Nurse Education Today (1991) lI,24-29 0 Longman Group UK Ltd 1991
Nurses’ interpersonal perceptions Phillip
Burnard
skills: a study of nurses’
and Paul Morrison
Six Category Intervention Analysis was used as the framework of a study which involved asking 117 trained nurses to rate their interpersonal skills along six dimensions. The findings suggested that the nurses viewed themselves as being more skilled in offering support, information and prescription in their dealings with patients and less skilled in being catalytic, cathartic and confronting in similar circumstances. The findings in this study were similar to those of previous studies in this field. The study has implications for the development of interpersonal skills training programmes for nurses.
INTRODUCTION There is a growing interest in nurses’ developing interpersonal skills (Muldary, 1983; Faulkner & Maquire, 1984; Aidroos, 1985; Kagan, 1985; Conboy-Hills, 1986; Fielding SCLlewelyn, 1987; Reynolds & Cormack, 1987; Burnard, 1989a; 1989b). Nurses are being encouraged to develop a range of communication, counselling, assertiveness, facilitation and social skills. What remains unclear is how nurses view their own interpersonal skill levels. It is asserted that such views need to be taken into account before further interpersonal skills training can be planned. This study offers a format for the self-assesment of interpersonal skills. It builds on previous research by the authors (Burnard & Morrison, 1988 Morrison & Burnard 1989).
Philip Burnard MSc RGN RMN DipN Cert Ed RNT Lecturer in Nursing Studies and Paul Morrison BA (Hans) RGN RMN PGCE Lecturer in Nursing Studies, University of Wales College of Medicine, Cardiff, Wales (Requests for offprints to PB) Manuscript accepted 23 May 1990 24
The paper identifies a theoretical framework known as Six Category Intervention Analysis (Heron, 1989) offers an aim for the study, describes the methodology and findings and compares the results of the study with previous ones. It closes with a discussion of the findings and some suggestions for future research and training in the field. The present study seeks to test out the validity of our previous findings.
Six Category Intervention
Analysis
Six Category Intervention Analysis (Heron, 1975; 1989) developed out of previous work by Blake and Mouton (1976). It is a device for identifying possible types of effective interpersonal interventions between practitioners and clients. Heron’s category analysis is a theoretical analysis and the authors could find no reference to any empirical work that predated the development of the analysis nor could they find any later, published studies which used the analyses to guide research in this area. The analysis has been widely used at the Human Potential Research Project, University of Surrey (HPRP,
1987)
as a tool
for
communication those
training
skills.
courses
are
people
It is notable,
often
by
the
develop
their
interpersonal
ing, cathartic,
skills
identified
in Heron’s
&
advice
To be informative To
the person’s
beliefs. To be cathartic
Authoritative
Facilitative
Categories
Categories
Prescriptive informative Confronting
Cathartic Catalytic Supporting
and strong
or make
is to offer
sug-
informa-
be confronting
behaviours,
different.
To be
is to
attitudes
or
is to enable the release of
emotion
(tears,
anger,
fear
The point needs to be raised as 10 what
degree such analyses can appropriately ferred and modified Blake
and Mouton’s
tions. He further
self-
skilled
person
priately
and
confirm
the
further
other
person’s
subdivides
the categories
under the headings authoritative categories and facilitative categories. Authoritative interventions are those which enable maintain
some degree
tionship tive
and include
and
control
categories.
are those that enable
informaFacilitative
the locus of
to remain with the client and include the
cathartic, Table
to
over the rela-
the prescriptive,
confronting
interventions
the practitioner
of control
catalytic
1 identifies
analvsis
may
Mouton’s
(1976)
Analysis
be
which
and
supportive
these
categories.
compared
original
to
Intervention
comprised
the
categories. Heron’s Blake
and
who
move
can
between
suggests that no categorv tant
than
any
however,
other
he argues
form a ‘bedrock’
Ihr
to have improved
tat-
because
we
(Heron
He also offers
live
1977),
in
interventions that
the overt
ma\
c.c)nlnlunication the view that
a ‘non-cathartic
where
strong emotion
Paradoxicall),
that catalytic
type of intervention
and counselling.
societv’
expression
of
is not highly valued, the cathartic
will tend to be less frrquentlv
Fielding
and’I,lewelvn
are different
degrees
(1987)
and less
Ilote that there
01‘ resistant e to the o\‘et-t
expression
of emotion within the I ‘li, influenced
by culture.
