INTERPERSONAL COMMUNICATION ASSESSMENT SCALE: PSYCHOMETRIC STUDY OF THE PORTUGUESE VERSION ROSA CRISTINA CORREIA LOPES, MS,⁎ ZAIDA DE AGUIAR SÁ AZEREDO, PHD,† AND ROGÉRIO MANUEL CLEMENTE RODRIGUES, PHD‡ This article is a report of a study exploring the psychometric properties of the Portuguese version of the Interpersonal Communication Assessment Scale (ICAS) related to nursing education. Interpersonal communication in health care in general and in nursing care in particular is used to transmit messages between the members involved so as to convey a meaning in their interaction. The essence of nursing care is focused on the nurse–patient interpersonal communication. The validation of ICAS developed in 4 steps: translation, back translation, comparison of both versions, and evidence of the validity of Portuguese version. The psychometric study was carried out using the Statistical Package for the Social Sciences. The nonprobabilistic convenience sample was composed of 156 second-year students of the undergraduate nursing course (2008–2009). The psychometric analysis showed high values in Cronbach's alpha (ICAS: .939; advocacy: .857; therapeutic use of self: .890; and validation: .795), Pearson correlation (r = .740, P = .000), Bartlett's test of sphericity (2190.278, P = .000), and Kaiser–Meyer–Olkin measure of sampling adequacy (.910). In general, the psychometric properties of the ICAS–Portuguese version are comparable to the original version. ICAS showed high internal consistency in reliability analysis and excellent temporal stability, thus an appropriate tool for assessing interpersonal communication skills. (Index words: Interpersonal communication; Nursing education; Psychometric study; Portuguese version; Interpersonal communication assessment scale) J Prof Nurs 29:59–64, 2013. © 2013 Elsevier Inc. All rights reserved. R ENOWNED AUTHORS IN the science of nursing (Chalifour, 1993; Colliére, 1989; Lazure, 1994; Peplau, 1990; Phaneuf, 2005; Watson, 2006; among others) unanimously agree that interpersonal relationships and relational skills are the basis of nursing care, a skill that promotes excellence in nursing care. ⁎ Associate Professor, Nursing School of Coimbra, Portugal. †Associate Professor, Biomedical Sciences Abel Salazar Institute, University of Porto, Portugal. ‡Associate Professor, Nursing School of Coimbra, Portugal. This study was funded by the Foundation for Science and Technology— Ministry of Science, Technology, and Higher Education—Portugal, SFRH/PROTEC/67586/2010. Address correspondence to Prof. Lopes, MD: Nursing School of Coimbra, Portugal. E-mail: [email protected] 8755-7223/12/$ - see front matter The importance of communication/relational skills also includes the communication between different team members, taking into account that the nurse is part of a multidisciplinary health team. Communication and development of communication skills have gained a significant importance in the interpersonal relationships between health team members with an impact on quality of care. Background Interpersonal communication in nursing is used to convey messages between the different parties so as to provide a meaning to this exchange of messages. The sender/nurse should convey the message to the receiver in a clear and understandable way for the other person to understand and make the necessary changes. Riley (2004, p. 6) argues that interpersonal communication in nursing should be “assertive, responsible and caring” Journal of Professional Nursing, Vol 29, No. 1 (January/February), 2013: pp 59–64 © 2013 Elsevier Inc. All rights reserved. 59 http://dx.doi.org/10.1016/j.profnurs.2012.04.010 60 and that the acquisition of interpersonal communication skills is based on acquiring basic knowledge (cognitive domain), becoming safer by believing in the value and impact of positive communication (affective domain), and measuring skill performance (psychomotor domain). In nurses' daily work, communication is used in multiple activities of education, care delivery, and liaison in the multiprofessional team; thus, it is essential to consciously use communication by mastering communication skills (Silva, Brasil, Guimarães, Savonitti, & Silva, 2008). Some authors consider communication in nursing as a basic instrument of nurses, regardless of their area of