will try my best
to explain to them and help them with a more sincere attitude. Once I had
a female patient aged about 80, whose family member visited her along
with a domestic helper. This family member just watched the helper care
for the patient and kept complaining, but never talked to the patient.
During bed bathing, this family member even left the room, but since they
will need to bathe her after her discharge from hospital, we encouraged
the family member and domestic helper to have a hand in the procedure.
But the family member pointed to an adhesive bandage stuck on one arm
and refused to touch the water. This family member pretended to care for
the patient, but failed to do so.” (Undergraduate student no. 7)
This excerpt expressed another cause of anger among the partici-
pants. A negligent attitude towards patients on the part of family
members may cause participants to feel dissatis ed and prevent them
from communicating with forbearance and tolerance.
Z. C. Y. Chan Nu rse E duc at i on To day 5 9 ( 20 1 7) 33 –3 7

goals and
3.2.3. Sadness
transitions of care in critical care medicine has been designed incendiary conversations with family members (Olsen et al., 1999;
References
at the University
It is essential of
to Calgary's
converse withCumming Schoolofofpatients
the families Medicinewho(Roze Des
are in Pergert and Lützén, 2012; Regis et al., 2011). Participants also men-
Ordons et al., 2017). A care and communication quality improvement tioned that listening to patients' families is crucial in the process of
critical condition, dying, or who have passed away. Such moments are Ada ms , A. M .N . , M an ni x, T ., Ha rr i ng ton , A. , 20 17 . N ur se s' c om mu ni c at io n w i th fa mi l i es i
project was launched in a respiratory care unit to improve the quality of ncommunication. Active listening is the central skill in the development
particularly sad ones for the participants. the i nten s i ve c ar e u ni t – a l i ter atu re rev i ew . Nu rs . C ri t. C a re 2 2 (2 ), 70 –8 0.
communication with families (Loeslie et al., 2017). Within the nursing of supportive
Al ab du l az i z ,relationships
H. , Mo ss , C .(Barone
, C o pn elandl , BSwitzer,
., 2 01 7. 1995).
P aed i atr i c nu rs es ' per c ept i on s an d pr ac ti c
curriculum,
“Once I was bothresponsible
for the pre-registration
for the last oprogrammes and nursing
ce and for cleaning the patient's es of fam i l y-c en tre d c a re i n Sau d i ho sp i tal s : a mi xed m eth od s s tu dy . I nt. J. N ur s. St ud .
specialty
body. training, consideration
I had to ask should be some
the family members givenquestions
to including
whileboththey were 69 ,addition
In 66 –7 7. to asking the family members re exive questions and
theoretical input and training in skills for communicating
still deeply grieving. I can't forget the moment when I told them with families,
“Don'tbe Ba ro ne,them
giving J. T . a, Sw
sense i tz er
of, empowerment
J.Y . , 1 99 5. I nter vi ew
(Foy i n Timmins,
and g A rt a nd Sk i l l. AWright
2004; l ly n & , B o sto n, U SA .
in asoseries
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this patienttotalling
be morenot less than 20 Ih.was
comfortable.” Thisalso Bé laLeahey,
and ng er, L .,2005),
B o ur bo nn ai s , A. , also
participants Be rn suggested
i er, R. , B entaking
oi t, Mnotice
., 2 01 7of. Cthe omm fa-un i c ati o n betw e en
willgrieving
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time, andand registered
I had actuallynurses
taken adequate time
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patient
nu rs es an d fam i l y c areg i ver s of h os pi tal i s ed o ld er p ers on s : a l i tera tur e rev i ew . J. C l i n .
mily's attitude and body language in order to identify a suitable mo-
quire knowledge andI had
skills through a role play format, group with
discus- Nu rs . 26 (5 -6 ), 6 09 –61 9 .
week. Although little experience in communicating the pa- ment for e ective communication. The most interesting inspiration
sions, and family,
re ective learning. Bo gu e, T .L . , M oh r , L ., 2 01 7 . P u tti n g th e fam il y ba ck i n t he c en ter : a teac h -b ac k p ro toc o l
tient's I did my best to let the patient pass away more serenely and fromto communication with families came from the sharing of the nursing
i mp ro ve c om mu ni c ati o n d ur i ng r ou nd s i n a p edi a tri c i nte ns i ve c are u ni t. C ri t. C ar e
to give the family members con dence.” (Master's student no. 16) students'
Nu rs .own experiences,
C l i n. N or th Am. 2which 9 ( 2) , have seldom
23 3 –25 0. been explored in pre-
vious
C han , studies.
