This paper presents a structured PICOT worksheet and accompanying literature review focused on a critical problem in nursing practice: nurses' lack of confidence in communication with patients, families, and physicians. Using the PICOT framework, the paper identifies the problem, proposes a motivational and training-based intervention, and outlines expected outcomes including reduced communication errors and stronger trust among care team members. The literature review synthesizes six sources covering communication difficulties in nursing, training programs, and the consequences of poor communication for patient safety. The paper also details database search strategies using resources such as CINAHL-adjacent collections, Boolean limiters, and peer-reviewed journal filters to locate relevant evidence.
This worksheet applies the PICOT framework to identify and address a significant problem in nursing practice: nurses' lack of confidence in communicating with patients, their families, and supervising physicians. Effective communication is foundational to safe patient care, yet many nurses struggle to convey or receive information with the clarity and confidence required in clinical settings.
The problem identified is that nurses experience difficulty communicating effectively with both patients and physicians. A potential solution is the implementation of training and motivational programs designed to help nurses interact and communicate with greater confidence.
The central research question guiding this inquiry is: Why do nurses lack confidence in communication with patients and their families, as well as with the physicians managing patient care? The focus of this question is on improving nurses' communication confidence through targeted interventions.
The PICOT elements for this research question are defined as follows:
P — Population/Problem: The population in this study is nurses themselves, who serve as the "patient" of the intervention, since they are the ones experiencing the problem. Nurses are responsible for bridging communication between doctors and patients, yet their lack of confidence can cause them to miss important parts of messages or to misinterpret information — errors that can lead to serious consequences for patient safety.
I — Intervention: The proposed intervention is a motivational and communication training program for nurses. This motivation can be offered externally through structured programs, or nurses can engage in self-motivated improvement by identifying their own communication gaps and recognizing the importance of effective communication in reducing errors.
C — Comparison: Currently, nurses are trained primarily in medical and clinical nursing practices. Upon completing their education, they are placed in healthcare settings without having received detailed communication training that would allow them to practice effective communication — not merely receive instruction about it. The comparison, therefore, is between nurses who receive dedicated communication training and those who do not. Motivated and trained nurses are expected to show marked improvements in reducing miscommunication, decreasing nursing errors, and building trust among nurses, patients, and physicians.
O — Outcome: The expected outcome of external and internal motivational programs is that nurses will become more confident communicators. They will no longer doubt their listening skills, their capacity to convey information accurately, or their overall value in serving patients effectively.
T — Time: Ideally, communication confidence training should occur before nurses enter clinical practice, as it becomes progressively more difficult to change established habits afterward. However, if pre-entry training is not possible, the intervention should be introduced as early as possible once nurses are in practice.
Three databases available in the nursing library collection were identified as most relevant to this research question: Academic OneFile, Academic Search Complete, and the Nursing and Allied Health Collection.
Academic OneFile offers access to more than 13,000 titles, of which approximately 7,300 are peer-reviewed journals. Its broad coverage of medicine, social sciences, arts, and literature makes it useful for locating nursing communication articles at the intersection of social science and clinical practice. Academic Search Complete is a wide-ranging, multidisciplinary scholarly database offering more than 6,100 full-text periodicals across many academic disciplines, making it a strong source for nursing-related communication issues. The Nursing and Allied Health Collection provides approximately 400 titles authored by nursing professionals and nursing education faculty, and is especially relevant because it addresses profession-specific issues directly.
If initial search results are insufficient, two supplementary strategies can be used. First, a broader internet search can identify how other nursing departments and professional organizations have encountered and resolved communication challenges. Second, a primary research component — such as a survey of working nurses — could be conducted to better understand the specific barriers to confident communication and potential self-identified solutions.
To refine the search and manage the volume of results, several strategies are recommended. Boolean operators such as AND can be used to narrow results to sources that address multiple required dimensions simultaneously (for example, "nursing" AND "communication training" AND "confidence"). EBSCO subject headings provide a controlled vocabulary approach that ensures consistent indexing across articles, enabling more disciplined and reproducible searches. Standard limiters such as publication year (favoring recent literature), peer-reviewed journal status, English language, and human subjects further reduce results to the most relevant and credible sources. Matching exact keywords from the problem statement to subject headings also plays a critical role in identifying the most pertinent resources.
The following six sources were identified through the database search process as relevant to the research question on nursing communication confidence. Each source is summarized below with its research type and key recommendations.
1. Anderson, L. (2012). "Why Communication in the Nursing Profession is Important?" Retrieved from NurseTogether.com. This non-peer-reviewed qualitative source discusses how a lack of communication confidence leads nurses to convey incorrect or incomplete messages to patients, peers, and physicians. The recommendation is to provide nurses with facilitated support to strengthen their communication practices.
"Six annotated sources on nursing communication"
The evidence gathered through this PICOT process highlights that communication confidence is a measurable, trainable skill in nursing. Addressing this gap through structured interventions before nurses enter practice is the most effective strategy. The literature consistently points to the connection between poor communication confidence and adverse patient outcomes, including medical errors and preventable injuries. Together, the PICOT framework and the six reviewed sources make a compelling case that healthcare institutions should treat communication training as an essential component of nursing preparation — not an optional add-on — and that further primary research with practicing nurses would strengthen the evidence base for targeted interventions.
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