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1. Introduction
1.1 Statement of the problem
Mental disorders are commonly occurring and often seriously harming in whole countries throughout the world(1). Mental illness is accountable around 14% of the world widely burden of disease whereas majority of the countries not more than 1% of their total health expenditure to mental health care service (2).Integration of mental health service into general medical services at all level is the foremost recommendation of the World Health Organization (WHO) mental health Gap Action Program(3). In the recent yearsin Ethiopia have shown a great changes in the pattern of mental health care services have transformed from isolation and rejection to integration and active involvement in general medical care(4).
over the last few decade, the concern of’ clients satisfaction with Psychiatricpatients has widely accepted and gained more attention across the global in mental health care service(5)(6). Satisfaction can be described as a patient’s response to several aspects of their service experience and thus evaluate the mental health-care services as well as the providers from their own subjective point of view(7,8).Patient satisfaction on the other hand is defined to be a result of each patient’s view of the care designed for that patient to reduce his/her problems(9).Satisfaction with mental health services has been proposedto be an integral part of determining the outcomes and performance of mental health clinical service provision(10).Patientsatisfaction with care is recognized as an important concept to assess in evaluating the quality of mental health care. In addition, it provides a feed-back for the evaluation and determination of the quality of service. Thus, assessing patient satisfaction with mental illness is advantageous and necessary(11).Assessment of patientsatisfaction with mental health care is measured as a major component of quality management and reflects mental healthcare professionals’ ability to meet their patients’ needs and expectations(12).Patient satisfaction is one of the most important areas of identifying and determining performance in any mental health system, although it is a complex to measure the satisfaction and apparentresponsiveness of health systems as not only the clinical but also the several non-clinical outcomes of care do affect the patient satisfaction(13).In mental health care good patients’ satisfaction is also strongly associated with high significant outcome in the assessment and improvement of qualityof mentalhealth care service, including adherence to treatment, intent to return for care and continuity of outpatient care and complete treatment regimens which have better health outcomes(14,15).Poor patient satisfaction with mental health care has causes of poor compliance to treatment, discontinuation of care and follow up which ultimately leads to poor health outcomes(16,17).
Different studies indicated that global level of patient satisfaction, scores ranged from 33.5% to 98.5%in US(18), 77.3% in India(19), 75% in Pakistan(20), 42.7 % in Libya(21), and 67.1 % in Ethiopia(22).
There have been a several studies conducted on level of patients’ satisfaction with mental health care service in the developed countries however, on this area few studies were conducted in Ethiopia(23). Understanding of level of patient satisfaction will useful in promoting metal health facility and service providers to support programs aimed at helping mental health professionals to deal with the problem and to improve quality of care(24).
Aim of this study is to identify the gap on level of patients’ satisfaction with psychiatric patient is the primary rationale for conducting this study. Additionally factors associated with level of patient satisfaction will be investigated.

