Group discussion teaching technique for small groups and encouragement of critical but constructive and creative thinking for finding new and efficient solutions can lead to provision of better health and medical services that is defined in clinical setting, as the clinical psychology finds a way for curing and education. The present study was conducted with the aim to compare the effects of creative group teaching and educational booklet on interpersonal skills of midwives in a clinical setting. The present study was conducted on 97 midwifery graduates working in hospitals in Kerman Province, in two groups of educational booklet (49 midwives) and educational workshop (48 midwives) who participated in a 3-day creative teaching workshop in summer 2015. Creative problem-solving teaching intervention group was taught through educational workshop method, including small group and team working, group discussion and mini lectures. Midwifery 1 intervention group was provided with an educational booklet validated by professors of Nursing and Midwifery School for independent and individual study by midwives working in Kerman Province hospitals. The two groups were matched in terms of personal details. Hospitals were randomly selected, and midwives were selected by quota sampling. Interpersonal communication skills of both groups were assessed before and after intervention, and two months later using Interpersonal Communication Skills Test. The results obtained were analyzed in SPSS-16 using descriptive statistics, including frequency and percentage, mean and standard deviation, and inferential statistics including U-Mann-Whitney, paired t, independent t, repeated measures ANOVA tests at significance level of P < 0.05. Mean changes in interpersonal communication scores in workshop group were significantly greater than those in educational booklet group after intervention, and educational workshop had caused a mean score change of 8.46 in every participant ( P < 0.001). Two months after educational intervention, mean score change was 8.89 in workshop group, significantly different from 3.11 in educational booklet group ( P < 0.001). According to paired t-test, mean scores of interpersonal communication significantly increased in both workshop (100.14 to 117.12) ( P < 0.001) and booklet (96.56 to 99.8) groups ( P < 0.001). Both teaching methods improved midwives’ interpersonal communication skills. Therefore, standardized educational booklets which produce cost-effective similar results are recommended.
Various educational methods, presenting real cases, reflection through debate and exchange of views, and immediate feedbacks will all help improve learning. As an active learning method, practical educational workshops utilize brainstorming, feedback and acquisition of knowledge and skills [
Problem-solving is a cognitive-behavioral process and a coping skill associated with good personal adaptation, and involves five steps: self-concept, problem statement, listing various solutions, choosing the best solution, and testing the chosen solution [
Emergency departments (such as midwifery) are highly complex settings with huge workloads, where tension is high, every second counts, events are unpredictable, and early diagnosis, treatment of patients and correct application of information are commonplace, which requires personnel to have adequate information, and sufficient problem-solving skills for every circumstance [
According to Gagne’, problem-solving conditions include learner’s inner conditions and learning setting, where learner combines simple rules to reach higher rules, and this leads to problem-solving. He therefore considers problem-solving as an essential learning skill, and believes that in problem-solving previous learning, especially rules, should be combined in a new way to create a higher rule [
In their workplace, midwives face with unpredictable and stressful events that affect their decision-making. They should therefore learn and apply problem-solving skills in any given situation. In today’s complex healthcare, medical teams should be able to act quickly and correctly [
In view of D’Zurilla and Goldfried, problem-solving stages include: General orientation, problem definition and formulation, generating creative solutions, decision making, and verification [
To help mothers, midwives require the right decision making capacity for dealing with problems, and midwives with such a skill can easily deal with challenges in different situations [
In their systematic review, Choon-Huat Koh (2008) concluded that problem-solving training positively affected doctors’ capabilities after graduation, especially in social and cognitive areas [
A good physician-patient relationship leads to better patient compliance, and therefore better patient recovery [
The present quasi-experimental study was conducted on two groups of midwives working in maternity wards of hospitals in the city of Kerman in 2015. Two groups of hospitals were chosen by simple random method as the researcher wrote the names of hospital on small identical pieces of paper, put them in an envelope and drew them one by one. Every other hospital was assigned to intervention 1 or intervention 2 groups, thereby minimizing contact between them. Three hospitals were assigned to intervention 1 and three to intervention 2 groups. Because of the difference in numbers of midwives working in each hospital, midwives were selected per quota from each. To this end, quota was determined by the ratio of midwives per sample size in each group (50 midwives), which provided equal distribution of midwives and produced better quality of work. Once the researcher was sure of the cooperation of the six hospitals, she divided them randomly into two groups. Quota sampling from each hospital was conducted by knowing number of midwives in each and using equation n = n N1/N, which produced sample size needed from each hospital; where n = sample size needed in each intervention group; N1 = number of midwives working in each hospital; and N = total working population of midwives. The main aim in the present study was to compare mean scores of interpersonal communication in the two groups. Thus, sample size was determined according to comparison of means formula, with 95% confidence interval and 80% test power, where the difference in mean scores between the two groups will be significant when ≥13. Given the range of variations in communication scores of 34 - 170, standard deviation was assumed 26. To overcome potential withdrawals, an extra 6% was added to samples, taking into account ratio of numbers in intervention groups 1 and 2 one-by-one. Hence, final total sample size was determined 100 midwives. Due to similarities in type of intervention with [
The present study was conducted with pretest/posttest design, and participants from both groups were given interpersonal skills questionnaire before intervention. To this end, the researcher introduced herself to the deputy of treatment of Kerman University of Medical Sciences, and explained the study objectives, and obtained permission to enter and sample in hospitals. The researcher then made arrangement to find number of midwives working in hospitals with maternity wards.