Heron goes on to make a case for the value of cathartic and contentious
which is beyond the
appro-
various
is more or less impor-
category.
serve as the basis for effective
pertinent
and principles.
interven-
when using the categol-) analysis as a of guiding therapeutic. action. Heron
therapeutic
4. prescription;
analysis appears
is one freely
skilfully used bv many practitioners.
3. confrontation;
Heron’s
of therapeutic
category
1. acceptant;
for his
claims that the interpersonallv
Category
2. catalytic;
5. theories
egories means
range
following
categories:
for
whilst Heron’s
Heron claims that the category- analysis offers
is to
or
was intended
context,
analysis.
f’urther self-exploration. worth. Heron
analysis
claims a much wider range of application
an exhaustive
To be supportive
be trans-
in this way. It is notable that
use in a fairly specific
etc.). To be catalytic is to draw out, to encourage validate
cateaories
category confront-
and supportive.
is to offer
or instruction.
tension
for
(Nicolas
informative,
catalytic
prescriptive
challenge
Boards
and facilitative
1982).
The categories
tion
nurse
for those who wish to
analysis are: prescriptive,
gestions.
by
that
Table 1 Authoritative
and have been
National
Nurses as suitable courses Gooderham,
too,
attended
Leachers and nurse practitioners recommended
in using
commentators
internal logic of the category analysis, has removed the ‘theories and principles’ category and added other categories. It is notable, also,
being
that Blake and Mouton’s focus of attention was interventions made in management: Heron’s concern is with interpersonal interventions. Thus the purpose of the two sorts of analysis is
experiences
release argument
the remit of this paper.
may not view cathartic
of such
a highly but one
importance.
George
Other
release as Kelly,
for
example, in acknowledging the need to ‘look forward’ in life, rather than to look back at past says ‘the only valid \\a> to live
OIW’S
life is to get on with it’ (Kelly. 1969) The c-ategorv analysis is pitched at the level of intention. That is to say that it does not pick out a
26
NURSE EDUCATION
TODAY
range of specific verbal behaviours to guide the user’s intentions peutic
interventions.
mechanical, means between
enabling
a range
implication,
people’s
training
the
user
device
intentions
can remember
can
access
and whether
their intentions,
The word ‘intervention’
(and, by
to the
or not people after the event!
is used here to describe
any verbal or non-verbal statement or behaviour that the practitioner may use in the therapeutic relationship. denote
The word ‘category’
is used here to
a range of related interventions.
Hammond atric nurse
(1983),
in the context
education
noted
of psychi-
that the category
analysis could be used in two ways:
4
as a means
of interpreting
interventions
b)
sessions.
Goodwin
nurse/patient
during
cathartic
of the category
in
counselling described
described
(1985)
as per
the
The
interpersonal
the use of
counselling
skills
use
category
of
skills
skills
development
elsewhere
(Burnard,
ranking
the
training had 1983;
Table 2 Synopsis of the six category intervention
Cathartic Catalytic Supportive
(1989)
has sug-
approach
management
is also
strategies.
out two previous studies using a
schedule
trained
to determine
staffs’ perceptions
skills (Burnard and Burnard following
student
and
of their interpersonal
and Morrison 1989).
nurses’ perceptions,
1988,
Morrison
In the study of 93 trained using the six categories,
the
rank order emerged:
1. supportive; 2. informative; 3. prescriptive; 4. catalytic; 5. cathartic;
In the
above
resents
the category
skilled
in using
category
that
to and
been 1984;
overall
ranking,
and
item
yielded a similar response obtained The
present
the in
nurses’ perceptions and the details of the two studies
can
be
of those studies.
study was designed
of those
rep-
felt most
felt least skilled
the
from the reports
reliability
one
six represents
respondents
between
item
that respondents
using. Our study of student
previous
studies
different
method
of collecting
category
analysis
described
to test the by using a
data, using the
here.
