Journal of Nursing Science Research
E-ISSN : 3062-8865
Volume 1 Nomor 1 Juni 2024
Hal : 34-48
EFFECTIVE COMMUNICATION IN NURSING: A COMPREHENSIVE
SYSTEMATIC REVIEW OF BEST PRACTICES
Citra Suraya1* .
Tukimin bin Sansuwito2
Aris Citra Wisuda4
Regidor i Dioso 3
1,2,3
Faculty of Nursing.
Lincoln University College.
Malaysia Faculty of Nursing.
Sekolah Tinggi Ilmu Kesehatan Bina Husada Palembang.
Indonesia Email: citrasuraya.
edu@gmail.
ABSTRACT
Background: Effective communication is crucial in patient safety management, as it minimizes and prevents actions that could negatively impact nursing care.
Effective communication involves strategies to ensure clear and accurate message delivery, enhance patient safety, and reduce work-related risks for nurses and other healthcare professionals.
This can be initiated by adhering to Standard Operating Procedures for effective communication and leveraging virtual technology.
Objectif: This research aims to identify the implementation of effective communication in the context of patient safety within nursing care settings.
Method: The article search involved querying five databases: PubMed.
ProQuest.
ScienceDirect.
DOAJ, and Garuda.
The analysis method included selecting journals relevant to the research purpose and thoroughly reading each.
Inclusion criteria for this literature review encompassed communication, nurses, nursing service settings, and journal articles published within the last five years.
Exclusion criteria included journals that were not open access, articles with unclear or unstructured research methods, articles available only in abstract form, systematic reviews, and scoping reviews.
Results: Through feasibility testing, eight journal articles were identified that demonstrated the application of effective communication in the context of patient safety.
These included communication training programs, interprofessional team integration in service, and communication management focused on patient safety.
Effective communication can be achieved successfully when nurses are adept at selecting appropriate communication methods tailored to the specific needs of the nursing service setting.
Keywords : Communication Standards.
Effective communication.
Interprofessional.
Nursing Practice.
Nurses INTRODUCTION Communication forms the foundation of the nurse-patient relationship and is crucial for establishing trust and comfort in nursing care (Potter and Perry, 2.
Santosa & Ariyani .
note, effective communication is a fundamental yet intricate concept in nursing practice.
It is the primary mode of interaction between the healthcare team, patients, and their Nurses must be proficient in collaborating within teams to ensure that accurate information is conveyed promptly.
When effective communication is lacking, the quality of nursing care is compromised.
According to Murdiany .
Effective communication among nurses is vital for ensuring patient safety and security, yet numerous challenges can hinder healthy and efficient communication.
Physicians, often with an action-oriented approach, prefer direct and concise communication to Page | 34 Journal of Nursing Science Research Vol.
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Overcoming these challenges necessitates a concerted effort to enhance communication skills and By fostering improved communication, healthcare providers can achieve better patient outcomes and cultivate a more collaborative and supportive care atmosphere.
Nursing services in communication involve various important aspects that support the quality of care and patient Therapeutic communication is used by nurses to help patients overcome problems, understand their conditions, and make informed decisions through active listening, empathy, and emotional support.
Additionally, communication with other healthcare professionals ensures coordination and fulfillment of all aspects of patient care.
Nurses also provide education to patients and their families, which requires clear and easy-to-understand communication (Potter and Perry, 2.
Documentation of every care action and interaction is also an important part of communication, helping to maintain continuity of care.
In addition, nurses need to have good communication skills to resolve conflicts, act as advocates for patients, and provide input to improve Thus, communication in nursing services is not only aimed at exchanging information, but also building relationships based on trust, empathy and respect to achieve optimal care results and improve patient welfare (Craven, 2.
Fathya et al.
reported that data from the Joint Commission (JCI) indicated that out of 936 harmful incidents in 2015, communication issues contributed to over 70% of these events, making them a significant precursor to medical errors.
This highlights the urgent need for a critical evaluation of communication's role in the strategic management of healthcare The findings suggest that while effective communication is essential for organizational success, its impact is primarily influenced by the chosen communication methods, the effectiveness and appropriateness of the media used, and the quality of access and receptiveness between superiors and subordinates.
