Nurse Education Today (1991) lI,24-29 0 Longman Group UK Ltd 1991

Nurses’ interpersonal perceptions Phillip

Burnard

skills: a study of nurses’

and Paul Morrison

Six Category Intervention Analysis was used as the framework of a study which involved asking 117 trained nurses to rate their interpersonal skills along six dimensions. The findings suggested that the nurses viewed themselves as being more skilled in offering support, information and prescription in their dealings with patients and less skilled in being catalytic, cathartic and confronting in similar circumstances. The findings in this study were similar to those of previous studies in this field. The study has implications for the development of interpersonal skills training programmes for nurses.

INTRODUCTION There is a growing interest in nurses’ developing interpersonal skills (Muldary, 1983; Faulkner & Maquire, 1984; Aidroos, 1985; Kagan, 1985; Conboy-Hills, 1986; Fielding SCLlewelyn, 1987; Reynolds & Cormack, 1987; Burnard, 1989a; 1989b). Nurses are being encouraged to develop a range of communication, counselling, assertiveness, facilitation and social skills. What remains unclear is how nurses view their own interpersonal skill levels. It is asserted that such views need to be taken into account before further interpersonal skills training can be planned. This study offers a format for the self-assesment of interpersonal skills. It builds on previous research by the authors (Burnard & Morrison, 1988 Morrison & Burnard 1989).

Philip Burnard MSc RGN RMN DipN Cert Ed RNT Lecturer in Nursing Studies and Paul Morrison BA (Hans) RGN RMN PGCE Lecturer in Nursing Studies, University of Wales College of Medicine, Cardiff, Wales (Requests for offprints to PB) Manuscript accepted 23 May 1990 24

The paper identifies a theoretical framework known as Six Category Intervention Analysis (Heron, 1989) offers an aim for the study, describes the methodology and findings and compares the results of the study with previous ones. It closes with a discussion of the findings and some suggestions for future research and training in the field. The present study seeks to test out the validity of our previous findings.

Six Category Intervention

Analysis

Six Category Intervention Analysis (Heron, 1975; 1989) developed out of previous work by Blake and Mouton (1976). It is a device for identifying possible types of effective interpersonal interventions between practitioners and clients. Heron’s category analysis is a theoretical analysis and the authors could find no reference to any empirical work that predated the development of the analysis nor could they find any later, published studies which used the analyses to guide research in this area. The analysis has been widely used at the Human Potential Research Project, University of Surrey (HPRP,

1987)

as a tool

for

communication those

training

skills.

courses

are

people

It is notable,

often

by

the

develop

their

interpersonal

ing, cathartic,

skills

identified

in Heron’s

&

advice

To be informative To

the person’s

beliefs. To be cathartic

Authoritative

Facilitative

Categories

Categories

Prescriptive informative Confronting

Cathartic Catalytic Supporting

and strong

or make

is to offer

sug-

informa-

be confronting

behaviours,

different.

To be

is to

attitudes

or

is to enable the release of

emotion

(tears,

anger,

fear

The point needs to be raised as 10 what

degree such analyses can appropriately ferred and modified Blake

and Mouton’s

tions. He further

self-

skilled

person

priately

and

confirm

the

further

other

person’s

subdivides

the categories

under the headings authoritative categories and facilitative categories. Authoritative interventions are those which enable maintain

some degree

tionship tive

and include

and

control

categories.

are those that enable

informaFacilitative

the locus of

to remain with the client and include the

cathartic, Table

to

over the rela-

the prescriptive,

confronting

interventions

the practitioner

of control

catalytic

1 identifies

analvsis

may

Mouton’s

(1976)

Analysis

be

which

and

supportive

these

categories.

compared

original

to

Intervention

comprised

the

categories. Heron’s Blake

and

who

move

can

between

suggests that no categorv tant

than

any

however,

other

he argues

form a ‘bedrock’

Ihr

to have improved

tat-

because

we

(Heron

He also offers

live

1977),

in

interventions that

the overt

ma\

c.c)nlnlunication the view that

a ‘non-cathartic

where

strong emotion

Paradoxicall),

that catalytic

type of intervention

and counselling.

societv’

expression

of

is not highly valued, the cathartic

will tend to be less frrquentlv

Fielding

and’I,lewelvn

are different

degrees

(1987)

and less

Ilote that there

01‘ resistant e to the o\‘et-t

expression

of emotion within the I ‘li, influenced

by culture.

