Summary summarize the document to a page. International Journal of Environmental Research and Public Health Review Educational Interventions for Nurs

Summary summarize the document to a page. International Journal of

Environmental Research

and Public Health

Review

Educational Interventions for Nursing Students to
Develop Communication Skills with Patients:
A Systematic Review

Lorena Gutiérrez-Puertas, Verónica V. Márquez-Hernández * , Vanesa Gutiérrez-Puertas,
Genoveva Granados-Gámez and Gabriel Aguilera-Manrique

Department of Nursing, Physiotherapy and Medicine, Research Group for Health Sciences CTS-451,
Universidad de Almeria, 04120 Almeria, Spain; lgp524@ual.es (L.G.-P.); vgp919@ual.es (V.G.-P.);
genoveva@ual.es (G.G.-P.); gaguiler@ual.es (G.A.-M.)
* Correspondence: vmh380@ual.es

Received: 25 February 2020; Accepted: 23 March 2020; Published: 26 March 2020
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Abstract: Introduction: Nursing students establish therapeutic relationships with their patients and
as future nursing professionals, they should be trained to be effective communicators. The objective
of this systematic review was to know the impact of educational interventions on nursing students to
develop their communication skills with patients. Methods: A systematic review of literature was
carried out. The following databases were consulted: CINAHL, PubMed (Ovid Medline), SCOPUS
and Web of Science. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guided this review. As for inclusion criteria, published articles in English from 2000 to 2020 were
included. The methodological rigor of the included articles was evaluated with the JBI Critical
Appraisal Checklist for Randomized Controlled Trial or Quasi-Experimental Studies. Changes in
communication skills with the patient after the implementation of an intervention were analyzed.
Results: Of the included studies in this systematic review (N = 19), two studies were randomized
controlled trials, others were single group quasi-experimental studies (N = 11) and two group
quasi-experimental studies (n = 6). The majority of the studies were carried out in the USA (n = 7).
The most frequent educational intervention was simulation (n = 11). As for the improvement of
communication skills, 13 of the 19 articles found statistically significant differences in patient-centered
communication skills of nursing students. Conclusions: This systematic review provides preliminary
evidence of the effectiveness of interventions used to train nursing students in patient-centered
communication. Although all the interventions obtained significant results in communication skills,
it has not yet been determined which methodology is more effective.

Keywords: nurse-patient communication; nursing students; patient-centered communication;
systematic review; therapeutic communication; training

1. Introduction

Therapeutic communication (TC) is defined as the process of using verbal and nonverbal
communication to connect with patients [1]. TC is holistic, patient-centered and involves aspects of
the physiological, psychological, environmental and spiritual care of the patient [2]. It is based on
understanding and addressing the patient’s situation, including life circumstances, beliefs, perspectives,
relevant concerns and needs in order to plan adequate patient care [3,4]. TC between the nurse and
patient is considered one of the most significant clinical methods of communication and the basis of
nursing care [5].

The TC that nurses establish with their patients has been explored in various clinical areas.
In particular, with psychiatric patients, it has shown improved health outcomes and decreased clinical

Int. J. Environ. Res. Public Health 2020, 17, 2241; doi:10.3390/ijerph17072241 www.mdpi.com/journal/ijerph

http://www.mdpi.com/journal/ijerph

http://www.mdpi.com

https://orcid.org/0000-0003-1163-4394

http://dx.doi.org/10.3390/ijerph17072241

http://www.mdpi.com/journal/ijerph

https://www.mdpi.com/1660-4601/17/7/2241?type=check_update&version=2

Int. J. Environ. Res. Public Health 2020, 17, 2241 2 of 21

anxiety and depression [6]. In the case of chronically ill patients, it has contributed to an increase in
adherence to treatment [7], and therefore, an improvement in the self-management of their disease [8].
Additionally, in palliative care, communication skills are essential to provide the patient with effective
symptom management, psychosocial and spiritual support and advance care planning [9].

A nurse’s ability to communicate in an effective way is essential for developing therapeutic
relationships with their patients and obtain greater patient satisfaction. It also minimizes treatment
errors and improves the quality of nursing care [10,11]. Patients and their caregivers positively value
professionals who attentively listen, the depth of conversation, the moment of delivering information
and communicating in an empathetic way [12]. However, various studies have shown that nurses
lack communication skills due to inadequate training or a failure to appreciate the importance of
patient-centered communication [7,13]. For this reason, nursing professors must find active and
effective ways to foster communication skills in the education of nursing students [14].

