📄 medicine

Factors influencing delivery, effectiveness, and implementation of a patient-centered communication skills training in nursing care: multimethod process evaluation of a randomized controlled trial

This multimethod process evaluation of a randomized controlled trial identifies key factors—ranging from recruitment challenges and contextual influences to management support—that shaped the delivery and effectiveness of a patient-centered communication skills training for nurses, offering practical guidance for its future long-term implementation.

Original authors: Kendra MIELKE, Wiebke FRERICHS, Katja CÖLLEN, Martin HÄRTER, Isabelle SCHOLL

Published 2026-06-26

📖 6 min read🧠 Deep dive

CC BY 4.0

Original authors: Kendra MIELKE, Wiebke FRERICHS, Katja CÖLLEN, Martin HÄRTER, Isabelle SCHOLL

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

The Big Picture: Teaching Nurses the "Soft Skills" of Care

Imagine nursing as a high-stakes dance. The nurses know the steps (medical procedures, giving meds, checking vitals), but the paper argues that the music they dance to—the way they talk to patients, listen to fears, and handle tough emotions—is just as important.

The researchers at the University Medical Center Hamburg-Eppendorf created a special "dance class" called the KOMPAT-Training. This wasn't a medical lecture; it was a workshop designed to teach nurses how to communicate better with patients and their families. They tested this training in a large experiment (a Randomized Controlled Trial) and found that it worked: nurses felt more confident and had better attitudes after the class.

However, the paper you are reading isn't about whether the training worked. It's a process evaluation. Think of this as the "behind-the-scenes" documentary of the experiment. The researchers wanted to know: How did we actually get this training into the nurses' hands? What went right, what went wrong, and how do we keep doing it forever?

The Recipe and the Kitchen (Methodology)

To figure this out, the researchers didn't just look at test scores. They acted like detectives, gathering clues from three sources:

Interviews: They talked to 20 people, including nurses who took the class, the managers who hired them, and the teachers who led the sessions.
Field Notes: They kept a diary of what happened during recruitment (trying to get nurses to sign up) and during the training itself.
Numbers: They counted how many flyers were handed out, how many emails were sent, and how many people actually showed up.

They used two famous "rulebooks" for evaluating programs (the MRC and RE-AIM frameworks) to organize their findings. You can think of these rulebooks as a checklist to ensure they didn't miss any important details about how the program was delivered.

What They Discovered (The Findings)

1. Tweaking the Recipe (Adaptations)

Just like a chef might adjust a recipe based on the ingredients available, the training team made small changes to the class schedule and content.

The Schedule: They noticed nurses started their shifts early, so they moved the class start time from 9:00 AM to 8:00 AM to fit better.
The Role-Plays: Sometimes, if a group was too small to split up for practice scenarios, they kept everyone together. If a teacher felt nervous giving feedback, a researcher stepped in to help.
The "Heavy" Topic: One part of the class dealt with talking to dying patients. It was so emotional that the teachers added a "warning label" before starting and taught students how to take a break if they got overwhelmed.
The Verdict: These were minor tweaks that didn't ruin the recipe; they actually made it fit the kitchen better.

2. The Empty Seats (Reach)

This was the biggest hurdle. The team tried everything to get nurses to sign up: flyers, posters, emails, newsletters, and presentations at meetings. They even handed out 537 flyers!

The Problem: Despite the noise, many seats remained empty.
Why? Some nurses were too busy (the "I have too much work" excuse). Some managers were skeptical. One manager admitted they only invited the "easy" nurses to join, avoiding the ones who were already struggling with communication because they didn't want to rock the boat.
The Analogy: It was like trying to fill a concert hall. You put up billboards and send invites, but if people are working double shifts or don't think the music is for them, the seats stay empty.

3. The Taste Test (Mechanisms of Impact)

Once the nurses were in the room, how did they like the class?

The Good: They loved the atmosphere, the food, and the small group size. They felt the teachers were supportive.
The "Toolbox": The part where they built a personal "toolbox" of communication skills was a hit.
The Mixed Reviews: Some felt the first part was too boring and theoretical. Others felt the final module (talking about death) was rushed. It was like serving a great meal but finishing the dessert too quickly.
The Result: Most nurses felt they learned something, but some weren't sure if the changes in their behavior were because of the class or just because they were having a good week.

4. The Environment (Contextual Factors)

The training didn't happen in a vacuum; it happened in a busy hospital.

Barriers: The biggest enemies were time and staff shortages. If a nurse is short-staffed, they can't leave for a full-day class. Some nurses also felt they already knew how to talk to people, so they didn't see the point.
Helpers: When a manager said, "I'm going too, so you should," it helped. When a specific person was assigned to answer questions, it helped.

5. How to Keep the Party Going (Implementation)

If they want to run this training for years to come, what needs to happen?

Don't Let It Fade: They need to keep advertising it, not just once, but constantly.
Make it Easy: It needs to be part of the standard "menu" of training that every nurse takes, not a special event.
Leadership: The managers need to be the cheerleaders. If the boss doesn't care, the staff won't either.
Refreshers: Skills get rusty. They need "booster shots" or follow-up sessions to keep the skills sharp.

