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Scholarly Paper: Communication and Therapeutic Nurse-

Patient Relationship

Abstract
Communication is one of the essential factors to maintain a good quality of life
because it allows humans to interact and provide comfort. In hospitals, the
importance of communication becomes even more evident. Therapeutic nurse-
patient communication helps nurses to build positive relationships with patients by
showing warmth, respect, and empathy. In order to accomplish the effective
communication and empower the patient, a nurse needs to identify and be aware of
the patients physical, psychological, or social barriers. Communication skills may
be useful to overcome the barriers that inhibit nurses from building healthy patient-
nurse relationship.
Keywords: Therapeutic communication, nurse-patient relationship
I. Introduction
Overview of issue:
Communication is one of the essential factors to maintain a good quality of
life because it allows humans to interact and to provide comfort. Communication
includes verbal and nonverbal. During verbal communication, there are many
factors that affect the choice of words. For example, age, race, socioeconomic
status, education background, gender, place, and situation are the factors.
Nonverbal communication includes body language, facial expressions, and active
listening. The ability to classify information in ways that can be understood by self
and others would be severely impaired if spoken languages were not used
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(Arnold&Boggs, 1999). In hospitals, the importance of communication becomes
even more evident. Not only a lot of information is given and understood by
communicating, but also a patients needs and feelings are mostly learned through
communication. Therefore, therapeutic communication is as important as
knowledge, evidence based practice, and so on. But, often significance of
therapeutic communication is forgotten. So, the importance of effective
communication should be thoroughly discussed and learned.
Importance in professional practice:
Therapeutic nurse-patient communication helps nurses to build positive
relationships with patients by showing warmth, respect, and empathy. It also
increases confidence of the nurse by enabling nurses to ask for support, open up for
feedbacks, and overcome anxiety. Therefore allows nurses to provide the best
possible care for patients. Effective nurse-healthcare provider communications
assure optimal patient-centered care (Ashurst & Taylor, 2010).
Application to a patient scenario:
BD, 85 years old male, was admitted from a nursing home with complaint of
short of breath and a change in mental status. When I assessed BD, his mental
status was stabilized. However, he was very demanding and wanted to get things
done in his own way. BDs nurse and LNA seemed very agitated with him and did
not want to communicate with him unless it was necessary. It was a good time for
me to learn how to deal with a difficult nurse-patient relationship. However, I
believe that even if a patient may be difficult to have pleasant interactions with, a
nurse should never abandon or avoid communicating with the patient.
BC, 72 years old diabetic female, was admitted with CHF. She was a very
pleasant lady, and I assumed she would not have any frustration or depression with
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her health and life. However, while I was talking to her, she said I dont want to
bug anyone, and I just want to die soon. I was very surprised, and at first I did not
know what to say to her. But then I asked her what made her to think that she
would be bugging anyone and why would she want to die soon. She told her
frustration of limited mobility and not being able to do activities she enjoys. I told
her she will get better and held her hand. However, I did not know if saying you
will get better would be a false hope and not an appropriate therapeutic
communication.
ND was admitted due to CHF and headache. When I assessed her, I heard
crackles on her base of lungs and her pain was 6 out of 10. I notified her nurse to
give the prn pain medication, but she was too busy to give the medication. My
patient hesitated with asking for the pain medication again because she felt it
would be too demanding. The nurse seemed distracted with other issues and was
very stressed out, so she failed to meet my patients needs. She finally did ask for
the medication, but the nurse came back about 30 minutes later. I wish I could
have spoken up for my patient, but because I am a nursing student, it was hard for
me to step up and talk to the nurse. There are many barriers that distract nurses
from providing better care for patients. In this situation, stress and overload of
work made the nurse draw attention away from my patient. In addition, I believe if
a nurse properly communicated with other healthcare providers and patients,
positive outcomes, such as faster patients optimal physical and psychological
health/wellness achievement, would more likely to be produced.