According to Noviyanti et al.
Improving communication strategies within healthcare settings is crucial to enhancing patient safety and minimizing Requires a focused effort on selecting suitable communication channels and fostering an environment where open and effective communication is encouraged and maintained across all levels of the Numerous implemented to enhance effective communication in nursing care settings.
Essential strategies include conducting interviews with open-ended questions, performing in-depth interviews, and involving patients and families in the documentation process through tools like IPASS (Illness Severity.
Patient Summary.
Action List.
Situation Awareness and Contingency Planning.
Synthesis by Receive.
, which enhances SBAR (Situation-Background-AssessmentRecommendatio.
during handovers.
Additionally, training teams can improve work production effectiveness, while virtual technology aids in room or ward management (Bello, 2.
Various initiatives have been undertaken to boost professional communication competence in nursing, particularly concerning patient However, there remains a gap in reviewing the scope, methods, and communication education for registered A systematic review framework is essential to gain a comprehensive understanding of the current state of this This review will help identify gaps, highlight best practices, and guide the development of targeted educational Page | 35 Journal of Nursing Science Research Vol.
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This research aims to identify the various methods used to enhance effective communication in nursing service settings and explore the challenges that arise when By examining these methods and obstacles, the review aims to comprehensively understand best practices and potential pitfalls in communication within nursing care.
This knowledge is essential for developing strategies that ensure clear, efficient, and effective communication, ultimately improving patient care and safety.
METHODS
This research is a systematic review focusing on the implementation of effective communication by nurses to ensure patient A comprehensive search strategy was employed to identify relevant journal articles using five databases: PubMed.
ProQuest.
ScienceDirect.
DOAJ, and Garuda.
The search utilized keywords such as "communication standards," "effective "nurses," "student nursing," "interprofessional," and "nursing " Articles were selected based on inclusion criteria, including publications from significant journals in communication and healthcare, relevance to health workers and students in nursing service settings, and journals published within the last five years .
0 to 2.
Exclusion criteria included non-open access articles, those with unclear or unstructured research methods, abstracts only, and articles that were systematic or scoping reviews.
Two researchers actively collaborated to collect the journal articles from the five databases.
The gathered articles were then imported into the EndNote application for further filtering, ensuring the inclusion of only the most relevant data.
This meticulous process provides a comprehensive overview of effective communication in nursing practice and its impact on patient safety.
RESULTS
Literature search The research selection process is illustrated in Figure 1.
A total of 1,412 articles were identified through nine literature searches conducted from 2020 to Screening the search results yielded 266 articles from PubMed, 471 from ScienceDirect, 225 from ProQuest, 147 from DOAJ, and 303 from Garuda.
The authors independently evaluated all articles identified as potentially relevant for the systematic review.
Several articles were excluded from the initial pool of 1,412 based on various criteria.
Exclusions included publications older than five years .
, articles not written in English or Indonesian .
, and titles and abstracts that did not align with the research questions .
, resulting in 379 articles.
Further exclusions were made for articles lacking full text .
, duplicates .
, and those without a straightforward research design .
, leaving 23 eligible full-text articles.
After a more detailed review, 14 articles were excluded for not meeting the research objectives, resulting in nine articles being selected for the final This rigorous selection process ensures that the included studies are highly relevant and contribute valuable insights communication in nursing practice for patient safety.
Page | 36 Journal of Nursing Science Research Vol.
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Summary table of studies included in the review Author Name (Yea.
Title (Sri Handayani et al.
The Influence of Therapeutic Communication on the Anxiety Level of Preoperative Patients.
(Prismeiningrum.
The Influence of Therapeutic Communication on The Quality of Nursing Services Method (Population/ Sampl.
controlled trial (RCT) implement skills-based learning strategies for clinical communication in situations involving clinically deteriorating The study involved 56 third-year nursing students in a clinical setting and 116 final-year students in a hospital Participants randomly assigned to one of three groups and underwent performance assessments using the ISBAR communication These assessments focused on managing deteriorating patients in high-fidelity providing realistic and practical training to communication skills.
Analyzing the effect of TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safet.
training on nurse group hospitals for quality of service was conducted which included both a control group and an Eighty-four nurses were randomly assigned to the control group .
intervention group .