1.2 Literature review
1.2.1 Magnitude
Longitudinal study conducted in the U.S,for two years based on Patient Satisfaction and to Change Care Provider, indicates that about 66 % of those who expressed the least satisfaction changed providers during the next year, as compared with about 42% of the most satisfied patients. Thus, the one third of patients who were leastsatisfied was about 57% more likely to change provider. Individuals scoring in the middle satisfaction distribution were about 27% more likely to change physicians than the most satisfied group and were about 24% less likely to change than the least satisfied group(25).
A survey conducted inGeneva, Switzerlandin differenttwelve public outpatients’ psychiatric clinics of adults’ treatment settings, using CSQ-8 Client Satisfaction Questionnaire measuring global satisfaction, among707 study participants, the result ofglobal satisfaction rate was showed that high (38.5% satisfied and 54.6% very satisfied). (26).
comparative cross-sectional study done in Germany based on secondary data in different selected hospitals using WeisseListe/White List” for patient satisfaction,in the four quality dimensions showed that the mean rating of patient satisfaction was approximately 81.5%, (medical care 82.85%, nursing care 81.76%, organization and service 79.34% and in general 82.43%). In general, all hospitals included in study were succeeded a high level of patient satisfaction with patient care.Conversely, a standard deviation of up to ±6.5% and a range of up to 41% revealed clear differences in patient satisfaction between hospitals(27).
A Survey carried out in University of California, Los Angeles among 1004 outpatients with anxiety disorders frompatients to received appropriate anti-anxiety medication in the previous 6 months,667 study participants(66.6%) reported being satisfied or very satisfied with their overall health care service. But 432 subjects (44.8%) of patients reported being satisfied or very satisfied with their mental health care(28)
A Study done in Austria, in four community mental health centers and in two psychiatric hospital wards among 420 study subject found 60 % had a positive overall satisfaction score with service; 99 (24 %) had an overall score of 0, showing a neutral evaluation; and 67 (16 %) had a negative overall score(29).
Prospective study done in France for 6-month follow up by using randomized and controlled open-label study with Patients of schizophrenia, randomly assigned 124 members’ into four groups of standard psychiatric assessment; QoL assessment with standard psychiatric assessment; and QoL feedback with standard psychiatric assessment. Global satisfaction was significantly higher in the QoL feedback group (72.5% of patients had a high level of satisfaction) compared with the standard psychiatric assessment (67.5%) and QoL assessment groups (45.2%)(30).
Cross-sectional survey conducted in China on Patient satisfaction in public and private hospitals using Picker Patient Experience Questionnaire (PPE-15). Majorityof (77.9%) graded the global satisfaction with the hospital as score 7 or above, where 10 is the highest satisfaction score. The mean global satisfaction scores for public and private sectors were 7.3 and 7.8, respectively(31).
Cross-sectional study done in Indiafrom patients of age 18-60 years receiving medication for at least six months from outpatient treatment center of Mental Health Institution using interview method of Patient Satisfaction Questionnaire (PSQ-18) showed that general satisfaction level was 57%. But the remaining was not satisfied with the service. (32).
Cross-sectional facility-based study done on patients’ satisfaction in Saudi Arabia which the data collected through a pre-coded and interviewer-administered questionnaire, the respondents result indicated that 81.7%were satisfied and the 18.3%wereunsatisfied. The reasons behind satisfaction of the respondents were asked close ended questions to choose the most important single reason for satisfaction(33).
A cross-sectional study conducted in Iran, the study’s sample that consisted of 969 patients who were recruited from eight private general hospitals.Using patient Satisfaction questionnaires (PSQ-21 items). The study result displayed that about 45% of the discrepancy in overall satisfaction was explained by four dimensions of perceived service quality. The cost of services, the quality of the process and the quality of interaction had the greatest effects on the overall satisfaction of patients, but not found a significant effect on the quality of the physical environment on patient satisfaction(34).
Quantitative descriptive cross-sectional study done in Uganda, with medical consultations of 384 respondents were interviewed by using a structured questionnaire adapted from the Medical Interview Satisfaction Scale (MISS-21), from the study sample 53.9% were satisfied with the medical consultation(35).
Institutional based cross sectional study done in Ethiopiaon psychiatric patients using Charleston Psychiatric Outpatient Satisfaction Scale, a 15-item Likert scale ranging.The global satisfaction of patient showed that 61.2% almost half of the participants revealed high satisfaction with the psychiatric care services. The three items for which most patients showed higher satisfaction with monthly service bill (93.4%), appearance of the office (85.5%), and distance from transportation (84.4%). The three items for which most patients showed lower satisfaction were amount of waiting time (49.4%), location of the outpatient service (46%), and appearance of the waiting area (67.3%)(36)
1.2.2 Factors associated with health care service satisfaction
Different studies showed that other than the quality of Patient satisfaction is affected by many factors such as the quality of service delivery, patients’ diagnosis, age, gender, living conditions and previous service experiences, monthly income, waiting time for service, Communication With Doctors, responsiveness of hospital staff, information given about treatment, Cleanliness of the hospital, and respect for patient preferences. Mismatch between patient expectation and the service received is related to decreased satisfaction. Assessing patient perspectives gives them a voice, which can make mental health services more responsive to people’s needs and expectations (37 -39).