The
rating
scale used in this study also allowed greater flexibility of analysis than did the ranking schedule. (Kruskal
Confronting
Heron
Previous research
analysis
Prescriptive Informative
1989b).
the six category
useful in planning
differences
the application
had discussed
in teaching
‘non-psychologists’. analysis
of catalytic and
analysis for use in peer support
Dryden
analysis
had
analysis, in health visitors.
Bond and Kilty (1983)
the
(1978)
skills development,
category
groups.
counselling
and Bond
called for the development
that
6. confronting;
and
as an aid to the nurse
1989a;
We had carried
as to the degree
have
1985; gested
but a
interventions.
however,
researchers
a
to discriminate
of varied therapeutic
remains,
thera-
it is in no sense
non-therapeutic)
The question to which
Thus
behavioural
of
but attempts
in making
The results of this study were open to using multidimensional &Wish,
1978; Forgas,
scaling
(MDS)
1979): a method
that allows the data to be viewed from a variety of analysis
To offer advice, make suggestions etc. To oive information, instruct, impart knowledge etc. To challenge restrictive or compulsive verbal or non-verbal behaviour. To enable the release of emotion through tears, angry sounds etc. To be reflective, to ‘draw out’ through the use of questions, reflections etc. To offer support, be validating, confirming etc.
perspectives and allows hidden patterns and trends to emerge from them in ways that would not be possible using more conventional methods. This analysis of the data will be reported
on
at a later date. The present study is an extension of the two previous studies and part of a larger study on interpersonal skills in nursing.
Aims of the study The present
study built on previous work on the
iiVRSE
six category 1987;
approach
Morrison
interested
in testing
findings
in the
wanted
(Burnard
& Burnard, out
studies
& Morrison,
1989).
the
validity
discussed
to find out whether
We were of
the
above.
or not there
In view of the paucity of research lar domain,
we felt justified
isation with the category
we may be more
methods,
educational
niques and further
policy,
assessment
tech-
that
prior to our
Heron’s
analysis had not been tested empirically about
their own interpersonal
a period of introduction
nurses’
such
a
completing
analysis,
a rating scale (Table
the nurses in 3). Specifically.
was asked to rate the six cat-
egory items to correspond
category
perceived
and little
patients in a professional
perceptions
and familiar-
each case were invited to take part in the study b) each respondent
previously,
it appeared
had been written
con-
training
research.
Also. as we suggested research
to develop
in this particu-
in using
Procedure
consistency
was present
2’i
We was a
Following
in using our results
TOD.-\Y
sample.
consistency in the way nurses viewed their interpersonal skills in terms of Heron’s analysis. If fident
EI)l_“(:.~~IO~
themselves
with how skilled the)
to be
while
nursing
talking
to
setting.
of
skills.
Analysis Once the rating scales had been completed, in which each row represented
DESIGN OF THE STUDY
each
Methodology Whilst this was essentially guiding principle summed
a quantitative
in designing
up by George
Kelly:
ask
them,
(Epting,
analysis.
From
this
calculate
mean
rating
categories. order
From
might
about somejust
tell
skill levels,
whilst
analysis served as a framework
their own
the
category
for making sense
of‘ these perceptions.
characteristics
Our findings
able
to
of the to rank
in terms of the dimen-
most skilled’. These
findings
4.
were as follows. The category
was identified felt most
(mean
sample
1985)
nurses
present
the
able
for each
we were
and
RESULTS
category
We used a convenience counselling
scores
these
in Table
117
trained
skills workshops
skilled
authors
(PB).
the fields of general,
These
who
nurses
psychiatric
in using
was the supportive
(mean rating score 4.23. rank order rating
category
score 3.94,
attended
rank order
2,. Third
were from
Table 3 Rating Scale
and community
nursing. On the one hand, the convenience sample offers the opportunity of gathering larger amounts of data. On the other, the sample cannot be said to be representative. Any conclusions that are drawn from a study using a convenience sample must be tentative in nature.