The received TeamSTEPPS Research result Incorporating a PracticeBased Learning (PBP) simulation program into the e-learning module ISBAR communication patients with deteriorating health conditions.
The approach is evident, as nurses' application of communication skills has effectiveness, with a pvalue of 0.
Indicates a proficiency, crucial for patient care in critical The TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safet.
in this study may be attributed to the training period being shorter than the AHRQ standard, as the training schedule was adjusted to avoid conflicts with nurse shift structures in the hospital .
-value = 0.
Additionally, the results could be influenced by motivation to engage in and complete the training Page | 37 Journal of Nursing Science Research Vol.
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Effective Communication Training in Nursing for Nurses (Sans, 2.
Factors Associated with the Implementation of Nurses' Therapeutic Communication training, utilizing the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) and the TeamSTEPPS Teamwork Attitude Questionnaire (TTAQ), each comprising 18 questions.
This enhance communication skills and teamwork among nurses, assessing their perceptions and teamwork before and after the intervention.
An evaluation compared program using computer simulation to enhance teamwork skills.
The randomized controlled trial (RCT) method, involving 56 nursing undergraduate nursing students divided into two groups, with 48 participants per group.
The virtual simulation orientation on operating the laboratory and ward settings, communicating performing assessments on patient avatars.
Nursing students in this group were randomly assigned roles and took role-playing, participating in two scenarios to develop their skills.
Quantitative, retrospective methods were employed in this study involving 227 Emergency Room (ER).
Implementing training using simulation at the pre-registration level challenges due to the difficulty of coordinating disparate groups of nursing This study found no significant differences between computer and traditional live simulations in fostering cooperative enhancing communication These findings support the potential use of virtual reality in training The results indicate a significant positive impact on patient safety, with a p-value of It was observed that most of the compliance results regarding Transfer Notes (NT) and the Modified Early Warning Score (MEWS) reached 89.
commendable level of Page | 38 Journal of Nursing Science Research Vol.
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Descriptive was conducted to assess
the effectiveness of Transfer Notes (NT) and the Modified Early Warning Score
(MEWS)
communication tools for patient safety.
These tools were utilized by nurses during patient Emergency Department based on data extracted from electronic patient records in the Adult Emergency Service.
Nurses Transfer Notes (NT) scripts.
Modified Early Warning Score (MEWS) scores, and patient goals to facilitate transfers to outpatient hemodynamic center.
When patients were transferred to inpatient units, the Intensive Care Unit (ICU), or the Surgical Block, the Transfer Notes (NT) comprehensive and was deemed complete when all fields were filled out.
The Modified Early Warning Score
(MEWS)
score was applied alongside the Transfer Notes (NT) transferring the patient, as recorded in the electronic registry.
compliance and has a .
Although this underscores the integral role of this tool in the nursing task and its contribution to systematic In turn, directly improves patient safety and mitigates the risk of adverse outcomes.
However, during peak occupancy, there was a trend towards worsening outcomes, indicating that overcrowding may hurt patient safety and the overall quality of services.
Page | 39 Journal of Nursing Science Research Vol.
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Application of Therapeutic Communication to Inpatients in Nursing Practice The lean (Less.
Effort.
Action.
Nurturin.
eliminating unnecessary steps, reducing the time required by up to 50% direction, and fostering communication among nursing team leaders.
Qualitative research was conducted with 25 team themed "Hearing Staff Voices" to identify the causes of the protracted handover process.
This approach aimed to streamline the handover process, ensuring more effective and timely communication within the nursing teams.
All research activities could initiate and conclude the handover process with the team leader.
The average duration of the handover was consistently between 15 to 30 minutes.
This approach reduced the handover process time with the team leader by up to 50%, demonstrating (Seinwil, 2.
Efforts to Improve Nurses' Effective Communication This study explores nurses' perspectives on their patient handover aspects and identifying elements for handover.
Qualitative research was conducted with 15 nurses who met the inclusion criteria having 10 years of experience, with some participants Pre-hospital Emergency Medical Services (PEMS).
Interviews conducted using 10 open-ended questions process standardization, effectiveness of actions, the transfer process, materials, information information exchange.