A survey conducted in Switzerland, in different treatment settings of psychiatric outpatient department, using CSQ-8 Client Satisfaction Questionnaire measuring global satisfaction, Reasons for greater satisfaction were therapeutic interventions, relationship with staff and confidentiality, while a lower satisfaction were related to information on treatment and medication, clinic organization and environment. A significantly larger proportion of male, single, pensioned, chronically-ill patients with minimum education were followed at the general psychiatric consultation centers, where diagnosis of schizophrenia was the most frequent less satisfied(26).
A Study done in Austria, in four community mental health centers and in two psychiatric hospital wards, Patients were mostly satisfied with staff and least satisfied with other patients. Inpatient or outpatient setting was not related to satisfaction. The interactions between status and setting were also not significant. The chi square test showed that long-term patients had a significantly more positive impression of care than did first-time patients and that first-time patient’s evaluated care significantly more neutrally than did long-term patients(29).
Cross-sectional study done in India, from patients of receiving treatment for at least six months from outpatient department of Mental Health Institute, using interview method of Patient Satisfaction Questionnaire (PSQ-18),anxiety disorder (36.6%), major depressive disorder (30.0%), bipolar disorder (16.6%), and schizophrenia (16.6%). Greatest level of satisfaction was noted in interpersonal aspects (71.4%) and time spent with doctors (62.4%). Diagnostic categories were statistically significant; patients with depression had the highest score followed by those with anxiety disorder, bipolar, and the least was with schizophrenia patients(32).
While another cross sectional study carried out in India, in public health facilities more teenagers (82.7%) were satisfied with the dimensions of service provision at the health care facilities as compared to middle aged; in dispensaries health care facility management practices and literacy of the patient are significantly correlated. In polyclinic, the physical environment of the health facility was significantly related to satisfaction. At Community health center, physical environment of the health facility and literacy of the patients are significant factors affecting patient satisfaction. At district hospital, the physician care along with literacy of the patient determines patient satisfaction(19).
Cross-sectional facility-based study done on patient’s satisfaction in Saudi Arabia which the reasons behind satisfaction of the respondents were based on the literature the reason given cleanliness of the hospital , technical competencies of staff, respect of client, good handling and good services. The first reason behind satisfaction was the cleanliness of the facility (33.1%). Other reasons were good staff 73 (24.2%), respect and good handling 70 (23.2%), good services 25 (8.3%). Other reasons behind satisfaction constituted 11%(33).
Cross-sectional study done in sir Lanka on level of patient satisfaction about being financially Cost of services for medical expenses most patient were not satisfied (76.5%), 23.51% was satisfied with the price of pocket spent on medical service. The overall score is very satisfying with 41.8% of patients, 58.2% suggesting low value of environmental satisfaction. According to the patient education, the secondary school group were highly (14.7%) satisfied with care services. The least percent found in no education groups and 3.5% with high satisfaction. In most of the surveys higher educated patients incline to be less satisfied with the services and low educated patients would be more satisfied with services(40).
A prospective cross sectional study conducted in Qatar based on the psychiatry hospital male patients (55.5%) were more satisfied with the treatment of psychiatrists than females (44.5%). 91.6% literate patients with 25% university graduates and 36.3% having secondary level of education. Significant associations were observed between male and female patients in their satisfaction level in terms of marital status, educational level, occupation, and monthly income. The satisfaction level significantly increased with higher education in both the groups(41).
Cross sectional study completed in Egypt on Patient satisfaction strongly and positively correlated with doctors’ hearing patient complaints, duration of waiting time, site of medical service, system of hospital follow-up, waiting areas and negatively correlated with disease relapses. While other clinical and demographic factors did not correlate with client satisfaction. However, in regression analyses, the duration of waiting in the center and the number of disease relapses, were the most important determinants of service satisfaction(42)
Quantitative descriptive cross-sectional study done in Uganda with medical consultations using a structured questionnaire adapted from the Medical Interview Satisfaction Scale (MISS-21), Patients’ average scores showed lowest satisfaction for information provision compared with communication skills, patient confidence in the clinicians and consultation time. Being older, employed, living further away from the health center and frequently visiting the center were positively associated with patient satisfaction(35).
A cross sectional study done in Ethiopia, 63.1% of the participants responded as satisfied by provider related characteristics, 62% of patients were satisfied with the way health providers concerned about their privacy. Most of the patients rated higher satisfaction level to service characteristic and services variables than provider related characteristics. Only 64.3% patients were satisfied to the cleanliness of waiting area and nearly 40% of patients were not satisfied to the availability of drugs in the facility. Overall only 57.2% of patients are satisfied their visit of medical outpatient services in the facility(43)
Another Cross sectional study carried out in Ethiopia, from the total of 414 respondents, 239 (57.7%) patients were satisfied by the overall service rendered in the hospital. Majority of the patients 350(84.5%), 253(61.1%) 368(88.9%), 288(69.6%) were satisfied with the availability of professionals for consultation, privacy during examination, quality of medical equipment’s, clean and tidy environment respectively. Age, educational status, payment status, waiting time, availability of drug and supply were found to be significantly associated with patient. Furthermore, respondents who had higher education and spent more than two hours in the hospital before getting service were 61% and 84% less likely satisfied than those who were illiterate(44).

