Introduction
In the field of child care, commu­nication is an essential element. Hospitalization of a child leads to family turmoil and is a challenging experience for the family [1]. In nursing, the communication between the nurse and the child is the core of child care [2]. Some barriers can affect the nurse-patient relationship to have proper communication skills for child care [3]. Communication skills are essential for nurses, but mastering communication skills can be difficult. Nurses interact with people at different educational, cultural, and social levels, and they have to use these skills in an effective, compassionate, and pro­fessional manner when communicating with patients and their families [4]. Each member of the treatment team has special knowledge and information that will be useful to the other members [5].
Learning communication skills for child care is very im­portant because of the differences in how children com­municate with adults [6, 7]. The hospitalization of a child also affects family members. Parents, especially mothers, usually accompany the child during hospitalization [8]. Communication between different members of the treatment team, including physicians and nurses, in patient care is to achieve a common therapeutic goal [9, 10]. Studies in Iran show that the relationship between nurses and hospitalized children’s mothers is relatively favorable [11, 12].
Medical educations are now focused on teaching human and communication skills rather than on theoretical teachings [13, 14, 15, 16]. To acquire effective communication skills, appropriate group situations must be created so that individuals can exchange their experiences through sharing their ideas and believes about some problems they have faced and then learn actively [17]. 
Telling experiences is a teaching method and using personal memories is a way to learn from one’s past experiences and subjective knowledge [18]. So, the learning is achieved through interaction with others and enhances the nurses’ skills [19]. The basis of the reminiscence program is the theory of cognitive adaptation [20]. This method reflects on an experience purposefully and recalls thoughts and memories about a subject to find a new solution to change that situation if necessary [21, 22]. Because of the few studies on communication skills in pediatrics literature, this study aimed to determine the effect of reminiscence training on professional communication between the nursing staff of pediatric wards. 


Materials and Methods 
The present study has a quasi-experimental design, with pre-test and post-test and a one-month follow-up to determine the effect of reminiscence training on professional communication of pediatric nursing staff. The study population consisted of all pediatric nursing staff working in a teaching hospital in Bushehr City, Iran. The study participants were 88 nurses entered into the investigation by a consensus method.
The sample size was calculated for each group (at least 84 samples), considering the type I and type II errors (α= 0.05 and β=0.2), and based on a study in which the mean of learning professional communication between the two educational groups was 15.90 and 17.35 with a standard deviation of 1.95 and 2.64, the minimum sample size was 84 [23]. 
A total of 88 participants were randomly allocated to an intervention (n=44) or a control (n=44) groups. Random allocation was performed by permuted - block randomization method with 22 blocks of 4. Finally, 41 participants in the intervention group and 43 in the control group participated until the end of the study.
The inclusion criteria were having a diploma in nursing and having at least, one-year of work clinical experience in pediatrics at least. The exclusion criterion was not participating in the reminiscence session (Figure 1).

These questionnaires were used in this study. The first questionnaire collected demographic information. Then, nursing staff communication skills were measured by nurses’ professional communication skills questionnaire. The revised version of the nurses’ professional communication skills questionnaire based on Tamimi study [24] consists of 13 items. It is scored on a 5-point Likert-type scale from 1= never to 5= always. The total score ranges between 13 and 65. A score of 65 shows the highest level of peer-to-peer communication. To validate the questionnaire qualitatively and quantitatively, it was given to 10 experts, and their given total scores of content validity index and content validity ratio for 13 items were 0.89 and 0.81, respectively. To test the reliability of the questionnaire, the Cronbach α coefficient was calculated, and its value was 0.89.
The last questionnaire was the nurses’ communication skills with the mother, taken from the study of Cheraghi et al. [11]. It has 19 phrases with a 5-point Likert-type scale ranging from 1= never to 5= always. The total scores range from 19 to 95. The score obtained from this questionnaire is calculated separately, and the score of 95 shows the highest. The score of 19 indicates the lowest level of communication between staff and nursing with patients’ mothers. The internal consistency of the questionnaire was checked by the Cronbach α coefficient that was 0.88. The reliability of the questionnaire was also assessed by the test-retest method. The intraclass correlation coefficient was 0.83. The pilot study was performed on 20 nurses in another pediatric center who did not participate in the research process.
The experimental group was invited to a meeting, and the study objectives were explained. Also, they were reassured that their information would be kept confidential, generally analyzed, and can be deleted at any time. At the end of the session, and informed consent form was obtained. Besides, the control group was invited to another session, and the study’s objectives were explained to them, and their informed consent was received. The pre-test was taken from the experimental and control groups. The experimental group was divided into four subgroups, and an 8-hour reminiscence session in 3 sessions was held for each subgroup. During the sessions (Table 1), the nurses voluntarily shared memories of events related to a professional relationship, actively participating in or witnessing the event.