Very skilled
Not skilled Prescriptive Informative Confronting Cathartic Catalytic Supportive
1 1 1 1 1 1
2 2 2 2 2 2
1).
was in second position
(Field & Morse
run by one of the
that
as the one that the respondents
The informative
of
we were
of
you’.
was to ask the nurses in our
to tell us how they perceived
interpersonal
Sample
matrix
the six categories
are illustrated
a respondent a category
1984)
Thus our intention sample
they
represented
sion ‘least skilled -
‘If you want to know something one,
survey, a
the study was that
column
we
of rows and columns
drew up a matrix consisting
3 3 3 3 3 3
4 4 4 4 4 4
5 5 5 5 5 5
28
NURSE EDUCATION
TODAY
Table 4 Mean rating and rank order of the six categories Type of intervention
Category
Mean rating
Rank order
Authoritative
Prescriptive Informative Confronting Cathartic Catalytic Supportive
3.75 3.94 2.37 2.81 3.3 4.23
3 2 6 5 4 1
Facilitative
was the prescriptive 3.75,
rank order
ranked
category
(mean rating score
3). The catalytic
category
was
next (mean rating score 3.3, rank order
4) followed
by the carthartic
rating score 2.37, ing category
rank order
category
(mean
5). The confront-
was in last position
(mean
rank
order
mirrors
of our previous
perceptions of
order
the
exactly
study of trained
of their interpersonal
six categories
the
(Burnard
nurses
rank staffs’
skills in terms & Morrison,
investment
sufficiently
trained in using these methods.
often
and nurses
involves
that
some
client-centred
supportive,
confirmed
are
more
informative
and
less skilled in being catalytic, fronting.
In our previous
Morrison,
1988; Morrison
offer
some suggestions
may be apparent. these arguments following
the suggestion skilled
in being
prescriptive cathartic
papers
and con-
(Burnard
& Burnard,
and &
1989) we
as to why these trends
We do not intend
to rehearse
again in this paper but offer the
list of some factors that may influence
the findings: The organisational
culture (Sathe,
1983) in
hospitals may work against the development of a facilitative style of interpersonal relationships between nurses and patients. The ‘facilitative’ approach takes time. Nurses may feel that they do not have time to spare to develop relationships that involve being catalytic, cathartic and confronting. Catalytic, approaches
cathartic and confronting involve an ‘investment of self
be
activities
as involving
approach
to working.
There has been a considerable emphasis on the ‘information giving’ aspect of nursing
egory
nurses
b) not
practical
may see the job
1975; Boore,
1978; Devine
1983). This may account
of the emphasis
This study has further
and/or
‘getting the work done’ (Melia, 1987). This may mitigate against the use of a more
& Cook,
DISCUSSION
Some
emotional
care (Hayward,
1988).
draining.
may a) not want to make such an
Nursing
rating
score 2.37, rank order 6). This
that may be emotionally
noted
for some
on the informative
in this study.
Indeed,
nurses
may view their jobs
cerned
with information
catsome
as more
con-
giving than with
being catalytic or cathartic. It may be the case that many aspects nursing catalytic,
practice
do not require
cathartic
The respondents offered a general
and confronting
needed.
skills
skills.
in our studies have picture of their skills. It
may be that catalytic, fronting
of
the use of
are
cathartic
only
rarely
and conused
or
It would seem odd to argue that all
six categories
are
equally
as frequently
required as one another, given their different nature. On the other hand, the person who does not often use certain interventions may also not be very skilled in using them when she has to. This raises complicated questions about the nature and content of interpersonal programmes.
skills training
Having noted all of these possible explanations for our findings, the issue that remains clear is the regularity with which the pattern of in terms of the six categories, has response,
NL’KSE EDL’C:.ATION -1.OD.41
recurred. Thus it would seem that for many nurses, the rank order: supportive, informative, prescriptive, catalytic, cathartic and confronting, characterises their perceptions of their own interpersonal skills. This paper has described a further study of the use of six category intervention analysis in the exploration of nurses’ perceptions of their interpersonal skill levels. The findings of these six category analysis studies are recurring frequently enough to suggest that trainers in this field may need to review their interpersonal skills training programmes to ensure that nurses are developing competences in a wider range of skills. At the moment it would appear that little has changed on the interpersonal scene. Nurses are still ‘nurse’ centred as opposed to ‘patient’ centred. Given the present emphasis on individualised nursing care, it is possible to question whether or not this should continue to be the (‘ise.
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