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1.1 Background
The process of transferring ideas, message, information and attitudes that provides the possibility of turning those data into action called communication, which is considered as one of the mankind’s basic and essential skills like any other skills. (Azari et al., 2015). Communication is the basic tool in nursing, a crucial element in health care.(Ferreiraa, Silva, Pires, Sousa, ; Calheiros, 2016). Good communication skills in the health care setting is very important to ensure patient satisfaction to the care provided, consulting, identify client’s needs and take appropriate actions, minimize the possibilities of client’s complaints and creating clients-provider trust. In facts communication is the means good means of exchanging information, concepts, values, beliefs in health care setting for better patient’s outcomes.
Communication skills use verbal and non-verbal communication skills that can convey the reasonable information from the sender to the receiver through specific medium of communication. The ability to express to express good communication skills capacity is crucial skills for every nursing student. This can be achieved by having regular training for students in communication skills knowledge to enhance their capacities and their application of this knowledge in improving patient care.(Furnes, Kvaal, & Høye, 2018)
Having good communication skills will be useful in encounter patients and their families with sensitivity, empathy, and moral accountability. The nursing students should learn those skills as any other skills. The effective care to the patient that will consider their ethnic group, religious and cultural background will provided sufficiently if the provider has knowledge in communication skills.(Sheldon, 2015)
However, despite this reasonable importance of communication skills in providing good care to the client, there is a challenge of applying this knowledge in the clinical setting. The complicated schedule of nurses in their clinical areas makes them to poorly applying the skills. Failure to do so results into patient’s dissatisfaction , complaints, poor adherence to treatment, mistrust of health care providers and poor consultation.
1.2 Problem statement.
There is great need for effective communication skills between health care providers and their clients in order to ensure effective flow of care. Many challenges including patient dissatisfaction, complaints, mistrust of health care providers and poor adherence to treatment are increasing as a result of poor communication skills between health care providers and their clients.There is need to improve communication and more training to create awareness about barriers to effective communication in related to nursing intervention, because of very busy schedule of nurses in majority of health care settings, they become less aware of the problem of effective professional communicationstyle.(Bello, 2017). The expected consequences of not fix the problem may result into decreased quality of care, unachievable nursing interventions, continuation of mistrust of healthcare providers by their clients, dissatisfaction to health care provided as well as complaints to the nature of nursing care provided. This study is going to focus in assessing the communication skills knowledge among nursing students who are studying at MUHAS to evaluate if they have reasonable knowledge in communication skills for better outcome to the patient.
2. DESCRIPTION OF THE TOPIC
My topic is “assessment of knowledge of knowledge of communication skills among nursing students at MUHAS”
This study is going to assess if nursing students having good knowledge of communication skills that is useful for better patient outcome. The study will come out with the results to explain about this knowledge. The population to be focused by this study specifically will be nursing students at MUHAS.
3. OBJECTIVES
3.1 Broad objective
To assess knowledge assess knowledge of communication skills among nursing students at MUHAS.
3.2 Specific objectives
(i) To identify the common clinical communication skills nursing students have.
(ii) To identify if nursing students understanding about communication skills clues.
(iii) To identify major communication skills barriers among nursing students at MUHAS.
(iv) To identify if nursing students understanding about poor communication skills consequences in the clinical practices.
4.0 RESEARCH QUESTIONS
(i) What are the common clinical communication skills nursing students have?
(ii) Are nursing students aware of communication skills clues?
(iii) What are the main communication skills barriers facing nursing students at MUHAS.
(iv) What is the understanding of poor communication skills consequences to nursing students at MUHAS.
5. HYPOTHESIS
The researcher suggested the existence of relationship between dependent and independent variables which results into the prediction of the alternative hypothesis which states;
“There is significance knowledge of communication skills among nursing students at MUHAS”
6. CONCEPTUAL FRAMEWORK.
The two key variables such us knowledge and communication skills are ones to given attention. The independent variable is knowledge while, communication skills is dependent variable. This means that communication skills will be affected by having its knowledge. To be good in communication skills knowledge is needed. The study will be structured to asses this knowledge.The good communication skills affected by having good knowledge and this influence capacity, treatment adherence, trustfulness, and good provider-patient relationship.