Heron goes on to make a case for the value of cathartic and contentious

which is beyond the

appro-

various

is more or less impor-

category.

serve as the basis for effective

pertinent

and principles.

interven-

when using the categol-) analysis as a of guiding therapeutic. action. Heron

therapeutic

4. prescription;

analysis appears

is one freely

skilfully used bv many practitioners.

3. confrontation;

Heron’s

of therapeutic

category

1. acceptant;

for his

claims that the interpersonallv

Category

2. catalytic;

5. theories

egories means

range

following

categories:

for

whilst Heron’s

Heron claims that the category- analysis offers

is to

or

was intended

context,

analysis.

f’urther self-exploration. worth. Heron

analysis

claims a much wider range of application

an exhaustive

To be supportive

be trans-

in this way. It is notable that

use in a fairly specific

etc.). To be catalytic is to draw out, to encourage validate

cateaories

category confront-

and supportive.

is to offer

or instruction.

tension

for

(Nicolas

informative,

catalytic

prescriptive

challenge

Boards

and facilitative

1982).

The categories

tion

nurse

for those who wish to

analysis are: prescriptive,

gestions.

by

that

Table 1 Authoritative

and have been

National

Nurses as suitable courses Gooderham,

too,

attended

Leachers and nurse practitioners recommended

in using

commentators

internal logic of the category analysis, has removed the ‘theories and principles’ category and added other categories. It is notable, also,

being

that Blake and Mouton’s focus of attention was interventions made in management: Heron’s concern is with interpersonal interventions. Thus the purpose of the two sorts of analysis is

experiences

release argument

the remit of this paper.

may not view cathartic

of such

a highly but one

importance.

George

Other

release as Kelly,

for

example, in acknowledging the need to ‘look forward’ in life, rather than to look back at past says ‘the only valid \\a> to live

OIW’S

life is to get on with it’ (Kelly. 1969) The c-ategorv analysis is pitched at the level of intention. That is to say that it does not pick out a

26

NURSE EDUCATION

TODAY

range of specific verbal behaviours to guide the user’s intentions peutic

interventions.

mechanical, means between

enabling

a range

implication,

people’s

training

the

user

device

intentions

can remember

can

access

and whether

their intentions,

The word ‘intervention’

(and, by

to the

or not people after the event!

is used here to describe

any verbal or non-verbal statement or behaviour that the practitioner may use in the therapeutic relationship. denote

The word ‘category’

is used here to

a range of related interventions.

Hammond atric nurse

(1983),

in the context

education

noted

of psychi-

that the category

analysis could be used in two ways:

4

as a means

of interpreting

interventions

b)

sessions.

Goodwin

nurse/patient

during

cathartic

of the category

in

counselling described

described

(1985)

as per

the

The

interpersonal

the use of

counselling

skills

use

category

of

skills

skills

development

elsewhere

(Burnard,

ranking

the

training had 1983;

Table 2 Synopsis of the six category intervention

Cathartic Catalytic Supportive

(1989)

has sug-

approach

management

is also

strategies.

out two previous studies using a

schedule

trained

to determine

staffs’ perceptions

skills (Burnard and Burnard following

student

and

of their interpersonal

and Morrison 1989).

nurses’ perceptions,

1988,

Morrison

In the study of 93 trained using the six categories,

the

rank order emerged:

1. supportive; 2. informative; 3. prescriptive; 4. catalytic; 5. cathartic;

In the

above

resents

the category

skilled

in using

category

that

to and

been 1984;

overall

ranking,

and

item

yielded a similar response obtained The

present

the in

nurses’ perceptions and the details of the two studies

can

be

of those studies.

study was designed

of those

rep-

felt most

felt least skilled

the

from the reports

reliability

one

six represents

respondents

between

item

that respondents

using. Our study of student

previous

studies

different

method

of collecting

category

analysis

described

to test the by using a

data, using the

here.