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Limitations
participant recalled the sad moment of performing the last of- learning
C ro ni n , experience
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17 . I mp training,
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Ho sp . P alto l ia t. Nu r s. 1 9 ( 2) ,
ce, especially when she had to ask the patient's family some questions 14 0–1plan
the care 4 6. of a patient. To provide quality care and allow nursing
while everyone
It is unlikelywas thatgrieving
one-timedeeply.
in-depthAlthough the experience
interviews with nursing of stu-
caring Fo y, C . R. , T i mcommunication,
student-family mi n s, F. , 2 00 4. Imeasures mp rov i ngshould
c om mube ni taken
c at i on
ini clinical
n day su rg ery se tti ng s. N u rs .
for this patient in the preceding week made her feel sad, she persevered Stan d.to1 ensure
learning 9 , 37 –42 . students spend adequate time in a particular
that
dents can reveal all aspects of nursing student-family communication.
in her role of letting the patient pass away more serenely. Gi l l ett, K., O'N ei l l , B . , B l oo m e ld , J. G ., 20 16 . F ac to rs i n ue nc i n g the d evel o pm ent o f en d -
ward or clinical setting to be able to build rapport with a patient and
This study is therefore limited, and the following three recommenda- of-l i fe c o mm un i c ati o n s ki l l s: a foc u s gro up s tu dy of n ur s in g and m edi c al s tu de nts .
tions are proposed. First, as nursing students accumulate experience in his/her
Nu rsfamily.
e E du cNursing
. T od ay students
36 , 39 5– should
40 0. be further encouraged to re-
communicating with patients' families during their clinical practice, it is spond
Gi l marto ti nenquiries
, J. , W r i clearly,
gh t, K. , steer
20 08 clear
. Da y of
s ursensitive
ger y: p atitopics,
en ts' fellisten
t ab antodopa- ned d ur i ng th e pr e-
3.2.4. Anxiety
suggested that a follow-up longitudinal study be conducted to explore tients' families
op erat i ve w and, ifCnecessary,
ai t . J. l i n . Nu r s.share
17 , 2their
41 8–own24 25experiences
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Second, this study
communication wasdid not interview
anxiety. Lackingthe family members
sophisticated of patients.
experience in not touch
Ha rve y, P .,on issues
A hm ann ,of religion,
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fa mi l y-c orientation).
en ter ed c omm u ni c ati o n sk il l .
Research
healthcareon family
and members'
concerned aboutview
the on communicating
critiques with media,
from the mass nursingthe Nep hr ol . N ur s. J . 4 3 (1 ), 6 1–6 6 .
students will be enriched if their perspectives are included. Finally, a He ern an , M. , Q ui n n Gri n , M .T . , Si s ter, R. M . , Fi tz p atri c k , J. J., 2 0 10 . Sel f-c o mp ass i on
participants were anxious when performing procedures on patients or
comparative study ontheir
the similarities and em oti o na l i ntel l i ge nc e i n n ur ses . In t. J. Nu rs . P rac t. 1 6 , 36 6–3 7 3.
communicating with families. and di erences between nursing
students and registered nurses in communicating with families should Hei s e, B . A. , Gi l pi n , L. C . , 20 16 . N ur si n g s tu den ts ' c l i ni c al e xper i en c e w i th dea th : a pi l
o t Emotions
stu dy . Nu rsplay . E du c . Pe rs pec
a crucial rolet. in3 7nursing
(2 ), 10 4student-family
–10 6 . commu-
be conducted, so that the nursing curriculum can be designed to re-
“I am
spond very
to the cautious
needs, in my conversation
expectations, with patients'
and real clinical family
practices members. I
of each
Hem mi n g, L. , 2 01 7 . B r eak in g bad n ew s: a c ase stu d y o n c o mm un i c ati on i n h eal th c ar e.
nication, and self-compassion and emotional intelligence largely de-
am On especially afraid oftosaying something wrong, since of
theout-
mass media Gas tro i nt est. N u rs . 1 5 (1 ), 4 3–5 0 .
group. the other hand, further enhance the recovery termine the e ectiveness of such communication. In developing end-of-
Hen o ch , I. , Löv gr en, M ., W i l d e-Lar ss on , B ., T i sh el m an, C . , 20 12 . Pe rc ep ti on of q u al i ty o f
makeand exaggerated
the qualityclaims. It is not appropriate for familythat
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i th c atheync er must
fol l obew iable
ng pr e-reg i str ati o n n ur s e
impression of medical sta .” (Undergraduate student no. 1)
munication. to manage
edu c ati their o n: a own
qu al emotions
i tati v e st ud during
y. N urthe provision
se Ed u c . T o da of yhealthcare
4 8 ( 1) , 62 –6 6.
