Effects of Wearing PPE on Communication between RN, RN Students, and Patients (TOP-SCORING POSTER)

Purpose: The purpose of this study was to investigate nursing student awareness of their communication manner while wearing personal protective equipment (PPE).

Background/significance: Approximately 80% of communication happens non-verbally. PPE may affect communication between nurses and patients in a negative way. Nursing students are educated to use therapeutic communication and students are instructed on how to wear PPE; however, the challenges of effective communication while wearing PPE are incorporated or taught together in nursing courses or during their clinical rotations. It is important to examine nurse-patient communication strategies to improve awareness of effective communication while wearing PPE and to mitigate communication misunderstandings, promote comfort, and improve health outcomes.

Method: After obtaining IRB, an approved cover letter and online anonymous surveys were emailed to 1,110 undergraduate and graduate students in February 2022, with one reminder (4 weeks later) through the enrolled nursing student listserv. The cover letter explained the purpose of the study and requested student participation in the study. Consent was implied by completing the survey. The setting for the study was a college of nursing at a large southwestern university with a rural and urban care delivery area.

Result(s): The study response rate was approximately 9%. Most respondents were undergraduate nursing students (56%). When asked about where they learned about PPE, 33% responded in nursing school and 53% responded both nursing school and work. When asked where they learned about communication skills, 23% responded in
nursing school and 61% said both nursing school and work. An important finding was that 97% of students did not learn communication skills while wearing PPE. When students were asked about actively listening to patients’ concerns while wearing PPE, 90% reported always and 11% reported usually. When asked if patients could hear
while the nursing student was wearing PPE, 7% reported always, 67% reported usually and 23% reported sometimes. Students perceived their communication skills while wearing PPE was effective. When asked about effectiveness, 13% reported sometimes, 63% reported usually and 21% reported always. However, there may be other factors in addition to the PPE that may have contributed to the patient’s medical condition and communication ability as well as the students’ perceived ability and experiences while delivering patient care wearing PPE.

Conclusions/implications: Nurses learn about PPE and communication skills in nursing school. However, the challenges of effective communication while wearing PPE are not addressed directly. Wearing a face mask muffles the speaker’s voice, conceals their lips and intonation, and hides facial expressions, which leads to the patient who may not understand the nurse’s speech. This concealment could possibly lead to patient frustration, anxiety, and even decreased quality of care. Nurses must acknowledge communication challenges while wearing PPE and develop approaches to promote effective communication. Communication is vital when discussing plans of care for patients (and families) to promote engagement and to improve health outcomes. It is recommended that nurse educators develop methods and approaches to educate student nurses in effective communication will wearing PPE.

Evidence-based references
1. Akgün, K. M., Shamas, T. L., Feder, S. L., & Schulman-Green, D. (2020). Communication strategies to mitigate fear and suffering among COVID-19 patients isolated in the ICU and their families. Heart & Lung: The Journal of Cardiopulmonary and Acute Care, 49(4), 344-345.
2. Duckett, K. (2020). Behind the Mask: New Challenges to Gaining Patient Trust. Home Healthcare Now, 38(6), 327330.