Communication Skills and Anger Management Training for Nurses

Objective: The aim of this study was to determine the effect of training given to nurses on communication and anger management skills in the presence of standardized patients.

Method: The study was conducted using a convergent parallel design, which is a mixed-method design. The experimental and control groups of the study were conducted with a total of 56 nurses. Data were collected using a socio-demographic data collection form, Communication Skills Inventory and State-Trait Anger and Anger Expression Scale. The intervention group participated in the simulation, and qualitative data were collected during the debriefing session of the simulation. The scales were administered to the groups 3 times in total: before the training, after the training and 6 weeks after the end of the training.

The patient-nurse relationship is a dynamic process that can change as the patient's health needs change and nurses can show positive emotions and behaviors to their patients. However, due to the nature of human beings, it may be impossible to show positive behaviors at all times, and in communication processes, situations that make communication difficult may occur from time to time (Gorman 1996). When the studies examining the communication between patients and nurses are examined, it is found that some patient behaviors that may cause problems in the relationship and the inadequacies of nurses in controlling their emotions are the causes. When these studies are examined, the concept of "difficult patient" attracts the most attention (Akgün-Çıtak 2011, Wolf and Smith 2007, Macdonald 2007, Kennedy Sheldon et al. 2006).

"Difficult patients" are defined in the literature as patients with behaviors that hinder communication. (Göral 2011, Koekkoek et al. 2006). In a study conducted by Essary et al. (2005), it was observed that patients were labeled as "difficult patients" as a result of ineffective communication between nurse and patient and that nurses tended to blame patients as a result of labeling. In the literature, it is stated that improving communication skills with the difficult patient group will benefit nurses and the onset of conflicts can be prevented, which should not be forgotten that conflicts that cannot be prevented arouse feelings of anger in individuals. (MacLean at all 2017, Baran and Okanlı 2015) For this reason, it is as important for nurses to improve their communication skills as it is for them to improve their ability to cope with anger.

Although anger is a frequently felt emotion in the nursing profession, this emotion should not be expressed with aggression or suppressed in order to be healthy and useful. Nurses should gain the ability to express anger in a healthy way by recognizing and accepting it like all other emotions (Bozkurt 2010, Akdeniz 2007). Expressing anger openly in an acceptable way is a positive personality trait. However, such emotions that cannot be controlled and are ignored by denial or suppression have the potential to be harmful for both the person and his/her environment (Kaya et al. 2012). In the study conducted by Baran and Okanlı in 2015, it was emphasized that nurses should regularly receive in-service trainings on anger and anger expression in order to recognize their anger, accept its existence and express their anger correctly. Trainings on anger management can be given in many ways like other trainings. These ways can be in the form of individual and group trainings as well as using various simulations.

Simulation-based trainings are ideal for nursing education as they include an interactive method that can be used to teach cognitive, psychomotor or emotional skills to individuals or groups at any skill or proficiency level. ( Zengin \& Eren Fidancı 2024, Tanis, Quinn, \& Bischoff, 2019) In standardized patient simulation, the patient or case study is animated by playing the scenario prepared with structured steps. The use of standardized patients in teaching contributes to the development of participants' communication skills, history taking and physical examination skills. ( Zengin \& Eren Fidancı 2024). When the literature is examined, it is seen that skill-oriented studies are frequently used in simulation-based studies, but emotion-oriented studies are weaker, and the majority of the studies are conducted with student nurses, and the intervention study conducted with working nurses is very limited.

Eligibility Criteria:
Inclusion Criteria:

* Volunteering to participate in the research
* Working as a nurse in any of the surgical or internal medicine clinics of the hospital
* According to the results of the pre-test application, anger control scores were lower than the other nurses participating in the study.

Exclusion Criteria:

* Not volunteering to participate in the study
* Not having participated in simulation training in the experimental group