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1.1 Background
The process of transferring ideas, message, information and attitudes that provides the possibility of turning those data into action called communication, which is considered as one of the mankind’s basic and essential skills like any other skills. (Azari et al., 2015). Communication is the basic tool in nursing, a crucial element in health care.(Ferreiraa, Silva, Pires, Sousa, ; Calheiros, 2016). Good communication skills in the health care setting is very important to ensure patient satisfaction to the care provided, consulting, identify client’s needs and take appropriate actions, minimize the possibilities of client’s complaints and creating clients-provider trust. In facts communication is the means good means of exchanging information, concepts, values, beliefs in health care setting for better patient’s outcomes.
Communication skills use verbal and non-verbal communication skills that can convey the reasonable information from the sender to the receiver through specific medium of communication. The ability to express to express good communication skills capacity is crucial skills for every nursing student. This can be achieved by having regular training for students in communication skills knowledge to enhance their capacities and their application of this knowledge in improving patient care.(Furnes, Kvaal, & Høye, 2018)
Having good communication skills will be useful in encounter patients and their families with sensitivity, empathy, and moral accountability. The nursing students should learn those skills as any other skills. The effective care to the patient that will consider their ethnic group, religious and cultural background will provided sufficiently if the provider has knowledge in communication skills.(Sheldon, 2015)
However, despite this reasonable importance of communication skills in providing good care to the client, there is a challenge of applying this knowledge in the clinical setting. The complicated schedule of nurses in their clinical areas makes them to poorly applying the skills. Failure to do so results into patient’s dissatisfaction , complaints, poor adherence to treatment, mistrust of health care providers and poor consultation.
1.2 Problem statement.
There is great need for effective communication skills between health care providers and their clients in order to ensure effective flow of care. Many challenges including patient dissatisfaction, complaints, mistrust of health care providers and poor adherence to treatment are increasing as a result of poor communication skills between health care providers and their clients.There is need to improve communication and more training to create awareness about barriers to effective communication in related to nursing intervention, because of very busy schedule of nurses in majority of health care settings, they become less aware of the problem of effective professional communicationstyle.(Bello, 2017). The expected consequences of not fix the problem may result into decreased quality of care, unachievable nursing interventions, continuation of mistrust of healthcare providers by their clients, dissatisfaction to health care provided as well as complaints to the nature of nursing care provided. This study is going to focus in assessing the communication skills knowledge among nursing students who are studying at MUHAS to evaluate if they have reasonable knowledge in communication skills for better outcome to the patient.
2. DESCRIPTION OF THE TOPIC
My topic is “assessment of knowledge of knowledge of communication skills among nursing students at MUHAS”
This study is going to assess if nursing students having good knowledge of communication skills that is useful for better patient outcome. The study will come out with the results to explain about this knowledge. The population to be focused by this study specifically will be nursing students at MUHAS.
3. OBJECTIVES
3.1 Broad objective
To assess knowledge assess knowledge of communication skills among nursing students at MUHAS.
3.2 Specific objectives
(i) To identify the common clinical communication skills nursing students have.
(ii) To identify if nursing students understanding about communication skills clues.
(iii) To identify major communication skills barriers among nursing students at MUHAS.
(iv) To identify if nursing students understanding about poor communication skills consequences in the clinical practices.
4.0 RESEARCH QUESTIONS
(i) What are the common clinical communication skills nursing students have?
(ii) Are nursing students aware of communication skills clues?
(iii) What are the main communication skills barriers facing nursing students at MUHAS.
(iv) What is the understanding of poor communication skills consequences to nursing students at MUHAS.
5. HYPOTHESIS
The researcher suggested the existence of relationship between dependent and independent variables which results into the prediction of the alternative hypothesis which states;
“There is significance knowledge of communication skills among nursing students at MUHAS”
6. CONCEPTUAL FRAMEWORK.
The two key variables such us knowledge and communication skills are ones to given attention. The independent variable is knowledge while, communication skills is dependent variable. This means that communication skills will be affected by having its knowledge. To be good in communication skills knowledge is needed. The study will be structured to asses this knowledge.The good communication skills affected by having good knowledge and this influence capacity, treatment adherence, trustfulness, and good provider-patient relationship.

