Nurses communication skill and associated factors in Amhara Region Referral Hospitals, Ethiopia, 2019

Background: - Nurses are critical in the delivery of essential health services and are core in strengthening the health system. So, the aim of this article was to assess the prevalence of the communication skills of nurses patient and determinant factors Amhara Region Referral Hospitals, Ethiopia, 2019 Methods: Institution based cross-sectional study was conducted from March 18 to April 16, 2019 in Amhara Region Referral Hospitals. A simple random sampling technique was used to select 684 respondents. Data was collected using pretested and self-administered questionnaire. Collected data was entered into Epi Info version 7.1.2.0 and exported to SPSS version 25.0 for analysis. Bivariate analysis was used primarily and variables with p-value ≤ 0.2 were further examined using multivariable logistic regression model to control con-founders. Then, variables having p-value less than 0.05 with 95% CI were used to determine associated factors. Results: - Out of 678 study participants, 403 (61.4%) of them had effective communication skills with 96.8 % of the response rate. Less than 5 years of working experience [AOR=2.77; 95% CI: (1.28, 5.99)], workload [AOR=1.52; 95% CI: (1.09, 2.12)], and poor evidence-based utilization [AOR=2.00; 95% CI: (1.40, 2.85)] were associated with the nurse’s effective communication skill to patients. Conclusions: More than half of the participants were had effective communication skills. Year of working experience, workload, and poor evidence-based utilization were the main contributing factors of the communication skills.

A cross-sectional study from Iran explained that disorganized environment was significantly associated with communication skills (12).
Regardless of strong emphasis on training and improving the caregiver's communication skills, there are still noticeable lacks and therefore effective communication is restricted by a number of organized factors (2).
To enhance health care and decrease patients' dissatisfaction, the factors that affect communication between nurses and patients must be recognized and taken into account; also, response to all communication needs of patients should be provided (28). Therefore, this study was aim to assesses the associated factors with the Nurse to patient communication skill at Amhara Region Referral Hospital, Ethiopia, 2019.

Study design and setting
An institution based cross-sectional study was employed among nurses working in Amhara Regional state Referral Hospitals, Ethiopia. This region has five Referral Hospitals which includes; Debre Birhan, Debre Markos, Felege Hiwot, Gondar University comprehensive and specialized and Dessie Referral Hospitals. Each of them serving 3.5-7 million people (29).

Source and study population
All nurses who were working in Amhara Region Referral Hospitals and at list who had 6 months of working experience during data collection period were included. Whereas Nurses who were on maternity or annual leave or those who were seriously ill during the data collection period were excluded.
The sample size was determined by using single population proportion formula with the assumption of: nurses' level of communication 65.5 % (20) proportion, Z = standard normal distribution value at 95% confidence level of Za/2 = 1.96 and 5 % margin of error for first objective. This gave 347.1 plus 35 non-response rate equals to 382. Whereas Sample size for the second objective was determined by using double population proportion formula for cross-sectional study by considering the following assumptions taking two significant factors from the previous study (20) (Table 1). So, the largest sample size with power calculation was 678, which is higher than the sample size calculated from the single population proportion formula above. Thus, the minimum adequate sample size for this study was 678.
Of the 1465 Nurses working in the Amhara Regional Referral Hospitals, Ethiopia, 678 of them were recruited for the study at the time of data collection. Study participants were included using a simple random sampling procedure.

Data Collection
Data were collected by five trained BSc nurses that facilitates the process of filling pretested selfadministered questionnaires and supervised by three MSc nurses. The data collection instrument had different components: socio-demographic characters, working environment attributes and nurse patient communication skills of the participants using a checklist that was developed on the basis of various prior similar studies and further modified to include important variables of this study to ft the study area context (20,30). Sixteen questions were adapted from a previous study (30) to measure the effectiveness of nurses' communication skill with the patient. Each item had a 5-point Likert scale (1= strongly disagree, 2 = disagree, 3 = neutral, 4 = agree and 5= strongly agree) with a minimum score of 16 and a maximum score of 80.
The variation might be due to the difference in study design, data collection tool, and sample size in study participants.
The finding was also identified as different significant factors that had an association with Nurse to patient communication skills. With respect to year of experience, less than five years of service was significantly associated with Nurse to patient communication skill. Those with less than five years of working experience were 2.77 [AOR = 2.70 (95% CI = 1.28, 5.99)] times more likely to be ineffective on communication than those who had more than ten years of working experiences, which was similar to the study done in Saudia Arabia (26). The possible reason for this might be frequently practicing or communicating with client for long period can predispose nurses to perform their duties effectively. We declare that this is an original paper and any comments regarding the manuscript will be accepted by Kassahun Gebeyehu, E-mail address: Kassish6@gmail.com.

Ethics approval and consent to participate
Ethical clearance was obtained from the Ethical Review Committee of the School of Nursing, College of Medicine and Health Sciences, University of Gondar and written consent was taken from participants.

Data availability
The data used to support the findings of this study are available from the corresponding author upon request.

Funding
This research article was funded by University of Gondar.