This cross-sectional descriptive research was conducted on 200 nurses and 200 patients at hospitals affiliated with the Shahroud University of Medical Sciences. The participants included nurses and patients from different wards of Emam Hossein and Bahar hospitals. To sample nurses by the stratified method, the sample size was first divided by the total number of nurses in the mentioned hospitals to obtain the sampling fraction. According to the following formula and 95% confidence, the sample size was calculated in the domains of individual/social factors (n = 397), occupational characteristics (n = 393), clinical conditions of the patient (n = 399), and environmental factors (n = 385).
Individual/Social Factors N\(\text{ = }\frac{\text{ }{\text{z}}_{\text{ 1 - }\frac{\text{a }}{\text{ 2 }}}^{\text{ 2}}\text{ }{{\sigma }}^{\text{ 2}}\text{ }}{\text{ }{\text{d}}^{\text{ 2}}\text{ }}\text{ }\)= \(\frac{{\left(1.96\right)}^{2} {\left(5.28\right)}^{2}}{{\left(0.52\right)}^{2}}\) = 397
Job Characteristics N\(\text{ = }\frac{\text{ }{\text{z}}_{\text{ 1 - }\frac{\text{a }}{\text{ 2 }}}^{\text{ 2}}\text{ }{{\sigma }}^{\text{ 2}}\text{ }}{\text{ }{\text{d}}^{\text{ 2}}\text{ }}\) = \(\frac{({1.96)}^{2} {\left(5.86\right)}^{2}}{{\left(0.58\right)}^{2}}\)= 393
Patient's Clinical Conditions N\(\text{ = }\frac{\text{ }{\text{z}}_{\text{ 1 - }\frac{\text{a }}{\text{ 2 }}}^{\text{ 2}}\text{ }{{\sigma }}^{\text{ 2}}\text{ }}{\text{ }{\text{d}}^{\text{ 2}}\text{ }}\) = \(\frac{{\left(1.96\right)}^{2} {\left(3.36\right)}^{2}}{({0.33)}^{2}}\)= 399
Environmental Factors N\(\text{ = }\frac{\text{ }{\text{z}}_{\text{ 1 - }\frac{\text{a }}{\text{ 2 }}}^{\text{ 2}}\text{ }{\sigma }^{\text{ 2}}\text{ }}{\text{ }{\text{d}}^{\text{ 2}}\text{ }}\text{ }\)= \(\frac{{\left(1.96\right)}^{2}({6.90)}^{2}}{{\left(0.69\right)}^{2}}\) = 385
According to these formulas, the largest sample size (n = 399) was taken as the sample size required for the research. Therefore, 200 nurses and 200 patients were designated as the sample size. Considering that the total number of nurses is around 700 and the sample size calculated by the statistics consultant is 200 nurses, our sampling fraction was calculated as \(\frac{2}{7}\). Therefore, \(\frac{2}{7}\) personnel of each department were included in the study. The patients were sampled by a systematically random method using the hospital list, file number, and dates of admission and discharge. The inclusion criteria for nurses were a bachelor's degree or higher and a minimum literacy level for patients to complete the questionnaire. Because COVID-19 patients were admitted to all wards of Emam Hossein hospital at some periods, the nurses of COVID-19 and non-COVID-19 wards were selected from Emam Hossein and Bahar hospitals. Moreover, the questionnaire contained questions about the nurses' work experience or no experience in COVID-19 wards. The duration of working in COVID-19 wards was included in the questionnaire questions, and the duration was considered in the analysis. Data were collected using a questionnaire provided to the nurses through daily visits to various wards of the mentioned hospitals, including emergency, surgery, special care, internal medicine, gastroenterology, cardiology, urology, orthopedics, ICU, CCU, and other wards. The questionnaire was also provided to the patients hospitalized in surgery, special care, internal medicine, gastroenterology, cardiology, urology, ICU, and CCU, wards, among others. Due to the reduced coronavirus spread during that period, the information on COVID-19 patients was accessed using hospital information by obtaining permission, and the questionnaire was completed through phone calls.
Demographic information form
It contained questions about information related to age, gender, marital status, language, and residence.
Communication barrier questionnaire
The barriers to effective nurse-patient communication were investigated using the same questionnaire designed by Baraz Pordanjani et al. This questionnaire contains 30 questions for nurses and aims to evaluate nurses' views about the barriers to effective nurse-patient communication. The response of this questionnaire is in the Likert range (completely false = 1, false = 2, I have no opinion = 3, agree = 4, and completely agree = 5). The nurses' questionnaire contains four dimensions, and the question numbers of each dimension include individual/social factors (1–8), occupational characteristics (17 − 9), patient's clinical conditions (18–21), and environmental factors (22–30). The patient questionnaire contains 15 questions and aims to evaluate the patients' views about the barriers to effective nurse-patient communication. The response of this questionnaire is in the Likert range (completely false = 1, false = 2, I have no opinion = 3, agree = 4, and completely agree = 5). No separate dimension was considered for the patient questionnaire. The total score of the questionnaire is obtained by summing up the total scores of all questions. The score of each dimension is obtained from the sum of scores for each question of that dimension. Higher scores in each dimension indicate the greater strength of that dimension as a barrier to effective nurse-patient communication and vice versa. Baraz Pordanjani et al. (2009) obtained the content validity of the questionnaire through library studies and the comments of professors and instructors of the School of Nursing and Midwifery, Jundishapur University of Medical Sciences, Ahvaz. They used the internal homogeneity method (even and odd) to ensure scientific reliability, with a reliability coefficient of 85% (12). After completing the communication barrier questionnaire, a separate question was asked from the patients and nurses about whether or not the face mask was a communication barrier. This question was scored with a Likert scale (completely false = 1, false = 2, I have no opinion = 3, agree = 4, and completely agree = 5). The score of this question was measured separately from the nurse-patient communication barrier questionnaire.
Initially, necessary permissions were obtained from the Vice Chancellor of Research and Technology and the Research Ethics Council (code of ethics: IR.SHMU.REC.1401.140) at the Shahroud University of Medical Sciences. Necessary coordination was also made with the administrators of Bahar and Emam Hossein hospitals in Shahroud. After explaining the purpose of the research and answering the questions of nurses and patients regarding the questionnaire and how to complete them, enough time was given to answer them. Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential tests.