Teaching and training how to effectively communicate can be complicated due to the variety of
potentially difficult conversations that nursing students may face in clinical settings [15]. This situation
constitutes a challenge for university professors in charge of educating nursing students [15,16]. Nursing
students establish therapeutic relationships with their patients, and as future nursing professionals,
they should be trained to be effective communicators [17]. Therefore, the concept of TC should be
emphasized in the nursing curriculum to meet the educational needs of the students, as well as the
needs of the patients [18–20]. However, most interventions aimed at improving patient-centered
communication have been for doctors [21,22]. Given the above, the question was posed as to whether
nursing students that receive educational interventions could improve their communication skills with
patients. Therefore, the objective of this systematic review was to know the impact of educational
interventions on nursing students to develop their communication skills with patients.

2. Method

2.1. Search Strategy

A systematic review was carried out from September 2019 to January 2020. For this purpose,
a critical evaluation of all related evidence was conducted, following a widely documented methodology,
in order to answer the specific research question [23]. The Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) checklist was used as a guide for the search and presentation
of the results [24–46].

An initial search was conducted to obtain information on the breadth of publications and identify
the words contained in the titles and abstracts on Google Scholar. A search was then made in the
PubMed database (see Box 1) through the US National Library of Medicine in order to identify the
Medical Subjects Headings (MeSH). However, the term MeSH ‘therapeutic communication’ and similar
terms found were not linked to any educational subgroup in the search tree. Subsequently, a systematic
search was performed using all the keywords identified in the following databases: CINAHL, PubMed
(Ovid Medline), SCOPUS and Web of Science.

Box 1. Example of search strategy conducted in PubMed.

their disease [8]. Additionally, in palliative care, communication skills are essential to provide the 46
patient with effective symptom management, psychosocial and spiritual support and advance 47
care planning [9]. 48

A nurse’s ability to communicate in an effective way is essential for developing therapeutic 49
relationships with their patients and obtain greater patient satisfaction. It also minimizes 50
treatment errors and improves the quality of nursing care [10,11]. Patients and their caregivers 51
positively value professionals who attentively listen, the depth of conversation, the moment of 52
delivering information and communicating in an empathetic way [12]. However, various studies 53
have shown that nurses lack communication skills due to inadequate training or a failure to 54
appreciate the importance of patient-centered communication [7,13]. For this reason, nursing 55
professors must find active and effective ways to foster communication skills in the education of 56
nursing students [14]. 57

Teaching and training how to effectively communicate can be complicated due to the variety 58
of potentially difficult conversations that nursing students may face in clinical settings [15]. This 59
situation constitutes a challenge for university professors in charge of educating nursing students 60
[15,16]. Nursing students establish therapeutic relationships with their patients, and as future 61
nursing professionals, they should be trained to be effective communicators [17]. Therefore, the 62
concept of TC should be emphasized in the nursing curriculum to meet the educational needs of 63
the students, as well as the needs of the patients [18-20]. However, most interventions aimed at 64
improving patient-centered communication have been for doctors [21,22]. Given the above, the 65
question was posed as to whether nursing students that receive educational interventions could 66
improve their communication skills with patients. Therefore, the objective of this systematic 67
review was to know the impact of educational interventions on nursing students to develop their 68
communication skills with patients. 69

2. Method 70

2.1. Search Strategy 71
A systematic review was carried out from September 2019 to January 2020. For this purpose, 72

a critical evaluation of all related evidence was conducted, following a widely documented 73
methodology, in order to answer the specific research question [23]. The Preferred Reporting 74
Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used as a guide for the 75
search and presentation of the results [24]. 76

An initial search was conducted to obtain information on the breadth of publications and 77
identify the words contained in the titles and abstracts on Google Scholar. A search was then 78
made in the PubMed database (see Box 1) (Box 1 at the bottom of the paper) through the US 79
National Library of Medicine in order to identify the Medical Subjects Headings (MeSH). 80
However, the term MeSH ‘therapeutic communication’ and similar terms found were not linked 81
to any educational subgroup in the search tree. Subsequently, a systematic search was performed 82
using all the keywords identified in the following databases: CINAHL, PubMed (Ovid Medline), 83
SCOPUS and Web of Science. 84
85