7. LITERATURE REVIEW
In the review of literature selected articles has been identified after narrowing the topic. The selection of literature based on relevancy of the article to the topic and current of the article. The topic is issued in assessing knowledge of communication skills among nursing students. The review of literature done under the following criteria;
7.1 Main issues to be addressed in the literature.
In literature review the following issues has been addressed to find what other researchers say in their studies. The following things have been addressed in the literature review:
(i) To understand experience in the development of the communications skills for both nursing students and registered nurses.
(ii) To find the consequences of poor knowledge in communication skills and what are the effects of teaching communication skills to nursing students on the quality of care for patients.
(iii) To identify the research methods of data collection, sampling techniques used by other researchers in developing of their works.
(iv) To identify what are limitations facing studies of other researchers, what are their recommendations and what the gap of knowledge needed to be addressed in communication skills.

7.2 Evaluation of the reviewed literatures
From the literature it has explained that, good communication between nurses and patients is essential for the successful outcome of individualized nursing care of each patient. To achieve this, however, nurses must understand and help their patients, demonstrating courtesy, kindness and sincerity. Also they should devote time to the patient to communicate with the necessary confidentiality, and must not forget that this communication includes persons who surround the sick person, which is why the language of communication should be understood by all those involved in it. Good communication also is not only based on the physical abilities of nurses, but also on education and experience.(Kourkouta ; Papathanasiou, 2014)
The study conducted in University of Sadney, Australia explained, effective communication is a vital component of nursing care (Mullan, Mullan, ; Kothe, 2010). However, nurses often lack the skills to communicate with patients, careers and other health care professionals. Communication skills training programs are frequently used to develop these skills. However, there is a paucity of data on how best to evaluate such courses. The study evaluated the relationship between student self, rating of their own ability and their satisfaction with a nurse training course as compared with an objective measure of communication skills (Mullan et al., 2010). The sample included 209 first year nursing students completed a communication skills program. Both qualitative and quantitative data were collected and associations between measures were investigated. Paired samples t-tests showed significant improvement in self-rated ability over the course of the program. Students generally were very satisfied with the course which was reflected in both qualitative and quantitative measures (Mullan et al., 2010). However, neither self-rated ability nor satisfaction was significantly correlated with the objective measure of performance, but self-rated ability and satisfaction were highly correlated with one another. The importance of these findings is discussed and implications for nurse education are proposed. (Mullan et al., 2010)
The other study suggests, the communication between healthcare providers and patients affects patient care and safety. Nurses develop communication skills at the undergraduate level, after graduation and throughout their practice. This study explored perspectives of new graduates on the development and implementation of communication skills within the first six months after graduation. The study is descriptive study used an electronic survey to three cohorts of recent graduates. Surveys were sent within six months after graduation (Sheldon, 2015). The total of 700 surveys were sent to three cohorts of recent graduates with 206 surveys completed (response rates ranged from 26%-35%). Participants reported always feeling confident communicating with patients and families 27% of the time, and23.5% of the time with interdisciplinary teams. Only 50.8% reported always feeling confident to provide safe care all of the time with 44.5% reported feeling always able to ask colleagues for help with challenging situations (Sheldon, 2015). Then finally the study concluded, undergraduate nursing programs should incorporate more didactic communication skills training and simulation to prepare nursing students and increase their confidence to provide safe care and consult with colleagues for help. Communication skills training in practice settings after graduation to increase skill development and confidence during independent clinical practice.(Sheldon, 2015)
The study accepted (2017) in Islamic Azad University of Mahabad, in Urmia, Iran suggested nursing profession requires not only the academic knowledge but also the interpersonal relationships, technical, and intellectual abilities (Taghizadeh, Hasanpour-dehkordi, ; Shakhaei, 2017). The study aimed to determine the impact of teaching communication skills to nurse students on the quality of care given by nursing students. This study was a quasi-experimental research that was performed on 66 last year students and 132 patients using a goal-oriented sampling method in 2016. The data collection tools included a demographic information form of the units under study, a checklist of students’ communication skills, and a quality of care questionnaire for patients. The study tools were completed by the students and patients before the intervention and after completion of the training course. After collection, data were analyzed using SPSS v16 and descriptive and inferential statistics such as paired t-test and Pearson correlation coefficient (Taghizadeh et al., 2017). The results showed that there was a significant difference between the mean quality of patients’ care prior to and following the intervention (p?0.001).Also, there was a significant difference between the means for nursing student’s’ communication skills before and after the intervention. Moreover, there was a significant correlation between mean scores of students and the quality of care and communication skills (p?0.001). The conclusion recommended that the professionals in the field of nursing incorporate “communication skills” into their instructional programs so that the nursing students acquire the requisite experience in the field prior to entering into this profession. Also teaching communication skills should be followed up after the students’ graduation.(Taghizadeh et al., 2017)
