Therapeutic Communication and Barriers in Nursing

Abstract

Therapeutic communication is essentially different from other forms of social encounters. It helps nurses to build therapeutic relationships with their patients. Healthy relationships can be built by being compassionate and respectful to the patient. Various communication strategies help nursing professionals to manage the therapeutic relationships. To build therapeutic relationships, nurses must understand common communication barriers and learn how to overcome them. The College of Nurses of Ontario (CNO) has set standards that guide interpersonal relations between the nurse and the patient. Effective communication and interpersonal skills help nurses to overcome communication barriers and establish healthy interpersonal relationships with patients under their care.

Introduction

Interpersonal interactions always involve communication. Communication allows people to interact and build healthy relationships. It involves the use of verbal and nonverbal cues during interpersonal interactions. Different factors influence verbal and nonverbal communication. While in verbal communication, race/ethnicity, gender, age and socioeconomic status may influence the spoken word, nonverbal messages are communicated via facial expression and body language. Language and speech help people to communicate clearly and understand one another (Arnold & Boggs, 2011). In hospital settings, communication is crucial; it is through communication that nurses get to know the patient’s feelings and condition.

Besides, nursing, as a profession, incorporates communication and interpersonal skills in the context of therapeutic relationships between the nurse and the patient (Arnold & Boggs, 2011). However, the nurse also has to communicate with other health care professionals and the patient’s family members. In particular, family engagement can help the nurse to understand the causes of the patient’s illness. Therefore, the nurse-patient therapeutic relationships require nurses to have skills and knowledge in therapeutic communication and interpersonal relationships. This paper uses clinical scenarios to analyze the strategies of effective communication and relationships in the context of therapeutic relationships.

Therapeutic Communication

Therapeutic communication helps nurses to establish healthy relationships with their patients. It is through therapeutic communication that nurses are able to provide holistic care. In a therapeutic relationship, the nurse is able to provide for the patient’s physical, social, psychological and emotional needs (Arnold & Boggs, 2011). Therapeutic relationships also help nurses to monitor the health of the patient under their care. Thus, therapeutic communication helps nurses to provide holistic care for patients, which improve the patient outcomes. Effective therapeutic communications also ensure patient-centered care.

Patient Scenarios

Ms M, a 65-year-old female patient, was admitted with signs of confusion and symptoms of shortness of breath, wheezing and chest pain. She had been living in a nursing home for five years now. She was immediately put under antidepressants. However, Ms M was uncooperative and even refused to respond to questions about her illness and lifestyle. Her nurse seemed unhappy with her and refused to communicate with her or her family, only conducting the basic tests to ascertain the nature of her illness. Shortness of breath or dyspnoea has multiple causes that affect the respiratory passages. Thus, effective nurse-patient communication can help ascertain the exact cause of Ms M’s condition.

As a nursing student, this scenario gave me an opportunity to learn the role of therapeutic communication in building positive patient-nurse relationships. Most nurses abandon difficult patients because they are unable to communicate with them. In Ms M’s case, the patient’s attitude was a barrier to effective communication. Engaging the patient’s family is one way Ms M’s nurse could have used to interact with her. Also, showing empathy and respect to the patient can make her open up and talk to the nurse. I believe that even if the patient is difficult, the nurse should not refuse to communicate with him or her.

Another scenario I witnessed involved Mr. GS, a 70-year-old male, who was admitted with symptoms of congestive heart failure (CHF) and seemed to be in a lot of pain. Mr.GS was diabetic and under insulin therapy. Mr. GS did not look depressed or frustrated with his deteriorating health condition. However, I was surprised when he said that he does not want to bother anyone anymore, and would like to die soon. I did not know how to respond to this; but I asked him why he would think that way. He explained how his health had affected his life; he no longer did even small tasks and always needed assistance to move around the house. I held his hand and reassured him that he will get better, which I thought was an appropriate therapeutic communication in the context. This seemed to make him feel better.

After assessing him, I found that his pain was 7 out of 10. I told his nurse to administer prn medication to help relieve his pain. But she seemed too busy and could not administer the medication on time. She was handling two other patients and looked stressed out. The patient had to ask for the drug, which the nurse managed to give 20 minutes later. As a nursing student, I felt that I should have intervened to have the patient given the pain medication on time. I noticed that barriers such as workload and stress affect therapeutic communication.

Discussion of the Findings

Standards of Therapeutic Relationships

In nursing practice, therapeutic relationships between the nurse and the patient should meet the requirements and guidelines set by the CNO. In particular, therapeutic relationships should follow professional standards with regard to therapeutic communication skills, balance of power, boundaries and patient-centered care (CNO, 2006). Brunero and Lamont (2010) write that, in a therapeutic relationship, nurses must allow the patient some level of privacy and engage directly with the patient family members. Thus, as professionals, nurses are required to establish therapeutic relationships with their patients (CNO, 2007). The CNO (2007) documents five specific components of a healthy therapeutic relationship: respect, empathy, power, trust and warmth/intimacy (Para. 4). Therefore, to build a positive therapeutic relationship in clinical settings nurses must be respectful, empathic and intimate with their patients.