Study inclusion criteria were minimum of one year’s work experience, not being on obliged services, and not passing life skills workshops such as problem-solving and communication in the past six months. Study exclusion criteria were minimum of two sessions’ absence for the intervention group, incomplete questionnaires, withdrawal while completing questionnaires, and failure to study educational booklet.
Data were collected using a two-part questionnaire. The first part consisted of demographic details, including age, education, marital status, employment status, work history, working shift, and history of participation in life skill workshops in the past six months, and the second part assessed interpersonal communications (completed by midwives) using the standard Interpersonal Communication Skills Test, with 34 items based on 5-point Likert scale (almost never, rarely, occasionally, often, and almost always), with scores ranging from 34 to 170. This questionnaire has been used in several studies including [
In the first stage and after obtaining permission from the treatment deputy and hospital heads, and ethical consents from midwives, the researcher visited every hospital on different working shifts of midwives (from both groups) and distributed and then collected Interpersonal Skills questionnaires after completion. Intervention was performed in the second stage, and intervention group 2 was called to participate in educational workshop by attending a previously arranged (with university treatment deputy) education venue of one of the intervention hospitals at a previously notified time. Educational workshop intervention was performed over three 4-hour sessions (8am to 12 noon) held in three consecutive days using a variety of teaching methods according to learners’ needs. To this end, based on previous studies and related preparatory classes (two private sessions with a psychologist) and acquiring problem-solving knowledge and skills, the researcher prepared educational contents in the form of a Power point presentation and a pamphlet, which was qualitatively validated by four professors from Tehran School of Nursing and Midwifery; she then held educational sessions according to the contents thus prepared. Educational sessions were conducted by the researcher and supervised by a psychologist through lectures, group discussion, questions and answers, brainstorming, role-play, and critique and debate using D’Zurilla and Goldfried model.
In each session, a summary of the previous session was first presented by participants, followed by teaching new materials through interactive lectures involving participants and two presenters that moderated these sessions and displayed the already prepared Power point part of the educational content for half an hour in each session after conclusions were drawn from discussions. Group members participated in debates and then presented a summary of what they had learned in that session. Issues raised were resolved through questions and answers, and assignments were given for the next session in the form of a clinical scenario similar to experiences described by midwives to review and ponder to find individual solutions and practical strategies, so as to practice creative thinking individually as well as in groups. Timetable of creative problem- solving educational workshop is shown in
Additional workshops were held for midwives that were absent for a day for whatever reason. Ultimately, 48 midwives were trained. Problem-solving educational pamphlets were made available to intervention group 2, so that they could be better introduced to educational points.