7.3 Identified gap of knowledge from the literature.
Lack of a strong association between student evaluation and performance is particularly worrying given that student evaluations using standardized tools remain the most widely used measure of course success (Wolfer and Johnson, 2003). Whilst further research may be warranted to replicate these findings, the current study provides an important insight into the relationship between student evaluations of a course and their own ability as it relates to performance. The data from this study suggests that such student evaluations do not meaningfully correspond to demonstrable communication skills.(Mullan et al., 2010). Therefore this study recommends to replicates the study to find strong association between student’sevaluation and real practices as far as communication skills is concerned.(Mullan et al., 2010)
It’s also proposed that, future research should ask new graduates what they would recommend to improve undergraduate and postgraduate education on communication skills. Studies could incorporate specific scales to measure health literacy and cultural awareness (Sheldon, 2015). These scales would help identify specific components of cultural awareness and sensitivity, and health literacy that are amenable to the development of interventions at the undergraduate level and for continuing education for practicing nurses. Future studies should include additional demographic information about respondents’ current work settings and duration of practice. Furthermore, institutional programs should be implemented that enforce inter professional training programs in academic and practice settings. These programs should emphasize communication skills, collaboration, collegiality, and conflict resolution to improve patient care processes, safety, and outcomes.(Sheldon, 2015)
From the literature we see the main recommendations including, finding the relationship between the evaluation methods and actual practice in communication skills, the studies also recommends on what should be done in order to improve communication skills in health care setting to improve the quality of care to the clients. The studies also recommend on how the institutional programs in can improve the communication skills to the nursing students. (Sheldon, 2015)

REFERENNCES

Azari, S., Mokhtari, S., Mousavi, H., Mohammadi, M., Aliyari, A., Salimi, M., ; Gh, A. (2015). Relationship between learning styles and interpersonal communication skills of nursing student in Medical Sciences Tehran University in 2012, 8(3), 178–183.
Bello, O. (2017). Effective Communication in Nursing Practice?: A literature review Opeyemi Bello Bachelor ‘ s Thesis Degree Programme in Nursing.
Ferreiraa, M., Silva, D., Pires, A., Sousa, M., & Calheiros, N. (2016). Clinical Skills and Communication in Nursing Students.
Furnes, M., Kvaal, K. S., & Høye, S. (2018). Communication in mental health nursing – Bachelor Students ‘ appraisal of a blended learning training programme – an exploratory study, 1–10.
Kourkouta, L., ; Papathanasiou, I. V. (2014). Communication in Nursing Practice, (February), 65–68. https://doi.org/10.5455/msm.2014.26.65-67
Mullan, B., Mullan, B. A., ; Kothe, E. J. (2010). Evaluating a nursing communication skills training course?: The relationship between self-rated ability , satisfaction and actual performance Nurse Education in Practice Evaluating a nursing communication skills training course?: The relationships between self-rated ability , satisfaction , and actual performance. Nurse Education in Practice, 10(6), 374–378. https://doi.org/10.1016/j.nepr.2010.05.007
Sheldon, L. K. (2015). Development of communication skills in healthcare?: Perspectives of new graduates of undergraduate nursing education, 5(7), 30–37. https://doi.org/10.5430/jnep.v5n7p30
Taghizadeh, R., Hasanpour-dehkordi, A., ; Shakhaei, S. (2017). Pharmacophore THE EFFECTS OF TEACHING COMMUNICATION SKILLS TO NURSING STUDENTS ON THE QUALITY OF CARE FOR PATIENTS, 8, 10–13.