((((((((“students, nursing”[MeSH Terms] AND prelicensure[Title/Abstract]) OR
undergraduate[Title/Abstract]) AND intervention[Title/Abstract]) OR

effectiveness[Title/Abstract]) AND therapeutic communication[Title/Abstract]) OR nurse-
patient communication[Title/Abstract]) OR patient-centered communication[Title/Abstract])

OR interpersonal communication[Title/Abstract]) AND English[Language]

Box 1. Example of search strategy conducted in PubMed. 86

A systematic strategy was used derived from the terms ‘nursing students’ (population); 87
‘education’ or ‘teaching’ and ‘therapeutic communication’ (intervention); ‘undergraduate’ or 88

A systematic strategy was used derived from the terms ‘nursing students’ (population); ‘education’ or
‘teaching’ and ‘therapeutic communication’ (intervention); ‘undergraduate’ or ‘prelicensure’ or ‘university’
(context); and ‘effectiveness’ or ‘impact’ (outcome). Finally, manual searches were conducted in the references
lists of recent studies and reviews in search of eligible articles that could have been previously lost.

Int. J. Environ. Res. Public Health 2020, 17, 2241 3 of 21

As for inclusion criteria, the review included quantitative studies whose design were Randomized
Clinical Trials (RCT) and quasi-experimental trials published in English from January 2000 to January
2020. Regarding the participants, studies were included with participants that were undergraduate (or
pre-licensure) nursing students, regardless of their age, sex or country of origin. With respect to the
types of intervention, the review included studies of TC training or patient-centered training. In regards
to the types of measured results, the review considered any objectively measured or self-reported
quantitative data reporting on therapeutic communication outcomes.

2.2. Data extraction

A total of 5,845 articles were identified in the initial search. All citations and abstracts identified
in the search strategy were downloaded to Mendeley. The first author (LG) assessed the titles of the
articles obtained from the search in the databases. The search yielded 612 articles after eliminating
duplicates (see the systematic review flow diagram in Figure 1). The abstracts were reviewed and
studies were excluded if: (a) the intervention was not aimed at TC or patient-centered; (b) if the
intervention was not aimed at nursing students; (c) articles that were systematic reviews, meta-analysis,
qualitative studies, case studies, doctoral thesis or conference abstracts; (d) articles not written in
English. Of the 86 abstracts reviewed, 27 articles were selected by the first author for revision of
the full text. From the manual search, 10 relevant articles were identified for inclusion in the review.
Both reviewers independently analyzed the 27 articles taking the preestablished criteria into account.

Figure 1. Systematic review flow diagram.

Data from the included articles were reviewed by two independent reviewers (LG and VM), using
the JBI-MAStARI data extraction tool. The reviewers extracted information from each of the articles
including data on design, theoretical framework, participants, intervention, outcome measures and
results. The most relevant characteristics of the studies included in the review are summarized in
Table 1. Due to variations in the intervention methods and outcome measures, it was not possible to
carry out a meta-analysis.

Int. J. Environ. Res. Public Health 2020, 17, 2241 4 of 21

Table 1. Main characteristics of the selected studies.

Order Number
1st Author, Date

(Country)
MAStARI Participants Objetives Study Design

1
Becker et al. 2006 [31]

(USA)
1C

10
n = 147 nursing students enrolled in a

psychiatric nursing course (IG = 58;
CG = 89).

To evaluate knowledge of depression and therapeutic communication
skills SP.

Desing: randomized control group.
Data collection: pre-test, post-test.

2

Baghcheghi et al. 2011
[41]

(Iran)
2C

7
N = 34 sophomore nursing students (16 IG;

18 CG).
To evaluate the effect of tradicional learning and cooperative learning

methods on nursing students´communication with patients.

Design: Experimental, observer-blinder two groups
study.

Data collection: pre-test, post-test.

3
Kim et al. 2012 [34]

(Korea)
2C

7
n = 70 sophomores nursing students

enrolled in a theoretical course in maternity.

To determine the effect of simulation-based education on the
communication skill and clinical competence of nursing students in

maternity nursing practicum.

Design: quasi-experimental study, two gropup study.
Data Collection: pre-test, post-test.

4

Wittenberg-Lyles et al.
2012 [47]

(USA)
2D

7 n = 32 nursing students. To assess the effects of communication training for the practical nurse.
Design: quasi-experimental pilot study.

