The perception of nursing leaders towards communication and relationship management competencies in using digital platforms during COVID‐19 in Qatar: A cross‐sectional study

Abstract Aim To evaluate nursing leaders' perception of communication and relationship management competencies while using digital platforms during the COVID‐19 pandemic. Background Nursing leaders can achieve effective leadership by mastering these competencies leading to an overall improvement in the quality of nursing care. The COVID‐19 pandemic has brought numerous challenges in communication, and digital platforms have been widely used in healthcare settings to mitigate contagion. Design Cross‐sectional. Methods The study was conducted between February and March 2021. A survey was adopted from the American Organization of Nurse Executives (AONE) and was sent to nursing leaders in Qatar through email. Results A total of 250 nurse leaders were invited to participate, but only 116 responded (RR 46.4%). The male participants represented a more significant proportion of 64.10%. Influencing behaviour, relationship management and effective communication had the lowest scores, which indicates low competency. Conclusions Despite obtaining satisfying scores, nursing leaders in Qatar should strive for professional development and knowledge acquisition to improve their communications and relationship management competencies. Implications for Nursing Management Healthcare organizations must understand that nursing leaders should strive for professional development and knowledge acquisition to improve their communication and management.


| BACKGROUND
Nowadays, nursing leaders must have advanced management talent to correspond to the continuously increasing demands and complexity in healthcare provision (Cheryl Lacasse, 2013;Uhl-Bien et al., 2020).
Nursing leaders were expected to show measurable outcomes and efficiency to facilitate effective practice with evidence-based management. Most academic studies and nursing leadership programmes emphasize on competencies related to working environment effectiveness. The shift to evidence-based management has led to numerous efforts to define appropriate competencies for nursing leaders (Bianchi et al., 2018;Stefl, 2008). For example, communication and relationship management competency relates to how the leaders understand the individuals they work with and how they use their knowledge effectively in developing high-performance workplace relationships, in addition to how they utilize digital platforms to manage their working environment (Garman & Johnson, 2006;Temelkova, 2018). Overlooking the leadership skills for nurse executives and managers can have negative consequences, and selfreported competency can yield positive results (Flatekval & Corbo, 2019).
The American Organization of Nurse Executives (AONE), which was a member of the Healthcare Leadership Alliance (HLA), defined eight main domains correlated with this competency (Garman & Johnson, 2006). Most of these domains concentrate on communication and relationship management at the organizational level (e.g. understanding the corporation's structure and relationships, public relations and communicating the corporation's mission and vision).
Other domains concentrate on the departmental level (e.g. promoting alternative conflict resolution, practising and evaluating shared decision making and building, engaging in and leading teams) (Reid Ponte, 2004). However, mastering these competencies was only an entry ticket for leadership effectiveness, and the competency should be continuously utilized within the daily practice as part of continuous professional development. Over time, with constant utilization, this competency can significantly improve the effectiveness of nursing leadership and thus the quality of nursing care delivered to service users.
The COVID-19 pandemic has created an urgent need for coordinated mechanisms to respond to outbreaks across health sectors, and digital health solutions have been identified as promising approaches to meet this challenge (Allobaney et al., 2020;Nashwan, Abujaber, Mohamed, et al., 2021;Nashwan, Villar, Al-Qudimat, et al., 2021;Villar et al., 2021). Digital platforms are technologies used to boost interactions among people, offering more effective ways of transferring information (Caputo et al., 2018). The use of digital platforms during the pandemic has been a critical ally in addressing issues. Telemedicine was used to reduce the risk of infection as a successful healthcare model in both emergency and primary care (Fagherazzi et al., 2020). Official communication plans should promote accessible and varied channels to inform people of the epidemic, avoid rumours and reduce threats to public health. Social media platforms such as Microsoft Teams™ and Google Trends were beneficial for modelling trends in the epidemic and monitoring the evolution of patient symptoms or general reactions and outcomes of the epidemic over time. Numerous studies agree that the pandemic exacerbated and accelerated digital globalization, especially in healthcare (Alexopoulos et al., 2020;Liang, 2020;Parker et al., 2021;Popescu et al., 2021).

