After removing duplicates, a total of 754 records were obtained from the electronic databases searched. Title and abstract screening excluded 710 studies. Forty-four (44) studies went through the full article screening. Out of the 44 that were selected for the full articles screening, only 17 were included in this study. Twenty-seven (27) were excluded from the study because those studies did not address soft skills in nursing. Figure 1 shows the PRISMA flowchart showing the literature search and selection of studies.
The settings of these 17 included studies (shown in Table 1) were Portugal (n=3) with two studies each reported in Indonesia, Australia, the United Kingdom and the United States of America. Ghana, Egypt, Cyprus, Singapore, Sri Lanka, and Finland reporting one study each. The studies retrieved spanned from 2012 to 2020.
Five themes emerged from the review, namely; denotation of soft skills in nursing, benefits of soft skills in nursing, need for soft skills in nursing, inculcating soft skills into nursing practice and links between hard and soft skills.
Table 1 Summary of records reviewed
Author(s)
|
Year
|
Title
|
Main idea of the literature
|
Elmohmady, Abo Gad, Ramadan, Hamdy 18
|
2020
|
Contribution of Non -Technical Skills on Nurses' Performance Efficiency of Nursing Care Process in Intensive Care Units
|
Soft skills are the cognitive social capability that completes the technical skills of the nurse.
|
Hariti, Rejeki 19
|
2020
|
Strengthening soft skills as the character of student nurses through the preceptorship management model
|
Experience improves and strengthens the soft skills of the nurse
|
Kusmiran, Tohri 20
|
2016
|
Effect of Soft Skills Caring Training on Carative Factors of Nurses in Nursing Service
|
Soft skills improve nurses caring abilities
|
Laari, Dube 5
|
2017
|
Nursing students' perceptions of soft skills training in Ghana
|
Soft skills would improve nursing care and performance
|
Large, Aldridge 21
|
2018
|
Non-technical skills required to recognise and escalate patient deterioration in acute hospital settings
|
Soft skills provide multiple data source opportunity for the nurse to care
|
Lewis, Strachan, Smith 22
|
2012
|
Is high fidelity simulation the most effective method for the development of non-technical skills in nursing? A review of the current evidence
|
Nurses who lack soft skills lack effective communication abilities
|
Maria, Rania 23
|
2017
|
Nursing (self) assessment of soft skills in Cyprus: Training and educational issues
|
Both nurses and nurse managers understand the contribution and the necessity of soft skills
|
Morrell, Eukel, Santurri 24
|
2020
|
Soft skills and implications for future professional practice: Qualitative findings of a nursing education escape room
|
Soft skills are important but challenging to impart to students
|
Ng 25
|
2020
|
The perceived importance of soft (service) skills in nursing care: A research study
|
Patients rate soft skills as more important than hard skills
|
Pathiratne 26
|
2015
|
Emotional Intelligence, Soft Skills and Nursing Performance: A Study of Nursing in Medical and Surgical Wards of a Private Tertiary Care Hospital in Sri Lanka
|
Soft skills and emotional intelligence are related
|
Peddle, Bearman, Mckenna, Nestel 27
|
2019
|
Exploring undergraduate nursing student interactions with virtual patients to develop ‘non-technical skills’ through case study methodology
|
Soft skills improve the confidence of the nurse
|
Peddle, Mckenna, Bearman, Nestel 28
|
2019
|
Development of non-technical skills through virtual patients for undergraduate nursing students: an exploratory study
|
Communication is the most important among the soft skills
|
Peltonen, Peltonen, Salanterä, Hoppu, Elomaa, Pappila, Hevonoja, Hurme, Perkonoja, Elomaa 29
|
2020
|
An observational study of technical and non-technical skills in advanced life support in the clinical setting
|
Good soft skills show good technical performance
|
Pires, Monteiro, Pereira, Chaló, Melo, Rodrigues 30
|
2017
|
Non-technical skills assessment for prelicensure nursing students: An integrative review
|
Assessing soft skills is important
|
Pires, Monteiro, Pereira, Stocker, Chaló, Melo 31
|
2018
|
Non-technical skills assessment scale in nursing: construction, development and validation
|
Incorporate soft skills into graduate curricula for all health professionals
|
Piresa, Monteiroa, Pereiraa, Chalód, Melod, Rodriguesd 32
|
2016
|
Non-technical Skills in undergraduate nursing education: Consideration for a Training Course Development
|
Poor soft skills contribute to 80% of health care errors
|
Sills 33
|
2015
|
Meaningful recognition: Recognizing the" soft skills" of nursing
|
Soft skills are the arts of nursing the element of the soul, mind and the imagination of the very foundation of nursing care
|
Denotation of soft skills in nursing
Soft skills are the non-technical skills, the cognitive and social capabilities that complete the technical skills of the nurse 18. The review found several meanings of soft skills in nursing. These meanings were reported to denote what soft skills are in nursing. Non-technical skills, caring skills, ways of knowing such as intuition, tacit knowing or sixth sense of the nurse, effective communication skills, the art of nursing and team-building skills are among the terms reported 18,20,21,26,28,33.