expertise (Castro & Silva, 2001; Matoso, 2006; Mok & Chiu, 2004). Communication is a skill that should be developed, practiced and, above all, trained and reflected upon. However, the simple knowledge of communication and relational theories is considered insufficient to health care practice (Araújo, Silva, & Puggina, 2007; Batista, 2007; Cruz, Sá, Pereira, & Novais, 2002; Ferreira, 2001; Matoso, 2006). The client–nurse communication is not always therapeutic. In this relationship with the other, there are poorly constructed messages that can hurt the patient and cause hostility and exclusion from a therapeutic commitment, jeopardizing the creation of the necessary bond in the caring process and the development of a relational hierarchical process instead of a collaborative process. Thus, these messages can become iatrogenic factors (Araújo et al., 2007). Research studies with nurses in Belgium (Bowles, Mackintosh, & Torn, 2001) and in Canada (Boscart, 2009) show that the practice of communication skills through brief education-oriented interventions increases nurses' awareness in their interactions, resulting in a sustainable effect on the quality of the nurse–patient communication. Interventions using coping strategies have also proven to be very useful (de Lucio, Lopez, Lopez, Hesse, & Caamano, 2000), whereas interprofessional education approaches develop a more comprehensive understanding of caring based on trust and communication in the context of nursing care (Chan, Mok, Po-Ying, & Man-Chun, 2009). Therefore, nursing students/nurses should learn how to communicate in an effective way because building a relationship of concern and trust is to replace the habit of communicating in a noneffective and nontherapeutic way using actual helping relationships (Riley, 2004). The learning of specific techniques of interaction should be included in the curriculum of the degree course in nursing or education organized by the service (Apker, Propp, Zabava Ford, & Hofmeister, 2006). Despite interpersonal communication being viewed as the essence of nursing, there are few psychometric instruments available to measure this skill in students/ nurses. The reviewed studies in the area of communication in nursing usually use qualitative tools specifically developed for the respective study. LOPES ET AL In 2006, Klakovich and delaCruz developed the Interpersonal Communication Assessment Scale (ICAS) to measure the communication competencies of undergraduate and graduate students. The authors used retroductive triangulation, using both deductive and inductive methods and the model of relational competence in the conceptualization and development of the scale. The Study Aims This study aimed to validate and test the psychometric properties of the Portuguese version of the ICAS originally developed in English by Klakovich and DelaCruz (2006). Methodology The research literature recommends using versions of already tested measures in different cultures instead of creating new ones for each country (Duarte & Bordin, 2000). These measures need to be validated in the new cultural context and developed according to a strict methodology so as to ensure the semantic and technical equivalence and the construct, content, and criterion validity (Duarte & Bordin, 2000; Polit, Beck, & Hungler, 2004; Rocha et al., 2003). The ICAS– Portuguese version was validated in four phases: translation, back translation, comparison of both versions (original and back translated), and evidence of the scale's validity in the new context. The ICAS was first translated into Portuguese by a bilingual translator and, then, submitted to a panel of four bilingual experts with renowned experience in the scientific and academic community in the areas of nursing science, education, and research. It was then translated back into English by a bilingual translator unfamiliar with the original version. Both versions of the ICAS (original and back translated) were compared by the experts that confirmed the equivalence of both scales and the appropriateness of the Portuguese version. Sample/Participants Ribeiro (2008) considers that the number of participants to be included in a sample is usually related to the number of variables in the study, with five being the minimum number of participants required for each