Data collection: pre-test, post-test.

5
Jo and An 2013 [43]

(Korea)
2C

7
n = 39 nursing students (19 IG; 20 GC) from

two universities.

To examine the effects of a humanistic end-of-life care course on South
Korean undergraduate nursing students’ attitudes toward death, death

anxiety, and communication skills.

Design: quasi-experimental two group study.
Data collection: Pre-test, post-test.

6
Lau and Wang 2013 [44]

(China)
2D

7
n = 62 fourth-year nursing students enrolled

CST course.

To develop a learner-centered Communication Skills Training (CST)
course; (2) to evaluate the course by comparing scores for

communication skills, clinical interaction, interpersonal dysfunction, and
social problem-solving ability.

Design: quasi-experimental single group study,
two-phase mixed methods

Data collection: pre-test, post-test.

7
Lin et al. 2013 [35]

(Taiwan)
1C

9
n = 26 first year nursing students (14 IG; 12

CG).

To examine the effectiveness of using SP with SP feedback and group
discussion to teach Interpersonal and communication skills (IPCS) in

nursing education.

Desing: Randomized Controlled Study two group.
Data collection: pre-tets, post-test.

8
Lau and Wang 2014 [45]

(China)
2D

7
n = 59 fourth-year nursing students attended

the summer camp program.

To develop a learner-centered educational summer camp program for
nursing students and to evaluate the effectiveness of the camp program

on enhancing the participants’ communication skills.

Design: quasi-experimental single group study,
two-phase mixed methods.

Data collection: pre-test, post-test.

9
Webster 2014 [38]

(USA)
2D

7
n = 89 senior baccalaureate nursing students

enrolled in a psychiatric clinical course.

To determine the effectiveness of SPEs as a teaching modality to improve
nursing students’ use of therapeutic communication skills with

individuals with mental illness.

Design: quasi-experimental, one group study.
Data Collection: pre-test, post-test.

10
Bloomfield et al. 2015 [32]

(UK)
2D

6

n = 28 second-year nursing students and
fourth-year medical students from a

population of N = 180 nursing students and
N = 450 medical students.

To design, implement, and evaluate an educational intervention
employing simulated patient actors to enhance students’ abilities to

communicate with dying patients and their families.

Design: quasi-experimental single group study,
two-phase mixed methods.

Data Collection: pre-test, post-test.

11
Yoo and Park 2015 [42]

(Korea)
2C

7

n = 143 (72 IG; 71 CG) sophomore
undergraduate nursing student enrolled in a

mandatory health communication course
from a population of N = 151.

To evaluate the effectiveness of Case-based learning on undergraduate
nursing students in the health communication

course.

Design: quasi-experimental two group study.
Data collection: pre-test, post-test.

Int. J. Environ. Res. Public Health 2020, 17, 2241 5 of 21

Table 1. Cont.

Order Number
1st Author, Date

(Country)
MAStARI Participants Objetives Study Design

12
Lai 2016 [40]

(Taiwan)
2D

7
n = 50 quasi-experimental single group

study.

To implement an online video peer assessment system to scaffold their
communication skills and to examine the effects and validity of the peer

assessment.

Desing: quasi-experimental single group study.
Data collection: pre-test, post-test.

13

Martin and Chanda 2016
[36]

(USA)
2D

8
n = 28 prelicensure nursing students

enrolled in a mental health nursing theory
and clinical course.

To introduce therapeutic communication simulations with emphasis on
symptoms related to psychiatric disorders as a part of mental health

theory and clinical courses.

Design: quasi-experimental, one group.
Data collection: pre-test, post-test.

14
Taghizadeh et al. 2017 [46]

(Iran)
2D

8
n = 66 last year nursing students and n = 132

patients.
To determine the impact of teaching communication skills to nurse

students on the quality of care given by nursing students.
Design: quasi-experimental single group study.

Data collection: pre-test, post- test.

15
Shorey et al. 2018 [28]

(China)
2D

8
n = 124 first-year undergraduate nursing
students enrolled in the nursing course.

To evaluate the effectiveness of blended learning pedagogy in a
redesigned communication module among nursing undergraduates in

enhancing their satisfaction levels and attitudes towards learning
communication module as well as self-efficacy in communication.