II. Discussion/analysis of findings from your reading of the literature
Barriers
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According to Weaver (2010), in order to accomplish the effective
communication and empower the patient, a nurse needs to identify and be aware of
the patients physical, psychological, or social barriers. Within patients, physical
barriers may include sensory impairment and environment issues. Psychological
barriers could include personality or disability. Social barriers include cultural
values, religious beliefs, socio-economic status, and so on. While nonverbal
communication is almost similar among any country, verbal communication
depends on cultural tradition, religious values, geographic location, and so on.
Nurses may have conflicting values, commitments, and lack of value that would
affect communication, therefore leading to a failure of accomplishing patient-nurse
relationship (Arnold &Boggs, 1999).
Furthermore, nurses who participated in Sheldon, Barrett, and Ellingtons
(2006) research reported the difficulties in communicating specific diagnoses and
clinical situations, patient and family emotions, nurses emotions, triangle of nurse-
physician-patient communication, and nurse coping behaviors with difficult
communication. They felt they were not educated enough to communicate with
patients in difficult situations. Therefore, education to improve communication
skill is needed.
Improving Communication Skills
Communication skills may be useful to overcome the barriers that inhibit nurses
from building healthy patient-nurse relationship. The research done by Duxbury
and Whittington (2005) found that while nurses thought the environmental
condition and the patients mental illness precipitated the patients aggression, the
patient perceived the environmental condition and poor communication as the
aggression precursor. According to Robinson and Watters (2010), communication
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skills can be attained and improved through practice. Effective therapeutic
communication skills gather or transmit information successfully and promote
healing and recovery of the patient. Active listening is required since hearing
without actually listening may cause a problem (Jasmine, 2009). Listening allows
nurses to gain essential information, to understand patients, and to provide better
care. Egan (1990) suggested the proper body position that would help a person to
effectively engage in conversation: sit squarely in relation to the client, lean
slightly towards the patient, maintain open position, make reasonable eye contact,
and relax.
In addition, communication should be taken in place with minimal distraction. For
example, drawing curtains and moving a patient to a private counseling room
would provide less distraction. However, changing to a quiet room may be
difficult in real clinical setting due to lack of room availability or a patients
immobility. (Jasmine, 2009) Furthermore, patients may need some encouragement
and trust needs to be established to communicate their feelings and concerns to the
nurse. Encouragement can be done through using touch, humor, and tears.
Among various communication skills, exploring is another essential skill, and it
largely involves the use of effective questioning techniques to probe deeper into
the issues concerning a patient (Jasmine, 2009). For the better therapeutic
communication, open-ended questions can be used to assist the patient to discuss
and clarify what he or she is thinking, concerning, and feeling. Then, paraphrasing
conversations helps nurses to repeat and reinterpret what has been said during
communication (Jones, 2009).
The communicator needs to be assertive and responsive. In order to be assertive,
one needs to have competent knowledge, confidence, and ability to start,
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continue, and stop conversations (Schuster, 2000). Brunero and Lamonts
research showed that the e-learning package reduced stress and increased
knowledge, skill, and confidence of nurses in managing the difficult nurse-patient
relationship (2010). The e-learning package used scenario based learning method.
According to the authors, it is not only cost-effective, but also easily accessible.
Moreover, a nurse educator, clinical nurse specialist, and registered nurses
contributed in expanding and developing the scenario to maximize its purpose.
Improvement of difficult Patient Stress Scale (DPSS) total, confidence, skill, and
knowledge were statistically significant. According to the authors, the e-learning
package should be implemented and developed more since it had positive outcome,
which delivers better care to patients and reduces stress. The scenario and problem
based e-learning package could improve communication skills and difficult nurse-
patient relationship because the nurse has more knowledge, skill, and confidence.
As a result, patients may receive optimal care from the nurse.
III. Summary, Conclusion and next steps based on the literature.
There are many barriers that disrupt therapeutic communication. Based on
my findings, I need to carefully assess at my patients culture, religion, education
background, socio-economic status, and so on before I see my patient.
Comprehensive assessment will help me to find out what my patients needs are.
Moreover, I would be able to resolve barriers and to respect my patients beliefs.
Furthermore, I am going to carefully observe my patients nonverbal cues, such as
facial expression, voice tone, body language, and so on to make sure if he or she
has any distress or issue. Also, when my patient wants to discuss his or her
concern, or if I notice something different with my patient, I will stop what I am
doing, sit down, listen, and solve the problem with the patient. Then, I will
continuously evaluate the progress until the goal is achieved.
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IV. Epilogue/reflection/learning/so what
I believe communication could represent the aesthetic part of nursing. How I
artistically present myself and communicate with my patient could influence
healing processes. Based on the literatures I reviewed, I learned to practice and
focus on communicating with patients and building therapeutic relationship with
my patient. Since communication assures healthy nurse-patient relationship and
promotes healing process, I will focus on the whole person rather than disease or
tasks.
I learned to use appropriate therapeutic communication techniques according to the
situation. For example, making observation, asking opened question, offering self,
encouraging, accepting, using silence, focusing, exploring, and so on can be used
when my patient is having a difficult time or when I need to get to know about my
patient. In addition, I should never reject, tell patient what to do without
discussion, ask too many questions, make stereotyped or unrelated comments, or
interrupt my patient while communicating.
References
Arnold, E & Boggs, K. (1999). Interpersonal Relationships: Professional
Communication Skills for Nurses. Philadelphia, PA: W.B. Saunders Company.
Ashurst, A & Taylor, S. (2010). Communication, communication,
communication. Nursing & Residential Care, 12(3), 140-142. Retrieved from
CINAHL Plus with Full Text database.
Brunero, S., & Lamont, S. (2010). The difficult nurse-patient relationship:
development and evaluation of an e-learning package.Contemporary Nurse: A
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Journal for the Australian Nursing Profession,35(2), 136-146. Retrieved from
CINAHL Plus with Full Text database.
Duxbury, J., & Whittington, R. (2005). Causes and management of patient
aggression and violence: staff and patient perspectives. Journal of Advanced
Nursing, 50(5), 469-478. Retrieved from EBSCOhost.
Egan G. (1990). The Skilled Helper: A systematic approach to effective helping.
Brookes/Cole, California
Jasmine, T. (2009). The use of effective therapeutic communication skills in
nursing practice. Singapore Nursing Journal, 36(1), 35. Retrieved from
EBSCOhost.
Jones, L. (2009). The healing relationship. Nursing Standard, 24(3), 64. Retrieved
from EBSCOhost.
Robinson, K., & Watters, S. (2010). Bridging the communication gap through
implementation of a patient navigator program. Pennsylvania Nurse, 65(2), 19-21.
Retrieved from EBSCOhost.
Schuster, P. (2000). Communication: The Key to the Therapeutic Relationship.
Philadelphi,PA: F.A. Davis
Sheldon, L., Barrett, R., & Ellington, L. (2006). Difficult communication in
nursing. Journal of Nursing Scholarship, 38(2), 141-147. Retrieved from
EBSCOhost.
Weaver, D. (2010). Communication and language needs. Nursing & Residential
Care, 12(2), 60-63. Retrieved from EBSCOhost.

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