7. LITERATURE REVIEW
In the review of literature selected articles has been identified after narrowing the topic. The selection of literature based on relevancy of the article to the topic and current of the article. The topic is issued in assessing knowledge of communication skills among nursing students. The review of literature done under the following criteria;
7.1 Main issues to be addressed in the literature.
In literature review the following issues has been addressed to find what other researchers say in their studies. The following things have been addressed in the literature review:
(i) To understand experience in the development of the communications skills for both nursing students and registered nurses.
(ii) To find the consequences of poor knowledge in communication skills and what are the effects of teaching communication skills to nursing students on the quality of care for patients.
(iii) To identify the research methods of data collection, sampling techniques used by other researchers in developing of their works.
(iv) To identify what are limitations facing studies of other researchers, what are their recommendations and what the gap of knowledge needed to be addressed in communication skills.

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7.2 Evaluation of the reviewed literatures
From the literature it has explained that, good communication between nurses and patients is essential for the successful outcome of individualized nursing care of each patient. To achieve this, however, nurses must understand and help their patients, demonstrating courtesy, kindness and sincerity. Also they should devote time to the patient to communicate with the necessary confidentiality, and must not forget that this communication includes persons who surround the sick person, which is why the language of communication should be understood by all those involved in it. Good communication also is not only based on the physical abilities of nurses, but also on education and experience.(Kourkouta ; Papathanasiou, 2014)
The study conducted in University of Sadney, Australia explained, effective communication is a vital component of nursing care (Mullan, Mullan, ; Kothe, 2010). However, nurses often lack the skills to communicate with patients, careers and other health care professionals. Communication skills training programs are frequently used to develop these skills. However, there is a paucity of data on how best to evaluate such courses. The study evaluated the relationship between student self, rating of their own ability and their satisfaction with a nurse training course as compared with an objective measure of communication skills (Mullan et al., 2010). The sample included 209 first year nursing students completed a communication skills program. Both qualitative and quantitative data were collected and associations between measures were investigated. Paired samples t-tests showed significant improvement in self-rated ability over the course of the program. Students generally were very satisfied with the course which was reflected in both qualitative and quantitative measures (Mullan et al., 2010). However, neither self-rated ability nor satisfaction was significantly correlated with the objective measure of performance, but self-rated ability and satisfaction were highly correlated with one another. The importance of these findings is discussed and implications for nurse education are proposed. (Mullan et al., 2010)
The other study suggests, the communication between healthcare providers and patients affects patient care and safety. Nurses develop communication skills at the undergraduate level, after graduation and throughout their practice. This study explored perspectives of new graduates on the development and implementation of communication skills within the first six months after graduation. The study is descriptive study used an electronic survey to three cohorts of recent graduates. Surveys were sent within six months after graduation (Sheldon, 2015). The total of 700 surveys were sent to three cohorts of recent graduates with 206 surveys completed (response rates ranged from 26%-35%). Participants reported always feeling confident communicating with patients and families 27% of the time, and23.5% of the time with interdisciplinary teams. Only 50.8% reported always feeling confident to provide safe care all of the time with 44.5% reported feeling always able to ask colleagues for help with challenging situations (Sheldon, 2015). Then finally the study concluded, undergraduate nursing programs should incorporate more didactic communication skills training and simulation to prepare nursing students and increase their confidence to provide safe care and consult with colleagues for help. Communication skills training in practice settings after graduation to increase skill development and confidence during independent clinical practice.(Sheldon, 2015)
The study accepted (2017) in Islamic Azad University of Mahabad, in Urmia, Iran suggested nursing profession requires not only the academic knowledge but also the interpersonal relationships, technical, and intellectual abilities (Taghizadeh, Hasanpour-dehkordi, ; Shakhaei, 2017). The study aimed to determine the impact of teaching communication skills to nurse students on the quality of care given by nursing students. This study was a quasi-experimental research that was performed on 66 last year students and 132 patients using a goal-oriented sampling method in 2016. The data collection tools included a demographic information form of the units under study, a checklist of students’ communication skills, and a quality of care questionnaire for patients. The study tools were completed by the students and patients before the intervention and after completion of the training course. After collection, data were analyzed using SPSS v16 and descriptive and inferential statistics such as paired t-test and Pearson correlation coefficient (Taghizadeh et al., 2017). The results showed that there was a significant difference between the mean quality of patients’ care prior to and following the intervention (p?0.001).Also, there was a significant difference between the means for nursing student’s’ communication skills before and after the intervention. Moreover, there was a significant correlation between mean scores of students and the quality of care and communication skills (p?0.001). The conclusion recommended that the professionals in the field of nursing incorporate “communication skills” into their instructional programs so that the nursing students acquire the requisite experience in the field prior to entering into this profession. Also teaching communication skills should be followed up after the students’ graduation.(Taghizadeh et al., 2017)
7.3 Identified gap of knowledge from the literature.
Lack of a strong association between student evaluation and performance is particularly worrying given that student evaluations using standardized tools remain the most widely used measure of course success (Wolfer and Johnson, 2003). Whilst further research may be warranted to replicate these findings, the current study provides an important insight into the relationship between student evaluations of a course and their own ability as it relates to performance. The data from this study suggests that such student evaluations do not meaningfully correspond to demonstrable communication skills.(Mullan et al., 2010). Therefore this study recommends to replicates the study to find strong association between student’sevaluation and real practices as far as communication skills is concerned.(Mullan et al., 2010)
It’s also proposed that, future research should ask new graduates what they would recommend to improve undergraduate and postgraduate education on communication skills. Studies could incorporate specific scales to measure health literacy and cultural awareness (Sheldon, 2015). These scales would help identify specific components of cultural awareness and sensitivity, and health literacy that are amenable to the development of interventions at the undergraduate level and for continuing education for practicing nurses. Future studies should include additional demographic information about respondents’ current work settings and duration of practice. Furthermore, institutional programs should be implemented that enforce inter professional training programs in academic and practice settings. These programs should emphasize communication skills, collaboration, collegiality, and conflict resolution to improve patient care processes, safety, and outcomes.(Sheldon, 2015)
From the literature we see the main recommendations including, finding the relationship between the evaluation methods and actual practice in communication skills, the studies also recommends on what should be done in order to improve communication skills in health care setting to improve the quality of care to the clients. The studies also recommend on how the institutional programs in can improve the communication skills to the nursing students. (Sheldon, 2015)