In intervention group with educational booklet, contents included definitions relating to problem-solving, dealing with problems, creative solutions and their stages and
Day | workshop-participants’ activities | Duration |
---|---|---|
One | Free discussion about workplace communication problems encountered with colleagues and patients, and acceptance of the problem as a normal but modifiable phenomenon, and the belief in effectiveness of problem-solving in dealing with problems using small group discussion, performed by group leader and critiqued by other groups. | 2 hours |
Participants’ task: problem statement at the end of group session by group leader. Problem definition and formulation and determination of goals, followed by collection of data and analysis of problem using small group and group discussion, and presentation by group leader, and critique by other groups. Problem analysis by group leader at the end of teamwork session | 2 hours | |
Two | Generating a range of solutions that were critiqued by participating midwives | 2 hours |
Participants’ task: choice of common problems of clinical midwives group by group leader at the end of sessions, and selection of decision-making solutions and prediction of possible outcomes for each solution. At this stage, consequences and problems associated with implementation of selected solutions and their weaknesses were assessed Finally, decisions and prediction of consequence and weaknesses relating to the selected solution were explained by group leader at the end of each teamwork session. | 2 hours | |
Three | Review of previous sessions and implementation of solutions to real workplace cases proposed by participants through open discussion and role play | 2 hours |
Participants’ task: choosing the best solution for implementation within the existing context by group leader at the end of group sessions Review and summation of outcomes Evaluation of workshop and opinion survey at the end of teamwork sessions | 2 hours |
effects on problem-solving. Qualitative content validity of the booklet was assessed by five nursing and midwifery professors and necessary modifications were made, and then confirmed by a clinical psychologist. The booklet was then made available to midwives to study and contact the researcher if they had any questions on the number already provided. Intervention ended in the knowledge that study of the booklet had completed in booklet group and creative teaching teamwork sessions had ended in workshop group. Then, the Standard Interpersonal Skills questionnaire was completed by participants immediately after intervention and two months later. Ethical considerations observed included obtaining permission from the ethics committee of Tehran School of Nursing and Midwifery, introductory letter for holding educational workshop from Medical Deputy to hospitals, explanations about study objectives given to participants, and their permission to receive questionnaires, rights to participate or withdraw, ethics permission, registration of study on clinical trials site, and receiving registration code.
One of the study limitations was midwives’ shift rotation that made it impossible for all members of intervention group 2 to participate in workshop sessions, so additional sessions were held to overcome this limitation. Another limitation included initial non- cooperation of some hospital heads for facilitating midwives’ participation in the team- work, which was resolved through frequent visits and telephone contacts.
The results obtained were analyzed in SPSS-16, using U-Mann-Whitney, independent t, paired t and repeated measure ANOVA tests.
The majority of participating midwives in booklet (42%) and creative problem-solving workshop (39.6%) groups were aged between 31 and 35 years, and also the majority in booklet (68%) and workshop (81.2%) groups were married. The majority of midwives in booklet (94%) and workshop (91.7%) groups had university degree education. Mann- Whitney test showed no significant difference between the two groups. Kolmogorov- Smirnov test confirmed normal distribution of main study variables before intervention and immediately and two months after intervention (P < 0.05). Paired t-test was therefore used to verify study hypotheses. Independent t-test showed no significant difference in mean scores of interpersonal communication between booklet (96.56) and workshop (100.14) groups before intervention (P = 0.64), but immediately after intervention, interpersonal communication score showed greater increase in workshop (117.12) compared to booklet (99.8) group. According to paired t-test, mean scores of interpersonal communication significantly increased in both workshop (100.14 to 117.12) (P < 0.001) and booklet (96.56 to 99.8) groups, with significant differences between before and immediately after intervention scores (P < 0.001) (
Interpersonal communication before and immediately after | Intervention 1 (booklet study) | Intervention 2 (workshop) | ||
---|---|---|---|---|
Before intervention | Immediately after intervention | Before intervention | Immediately after intervention | |
Mean ± SD | 96.56 ± 11.71 | 99.80 ± 12.40 | 100.14 ± 6.61 | 117.12 ± 10.19 |
Paired T-test results | P < 0.001 df = 49 t = −408.8 | P < 0.001 df = 47 t = −808.13 |
Interpersonal communication before and two months after intervention | Intervention 1 (booklet study) | Intervention 2 (workshop) | ||
---|---|---|---|---|
Before intervention | Two months after intervention | Before intervention | Two months after intervention | |
Mean ± SD | 96.56 ± 11.71 | 99.92 ± 12.43 | 100.14 ± 6.61 | 115.72 ± 10.92 |
Paired T-test results | P < 0.001 df = 49 t = −627.7 | P < 0.001 df = 47 t = −110.12 |
The results also showed mean change of score in workshop and booklet groups of 8.46 and 3.24 respectively, with a significant difference between them, and significantly greater change in mean score of interpersonal communication in workshop group compared to booklet group. Thus, educational workshop was able to produce a change of score of 8.46 in participating midwives (P < 0.001). In the follow-up two months after intervention. Mean score change was 8.89 in workshop group and 3.11 in booklet group, with a significant difference between them. Thus, mean score change in interpersonal communication two months after intervention was significantly greater in intervention groups 2 compared to group 1, and intervention was able to cause mean score change of 8.89 in participants (P < 0.001).