The

rating

scale used in this study also allowed greater flexibility of analysis than did the ranking schedule. (Kruskal

Confronting

Heron

Previous research

analysis

Prescriptive Informative

1989b).

the six category

useful in planning

differences

the application

had discussed

in teaching

‘non-psychologists’. analysis

of catalytic and

analysis for use in peer support

Dryden

analysis

had

analysis, in health visitors.

Bond and Kilty (1983)

the

(1978)

skills development,

category

groups.

counselling

and Bond

called for the development

that

6. confronting;

and

as an aid to the nurse

1989a;

We had carried

as to the degree

have

1985; gested

but a

interventions.

however,

researchers

a

to discriminate

of varied therapeutic

remains,

thera-

it is in no sense

non-therapeutic)

The question to which

Thus

behavioural

of

but attempts

in making

The results of this study were open to using multidimensional &Wish,

1978; Forgas,

scaling

(MDS)

1979): a method

that allows the data to be viewed from a variety of analysis

To offer advice, make suggestions etc. To oive information, instruct, impart knowledge etc. To challenge restrictive or compulsive verbal or non-verbal behaviour. To enable the release of emotion through tears, angry sounds etc. To be reflective, to ‘draw out’ through the use of questions, reflections etc. To offer support, be validating, confirming etc.

perspectives and allows hidden patterns and trends to emerge from them in ways that would not be possible using more conventional methods. This analysis of the data will be reported

on

at a later date. The present study is an extension of the two previous studies and part of a larger study on interpersonal skills in nursing.

Aims of the study The present

study built on previous work on the

iiVRSE

six category 1987;

approach

Morrison

interested

in testing

findings

in the

wanted

(Burnard

& Burnard, out

studies

& Morrison,

1989).

the

validity

discussed

to find out whether

We were of

the

above.

or not there

In view of the paucity of research lar domain,

we felt justified

isation with the category

we may be more

methods,

educational

niques and further

policy,

assessment

tech-

that

prior to our

Heron’s

analysis had not been tested empirically about

their own interpersonal

a period of introduction

nurses’

such

a

completing

analysis,

a rating scale (Table

the nurses in 3). Specifically.

was asked to rate the six cat-

egory items to correspond

category

perceived

and little

patients in a professional

perceptions

and familiar-

each case were invited to take part in the study b) each respondent

previously,

it appeared

had been written

con-

training

research.

Also. as we suggested research

to develop

in this particu-

in using

Procedure

consistency

was present

2’i

We was a

Following

in using our results

TOD.-\Y

sample.

consistency in the way nurses viewed their interpersonal skills in terms of Heron’s analysis. If fident

EI)l_“(:.~~IO~

themselves

with how skilled the)

to be

while

nursing

talking

to

setting.

of

skills.

Analysis Once the rating scales had been completed, in which each row represented

DESIGN OF THE STUDY

each

Methodology Whilst this was essentially guiding principle summed

a quantitative

in designing

up by George

Kelly:

ask

them,

(Epting,

analysis.

From

this

calculate

mean

rating

categories. order

From

might

about somejust

tell

skill levels,

whilst

analysis served as a framework

their own

the

category

for making sense

of‘ these perceptions.

characteristics

Our findings

able

to

of the to rank

in terms of the dimen-

most skilled’. These

findings

4.

were as follows. The category

was identified felt most

(mean

sample

1985)

nurses

present

the

able

for each

we were

and

RESULTS

category

We used a convenience counselling

scores

these

in Table

117

trained

skills workshops

skilled

authors

(PB).

the fields of general,

These

who

nurses

psychiatric

in using

was the supportive

(mean rating score 4.23. rank order rating

category

score 3.94,

attended

rank order

2,. Third

were from

Table 3 Rating Scale

and community

nursing. On the one hand, the convenience sample offers the opportunity of gathering larger amounts of data. On the other, the sample cannot be said to be representative. Any conclusions that are drawn from a study using a convenience sample must be tentative in nature.