variable. Thus, in the 23-item ICAS, the minimum number required for our sample was 115 students. In the first stage of this study, the (nonprobabilistic convenience) sample was composed of 156 second-year students enrolled in the second semester of the nursing undergraduate program at the Nursing School of Coimbra and undertook their clinical training in nursing fundamentals (first clinical training) during the academic year 2008–2009. The ICAS–Portuguese version was administered in collaboration with these students' supervising teachers who were asked to complete the scale for each student in clinical training. INTERPERSONAL COMMUNICATION ASSESSMENT SCALE: PORTUGESE In the second phase of this study, 45 students who had already been part of the sample in the first phase were selected. 61 summative tool to assess the interpersonal communication skills of nursing students. Data Collection Instrument Reliability analysis using Cronbach's alpha revealed an extremely high reliability of .98 for the 54-item ICAS. The aim of the authors was to develop a scale that would be quick and easy for the supervising teachers in clinical training to complete. Preserving the integrity of the dimensions, the items with the highest item-total correlations, were retained, resulting in a 32-item scale. Exploratory factor analysis using principal components extraction and varimax rotation showed a four-factor solution. However, the fourth factor was not interpretable, and the scree plot indicated a three-factor solution. Thus, a repeat exploratory factor analysis with a forced free-factor solution allowed a logical interpretation of the results. Items that factor loaded .60 or higher were retained, resulting in a 23-item ICAS with three subscales that explained 60% of the variance: • F1—advocacy (clearly conveying diagnostic and other relevant information in a way that supports patient/family wishes and decisions); • F2—therapeutic use of self (demonstrating interpersonal behaviors that assist clients in achieving healthy emotional and behavioral outcomes by being genuine, empathetic, and respectful to the client); • F3—validation (listening carefully and verifying that the intent of messages is accurately interpreted). The ICAS is a Likert-type scale composed of 23 items related to the interpersonal communication skills expected from nursing students, and the level of effectiveness ranged from 1 (seldom) to 4 (almost always). The Cronbach's alpha for the 23-item ICAS (.96) and its dimensions (F1 = .93, F2 = .93, F3 = .84) showed good internal consistency. The authors concluded that ICAS is a reliable measure suitable for differentiating the interpersonal communication competencies in beginning and graduating students in undergraduate and graduate nursing programs, underscoring its potential as a formative and In the first phase, so as to analyze the internal consistency of the ICAS, 24 clinical faculty from a nursing college supervising second-year students enrolled in the second semester of the nursing undergraduate program and undertaking their clinical training in nursing fundamentals (first clinical training) during the academic year 2008–2009 were asked to complete the ICAS–Portuguese version. The teachers were informed about the purpose and scope of the study, and their participation in the study was voluntary and anonymous. Data were collected from June 22nd to June 26th, 2009. There were 156 returned measures usable for analysis. The second phase occurred after 2 weeks, so as to assess the temporal stability of the ICAS, and seven teachers were asked to apply the scale once again to the students that they supervised. Thus, 45 measures were duly completed and returned. Data were analyzed using the Statistical Package for the Social Sciences, Version 15, with a level of significance of P b .001. Ethical Considerations This study was approved by the Ethical Committee of the Research Unit in Health Science—Nursing of the Nursing School of Coimbra. Permission was obtained from the president of the institution to conduct this study. Participants were given a consent form explaining the purpose and scope of the study, underlining the voluntary nature of participation, and ensuring anonymity. Results In the first phase, the sample was composed of 156 students aged 19–33 years, with a