Standardizing the transfer process is a critical concern for nurses.
Before a patient arrives.
ER nursing tasks.
Pre-hospital Emergency Medical Services (PEMS) encompass all nursing activities performed, with adequate time allotted for discussions with patients Effective communication is paramount without prompting nurses to seek PEMS typically provides detailed reports, including Nurses emphasize the importance of clear, readable clinical notes that succinctly Page | 40 Journal of Nursing Science Research Vol.
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(Arda et al.
, 2.
Implementation of Nurse Therapeutic Communication in the Inpatient Room The research design employed for this study is qualitative, focusing experiences during the remote monitoring of elderly individuals with The study involved a randomized trial with 78 participants implantation, followed year-long observation period postimplantation.
Six months into the study, participants responded questionnaire adapted from the HCCQ.
After 12 months, in-depth conducted using guide to delve deeper experiences related to their pacemakers.
These interviews included a mix of open-ended and closed-ended questions participants interacted with and perceived the communication aspects of their pacemaker with medical histories, administered, and explain referral reasons.
Although referral forms include nursing sections, they often feature unreadable complicating their utility.
There remote monitoring and Communicating with a doctor from home is primarily due to its convenience and the sense of security it provides Many participants perceive this approach as a safe alternative, ensuring they receive continuous care.
Additionally, hospital visits is seen as patients time and travel Page | 41 Journal of Nursing Science Research Vol.
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Therapeutic Communication Skills of Nursing Students Clinical Practice Identifying barriers and promoting effective use of interpreting services in pediatric care settings by Nursing students for children with Limited English Proficiency (LEP) is crucial.
The study employs Group Level Assessment (GLA), a structured seven-step process that Climate Control.
Generation.
Appreciation.
Reflection.
Understanding.
Selection, and Action.
GLA facilitators guided nurses and interpreters through 51 specific instructions aimed at Researchers meticulously recorded detailed notes and transcribed participants' during the sessions.
Upon participants filled out demographic surveys covering their years of fluency, and cultural This qualitative participatory approach engaged 36 doctors, 10 nurses, and provide insights into the with language barriers in pediatric healthcare.
Identified barriers include challenges in accessing unclear communication with Limited English Proficiency (LEP) preferences, roles, and Effective communication can be achieved when healthcare providers and interpreters collaborate closely to coordinate services.
It's crucial to understand the influence of cultural traditional care practices and to approach clients Using active communication methods that engage families in decision-making processes is also essential for fostering effective improving patient care Page | 42 Journal of Nursing Science Research Vol.
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The inclusion process overview is depicted in the PRISMA Flow Diagram below:
Pubmed Identification Results are filtered .
Eligibility Articles identified .
= 1.
Included ScienceDirect
Screening ProQuest
DOAJ
Garuda Exclusion > Last 5 Years .
Not English & Indonesian .
The title and abstract do not match the research question .
= .
Exclusion There is no full text .
= .
Different study design .
= .
Duplicate .
Decent fulltext article .
Exclusion Not in accordance with research results .
Articles Included.
DISCUSSION The compiled research highlights various implementations to optimize effective communication within nursing settings, demonstrating its significant impact.
The PBP .
roficiencybased progressio.
simulation program has been integrated into an e-learning module for SBAR communication effectiveness (Harding & Hagler, 2.
Includes structured communication framework studies in simple language, periodic reports via simple boards, and training programs to enhance team management, such as LEAN (Less.
Effort.
Action.
Nurturin.
management, to boost the productivity of team leaders and nurses.
TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safet.
training and the exploration of nurse handover processes, focusing on standardization, information transfer, communication, and clinical notes, are also emphasized.
Interviews communication barriers were recorded, analyzed, and transcribed using thematic analysis (Prismeiningrum, 2.
The Group group-level assessment (GLA) was utilized to evaluate the LEP levels of patients and their families with limited English proficiency.
Furthermore, interactive workshops were conducted featuring role-play, group discussions, and experience exchanges among nurses, along with virtual technology like the Navi Space Gateway.
According Murdiany .
, communication skills education aims to mitigate the negative impact of bad news on patients and healthcare providers, including doctors and nurses.
Below, we will detail the methods, tools, and challenges of implementing effective communication strategies in nursing care settings.