Each session was attended by two nurses who taught professional communication workshops at the university where the research took place. Then they analyzed the stated memories and offered appropriate solutions if necessary. The post-test was taken immediately after the 8-hour session for the experimental group. There was no reminiscence training session for the control group, but a questionnaire session was held, and the control group received a post-test one month after the pre-test.
The data were analyzed by SPSS v. 21 software. The data analysis was provided in descriptive statistics, and Chi-square and t-test were used to compare the two groups in terms of demographic variables. Repeated measures ANOVA was used to compare the mean scores of professional relevance of each group between pre-test and post-test to compare mean scores of the intervention and control groups. The significance level was considered 0.05 or less. 

Results
Comparison of demographic data between the two groups showed that they were similar and did not significantly differ (Table 2).

The Mean±SD scores of the professional relationship between nursing staff and their colleagues before, immediately, and one month after intervention in the experimental group were 56.60±4.41, 59.70±5.11, and 60.90±5.75, respectively. The Mean±SD scores of the professional relationship between nursing staff and their colleagues before, immediately, and one month after the intervention in the control group were 53.81±8.38, 55.63±7.50, and 54.52±7.05, respectively. Results showed that the mean scores of nursing staff professional relationship with colleagues in pre-test between the experimental and control groups were not statistically significant, but there was a statistically significant difference between experimental and control groups in the post-test immediately (P=0.004) and one month (P=0.001) after the intervention (Table 3).

The Mean±SD scores of the professional relationship between nursing staff and mothers of the children before, immediately, and one month after the intervention in the experimental group were 78.41±9.54, 86.52±8.42, and 89.78±8.05, respectively. The Mean±SD scores of a professional relationship between nursing staff and mothers before, immediately, and one month after the intervention in the control group were 82.00±11.86, 85.27±8.05, and 81.77±8.05, respectively. There was no significant difference between the mean scores of nursing staff professional relationships with mothers in the pre-tests of control and experimental groups. There was no statistically significant difference between control and experimental groups in the post-test immediately after the intervention, but there was a significant difference in the post-test one month (P=0.001) after the intervention (Table 4).

Repeated measures ANOVA with group factor (control and experimental) showed that the interaction effect between group and time was statistically significant. The trend of scores mean changes in nursing staff professional relationship with colleagues (P=0.03) and mothers (P=0.001) during the study period (before, immediately, and a month after intervention) was different between the experimental and control groups (Table 5).