Soft skills were reported as the ‘caring skills’ in nursing because training in soft skills saw improvement in carative factors of nurses caring ability 20. Fifty-five per cent (55%) of students in a sample of 110 agreed that teaching soft skills in the classroom will help enhance their knowledge of patients and facilitate their ability to care well. This they believe will consequently enhance their nursing care 5. Based on this the authors recommended the incorporation of soft skills into the nursing curriculum suggesting that this will improve caring standards in nursing 25.
Some authors reported soft skills as a way of knowing, where they related it to intuition, tacit knowing or sixth sense of the nurse 21. Tacit knowledge, they said is acquired through practice and experience, difficult to communicate, specific to circumstance, and the individual is often unaware of its existence. The study reported that soft skills are linked to intuition which is also known as gut feeling and is interconnected with the sixth sense of the nurse 21.
Effective communication skills were the most reported subset of soft skills in nursing, the most referenced non-technical skill, that most participants took for granted thinking that it was already mastered 28. Communication in nursing as reported by Morrell, Eukel, Santurri 24 involves a collaborative dialogue, encouragement, and team consensus in the healthcare working environment. According to Laari, Dube 5 soft skill training will improve the communication skills of nurses because nurses who lacked soft skills, lacked effective communication skills and therefore their communication was haphazard and non-prioritised 21. Large, Aldridge 21 reported there was a difficulty for some nurses in communicating subtle changes that were not always quantifiable. Communication failure is one of the leading causes of inadvertent patient harm worldwide 22. So, Lewis, Strachan, Smith 22 reported that formal training for effective communication has historically been largely ignored yet the clinical environment in which healthcare takes place is becoming a progressively more complex 'socio-technical system, and the intrinsic limitations of human performance mean that communication must be a significant facet of healthcare education. This is because caregiving mostly would involve interpersonal interactions including communicating with family members and offering comfort to patients 25.
Further, some studies reported soft skills in nursing as the art of nursing which is interconnected with knowledge and experience. Nursing is defined
as both an art and a science 33. The science part is clear, as it seems the primary emphasis has always been on the scientific aspects with little consideration given to the art 33. Soft skills allowed nurses to use subjective data, and past experiences and knowledge that aided them in the recognition of patient’s needs and provided multiple data source opportunity for the nurse to care 21. Large, Aldridge 21 reported that art in nursing helped the nurses to identify when to disregard normal vital signs and took actions using subjective data. Nurses are central to making decisions leading to appropriate interventions following patient assessment, and the art and the experience of the nurse allowed him/her to act beyond medical direction 21. Sills 33 crowns this section with reports that nursing is not only series of skills and techniques but a process that assimilates elements of the soul, mind and imagination. And soft skills lies in the sensitive spirit and creative imagination, the very foundation of nursing care 33.
Soft skills are also reported as the ability of a nurse to work in a team successfully. Successful teamwork was reported as the link between the internal environment of the nurse and the professional world 26. Effective teams were seen as social entities that use shared knowledge, skills, attitudes, goals, and monitoring of their own and others' performance to achieve high-quality teamwork 22. Morrell, Eukel, Santurri 24 reported that healthcare teams are often unpredictable, such that a group of competent individual professionals can combine to create an incompetent team. Teamwork in healthcare is further complicated by the fact that some individuals who have probably not previously worked with each other and might not even be familiar with each other have to collaborate. This is for the benefit of the patient in this complex and dynamic clinical environment, working together as a team and being open to other's ideas and thoughts and, using them as resources call for soft skills 24. The development of soft skills facilitated efficient performance and a high level of harmonious human interactions in the workplace 26.
Benefits of soft skills in nursing
Several benefits were reported from soft skills. The review findings reported that soft skills are needed for success because these skills are important tools for performing at work and people with strong non-technical skills are mostly those who are successful in their career 18. It was also noted that it enhances career progression. Laari, Dube 5 reported that 89% of their respondents strongly agreed that the acquisition of soft skills can make a career, while the absence of soft skills can break a career. These authors also reported the students interviewed contend that soft skills were necessary skills which the nursing profession needs.
Soft skills are beneficial at the workplace as they facilitate communication, create enthusiasm, enhances attitude, teamwork, networking, problem-solving and critical thinking, and promote professionalism 24. Since soft skills and emotional intelligence are not innate abilities and could be developed, employers who achieved a higher level of productivity in organizations were those who ensured the development of soft skills of their employees 26. Another benefit of soft skills reported was its ability to enhance the development of self-confidence. Students interacting with Virtual Patients (VP) to inculcate soft skills reportedly developed confidence in their abilities to respond and manage practice situations. As one of the students noted, ‘I feel more confident in how to handle situations now. I feel a lot more prepared in handling a patient 27.