REFERENNCES

Azari, S., Mokhtari, S., Mousavi, H., Mohammadi, M., Aliyari, A., Salimi, M., ; Gh, A. (2015). Relationship between learning styles and interpersonal communication skills of nursing student in Medical Sciences Tehran University in 2012, 8(3), 178–183.
Bello, O. (2017). Effective Communication in Nursing Practice?: A literature review Opeyemi Bello Bachelor ‘ s Thesis Degree Programme in Nursing.
Ferreiraa, M., Silva, D., Pires, A., Sousa, M., & Calheiros, N. (2016). Clinical Skills and Communication in Nursing Students.
Furnes, M., Kvaal, K. S., & Høye, S. (2018). Communication in mental health nursing – Bachelor Students ‘ appraisal of a blended learning training programme – an exploratory study, 1–10.
Kourkouta, L., ; Papathanasiou, I. V. (2014). Communication in Nursing Practice, (February), 65–68. https://doi.org/10.5455/msm.2014.26.65-67
Mullan, B., Mullan, B. A., ; Kothe, E. J. (2010). Evaluating a nursing communication skills training course?: The relationship between self-rated ability , satisfaction and actual performance Nurse Education in Practice Evaluating a nursing communication skills training course?: The relationships between self-rated ability , satisfaction , and actual performance. Nurse Education in Practice, 10(6), 374–378. https://doi.org/10.1016/j.nepr.2010.05.007
Sheldon, L. K. (2015). Development of communication skills in healthcare?: Perspectives of new graduates of undergraduate nursing education, 5(7), 30–37. https://doi.org/10.5430/jnep.v5n7p30
Taghizadeh, R., Hasanpour-dehkordi, A., ; Shakhaei, S. (2017). Pharmacophore THE EFFECTS OF TEACHING COMMUNICATION SKILLS TO NURSING STUDENTS ON THE QUALITY OF CARE FOR PATIENTS, 8, 10–13.

1.0 Introduction

1.1 What is social network?
Social media are computer-mediated technologies that facilitate the creation and sharing of information, ideas, career interests and other forms of expression via virtual communities and networks. The variety of stand-alone and built-in social media services currently available introduces challenges of definition; however, there are some common features.

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• Social media are interactive Web 2.0 Internet-based applications.
• User-generated content, such as text posts or comments, digital photos or videos, and data generated through all online interactions, is the lifeblood of social media.
• Users create service-specific profiles for the website or app that are designed and maintained by the social media organization.
• Social media facilitate the development of online social networks by connecting a user’s profile with those of other individuals or groups.