| Data collection
An official email was sent from the researcher through the HMC research department to all targeted participants, explaining the nature and scope of the study and the voluntary nature of participation, including the right to withdraw at any time and the right to anonymity. Completion of the questionnaire was considered as approval of participation. Participants were informed that they had 2 weeks to fill in the questionnaire. Reminders were sent by email to complete the survey to improve the response rate. A 5-item Likert-type questionnaire adopted from the AONE (2005) questionnaire to evaluate communication and relationship management competencies. Benner's (1982) beginner to expert theory provides the foundation for this instrument. For the professional nurse, Benner recognized five levels of development: novice, advanced beginning, competent, proficient and expert. The survey has two sections: (1) demographics such as gender, years of experience in general and particularly in HMC, as well as the current managerial role. The second part consists of eight competencies including (1) effective communication (three items), (2) relationship management (seven items), (3) influence of behaviours (three items), (4) ability to work with diversity (six items), (5) shared decision-making (three items), (6) community involvement (three items), (7) medical staff relationships (eight items) and (8) academic relationships (six items).

| Ethical approval
The study was conducted in full conformance with principles of the Assumptions were checked and insured before using the inferential statistics. The researcher reviewed the outliers and the missing values and dealt with them appropriately. Then, the researcher ran the analysis. The data were considered significant when P value < .05.

| RESULTS
The majority of participants were male, consisting 63.8% of the sample size, whereas women were 36.2%. Nursing leaders were represented in all departments where 60.4% were head nurses, 28.4% were directors of nursing and 11.2% were executive directors and assistant executive directors of nursing. Years of experience ranged from 0 to above 10 years. The majority of the participants had over 10 years of experience (53.5%) ( Table 1).
The results of the study showed that all the items revealed a sufficient level of internal consistency with Cronbach alpha (α > .987) ( Table 2).

This study was conducted in different hospitals under HMC in
Qatar, the largest healthcare provider in the country.  (Table 3). Valid N (listwise) 5