Therapeutic communication Barriers

Effective therapeutic communication requires the nurse to understand the communication barriers, which may be social, physical and psychological barriers that impede communication (Registered Nurses Association of Ontario [RNAO], 2006). The nature of the care environment and the patient’s cognitive and sensory impairment due to illness are some of the physical barriers. Personality problems and mental issues are some of the psychological barriers to therapeutic communication. On the other hand, social barriers, in a therapeutic context, include the patient’s economic status, spiritual beliefs, cultural values/tradition and language. In most social contexts, nonverbal cues are largely similar; however, verbal communication is often influenced by culture, religious beliefs, age, gender and location (Arnold & Boggs, 2011). In this regard, cultural values, gender or age shape a nurse’s perspective; this may affect therapeutic communication and hinder the development of healthy therapeutic relationships between nurses and their patients. Therefore, a nurse should be sensitive to differences in culture, religious values, age, gender, and so on in order to enhance therapeutic communication.

A study by Ashurst and Taylor (2010) found that nurses encounter difficulties in relating or communicating with their patients especially with regard to clinical diagnoses, patient condition and family concerns/emotions. Also, most nurses lack coping strategies in difficult situations. In this study, the nurses felt that they lack specific communication skills that can allow them to communicate with the patient who might be in pain or distress. Thus, training in essential communication skills and coping behaviors can help nurses to manage therapeutic relationships, which will lead to improved patient outcomes.

Overcoming the Communication Barriers

To overcome the therapeutic communication barriers, nurses must learn essential communication skills. Although nurses feel that confinement in the care environment cause aggression in psychiatric patients, patients identify lack of communication as the cause (Arnold & Boggs, 2011). Nurses can acquire therapeutic communication skills through training and practice. Such skills can help nurses to build positive relationships that promote patient recovery. One such skill is active listening, which enables nurses to understand their patients’ needs and give holistic care (Ashurst &Taylor, 2010). Active listening skills include eye contact, relaxed posture and attentiveness. The nurse should also build trust and encourage the patient to communicate his or her feelings.

Another important skill in therapeutic communication is inquisitiveness; it entails “the use of effective questioning techniques to probe deeper into the issues concerning a patient” (Arnold & Boggs, 2011, p. 77). Exploring or inquisitiveness allows nurses to find out the patient’s concerns, feelings and worries about his or her health. The nurse should also be responsive and assertive. Assertiveness requires the nurse to be confident and competent to “start and stop patient conversations” (Arnold & Boggs, 2011, p. 56). Brunero and Lamont (2010) state that nurses can enhance their skills and knowledge in managing therapeutic relationships through e-learning methods that involve clinical scenarios. The authors established that the package is cost-effective and some of its aspects such as the difficult patient stress scale (DPSS) enhance the nurse’s skill and knowledge in building therapeutic relationships. The package has clinical cases that help nurses to learn how to handle difficult patients under their care. This will enable nurses to offer holistic care to patients under their care.

Personal Reflection

In my view, therapeutic communication is an integral part of the nursing profession. As a nurse, I should listen and communicate clearly to the patient under my care as a way of building a positive relationship with him or her. From the literature review, I have learnt that effective communication contributes to patient healing and health outcomes. I have learnt to apply different communication strategies for each scenario. I will use silence, exploring, active listening, observation, empathy and encouragement to handle a difficult patient and to ensure a patient-focused care. I will also be culturally sensitive, and avoid stereotypes and negative comments when communicating with my patient to foster positive relationships.

Conclusion

Therapeutic communication helps nurses to establish healthy relationships with their patients. However, social, psychological and physical barriers affect effective therapeutic communication. As a nurse, I have learnt the importance of first examining the patient’s socioeconomic status, cultural background, geographical location, age and gender before talking with the patient. This will help me to identify the patient’s needs and develop an appropriate plan of care for him or her. Also, I will carefully observe my client’s body language and facial expressions to gain a deep understanding of his or her condition. These communication strategies will help me to communicate and build healthy therapeutic relationship with my patient.

References

Arnold, E., & Boggs, K. (2011). 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.

Brunero, S., & Lamont, S. (2010). The ‘difficult’ nurse-patient relationship: development and evaluation of an e-learning package. Contemporary Nurse: A Journal for the Australian Nursing Profession, 35(2), 136-146.

College of Nurses of Ontario (CNO). (2006). Standards. Web.

College of Nurses of Ontario (CNO). (2007). Standards. Web.

Registered Nurses Association of Ontario (RNAO). (2006). BPG: Establishing Therapeutic relationships.

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