1.2 History of social networks

1.2.1 Evolution of internet
The internet technology was introduced in the 1960s. The forerunner of the modern Internet was called ARPANET and it was created in 1969 by a worked for the Advance Research Projects Agency (ARPA) in the U.S Department of Defense. Basically, they just wanted to build an electronic communication system that could carry military data without disturbance. In 1971, an engineer Ray Tomlinson invented the first electronic mail (e-mail) program. Twenty years later, in 1991, British scientist, Tim Berners-Lee, invented World Wide Web and created Hypertext Markup Language (HTML) that establish links.
(Carolyn Duffy Marson, 09 Feb 2009)

1.2.2 Development of social networks
Social networks evolved since the internet technology was first developed in the 1960s. One of the first online communities was Usenet, which was created by Duke University graduate students, Tom Truscott and Jim Ellis. Usenet was similar to a discussion forum where students can share their opinions and suggestions. In 1984, similar method of online interaction called Bulletin Board System (BBS) was introduced. Later, the emergence of social networks rocketed with the invention of World Wide Web by a British scientist, Tim Berners-Lee, in 1991.
One of the most dominant social networks in the history, Friendster, was founded by Jonathan Abrams and launched in 2003. Along with Friendster, LinkedIn and MySpace also become popular in their respective fields. After 2003, the social networks become so popular that, by the time Facebook was launched in 2006, the Internet users had more than two hundred social networks to choose from. Nowadays, Facebook is regarded as the most successful social network with over 1.06 billion monthly active users, 680 million mobile users, more than 50 million pages and 10 million apps. (Walt Howe, 23 August 2016)

2.0 Advantages of social networks

• Connectivity – The first and main advantage of the social media is connectivity. People from anywhere can connect with anyone. Regardless of the location and religion. The beauty of social media is that you can connect with anyone to learn and share your thoughts.

• Education – Social media has a lot of benefits for the students and teachers. It is very easy to educate from others who are experts and professionals via the social media. You can follow anyone to learn from him/her and enhance your knowledge about any field. Regardless of your location and education background you can educate yourself, without paying for it.

• Help – You can share your issues with the community to get help and giddiness. Whether it is helping in term of money or in term of advice, you can get it from the community you are connected with.

• Information and Updates – The main advantage of the social media is that you update yourself from the latest happenings around in the world. Most of the time, Television and print media these days are biased and does not convey the true message. With the help of social media you can get the facts and true information by doing some research.

• Promotion – Whether you have an offline business or online, you can promote your business to the largest audience. The whole world is open for you, and can promote to them. This makes the businesses profitable and less expensive, because most of the expenses made over a business are for advertising and promotion. This can be decreased by constantly and regularly involving on the social media to connect with the right audience.

• Noble Cause – Social media can also be used for the noble causes. For example, to promote an NGO, social welfare activities and donations for the needy people. People are using social media for donation for needy people and it can be a quick way to help such people.

• Awareness – Social media also create awareness and innovate the way people live. It is the social medium which has helped people discover new and innovative stuffs that can enhance personal lives. From farmers to teachers, students to lawyers every individual of the society can benefit from the social media and its awareness factor.

• Helps Govt and Agencies Fight Crime- It is also one of the advantages of the social media that it helps Governments and Security Agencies to spy and catch criminals to fight crime.

• Improves Business Reputation – Just like it can ruin any business reputation, It can also improve business sales and reputation. Positive comments and sharing about a company can help them with sales and goodwill. Since people are free to share whatever they want on the social media, it can impact positively when good words are shared.

• Helps in Building Communities – Since our world has different religions and beliefs. Social media helps in building and participating in the community of own religion and believes to discuss and learn about it. Similarly, people of different communities can connect to discuss and share related stuffs. For example Game lover can join games related communities; car lover can join communities related to cars and so on.

3.0 Disadvantages of social networks

• Cyber bullying – According to a report published by PewCenter.org most of the children have become victims of the cyber bulling over the past. Since anyone can create a fake account and do anything without being traced, it has become quite easy for anyone to bully on the Internet. Threats, intimidation messages and rumors can be sent to the masses to create discomfort and chaos in the society.

• Hacking – Personal data and privacy can easily be hacked and shared on the Internet. This can make financial losses and loss to personal life. Similarly, identity theft is another issue that can give financial losses to anyone by hacking their personal accounts. Several personal twitter and Facebook accounts have been hacked in the past and the hacker had posted materials that have affected the individual’s personal lives. This is one of the dangerous disadvantages of the social media and every user is advised to keep their personal data and accounts safe to avoid such accidents.

• Addiction – The addictive part of the social media is very bad and can disturb personal lives as well. The teenagers are the most affected by the addiction of the social media. They get involved very extensively and are eventually cut off from the society. It can also waste individual time that could have been utilized by productive tasks and activities.

• Fraud and Scams – Several examples are available where individuals have scammed and commit fraud through the social media.