| Descriptive statistics
Notes: The participants of this study had the highest mean score on effective communication, followed by influencing behaviours, relationship management, academic relationship, medical staff relationship and community involvement, and the lowest mean score on shared decision making. The items of digital competency, effective communication, relationship management and influencing behaviour obtained the lowest scores, indicating they have a low level of competency.
effective communication, and the lowest mean in shared decision making. Influencing behaviour scored the lowest standard deviation, and shared decision making had the highest standard deviation indicating minimal dispersion in the data. The digital platforms that enhance professional networking were only available and cater to individuals within these nursing professions (Krawczyk-Sołtys, 2017).
In addition, discussions and clinical topics in such sites often address diverse subjects, including biostatistics, ethics, practice management, politics and career strategies (Chen, 2018). The results from this study indicated that digital platforms provide a supportive environment for nursing leaders. Digital platforms also enhance crowdsourcing and involve harnessing society's skills and knowledge to gather opinions and information or solve problems (Shum et al., 2018). According to Hernandez et al. (2018), social media connects nurse leaders in developing countries with those from more medically advanced nations.
Digital platforms connect a broader nursing audience and magnify content and critical themes (Hernandez et al., 2018). From the responses in the survey, nurse leaders who use digital platforms, the assistance and information received were helpful. In the descriptive According to Lucas et al. (2018), nurse leaders can ask questions on Twitter or stream surgical procedures through the Internet (Lucas et al., 2018). Therefore, digital platforms offer a new communication channel for nurse leaders to network, exchange and share medical information in ways and at a pace that was never possible before.
The improved communication provided by digital platforms plays a critical role in improving clinical education. Hernandez et al. (2018) argue that the high utilization rate of digital platforms by individuals between 18 and 29 years fostered the adaptation of clinical curricula to reflect incoming students' culture and changing habits (Hernandez et al., 2018). This study's results indicate that the F value of the academic relationship is .793, indicating the null hypothesis is true.
That implies that nurse leaders actively use digital platforms to improve students' understanding of ethics, communication and professionalism.
The focus of the benefits of digital platforms in enhancing nursing leaders' work within the society came across strongly because of the need to provide integrated social and healthcare services in Qatar and the international emphasis to improve primary care to support patient self-management at home (Handtke et al., 2019). The nursing workforce needs to have a high level of generalized information and coordination, excellent communication and leadership skills, which will ensure they can navigate the complex online environment and effectively deliver healthcare services to the community. Furthermore, the advanced practice roles catering to the needs of patients will be critical for the aging population as it is now a global trend (Lucas et al., 2018). Therefore, there is a need to research the specialized healthcare services that the patients require, develop and implement them in nursing practice, education, the level of demand and policies governing the integration agenda, ensuring nurses were adequately equipped for the future.
T A B L E 4 Differences in nurse leaders' perception of communication and relationship management competency Notes: Statistical significance determined by P < .05. The items have an F value close to 1.0, indicating that the null hypothesis is true. Abbreviation: df, degree of freedom.
COVID-19 increased the need to deliver care remotely through networked care delivery and mobile consultations to limit the need for direct contact. Mast et al. (2018) argued that because healthcare providers will not physically examine the patients, clear guidance and good support were critical to ensure effective treatment and diagnosis at a distance (Mast et al., 2018). The findings of the study showed that digital platforms allow nursing leaders to provide ongoing guidance and support. In addition, the digital platform creates a need for nursing leaders to provide knowledge to patients to ensure they can evaluate and interpret the information from monitoring mechanisms to empower their decision-making process.
Nursing leaders should ensure transparent and clear communication between the user and the professional. The clarity, listening skills and voice intonation of virtual communication information are essential as face-to-face support and prompts are absent. For example, healthcare professionals may communicate through video or audio connections provided on digital platforms (Collins et al., 2017). This study's findings indicated that specific competencies needed for remote healthcare service provision include providing consultations to the community, being an influential member of professional organizations, representing organizations of non-health within the community.
Chen (2018) (Shum et al., 2018). Because digital platforms draw nursing leaders from various organizations, they must monitor information access (Handtke et al., 2019). They need to enhance effective information sharing across nurse leaders while considering legislation rules and national privacy laws.

| IMPLICATIONS FOR NURSING MANAGEMENT
Increased use of digital platforms in the healthcare setting creates a need for experts to research them to identify the bottlenecks associated with them and discover ways to successfully implement digital platforms in healthcare settings. Nursing leaders gain from including digital platforms in their engagement strategies, particularly during the COVID-19 pandemic, and should consider the following when using digital platforms to enhance healthcare service provision. First, they should consider the social media policies issued by a professional association or within the healthcare organization. Nurse leaders should also assess how analytics in digital platforms were driven and designed. There were some standard metrics, but the use and definition of platforms vary; therefore, they can be misleading. For instance, in Twitter, the term impressions refer to tweets posted to a tweeter stream. The impressions exclude social media information streamed to third-party applications such as Hootsuite. Therefore, the analytics reflect the size of the potential audience. A need for more nursing research will help understand the disadvantages and advantages of digital platform analytics, which will help educate nurse leaders and ensure nurses understand the drawbacks and benefits in interpreting virtual behaviours and online environments. In order to further understand the phenomena, a qualitative research methodology must be considered.

ACKNOWLEDGEMENT
The publication of this article was funded by Qatar National Library.

CONFLICT OF INTEREST
The authors declare that they have no competing interests.

ETHICS STATEMENT
The study was approved by the Medical Research Center (MRC)

Institutional Review Board (IRB) at Hamad Medical Corporation
(MRC-01-21-090). Implied consent was obtained from the participants, and the researcher assured voluntary participation for the subjects. Also, the questionnaire was disseminated without names or corporation numbers to assure participant anonymity and data confidentiality.

DATA AVAILABILITY STATEMENT
All data generated during this study are included in this published article.