Design: quasi-experimental single group study.
Data Collection: pre-test, post-test.

16
Blake and Blake 2019 [39]

(USA)
2D

5
n = 32 nursing students in their capstone

course from a population of N = 35.

To examine the effects of a nursing lab simulation used to increase the
self-efficacy of nursing students with their ability to use effective

communication.

Design: quasi-experimental single group.
Data collection: pre-test, post-test.

17

Donovan and Mullen 2019
[26]

(USA)
2D

7

n = 116 undergraduate nursing students
registered for three successive mental health
nursing courses during academic year from

a population of N = 160 (RR 72.5%).

To examine the efficacy of learned classroom therapeutic communication
techniques applied to a standardized patient mental health simulated

experience.

Design: quasi-experimental single group study.
Data collection: pre-test, post-test.

18
Gaylle 2019 [33]

(USA)
2C

7

n = 65 senior students enrolled in a
psychiatric clinical rotation at a public

university from a population of N = 67 (RR
97%). (IG = 32; CG = 33).

To explored the effects of in-simulation and postsimulation debriefing on
students’ knowledge, performance, anxiety, and perceptions of the

debriefing process.

Design: quasi-experimental, two group study.
Data collection: pre-test, post-test.

19
Ok et al. 2019 [37]

(Turkey)
2C

6

n = 85 third-year nursing students enroled in
a course on mental health and psychiatric at
two different universities from a population
of N = 103 (RR 82.5%). (IG = 52; CG = 33)

To measure the impact of using standardized patient simulation (SPS)
prior to clinical practice on the anxiety levels and communication skills.

Design: quaxi-experimental two group
Data collection: pre-test, post-test

IG, Intervention Group; CG, Control Group; SP, Standardized Patient; CST, Communication Skills Training; IPCS, Interpersonal Communication Skills; SPEs, Standardized Patient
Experiences; SPS, Standardized Patient Simulation.

Int. J. Environ. Res. Public Health 2020, 17, 2241 6 of 21

2.3. Quality appraisal

The selected articles were independently evaluated by two reviewers (GA and VG), before
being included in this review. The methodological validity was evaluated using the Joanna Briggs
Institute Meta-Analysis of Statistics Assessment and Review Instrument standardized critical appraisal
instrument (JBI MAStARI). For the RCTs, the JBI MAStARI for RCTs was used. This checklist is made
up of thirteen items. The possible answers to the items are yes, no, unclear or not applicable. If “yes” is
answered, a point is obtained. For the study to be included, it had to obtain a score equal to or greater
than seven. In the quasi-experimental studies, JBI MASTARI for quasi-experimental studies was used.
This checklist is made up of nine items that can be rated yes, no, unclear or not applicable. If “yes”
is chosen for the item, a point is obtained. For the study to be included in the systematic review, it
had to obtain a score equal to or greater than five. This process enabled an increase in methodological
rigor and evaluated possible biases and threats to the validity [25]. The discrepancies between the
reviewers of the articles that were to be included in the review were discussed until a consensus was
reached. After review, evaluation and discussion, eight articles were excluded that were not based on
TC interventions, as defined in the inclusion criteria, or for methodological reasons. Finally, 19 articles
were included after confirmation by both reviewers.

3. Results

3.1. Characteristics of the study

The overall sample size of the studies included in this review was N = 1,295 participants. In the
included studies, there was a great deal of variation in the sample size, ranging from 26 to 147 (median,
n = 62). Although the literature search was conducted from the year 2000, the first study included in
this review was from 2006. Ninety percent of the studies (n = 18) were carried out in the last ten years
and more than fifty percent (n = 10) were conducted in the last five years. Most studies (n = 9) were in
mental health. The other areas represented were end-of-life and maternity. As for the study designs,
the majority were quasi-experimental studies (n = 17) followed by RCTs (n = 2). In all of the included
studies, pre-test and post-test measurements were performed (N = 19) (Table 1).

3.2. Theoretical frameworks

Only two of the 19 studies included in this systematic review included a description of a theoretical
framework. Donova and Mullen [26] used the Constructivist Learning Theory by Merriam, Cafferella
and Baumgartner [27]. While Shorey et al. [28] used a combination of the two frameworks (a) the
Self-Efficacy Theory [29]; and (b) the Authentic Learning Concept [30].