The Bottom Line

This paper is a lesson in implementation science. It tells us that even a great training program can struggle if the "plumbing" of the hospital isn't right.

The researchers concluded that to make patient-centered communication a reality in nursing, we can't just build a great class and hope people show up. We need to:

Involve nurses in the planning so they feel ownership.
Fix the organizational problems (like giving them time off to learn).
Make sure managers are on board to lead by example.

It's not enough to teach the dance; you have to make sure the music is playing, the floor is open, and the dancers have the time to practice.

Technical Summary: Process Evaluation of Patient-Centered Communication Skills Training in Nursing

Problem Statement
Patient-centered communication is a cornerstone of high-quality nursing care, essential for building trust, improving patient understanding, and reducing healthcare professional burnout. Despite its importance, the implementation of standardized communication skills training (CST) within nursing professional development remains limited. Existing literature indicates a lack of needs-based, thoroughly evaluated CST programs for nursing professionals across diverse clinical disciplines in Germany. Furthermore, while effectiveness trials exist, they are rarely accompanied by process evaluations grounded in implementation research frameworks. This gap hinders the understanding of how to successfully translate communication interventions from research settings into routine practice.

Methodology
This study presents a multimethod process evaluation of the KOMPAT study, a randomized controlled trial (RCT) evaluating a newly developed, needs-based CST for nursing professionals. The evaluation utilized a hybrid effectiveness type 1 design, integrating qualitative and quantitative data to explore factors influencing delivery, effectiveness, and long-term implementation.

Frameworks: The analysis was guided by dimensions from the Medical Research Council (MRC) guidance for complex interventions and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.
Data Collection:
- Qualitative: Semi-structured interviews were conducted with $n=20$ participants, including nurses, ward managers (WM), nurse center managers (NCM), and co-trainers. Purposive sampling ensured diversity in medical disciplines and job levels. Interviews were conducted between July and November 2024.
- Quantitative & Field Notes: Data included recruitment statistics (distribution of flyers, emails, newsletter articles), training attendance numbers, and field notes documenting recruitment interactions, training delivery deviations, and feedback.
Analysis: Qualitative data underwent qualitative content analysis (Kuckartz) using a deductive-inductive approach based on the MRC and RE-AIM constructs. Quantitative data were analyzed using descriptive statistics.

Key Contributions and Results
The study identified five primary thematic areas influencing the training's delivery and potential implementation:

Adaptations (MRC): Minor deviations from the protocol occurred, including schedule adjustments (earlier start/end times) to align with nurse shifts, modifications to role-play groupings based on group size, and the addition of content warnings and coping strategies for the module on communicating with seriously ill or dying patients. These adaptations were deemed minor and unlikely to compromise the intervention's core theory.
Reach (MRC): Despite extensive promotion strategies (flyers, newsletters, presentations), motivating nurses to participate remained challenging. Recruitment barriers included high workload, time constraints, and competing training programs. Some managers employed strategic recruitment, targeting nurses perceived as receptive while potentially overlooking those with communication difficulties.
Mechanisms of Impact (MRC):
- Responses: Participants reported high satisfaction with the training environment, group size, and trainer support. Module 2 (general communication skills) and Module 3 (de-escalation) were highly valued. Module 4 (end-of-life communication) received mixed feedback; while some found it essential, others felt it was too brief or not relevant to daily routines.
- Consequences: Participants noted increased self-awareness, improved empathy, and better team cohesion. However, many were uncertain whether behavioral changes resulted from the training or other factors, highlighting the difficulty in isolating specific mechanisms of impact.
Contextual Factors (MRC):
- Organizational: High workload, staffing shortages, and time constraints were significant barriers. Information overload from various promotional channels sometimes reduced effectiveness.
- Personal: Motivation, prior training experience, and attitudes toward patient-centeredness influenced participation. Some nurses with extensive prior CST experience felt the content was redundant, while others lacked the necessary positive attitudes.
Implementation (RE-AIM): For long-term sustainability, participants emphasized the need for management support, designated contact persons per center, and integration into existing institutional education structures (e.g., mandatory courses or new employee onboarding). Continuous advertising and "booster" sessions were recommended to maintain skills.

Significance and Claims
The paper claims that this process evaluation provides valuable, practical insights into the rollout and long-term implementation of patient-centered CST in nursing. By utilizing established implementation frameworks, the study differentiates between inherent intervention failures and implementation failures.

The authors modestly conclude that while the training was well-received and effective in improving self-efficacy and attitudes, successful long-term implementation requires addressing multifaceted barriers. Key recommendations include:

Involving nursing professionals and managers across all hierarchical levels throughout the development and recruitment process.
Addressing organizational barriers, specifically time allocation and staffing.
Integrating training into existing, familiar continuous education structures to ensure sustainability.
Recognizing that personal factors, such as motivation and pre-existing attitudes, are critical determinants of success.

The study underscores that process evaluations are essential for understanding the "how" and "why" of intervention outcomes, offering a roadmap for future studies aiming to enhance patient-centered communication in clinical settings.