Discussion
The results showed no significant difference between the two groups regarding demographic factors. Analyzing data showed that the mean scores of nursing staff of pediatric wards with colleagues in the pre-test and post-tests between the two groups were statistically significant. The literature review did not reveal a study on training professional communication by reminiscence. However, in a quasi-experimental study, Rezaei et al. showed that nurses’ communication skills improved after holding training periods [25]. In the study of Tohidi et al., the professional status among nurses was moderate [26]. Moghadami et al. studied the effect of anecdotal on nursing students’ communication skills of 85 nursing interns of Golestan University of Medical Sciences. They found no significant difference between the mean scores of students’ clinical communication status before and after the intervention [27]. The results of the present study are inconsistent with this study. In that study, only students who were studying in the seventh and eighth semesters of Nursing and Midwifery School participated. Salimi et al. aimed to evaluate inter-personal communication skills and their related factors among paramedical students of Tehran Medical Sciences University. Their results showed that the obtained score of the interpersonal communication skills questionnaire of paramedical students who participated in the communication skills workshop was not statistically significant [28]. The results of the present study contradict this study. Of course, some factors can be attributed to this inconsistency, such as differences in the educational course, work experience in the clinic, the educational experience, employment or non-employment of the participants, etc. 
In the present study, employed people who were in contact with other staff in their field of work were investigated, and therefore motivation can be effective in improving their behavior. The probable reason for the difference between the present study’s findings and this study may be how the teachings are presented. Training method and the quality of the provided trainings were other factors that influenced on communication skills of the participants in this study. The training method in this workshop was to explore a new and attractive teaching method that can influence behavior change [22]. 
The present study results showed that the intervention significantly affected the pediatric nursing staff’s professional relationship with hospitalized children’s mothers. Although the knowledge of good communication is a precondition for optimal care and treatment in health care, severe communication problems are still experienced by patients and health care professionals [29]. Thus, effective communication is a vital component of nursing care. However, nurses often lack the skills to communicate with patients and other health care members. Communication skills training programs are always recommended [11] since mothers are an inevitable element of child care [30]. This study’s results were inconsistent with Abuqamar et al. They reported that 90% of nurses in the intensive care unit had no decent relationship with hospitalized children’s parents [31]. The different results of the present study with that study may be due to various study tools, the different research environments, and cultural differences. Their study was conducted in Jordan using the Arabic version of the parent satisfaction questionnaire; just one of its terms was related to parent’s communication. The results of this study were in line with the study of Svendsen et al. There was a positive and a linear correlation between nurses’ communication skills with parents and children, especially verbal communication, according to Svendsen et al. [32]. In another study, there was a statistically significant relationship in nurses’ communication skills with the patient between nurses who attended seminars and conferences on the subject and those who did not [33]. The results of that study showed that transferring knowledge and education through reminiscence was effective in improving and enhancing nurses’ professional communication. Thus, including this training in nurses’ educational programs can be a step towards facilitating professional communication training to the nurses. It is hoped that using this method will enhance the professional communication of nurses and thus promote the quality of nursing services. 
Filling out the questionnaire as a self-report was one of the study’s limitations, which the researcher attempted to resolve by explaining the study’s objectives to the samples and giving gifts to increase their motivation to collaborate. The reminiscence session was also considered an in-service training course for the participants. Future researchers are recommended to view and study how professional status is formed. Also, it is recommended to employ this method to increase professional communication in other nursing staff and improve their quality of professional relationships. 

Ethical Considerations
Compliance with ethical guidelines
This research project was approved by the Ethics Committee of Bushehr University of Medical Sciences (code IR.BPUMS.REC.2019.007). It was assured that their information would be kept confidential. The data were coded and anonymized on the computer. The samples were assured that they would be presented with the study results if desired.

Funding
The article is supported by the Research Deputy of Bushehr University of Medical Sciences. 

Authors' contributions
Design, conceptualization, resources, and review: Faezeh Jahanpour, Parviz Azodi, and Halimeh Zareii, Marzieh mahmoudi and Tahereh Tamimi; Investigation, draft preparation and editing: Marzieh Mahmodi and Halimeh Zareii; Data collection: Parviz Azodi, Halimeh Zareii, and Tahereh Tamimi; Data analysis: Marzieh Mahmoudi; Funding acquisition: All Authors.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
We are sincerely thankful to the following people who assisted and provided statistical consulting and data analysis to complete this research: Vice-Chancellor of Bushehr University of Medical Sciences and Clinical Researches Development Unit of Bushehr Persian Gulf Shohada Hospital, authorities, and nurses of this hospital.


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