(He
Li n ,ernan
M . F. et , Hal.,
su , 2010;
W .S . ,Wright,
H u an g,2008).
M .C . ,While Su , Y previous
. H. , C r aw studies
for d, Phave
. , T ang , C .C . , 2 01 7 . “ I c
ou l dn
focused
even 't taonl kthe anxiety
to th e p ati en oft”the: b patient
arr i er s and
to c om his/her
mu nifamilyc ati n gduring
w i th c the
an c er p ati en ts as p er c ei ved
“I had an unforgettable experience when dealing with an elderly patient by nu rs i process
therapeutic ng st ud en ts. E ur . J. and
(Gilmartin C an Wright,
c er C a re2008; 2 6 (4 Regis
), e1 26et 4 8.
al., 2011;
su ering from stroke. His wife took care of him and was nervous about Loe
Yorkesl i and
e, V. Cameron-Traub,
, Ab c ej o, M .S . , A2008), nd er sothen, Cparticipants
. , Lei b en gut inh,this
E . ,study
Mi el ktalked
e, C ., Ra bat i n, J. , 20 1 7.
his condition. Once I did a poor job of moving this patient onto the bed, more Imp l emen
about ti n gown
their f amiemotions
l y mee ti ng of shappiness,
i nto a r esp anger,i ra tor yand c aresadness.
u ni t: a cThe a re an d c om mu ni c at i on
qu al i ty i m pr ov emen t p ro j ec t. Di m ens . C ri t. C a re N ur s. 3 6 (3 ), 1 57 –1 63 .
5. Conclusion
and she reproved me, “Little girl, didn't you learn this in school?” I was participants were happy when they were appreciated for their attentive
Mar sh al l , A. , B el l , J. M. , Mo u le s, N .J. , 2 01 0 . B el i efs , su er i ng , an d h eal i n g: a c l i n i c
unhappy and apologized to her. I think communication with family careproracwhen
al they enjoyed friendship with a patient's family. If family
ti c e mo de l fo r fa mi l i es ex per i en ci n g m ent al i ll n es s. P ers pec t . P sy c hi a tr. C ar e 46 ,
members members were not: //dx
concerned about
10 . the
11 11patient's
/j . 17 44 condition
-6 16 3. 2 01or0.recovery
This studyis sheds
much some
more light
di cult
onthan
howwith patients.nursing
to improve Perhaps I am afraid
education so 19 7– 20
process,
8. h ttp
the. ,participants
.d oi . o rg/
were angry.
0 02 5 9. x.
of the former, and I am especially anxious when I am performing pro- Ol s en, S .F M ar sh al l , E. S. , M and l When
ec o, B family
. L. , Al lmembers
red , K. Wwere ., D ycdis-h es, T . T. , Sa ns om , N . , 19
that students receive proper training on how to communicate with the satis
99 . Supedpwith or t, ctheo mmnurses'
un i c performance,
ati o n, an d h ar or di nwheness i nthe fa mipatient
l i es wwas
i th in
c hcri-
i ld re n w i th di s ab i li ti e s. J.
cedures on patients. The family members observe every step with sharp
family members of patients. Nursing students should learn how to re- ticalFamcondition,
. Nu rs . 5,the 2 75 participants
–2 91 . h ttp:were //d x. also
d oi . in low0.spirits.
or g/1 1 17 7 /10 Finally,
74 8 40anxiety
79 90 0 50 03 0 3.
eyes. So I explain the caring procedure in detail to give them con dence
spond to enquiries, avoid sensitive topics, listen to patients' families, is not
Per ger the
t, P .,soleL ützpreserve
é n, K. , 20 of 1patients
2. B al anand c i ngtheir
tr uthfamily
-tel l i members;
n g i n th e pdue to aati on o f h op e: a r el a-
res erv
in me.” (Master's student no. 4)
and allow a certain degree of self-disclosure relevant to the patient's lacktiof onclinical
al eth i c experience
s app ro ac h .and Nu rsknowledge,
. E thi c s 19 nursing
, 2 1–2 9 students
. were also
care while still maintaining professional boundaries. Nursing students Regi
anxiouss , T when
. , Stei communicating
n er, M .J. , Fo rd , C . A .,patients'
with B yer l ey,families
J. S. , 2 0or 11performing
. P r ofes si o na li s m ex pec ta ti on s s een
also need to learn how to control their emotions if necessary. To con- thr ou
caring gh the ey esinofthe
procedures res presence
i d ent p hy of si cfamily
i an s anmembers.
d p ati en t Therefore,
fa mi l i es. Pe indi at ri c s 1 27 , 3 17 –3 24 .