Additionally, soft skills improve the performances and confidence of students. Pires, Monteiro, Pereira, Stocker, Chaló, Melo 31 reported a significant improvement in performance, confidence, and self-efficacy of nursing students, and that soft skill was an added value, as it helped students to better adjust to the complex clinical context and ultimately contributed to the safety and well-being of patients 31. Similarly, improving these skills is becoming a strategic priority within healthcare institutions at the international level 32.
Need for soft skills in nursing
As soft skills are important tools for performing at work and people with strong soft skills are mostly those who are successful in their career 18, teaching soft skills in the classroom will help enhance the care rendered to clients. Laari, Dube 5 reported that their participants perceived soft skills training as an impetus for nursing staff to give better care to their clients. The study results further indicate that there is a need for nursing students to be educated in soft skills and that this will enhance their job performance in the clinical environment and improve the way they communicate with their clients. Soft skills were seen as a required tool to effectively recognize patient needs 21. Maria, Rania 23 reported that managers and nurses understand the contribution and need of soft skills in performing nursing work as such both agreed on its significance and its contribution.
Patients and family members rated the soft skills of reliability and responsiveness to be highly important for nursing care. All nine service items such as reliability, promptness in helping, communication, willingness to help, sensitivity to others' feelings, courtesy, confidence in speech, going the extra mile to care and grooming standards were rated highly 25. Ng reported of a patient commenting that the nurse ‘sat by me and held my hands when I felt weakest and in pain” and that among 56 positive comments from patients and families, only two mentioned hard skills. Patients, however, complained in absence of soft skills in nursing with a patient commenting that ‘when my mother requested for water, the nurse just ignored my mother’. The study reported that soft skills are very important and could outweigh hard skills and in contrast to the very few comments on hard skills, the comments on soft skills were often descriptive and emotional and it portrayed the human-centred of how nursing care was perceived 25.
In the same vein, Pathiratne 26 reported that poor soft skills contributed to up to 80% of healthcare errors and the development of soft skills would facilitate performance efficiency and also a high level of harmonious human interactions in the workplace.
Inculcating soft skills into nursing practice
A number of the study findings 5,19,23,29,32 recommended the integration of soft skills into the nursing care process of undergraduate nursing curriculum as it would enhance nursing practice 18, because formal education that an individual acquires within a certain period was reported that it strengthens the soft skills with continuous exposures 19. Hariti, Rejeki 19 reported that nurses' soft skills were influenced by the difficulties faced during learning and these skills were improved with an increase in experiences. The years of service also contributed to the development of soft skills of the on-duty nurses 19. Laari, Dube 5 reported further that the educational curriculum should include soft skills modules, and it should be assessed practically before registration for practice 5, because soft skills were perceived to be required to effectively recognize and help patients meet their health needs 21. Therefore, integrating soft skills into the nursing curriculum to enhance the care standards should be prominent and explicit and not situational and incidental. Besides knowledge acquisition and technical competency, the nursing curriculum could explicitly incorporate more soft skills to enhance the care standard 25. Also, Peltonen, Peltonen, Salanterä, Hoppu, Elomaa, Pappila, Hevonoja, Hurme, Perkonoja, Elomaa 29 reporting on soft and hard skills emphasized that premium should be placed on both soft and hard skills in health professional education and in-service training 29. Developing a tool to measure non-technical skills, Pires, Monteiro, Pereira, Stocker, Chaló, Melo 31 reported that soft skill should be incorporated in both undergraduates and postgraduates training curricula as it will ascertain needs and improve care in healthcare contexts 31. With regards to patient’s safety soft skills were seen by undergraduates nursing students as beneficial to patient safety goals, improves clinical performance and hence a consideration on its incorporation into the curriculum ought to be prioritized 32.
links between hard and soft skills
Some authors reported a link between hard and soft skills 18,28,29,31
Elmohmady, Abo Gad, Ramadan, Hamdy 18 reported a significant correlation between observed nurses' all stages of the nursing care process and all domains of soft skills, their results revealed a significant positive relation between nurses' soft skills and all nurses' characteristics data. This relationship had the highest mean score for decision-making skills followed by communication competence skills, and team dynamic skills. While the lowest mean score was for leadership behaviour skills. Peddle, Mckenna, Bearman, Nestel 28 on the other hand reported that some students identified how hard and soft skills complement each other and the important role each plays in professional practice and patient safety 28. An association between hard and soft skills performance in real-life in-hospital ALS situations suggested that the resuscitation teams that showed a good soft skills performance also performed hard skills aspects of ALS better. In contrast, the resuscitation teams with poorer soft skills showed inferior hard skills performance during ALS 29. Similarly, Pires, Monteiro, Pereira, Stocker, Chaló, Melo 31, reported a significant and positive relationship, which suggests that the higher their soft skills competency in one dimension, the higher it will also be in the other dimension, and vice-versa 31.