Repeated measure ANOVA test showed significant differences in interpersonal com- munication scores in workshop group before intervention and immediately and two months after intervention (P = 0.001) (
The present study showed that teaching midwifery graduates in both educational workshop and educational booklet methods and according to D’Zurilla and Goldfried model positively affected and improved their interpersonal communications. The two groups were matched in terms of personal details before the study. Interpersonal communication score after three days of education was greater in educational workshop group compared to educational booklet group. Although this score also increased in
Repeated measure ANOVA | Mean | Standard deviation | Test criterion (F) | Significance |
---|---|---|---|---|
Educational booklet | 181.68 | 2 | 450.734 | P < 0.001 |
Educational workshop | 292.81 | 1.50 | 472.615 | P < 0.001 |
educational booklet group. In a randomized controlled study, Borhani et al. taught 25 nurses in a two-day workshop (8 hours per day), and conducted their follow-up over a two-month period through 24 text messages [
The present study showed that the effect of problem-solving skill teaching lasted for two months after intervention, which was in line with Moatari et al. study that was conducted to assess the effect of problem-solving skill training on self-concept in nursing students, and the results showed greater improvement in intervention group compared to control group a month after teaching problem-solving skills according to D’Zurilla and Goldfried model (due to time limitations, follow-up was conducted a month after intervention) [
In contrast to the present study, in Salimi et al. study (2011), participation of paramedical students in communication skills workshop made no significant difference in their scores in Interpersonal Skills Test, which may have been due to the difference in participants’ academic discipline. Furthermore, participants in their study were students, compared to working midwives in the present study that were in contact with various medical teams, and improvement in their communication skills would give them greater satisfaction with their profession, which encourages them to improve their behavior; whereas students may regard participation in educational workshop or reading as just another academic unit, and thus not very important. Another factor that affects participants’ communication skills is the quality and method of teaching. In the present study, new and varied teaching methods were used in the educational workshop, including group discussion, questions and answers, feedback, reflection, real life scenarios proposed by participants, critique and debate, which may have affected behavior change. These techniques are much more effective than lecture method. However, the relationship between students’ interpersonal communication skills and teaching method was not investigated in Salimi et al. study. In the present study, due to their desire for learning problem-solving skills, participants in booklet group scored higher on later occasions due to individual study of educational booklet, which shows the educational effect of individual study.
In a study by Hap (2011), poor verbal communication of nurses after intervention was highlighted that had led to dissatisfaction of service recipients, which disagrees with the present study [
Shahbazi et al. (2012) performed problem-solving educational intervention in the trial group in six two-hour sessions over eight weeks according to D’Zurilla and Goldfried social problem-solving model in the form of group discussion, brainstorming, and small group (3 people) debates supervised by two experienced teachers [
Asuero et al. conducted a randomized controlled innovative educational intervention for primary healthcare professionals, and reported post-intervention effect of 0.74, and thus recommended ongoing innovative education for prevention of burnout in these professionals [
In nursing and midwifery, effective interaction with patients and members of the medical team is essential, and given their career prospects and particular features of these disciplines, their desirable learning method is divergent, through which, a sociably and holistically minded student will use his creativity and initiative in his communications, especially with patients, and offer creative solutions, and thus achieve high levels of problem-solving [
Despite the efficacy of educational workshops, problems encountered in holding these workshops in terms of coordination and gathering the personnel (given their huge workload and hospital directors reluctant agreements) to take part in these workshops were the main limitations in the present study.
Thus, despite the positive effects of educational workshops on participants’ learning, due to personnel’s work and coordination problems for participation in workshops, and also the high costs of holding these workshops; it is recommended that personnel be encouraged to enhance their interpersonal communication skills through content validated educational booklets, which are much more cost-effective and produce nearly the same results. Furthermore, given the importance of communications in medical professions, teaching problem-solving and communication skills to midwifery students can at least be expected to be included in their curriculum as an optional unit. It is further recommended that communication skills education through other globally practiced educational methods such as simulation be studied.
The authors wish to thank hospital directors, those in charge of maternity wards, and all midwives for their enthusiastic participation in educational sessions. We also thank the Research Deputy of Tehran University of Medical Sciences, the ethics committee, and Iran’s clinical trials center for registration of the present study on their site (code: IRCT201410216284N8). We also thank hospital directors for certifying educational workshops. The present article is the result of a student thesis.
The authors declare that they have no competing interest.
All of research team participated in study design and coordination and helped to draft the manuscript. Dr. Modarres also collected the data and performed the paper writing. All authors read and approved the final manuscript.
Mandana, S., Mohammad, S., Maryam, M., Sadat, H.D.A. and Masud, Y. (2016) The Impact of Creative Group Teaching and Educational Booklet Methods on Interpersonal Communications among Midwives in Clinical Setting. International Journal of Clinical Medicine, 7, 698-711. http://dx.doi.org/10.4236/ijcm.2016.710076