Academic journal article Research and Theory for Nursing Practice

Nonverbal Communication Behaviors of Internationally Educated Nurses and Patient Care

Academic journal article Research and Theory for Nursing Practice

Nonverbal Communication Behaviors of Internationally Educated Nurses and Patient Care

Article excerpt

Background: Because of language barriers and cultural differences, internationally educated nurses (IENs) face documented communication challenges in health care delivery. Yet, it is unknown how and to what extent nonverbal behaviors affect patient care because of research gap in the existing nursing literature. Methods: This is an exploratory study evaluating nonverbal communication behaviors of IENs interacting with standardized patients (SPs) in a controlled clinical setting through videotape analysis. Participants included 52 IENs from two community hospitals in the same hospital system in a southwestern metropolitan area in the United States. Twelve nonverbal behaviors were rated using a 4-point Likert scale with 4 indicating the best performance by the research team after watching videos of SP-IEN interactions. The global communication performance was also ranked in four areas: genuineness, spontaneity, appropriateness, and effectiveness. The relationships between these four areas and the nonverbal behaviors were explored. Finally, a qualitative analysis of two extreme cases was conducted and supplemented the quantitative findings. Results: The IENs received average scores under 2 in 5 out of the 12 nonverbal behaviors. They were "hugging" (1.06), "lowering body position to patient's level" (1.07), "leaning forward" (1.26), "shaking hands" (1.64), and "therapeutic touch" (1.66). The top three scores were for "no distractive movement," "eye contact," and "smile" (3.80, 3.73, and 3.57, respectively). The average overall global impression score was 2.98. The average score for spontaneity was 2.80, which was significantly lower than the scores for genuineness (3.15), appropriateness (3.11), but comparable to the average score for effectiveness (2.85). Finally, therapeutic touch, interpersonal space, eye contact, smiling, and hugging were all significantly correlated with one or more of the global impression scores, with therapeutic touch showing moderate correlations with all of the scores as well as the overall global impression score. Implications: The IENs' nonverbal behaviors in areas such as hugging, lowering body position to patient's level, leaning forward, shaking hands, and therapeutic touch have room for improvement. Targeted interventions focusing on norms and expectations of nonverbal behaviors in the U.S. health care setting are called for to improve quality of care.

Keywords: internationally educated nurses; nonverbal communication; patient care

Internationally educated nurses (IENs) constitute an increasing segment of the U.S. nurse workforce (Buerhaus, Auerback, & Staiger, 2009). According to the 2008 National Sample Survey of Registered Nurses (Health Resources and Services Administration, 2010), at least 5.6% of the U.S. nurse workforce are internationally educated. One recent study (Buerhaus et al., 2009) estimated that 16.3% of the U.S. nursing workforce was foreign born; most presumably received their basic nursing education from other countries. The proportions of IENs in some states are much higher. For instance, IENs make up 29% and 24% of the nurse workforce in California and Florida, respectively (Aiken, 2007). More importantly, a significantly higher proportion of IENs (71.1%) were in direct patient care positions compared to their American counterparts (54.0%; Xu, Zaikina-Montgomery, & Shen, 2010).

Communication is critical for safe and effective patient care. Because of language barriers and cultural differences, IENs face communication challenges in health care delivery, particularly in face-to-face interactions with patients. Communication challenges of IENs are well documented in studies going back as early as 1970s (Davis & Nichols, 2002; Edwards & Davis, 2006; Hearnden, 2007; Jose, 2010; Kawi & Xu, 2009; Lin, 2009; Sarsfield, 1973; Xu, 2007; Xu, Gutierrez, & Kim, 2008; Yi, 1993). Consequently, researchers and policy makers have been concerned about real and/ or potential effects of the communication challenges on patient care, particularly patient safety (Aiken, Buchan, Sochalski, Nichols, & Powell, 2004; Brush, Sochalski, & Berger, 2004; Buerhaus et al. …

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