Improving Communication Methods in Nursing Service Settings Developingproficiency-based progression (PBP) professional training is more effective for teaching clinical communication to patients with advanced conditions than e-learning (Koldestam et Page | 43 Journal of Nursing Science Research Vol.
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Performance improvements with PBP simulations can be achieved using the same training time and facilitator/student ratio as standard simulations.
Implementing simulation-based enhances the acquisition of non-technical skills, thereby reducing medical errors and patient injuries in healthcare settings.
This approach underscores the necessity for evidence-based training programs that enhancing the educational experience.
According to Tahulending et al.
such training methods should be grounded in robust evidence to ensure they contribute significantly to improving clinical outcomes and patient safety.
Standardizing Communication Between Healthcare Providers and Patients Involving clients and families enhances patient safety (Hickey & Giardino, 2.
While the role of clients and caregivers in patient safety has recently gained attention, specific plans and interventions have been developed for both groups (Unikal, 2.
Patient safety outcomes are systematically measured in a structured and proactive manner by soliciting family safety reports and analyzing data obtained from these reports alongside data from other sources, such as provider reports and hospital incident This data is systematically investigated and assessed by a review team of nurses and physicians.
Utilizing families as a source of patient safety data is a validation method.
Collaborating with the client's family improves the quality of the data collected and the potential for effective Prioritizing involvement as a critical component of collaborationAi communication specialists, and health literacy expertsAienhances all aspects of study design, implementation, data collection and analysis, and the interpretation and dissemination of findings (Arda et al.
, 2.
Lean Management Techniques and TeamSTEPPS Training for Patient Handover TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safet.
is employed to enhance quality, safety, and efficiency in healthcare and to reduce errors.
It focuses on skills that support team performance principles, including specialized training, behavioral methods, human factors, and cultural change to improve patient safety (Prismeiningrum, 2.
The four TeamSTEPPS leadership skills, mutual support, situation monitoring, and effective communication between team members (Hickey & Giardino, 2.
Implementing this training effectively increases the patient safety culture, as evidenced by improved communication, handoffs, transitions, and a decreased frequency of reports regarding side effects (Haugen, 2.
In lean management, a crucial strategy is enhancing the clinical handover process between team leaders and core groups using the PDSA (Plan.
Do.
Study.
Ac.
tool in a four-stage problem-solving model.
This approach starts by introducing a new team leader on the handover sheet and a new "sign" for the ongoing team leader's handover written in Arabic and English to prevent unnecessary interruptions and Additionally, collaboration with the pharmacy department helps remove stationary drugs from the narcotics cabinet and prioritize slow-moving and fast-moving drugs across all units tested (Nasir et, 2.
Improving Processes and Establishing Standard Elements for Patient Handoffs To improve communication, avoid data loss, and reduce side effects, it is essential to standardize the patient transfer process between pre-hospital emergency medical services (PEMS) and hospital Page | 44 Journal of Nursing Science Research Vol.
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This standardization is critical to achieving clinical safety improvements.
During a patient transfer, comprehensive medical records must be included.
Nurses should propose adequate transfer actions, specifying when to receive patients and providing their profile and performance PEMS nurses must submit significant patient details based on a thorough nursing assessment documented in the medical record.
ED nurses must accurately verify all received information, repeating or asking questions for Notes from the PEMS nurse ED and PEMS nurses must systematically manage and store patient information during the transfer process.
This practice will help reduce medication errors, avoid side effects, prevent data loss, and enhance patient safety and professional satisfaction (Seinwil, 2.
Effective Interpreter Services for Caring for LEP Patients Improved access to technology and its functionality has enabled interpreters to deliver timely and predictable services.
Planned training programs for healthcare providers focusing on cultivating a culture of effective care delivery, consistent utilization of communication strategies, familiesAiincluding re-education and before meetings with Limited English Proficiency (LEP) familiesAiwere highlighted as crucial steps and expectations by participants (Deravin.
Cultural competency education for healthcare providers, as underscored by Group
Level Assessment
(GLA)
participants, is pivotal for delivering comprehensive and effective care (Smith.
Beyond fostering a culture of humility through education, participants stressed the importance of employing family-centered communication to enhance family engagement and understanding.