Very skilled

Not skilled Prescriptive Informative Confronting Cathartic Catalytic Supportive

1 1 1 1 1 1

2 2 2 2 2 2

1).

was in second position

(Field & Morse

run by one of the

that

as the one that the respondents

The informative

of

we were

of

you’.

was to ask the nurses in our

to tell us how they perceived

interpersonal

Sample

matrix

the six categories

are illustrated

a respondent a category

1984)

Thus our intention sample

they

represented

sion ‘least skilled -

‘If you want to know something one,

survey, a

the study was that

column

we

of rows and columns

drew up a matrix consisting

3 3 3 3 3 3

4 4 4 4 4 4

5 5 5 5 5 5

28

NURSE EDUCATION

TODAY

Table 4 Mean rating and rank order of the six categories Type of intervention

Category

Mean rating

Rank order

Authoritative

Prescriptive Informative Confronting Cathartic Catalytic Supportive

3.75 3.94 2.37 2.81 3.3 4.23

3 2 6 5 4 1

Facilitative

was the prescriptive 3.75,

rank order

ranked

category

(mean rating score

3). The catalytic

category

was

next (mean rating score 3.3, rank order

4) followed

by the carthartic

rating score 2.37, ing category

rank order

category

(mean

5). The confront-

was in last position

(mean

rank

order

mirrors

of our previous

perceptions of

order

the

exactly

study of trained

of their interpersonal

six categories

the

(Burnard

nurses

rank staffs’

skills in terms & Morrison,

investment

sufficiently

trained in using these methods.

often

and nurses

involves

that

some

client-centred

supportive,

confirmed

are

more

informative

and

less skilled in being catalytic, fronting.

In our previous

Morrison,

1988; Morrison

offer

some suggestions

may be apparent. these arguments following

the suggestion skilled

in being

prescriptive cathartic

papers

and con-

(Burnard

& Burnard,

and &

1989) we

as to why these trends

We do not intend

to rehearse

again in this paper but offer the

list of some factors that may influence

the findings: The organisational

culture (Sathe,

1983) in

hospitals may work against the development of a facilitative style of interpersonal relationships between nurses and patients. The ‘facilitative’ approach takes time. Nurses may feel that they do not have time to spare to develop relationships that involve being catalytic, cathartic and confronting. Catalytic, approaches

cathartic and confronting involve an ‘investment of self

be

activities

as involving

approach

to working.

There has been a considerable emphasis on the ‘information giving’ aspect of nursing

egory

nurses

b) not

practical

may see the job

1975; Boore,

1978; Devine

1983). This may account

of the emphasis

This study has further

and/or

‘getting the work done’ (Melia, 1987). This may mitigate against the use of a more

& Cook,

DISCUSSION

Some

emotional

care (Hayward,

1988).

draining.

may a) not want to make such an

Nursing

rating

score 2.37, rank order 6). This

that may be emotionally

noted

for some

on the informative

in this study.

Indeed,

nurses

may view their jobs

cerned

with information

catsome

as more

con-

giving than with

being catalytic or cathartic. It may be the case that many aspects nursing catalytic,

practice

do not require

cathartic

The respondents offered a general

and confronting

needed.

skills

skills.

in our studies have picture of their skills. It

may be that catalytic, fronting

of

the use of

are

cathartic

only

rarely

and conused

or

It would seem odd to argue that all

six categories

are

equally

as frequently

required as one another, given their different nature. On the other hand, the person who does not often use certain interventions may also not be very skilled in using them when she has to. This raises complicated questions about the nature and content of interpersonal programmes.

skills training

Having noted all of these possible explanations for our findings, the issue that remains clear is the regularity with which the pattern of in terms of the six categories, has response,

NL’KSE EDL’C:.ATION -1.OD.41

recurred. Thus it would seem that for many nurses, the rank order: supportive, informative, prescriptive, catalytic, cathartic and confronting, characterises their perceptions of their own interpersonal skills. This paper has described a further study of the use of six category intervention analysis in the exploration of nurses’ perceptions of their interpersonal skill levels. The findings of these six category analysis studies are recurring frequently enough to suggest that trainers in this field may need to review their interpersonal skills training programmes to ensure that nurses are developing competences in a wider range of skills. At the moment it would appear that little has changed on the interpersonal scene. Nurses are still ‘nurse’ centred as opposed to ‘patient’ centred. Given the present emphasis on individualised nursing care, it is possible to question whether or not this should continue to be the (‘ise.

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