mean age of 20.64 years and a standard deviation of 2.20. Of the participants, 133 (85.26%) were female, and 23 (14.74%) were male. In the second phase, 45 students were selected, aged 19–27 years, with a mean age of 20.31 years and a standard deviation of 1.31. Of the participants, 34 (75.56%) were female, and 11 (24.44%) were male. Table 1. Comparison of Mean, Standard Deviation, Ranges and Psychometric Properties (Reliability of Cronbach's Alpha Coefficient) of ICAS and it's Dimensions in the Original and Portuguese Version ICAS version Original (n = 145) Portuguese (n = 156) M SD Range Cronbach's α M SD Range Cronbach's α F1Advocacy (10 items) F2Therapeutic use of self (9 items) F3Validation (4 items) Total ICAS 20.68 7.72 10–39 .93 26.25 5.52 13–37 .86 24.72 6.57 9–36 .93 26.80 5.43 12–26 .89 8.13 2.82 3–15 .84 11.03 2.70 4–16 .80 53.53 15.17 22–86 .96 64.08 12.83 30–88 .94 62 LOPES ET AL Table 2. Reliability of Cronbach's Alpha Coefficient of the Items That Constitute the ICAS Item Corrected item-total correlation Cronbach's α if item deleted .737 .596 .935 .937 .651 .936 .666 .693 .936 .935 .645 .936 .595 .537 .937 .938 .677 .574 .624 .624 .936 .937 .936 .936 .640 .936 .663 .432 .703 .674 .483 .741 .936 .939 .935 .936 .938 .935 .356 .941 .684 .672 .935 .936 .596 .937 Dá instruções claras sobre a gestão das condições de cuidados. Descreve os comportamentos em vez de fazer juízos de valor sobre o doente/família para dar informações. Incentiva o doente/membros da família a expressar sobre as reacções aos cuidados e tratamentos. Providencia o encaminhamento do doente. quando necessário. Coloca perguntas específicas para obter pormenores sobre uma potencial área-problema. Revela comportamentos (como contacto visual. toque) quando comunica. se for adequado à situação e aceitável para a cultura de origem da outra pessoa. Pede confirmação das suas próprias percepções. Refere discrepâncias na informação fornecida pelo doente e família durante a entrevista. Pede clarificação. Detecta contradições entre a comunicação verbal e a não-verbal. Convida o doente e família a explorar as discrepâncias na informação. Prepara o doente/família para os procedimentos. explicando o processo e as suas razões antes de os efectuar. Dá feedback indicando observações gerais do processo. do conteúdo e dos sentimentos. Reconhece como importantes as preocupações do doente e da família. Requer consulta de outros profissionais de saúde quando necessário. Identifica necessidades de apoio emocional para o doente/membro da família. Ensina e promove cuidados preventivos de saúde. Explica ao doente/família as diferentes opções de tratamento. Dedica tempo com o doente e membros da família para ouvir as suas preocupações e problemas. Questiona a decisão do doente em não aderir ao tratamento ou interrompê-lo. As expressões faciais interligam-se com o contexto da conversa. Mantém a distância e o espaço adequado à cultura de origem da outra pessoa enquanto fala com o doente/membros da família. Inicia uma conversa com o doente/membro da família que habitualmente está em silêncio. Internal Consistency The internal consistency of ICAS was measured using Cronbach's alpha in the total sample of Portuguese nursing students (N = 156). The total ICAS revealed a high reliability (Cronbach's alpha = .939). The Cronbach's alpha also indicated a good internal consistency in the three dimensions (advocacy—.857; therapeutic use of self—.890; and validation—.795; Table 1). These values of internal consistency are slightly higher than the ones found by the authors in the original version (total ICAS—.96; advocacy—.93; therapeutic use of self—.93; and validation—.84; Table 1). As for the validity of the items in the Portuguese sample, interitem correlations, indicator of homogeneity of the scale, show very high means. Item-total correlations (indicator of the higher the correlation, the better the item discrimination) were high, with the exception of Items 20, 15, and 18 with the lowest coefficients of correlation (.356, .432, and .483, respectively). Cronbach's alpha if item deleted, which is the estimated value of alpha if the given items were removed from the model, was also high (alpha if item deleted was only higher than total alpha value in Item 20; Table 2). Test–Retest Reliability To assess the temporal