Adhering to widely accepted concepts among interpreters, recommended by consensus-based expectations regarding the scope of interpretive style, time constraints, and medical context before patient encounters.
This interactions and improves the quality of care provided to linguistically diverse patients and their families (Arda & Suprapto, 2.
Enhancing Team Training: Virtual Reality vs.
Conventional Live Simulation Furthermore, the development and evaluation of Artificial Intelligence (AI) technology can supplement and enhance human capabilities, enabling broader and more effective implementation through group-based interprofessional education Virtual reality (VR) is increasingly recognized for its practicality and feasibility, serving as a promising educational tool to prepare students for future collaborative roles in healthcare.
This approach cultivates competencies for delivering safe, high-quality patient care within an evolving healthcare landscape (Tahulending et al.
, 2.
Exploring Communication Experiences in Remote Monitoring of Patients with Pacemakers Telehealth revolutionize patient care by leveraging continuous digital advancements to effectively cater to diverse patient This study delves into the nuances of telehealth communications and affirms the favorable outcomes observed in remote interactions with patients equipped with pacemakers.
This emerging healthcare technology holds significant promise as a supportive tool, particularly for patients grappling with long-term health challenges.
Hence, there is a pressing need to develop further strategies to assess and enhance the Page | 45 Journal of Nursing Science Research Vol.
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, 2.
Recording of Transfer Notes and Issuance of Modified Early Warning Scores Standardizing and computerizing NT electronic medical record scripts can streamline equipment management for The widespread implementation and systematic use of NT and MEWS by treatment protocol teams are crucial to enhancing patient safety, improving the quality of care, fostering effective unexpected events during patient transfers.
Other healthcare units should adopt these communication strategies and ensure safe patient transfers.
Expanding on these efforts can improve healthcare delivery efficiency and reliability, benefiting patients and healthcare providers alike (Sans, 2.
Embedding characteristics in nursing settings begins with identifying barriers to effective healthcare providers and patients' families, advancements in nursing information systems, maintaining team cohesion through structured handover processes, implementing Team STEPPS for SBAR communication, and leveraging linguistic services to bridge language barriers.
Furthermore, the integration of AI virtual technology holds promise in facilitating healthcare providers and patients with limited proficiency in the local language, thereby fostering effective collaboration (Prismeiningrum, 2.
Communication Facilities in Nursing Practice Implementation communication in nursing service settings necessitates facilities that significantly Healthcare professionals, including nurses and doctors, play pivotal roles in ensuring the success of therapeutic communication initiatives.
They must broaden their understanding and expand their insights into the facilities required for effective communication (Abd El Rahman et al.
, 2.
Effective communication includes informed and caregivers, doctors, and patients, which are pivotal in delivering patient-centered health services and ensuring a well-organized nursing care system tailored to patient and Challenges in Implementing Effective Communication Methods in Nursing Service Settings Effective communication methods in nursing service settings face numerous challenges that cannot be overlooked.
Apart from necessitating strong collaboration among nurses, doctors, and other healthcare professionals, these methods also demand substantial institutional support.
For instance, enhancing translation services is crucial but complex.
healthcare facilities must establish and uphold policies that facilitate access to translators, standardize communication protocols, and improve the efficiency of language translation within These efforts are essential to ensure that language barriers do not impede enhancing overall care quality and patient outcomes (Nasir et, 2.
LIMITATIONS OF THE STUDY
In preparing this systematic review, several limitations were encountered.
Firstly, the choice of journals was restricted to those available in English, necessitating misinterpretations of the content.
Secondly, due to access restrictions, this research could not include journals that were not freely available despite their relevance to Page | 46 Journal of Nursing Science Research Vol.
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Thirdly, while eight journal articles were deemed sufficient for postgraduate-level research, the authors acknowledge that this number may not adequately capture the breadth of research on effective communication in nursing care settings and its broader impact, thus limiting the generalizability of findings.
Fourthly, the selected search keywords imposed further limitations on database Therefore, it is recommended to include a broader range of journals to representation and generalization of this CONCLUSION
Based on the findings from each study, it is evident that adhering to standardized communication practices in nursing significantly enhances service REFERENCES