Factors Predisposing Implementation of Effective Nurse Communication: a Systematic Review

Background: Communication skills are essential for nurses in providing health services. Efficacious communication will impact in the quality of care and patient safety. This manuscript is to identify factors predisposing implementation of effective nurse communication. Method: This study that data was retrieved uses systematic review design. Data was retrieved from database ProQuest, SCOPUS, EBSCO, Science-Direct, JSTOR, and Wiley-Online in the period of 2011 – 2017. The study was done for journal, article and literature review by applying the keywords nurse communication, health's communication, effective communication of nurse. Results: A total of 12518 studies was found from six databases. From, the number of these direct search, systematic review identifies conformity based on the title, so that it obtained 31 studies with a title that suitable for a selected discussion. The total of selected papers were 16 studies and identified Efficacious communication. Analysis result from the paper research was there were 16 papers that complement the criteria determined. Six factors are identified to have effect in an implementation of effective nurse communication: (1) intelligence and self-efficacy, (2) Communication Skills, (3) Work Experience, (4) Perceptions, (5) Socio-cultural, and (6) Organization culture. Conclusion: Effective communication will be executed best of it has become the work culture. Nurses Leaders has an imperative role as role models in doing effective communication. Effective communication will imply to the increase of nurses service quality


Introduction
Communication skills are essential for nurses to provide health services because it will be made possible for implementing conceptual knowledge or expertise of nurses. Excellent communication skills will have more prominent roles in decreasing inpatients stress the patient and families (1,2). Conversations between nurses and patients during the clinical consultation are the crucial component for the quality of health maintenance. Communication is essential for providing safe and quality health services (3).
Efficient communication between nurse and other health service providers are the principle of inpatients' care maintenance. Efficient nurses' communication is the foundation that guarantees safe patients care during the transitions (4). Therefore, effective communication will impact for a quality increase and patients' safety. One of the most important constituencies that influence the functions and effects of an organization is communication. Nurse communication involves in communicating mission, visions, and goals of an organization. The ability of nurses to speak and to hear will affect the nurses' satisfaction, teamwork, and patients' safety (5,6).
Communication centralized on patients is known as biopsychosocial, including open-ended questions, giving information, creating a partnership, positive conversation, and patients' perspective search that are related to etiology and treatment (7). It is necessary for nurses to communicate effectively. There are lots of factors that can influence them. With that in mind, the author compiled a systematic review, which aims to figure out the factors that are predisposing effective nurses' communication based on some literature study.

Methods
This manuscript is using systematic review design. Data were obtained from database ProQuest, SCOPUS, EBSCO, Science-Direct, JSTOR, and Willey-Online from 2011 through 2017. The research was done for journal, article, and literature review by using keywords nurse communication, health communication, effective communication of nurse. Paper of study result was identified based on criteria which set using the framework the PICos: P = participants, I = interest, Co = Context, and S = types of studies. Studies selection adapted PRISMA flow model.
The literature selections were determined by inclusions criteria as follow: 1) research sample which was the nurses in the hospitals; 2) articles published from 2011 through 2017, 3) articles published in English, 4) articles focused on nurses' effective communications, and factors that influence nurses' effective communication, 5) articles about nursing. Exclusions criteria contained articles that are related to general discussion or that are not related to health communication, and samples used were not nurses who work in hospitals or nursing students.

Result
As many as 12518 papers have been uncovered, that result was from six databases as follow: 1215 articles from ProQuest, 823 articles from SCOPUS, 1651 documents from EBSCO, 3257 papers from Science-Direct, 2315 JSTOR, and 1425 documents from Wiley-Online. Six factors that predispose nurse effective communication is found on analysis process paper (table 1). Those factors are classified based on the observation design study applied (table 2).

Emotional Intelligence and Self-efficacy
Emotional Intelligence (EI) refers to someone's endowment to solve problems and restrain behavior by observing, identifying, and applying emotional information to the self. Self-efficacy is commodious for developing clinical communication skills. Score for nurses' emotional intelligence and self-efficacy is 14,23 ± 2,61 and 25,36 ± 5,67 (p<0,01). Score for nurses' clinical communication skills is 4,14 ± 0,53. Nurses clinical communication competency correlates positively with nurses' emotional intelligence and self-efficacy (8). Nurses inefficacy in controlling emotions will become an obstacle to executing effective communication (9).

Communication Skills
Communication skills are one of the most substantial factors that have to be possessed by nurses so that they can communicate effectively. More than 80% of nurse practitioners (N = 194) routinely apply 3 out of 7 basic communication techniques: simple language, limit instructions 2-3 concepts and articulate slowly. More than 75 % of respondents trust that 6 out of 7 basic communication techniques is useful (7).

Work Experience
Work experience will influence people's behavior in communicating with patients, nurses or other interdisciplinary knowledge. Nurses hold a critical position in collaborating interdisciplinary. Therefore, nurses must establish the communication skills to uplift the quality of patients care in the hospitals, that connected to experience and nurses' skills (10,11).

Perceptions
The precedence of useful communication in nurses' services made nurses be able to identify and coordinate about the care to patients and the patient's family so that nurses can make percept and validate information that had been or yet to be received by the patients and its family. The similarity of nurses' perceptions with what is comprehended by the patients and their families is very imperative in reducing risks, injuries and inpatients complications (4,11,12).

Socio-Cultural
Nurse face communication challenge from a variety of socio-cultural characters. Comprehensive understandings are needed in sociocultural dimensions so that nurses can ascend their cultural issues and knowledge. Sociocultural differences become an essential aspect of the interaction process and communication, due to language difference inveigled by the cultural background to avoid miscommunication (1,13,14).

Organizations Culture
Organizations culture will shape the work environment and nurses' communication behavior. Open communication culture ties to the habits in communicating that can result in nurses' activeness in gathering information that relates to nurses' work style that will influence their behaviors in communicating. Open communication culture will create a comfortable working environment in exchanging information, state their ideas and opinions. Communications culture can also help establish good communications between nurses' managers and staffs (3,5,15). Effective communication will be executed if it has become the work culture. Nurses' leader has important roles as the role model for communication effectively (6,16).

Discussion
The analysis results in this study are shows six factors that influence nurses' effective communications. Organizations culture, open communication culture and sociocultural, are the most discussed factors in 16 selected studies. Open communication culture will create nurses to communicate effectively, stating opinions openly and increasing comfortability in working (3,5). These things will eventually lead to being a good organization. Cultural background is one of the factors that influence effective communication. Language difference tends to create miscommunications if nurses do not have a comprehensive understanding of one culture (1,13). Sensitivity towards sociocultural will increase information acceptance process, which minimalizes miscommunication in nursing services. Communications culture maintain good communications between nurses' managers and health provider (3,5,15).
Emotional intelligence and self-efficacy are essentials for nurses. When nurses can escalate their emotional intelligence, then they will help themselves in establishing positive traits (17). Self-efficacy also helps in developing nurses' clinical communication (8). Nurses inefficacy of controlling emotions will become an obstacle in executing effective communication and if the nurse has a low efficacy will lead to lower confidence in conveying the development of patient care that will impact on patient safety (9). Another study measured Communication skills, work experience, and perceptions are identified as factors that also influence the implementations of nurses' effective communications in this systematic review.

Conclusion
Identification outcomes from many studies showed some factors that predispose implementations of nurses' effective communication. Those factors are emotional intelligence and self-efficacy, communication skills, work experience perception, sociocultural, and organization culture.
Nurses need to develop themselves and to optimize their insights comprehensively of factors that predispose the implementation of effective communication to escalate effective communication.