• Security Issues – Now a day’s security agencies have access to people personal accounts. This makes the privacy almost compromised. You never know when you are visited by any investigation officer regarding any issue that you mistakenly or unknowingly discussed over the internet.

• Reputation – Social media can easily ruin someone’s reputation just by creating a false story and spreading across the social media. Similarly businesses can also suffer losses due to bad reputation being conveyed over the social media.

• Cheating and Relationship Issues – Most of the people have used the social media platform to propose and marry each other. However, after some time they turn to be wrong in their decision and part ways. Similarly, couples have cheated each other by showing the fake feelings and incorrect information.

• Health Issues – The excess usage of social media can also have a negative impact on the health. Since exercise is the key to lose weight, most of the people get lazy because of the excessive use of social networking sites. This in result brings disorder in the routine life. This research by discovery will shock you by showing how bad your health can be affected by the use of the social media.

• Social Media causes death – Not just by using it, but by following the stunts and other crazy stuffs that are shared on the internet. For example bikers doing the unnecessary stunts, people doing the jump over the trains and other life threatening stuffs. For example in a video 14 year old from Mumbai was doing stunts on a running train which caused his death. These types of stunts are performed by the teenagers because of the successful stunts made and shared over the social media.

• Glamorizes Drugs and Alcohol – One of the disadvantages of the social media is that people start to follow others who are wealthy or drug addicted and share their views and videos on the web. This eventually inspires others to follow the same and get addicted to the drugs and alcohol.

4.0 Influence on people in the future
4.1 Positive Influence
Apart from the negative aspects of social networks, there are some occasions that they can influence people’s lives positively in the future. One of these influences is that people will obtain more convenient ways of living. Holding meetings and discussion forums using social networks will make time for the busy business-men to spend more time with their family. Online shopping will reduce the time consuming of housewives, when they can do other house chores. Moreover, students can have online learning days where they can interact with people from different parts of the world and share their ideas and debate issues.
The next fact is that social networks will help people to be able to keep in touch with the developing world. This includes sharing latest news, stock share prices and gold prices. Since social networks become available on mobile phones during these days, people will always be informed with the current news of the world.
Last but not least, some experts of social networking want to advance it to the stage of communication where it can replace telephone. So far, social networking sites such as Google, Facebook and Skype became major media for oversea communication. Scientists of social networks believe that they can create new communication technology that could possibly replace mobile phones in the future.
4.2 Negative Influence
Although the social networks can conduct many positive influences, they impose negative ones at the same time. The major drawback is that people may start to lose physical communication and interaction in the real world. For example, two people become best friends online but they do not talk to each other in the real world. Besides, there will be no conversation between partners in the job as the systems are computer control and they can communicate by simply typing some words in chat box.
The second influence is the case of students and children. While students can gain knowledge when they use social networks, they can also face with threats and online hazards. Most people believe that cyber-crime rate will increase in the future as the criminals can manipulate different ways and methods of crimes in such a world with over 300 social networking sites.
On the other hand, there is possibility that people, especially between the age of 15 and 25, will become more addicted to social networks in the future. Moreover, since social networks start to focus their websites on entertainment and business commercials rather than on education, people may spend more of their time on the networks instead of reading or doing physical exercises. Spending over time on social networks is not favorable to health also because when one is using the networks, he or she is doing nothing but sitting in front of a screen or lying on a sofa.

5.0 Recommendation
After analyzing all the advantages and disadvantages of social networks, the organizations which specify their interest in social media, came up with several recommendation concerning with the usage of social networks.
• Parents must check their children profile regularly and explain about cybercrimes. This will make children to be familiar with the ways of approaching of cyber predators and parents can take precautions for their children.

• One should not accept friend requests if the person is not an acquaintance in the real world. Besides, one should not share personal information such as address, telephone number and email address in social networking sites.

• if someone is bullied or harassed, he or she should report to the authorities of respective social networking sites and contact police when serious threats are made.

6.0 Conclusions
As a communication media social networks has a big role in acting as a mediator of it. But on the practical life we need more time that we spend in the social networking sites so adjusting the time for social communicate and try to avoid it to not to get addicted to it. Proper time management will keep us safe from addicted to the social networks. It is possible to collect more knowledge with the help of social networks by connecting on the knowledge sharing pages or accounts. We can share our thoughts and opinions through social Medias and can share our happiness and sadness with others through it but it can’t help anyone to get ride from a danger. So there are many uses are there with social networks but the most important thing that user need to remember is use it wisely and care about yourself to keep you safe from different social networking problems.

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