Baccalaureate nursing students' communication process in the clinical setting

The purpose of this study was to describe and generate theory about how baccalaureate nursing students communicate with patients in the clinical setting using the qualitative method of grounded theory. Third-year and fourth-year generic baccalaureate nursing students were the primary participants in this study. Data were gathered during two academic semesters from formal and informal interviews and observations in hospital and home care settings. Transcribed audiotapes and field memos constituted the data generated in the study and were subjected to generating categories through open coding of data, applying theoretical codes to the data, collapsing and expanding categories reflective of the data, and memoing and uncovering the core category of the data. The core category then became the grounded theory. Analysis of the data revealed that students encountered a basic social psychological problem of "saying the right things to patients" in the clinical setting, which was preceded by the antecedent problem of "fear of saying the wrong things to patients." Students solved the problem, in part, by employing communication strategies and patterns. Eight communication strategies and five communication patterns incorporating communication strategies were identified. In addition, students went through a four-stage basic social psychological process. The process of learning a personal communication repertoire was uncovered as the substantive grounded theory. The repertoire was learned by students in the dynamic environment of the clinical setting in which RNs served as role models and communicating with difficult patients was the crucial step in the process of communication development.