stability of the ICAS, we applied the scale again 15 days after it was first applied to 45 students, and similar results were found in the test– retest measures (Cronbach's alpha = .932). Pearson correlation coefficient was also measured between both applications (Table 3), and a highly significant correlation was found between ICAS total scale (r = Table 3. Pearson Coefficient Correlation in Two Times (Test– Retest) Pearson correlation (n = 45) Advocacy Therapeutic use of self Validation Global ICAS ⁎P b .001. .744 ⁎ .553 ⁎ .775 ⁎ .740 ⁎ INTERPERSONAL COMMUNICATION ASSESSMENT SCALE: PORTUGESE Table 4. Tests KMO and Bartlett's Sphericity KMO measure of sampling adequacy Bartlett's test of sphericity χ df Significance 2 .910 2190.278 253 .000 .740; P = .000) and subscales: advocacy (r = .744; P = .000), therapeutic use of self (r = .553; P = .000), and validation (r = .775; P = .000). Factor Analysis As this study aimed to validate and not to design a new tool, it confirmed the factor analysis, the type of rotation, and the factorial solution found by the authors, which originally designed the instrument (Ribeiro 2008). Therefore, given that the original scale's structure is composed of three factors, the construct validity in the Portuguese version, obtained through the study on dimensionality, showed a forced three-factor solution in the factor analysis. The analysis converged into a threefactor solution, which explained 58.872% of the total variance, complemented by the principal component analysis with varimax rotation. This analysis allowed us to confirm the overall distribution of factors based on the factor structure indicated by the scale's authors. The degree of susceptibility or the suitability of the data to factor analysis, that is, the factorability of the scale, was assessed using Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy and Bartlett's test of sphericity. The KMO index was .910, indicating a very good adequacy of factor analysis to this study and sampling adequacy. Bartlett's test of sphericity (χ 2 = 2190.278; P = .000), indicating item correlation, confirms the adequacy of the factor analysis method to data analysis and item correlation (Table 4). Discussion Despite the slightly lower levels of internal consistency compared with the original version in the three dimensions (Cronbach's alpha: F1 = .96, F2 = .93, F3 = .93) and in the total scale (Cronbach's alpha = .84), the Portuguese version of the ICAS shows high levels of internal consistency and a general correlation with the scores of the original version (Pestana & Gageiro, 2005; Polit et al., 2004). As for the test–retest reliability, Pearson coefficients (F1: r = .744, P = .000; F2: r = .553, P = .000; F3: r = .775, P = .000; Total: r = .740, P = .000) showed a very good temporal stability between the first and second application of the Portuguese version (Ribeiro, 2008). The validity of the items in the Portuguese sample, based on the content, construct, and criterion validity proposed by the authors of the original version and confirmed by the judges of the Portuguese version, showed items with good discrimination and scale homogeneity (Pestana & Gageiro, 2005). Despite the highly satisfactory results in the sample of students undertaking their first clinical training in 63 nursing, further research is recommended using the ICAS–Portuguese version with final-year students of the nursing undergraduate program and, also, students of the master's in nursing. Conclusion This study aimed to validate the ICAS–Portuguese version in a sample of 156 students in their first clinical training of the nursing undergraduate program. Based on the content, construct, and criterion validity proposed by the authors of the ICAS original version and confirmed by the judges of the translation into Portuguese, we conclude that, in general, the psychometric properties of the Portuguese version are comparable to those originally reported by Klakovich and DelaCruz (2006). The reliability of the results is confirmed by the high levels of internal consistency of the total ICAS and its dimensions (advocacy, therapeutic use of self, and validation) and a very good temporal stability between the first and second application. Based on these results, the ICAS–Portuguese version was considered a suitable