3.3. Intervention characteristics

Eleven studies used simulation as the intervention. The majority of them (n = 8) used SP to facilitate
learning [26,31–37] and three studies used simulation to aid in the assessment of communication
skills, performed by a faculty member [38], peer [39], or both [40]. Nine were carried out through
simulation using Standardized Patients (SP) [26,31–33,36–38,40]. One study used simulation through
role playing [39] and with high-fidelity patient (n = 1) [34]. Three studies used innovative educational
methodologies, such as a blended learning environment [28], cooperative learning methods [41], and
Case-Based learning [42]. Five studies focused their intervention on the development of courses [43–47],
and four of the courses indicated the included activities.

Regarding the contexts of the interventions, nine studies focused on mental health [26,31,33,35–40],
three studies on end-of-life [32,43,47], one focused on maternity [34], and six studies focused on general
patient-centered communication skills [28,41,42,44–46]. As for the duration of the interventions,
it varied from one hour to one semester (Table 2).

Int. J. Environ. Res. Public Health 2020, 17, 2241 7 of 21

Table 2. Intervention characteristics.

Order Number
1st Author, Date

(Country)
Participants Study Design

Theoretical
Framework

Intervention
Quantitative Measures

1
Becker et al. 2006 [31]

(USA)

n = 147 nursing
students enrolled in a
psychiatric nursing

course (IG = 58;
CG = 89).

Design: randomized
control group.

Data collection:
pre-test, post-test.

Not mentioned.

Simulation—using Standardized
Patient (SP). Lectures on therapeutic communication and nursing

care of clients with depression (both group), Interview SP, debriefing,
videotape self-analysis with accompanying handbook.

Duration: once a week, 7 weeks. Interview SP (30 min), debriefing
(30 min), videotape self-analysis (after 1 week of the SP encounter).

CG – usual classroom lecture format.

Students:
Communication Knowledge Test

(CKT), developed by the authors for this study.
Student Self-Evaluation of SP Encounter

(SSPE), developed by the authors for this study.
Patients:

SP checklist, developed by the authors for this
study.

Standardized Patient Interpersonal Ratings
(SPIR), developed by the authors for this study.

2

Baghcheghi et al. 2011
[41]

(Iran)

N = 34 sophomore
nursing students (16

IG; 18 CG).

Design: Experimental,
observer-blinder two

groups study.
Data collection:

pre-test, post-test.

Not mentioned.

Cooperative learning methods.
(work in group)

Activities included in lectures: Socratic questioning, paired
discussion of homework assignments, paired pop quizzes, small

group discussion of case scenarios, paired concept-map generation
exercises, student identification of examples for concepts being

discussed, and think-pair-share exercises.
Each group would be responsible for presenting a 15 to 20-minute
review of information from their particular content category to the
class. Throughout the semester the group members evaluated each

other with a weekly evaluation tool; feedback.
Duration: one semester.

CG—usual classroom lecture format.

Nursing Students’ communication with patient
scale.

3
Kim et al. 2012 [34]

(Korea)

n = 70 sophomores
nursing students

enrolled in a
theoretical course in

maternity.

Design:
quasi-experimental

study, two group
study.

Data Collection:
pre-test, post-test.

Not mentioned
Simulation—using high-fidelity patient simulator.

Duration: 9 h over three weeks (briefing, simulation lab, debriefing).
CG—usual classroom lecture format.

Communication Skills Tool.
Clinical Competence Tool (CCT).

4
Wittenberg-Lyles et al.

2012 [47]
(USA)

n = 32 nursing
students.

Design:
quasi-experimental

pilot study.
Data collection:

pre-test, post-test.

Not mentioned

COMFORT communication and consulting course. interactive,
educational training session and taught students using a

combination of PowerPoint lectures, case studies, small group
discussions, and exercises.

Students were exposed to concepts including narrative clinical
practice, person-centered messages, the task and relational

components in all interactions, and participated in 3 encounters
using these concepts.

Duration: 3h.

Course Experience Questionnarie (CEQ) created
by authors for this study.

Perceived Importance of Medical Communication
(PIMC).

Communication Skill Attitude Scale (CSAS).
Caring Self-Efficacy Scale (CES).

5
Jo and An 2013 [43]

(Korea)

n = 39 nursing
students (19 IG; 20

GC) from two
universities.

Design:
quasi-experimental

two group study.
Data collection:

Pre-test, …