Although
clude, nursingthe primary target
student-family of nursing care
communication is is the patient,
important family
in building Ros emo nd , C . , Han s on , L. C ., Z i mm erm an , S. , 20 17 . Go al s o f c ar e or go al s of tr u st? H o w
addition to teaching professional skills in the nursing curriculum,
memberspromoting
rapport, and the mass media
mutual are very concerned
understanding, invitingabout the process
families partici- and fami l y m emb er s p erc ei v e go al s fo r d yi n g n ur si n g h om e re si d ents . J. Pa ll i at . M ed . 2 0
educators
outcome (4 ), 36 should
0 –36 5 .be aware of the emotional aspects of students' com-
pating in of caring.
care plans,The
andparticipants
preventing revealed anxiety
medical errors about
due commu-
to mis- munication with patients and family members. An intensive training
nicating with or performing procedures on patients under the watchful Roz e D es Or do ns , A. L. , Do i g, C . J. , C ou i l la rd , P. , L ord , J. , 20 1 7. Fr om c om mu n ic a ti on
communication. workshop
gaze of family members or the scrutiny of the mass media. ski l l s twith o sk imore
l lf ulopportunities
c om mu ni c a titoongain : a l hands-on
o ng i tud i na experience
l i n tegr ate andd c ur ri c u l um for c r i ti c al c
featuring
ar e role-plays about communicating with families should be
provided.
San medo iwc More
del sk importantly,
i nei ,feM.ll ,o2w01s. 0.
AW c ad. opportunities
M ed
h at's i n .a92 (4 ), 5Qu
n ame? for rei 05
01 al–5 ecting
tat .iv e don escone's own
r i pt io n rev i si ted . Res . Nu rs .
strengths
Hea l thand 33 ,on 77 the
–8 4.limitations of one's own conceptualizations, va-
4. Discussion
Source of Funding lues,
W and
it ten berskills
g, E ., in communication
R agan , S. L. , Fe rr elshould
l, B . , 2be 01promoted.
7. E xp l or i ng nu rs e c o mmu n i c ati on ab ou t
sp i ri tu al i ty. A m. J. H os p. P al l i at. M ed. 3 4 (6 ), 5 66 –57 1 .
W ri gh t, L. M . , 20 08 . So ften in g su eri n g t hr ou gh s pi r it ua l c are pr ac ti c es : o n e po ss i bi l i ty
Among
The Hong theKong
four inspirations
Polytechnic gained fromProject
University. nursingCode:
student-family
1-ZV5F. for hea l i ng fami l i es . J. Fam . Nu rs . 1 4, 3 94 –4 11 . htt p: //d x. do i . or g/1 0. 1 17 7/
communication, the participants placed the most emphasis on re- 10 74 84 0 70 83 2 64 93 .
sponding
Con ict oftoInterest
enquiries clearly. In particular, nurses should provide W ri gh t, L. M. , Leah ey , M . , 2 00 5. T he t hr ee mo st c om mo n er ro rs i n fami l y n u rs i ng : h ow to
concrete responses to family members or refer their questions to ap- avo i d o r s i de step . J. Fa m. Nu r s. 1 1, 9 0– 10 1.
propriate medical sta . Giving information based on a thorough as- Y or ke, J. , C ame ro n-T ra ub , E ., 2 00 8 . P at ie nts ' p erc ei v ed c are need s w hi l e w a i ti ng for a
The author
sessment declared important
is particularly that there when
is no con ict of
family interest.are burdened
members hea rt o r l u n g tr an sp l ant . J . C li n . Nu r s. 1 7, 7 8–8 7 .
with stress and other concerns (Yorke and Cameron-Traub, 2008). This 4.1. Implications for Nurse Education
argument is consistent with the ndings of Wright and Leahey (2005)
This is a pioneer study on understanding students' communication
that one of the common errors in family nursing is the premature giving with family members in the Chinese context. Communication with fa-
of advice. When providing information to family members, nurses milies should be viewed as a process and part of the on-going devel-
should avoid sensitive topics and disclose the patient's condition while opment of the health profession. There should be a shift in emphasis
taking into consideration the patient's willingness and the family's from communication skills to skillful communication (Roze Des Ordons
emotional competence to listen to such details. They must also use et al., 2017). A 20-hour training programme that includes discussion
suitable language and avoid joking about the patients or engaging in about the basic principles of communication and family meetings about

36
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