tool to assess the interpersonal communication skills of nursing undergraduate students in clinical training. The expansion of the study using the ICAS will make it possible to differentiate between the interpersonal communication skills of nursing undergraduate and graduate students and also provide a more in-depth approach to the process of validation that started with this study and that will never be truly finished. References Apker, J., Propp, K., Zabava Ford, W., & Hofmeister, N. (2006). Collaboration, credibility, compassion, and coordination: professional nurse communication skill sets in health care team interactions. Journal of Professional Nursing, 22, 180–189. Araújo, M., Silva, M., & Puggina, A. (2007). A comunicação não-verbal enquanto factor iatrogénico. Revista da Escola de Enfermagem de USP, 41, 419–425. Batista, M. (2007). Complemento de formação: A grande oportunidade para clarificar e interiorizar o essencial em enfermagem. Revista Sinais Vitais, 74, 7–9. Boscart, V. M. (2009). A communication intervention for nursing staff in chronic care. Journal of Advanced Nursing, 65, 1823–1832. Bowles, N., Mackintosh, C., & Torn, A. (2001). Nurses' communication skills: An evaluation of the impact of solutionfocused communication training. Journal of Advanced Nursing, 36, 347–354. Castro, R., & Silva, M. (2001). A comunicação não-verbal nas interações enfermeiro-usuário em atendimentos de Saúde Mental. Revista Latino-Americana de Enfermagem, 9, 80–87. Chalifour, J. (1993). Eiseigner la relation d'aide. Gaetan Morin Editeur: Quebéc. Chan, E. A., Mok, E., Po-Ying, A. H., & Man-Chun, J. H. (2009). The use of interdisciplinary seminars for the development of caring dispositions in nursing and social work students. Journal of Advanced Nursing, 65, 2658–2667. Colliére, M. (1989). Promover a vida: Da prática das mulheres de virtude aos cuidados de enfermagem. Sindicato dos Enfermeiros Portugueses: Lisboa. 64 Cruz, A., Sá, A., Pereira, G., & Novais, R. (2002). O método individual de trabalho e suas implicações. Revista Sinais Vitais, 43, 25–29. de Lucio, L. G., Lopez, F. J. G., Lopez, M. T. M., Hesse, B. M., & Caamano, M. D. C. (2000). Training programme in techniques of self-control and communication skills to improve nurses' relationships with relatives of seriously ill patients: A randomized controlled study. Journal of Advanced Nursing, 32, 425–431. Duarte, C., & Bordin, I. (2000). Instrumentos de avaliação. Revista Brasileira de Psiquiatria, 22, (Suppl II), 55–58. Ferreira, M. (2001). O relacionamento interpessoal—Um instrumento básico em enfermagem. Revista Servir, 49, 8–11. Klakovich, M., & DelaCruz, F. (2006). Validating the interpersonal communication assessment scale. Journal of Professional Nursing, 22, 60–67. Lazure, H. (1994). Viver a relação de ajuda: A bordagem teórica e prática de um critério de competência da enfermeira. Lusodidacta: Lisboa. Matoso, M. (2006). Supervisão de relações interpessoais em enfermagem. Revista Portuguesa de Enfermagem, 7, 53–56. Mok, E., & Chiu, P. (2004). Nurse–patient relationships in palliative care. Journal of Advanced Nursing, 48, 475–483. Peplau, H. (1990). Relaciones interpersonales en enfermeria. Salvat Editores: Barcelona. LOPES ET AL Pestana, M., & Gageiro, J. (2005). Análise de dados para Ciências Sociais—A complementaridade do SPSS. Edições Sílabo: Lisboa. Phaneuf, M. (2005). Comunicação, entrevista, relação de ajuda e validação. Lusociência: Loures. Polit, D., Beck, C., & Hungler, B. (2004). Pesquisa em enfermagem: Métodos, avaliação e utilização. (5th ed.). Artmed: Porto Alegre. Ribeiro, J. (2008). Metodologia de investigação em psicologia e saúde. (2nd ed.). Legis Editora: Porto. Riley, J. (2004). Comunicação em Enfermagem. (4th ed.). Lusociência: Loures. Rocha, A., Pires, A., Leandro, A., Afonso, M., SeabraSantos, M., Simões, M., et al. (2003). Directrizes internacionais para a utilização de testes—Versão Original International Test Commission (ITC)—Versão Portuguesa. CEGOC-TEA. Silva, L., Brasil, V., Guimarães, H., Savonitti, B., & Silva, M. (2008). Comunicação não-verbal: Reflexões acerca da linguagem corporal. Revista Latino-Americana de Enfermagem, 8, 52–58. Watson, J. (2006). Impacto de la relación sanadora en la práctica de la Enfermería. Revista ROL de Enfermería, 29, 806–812.
© Copyright 2024