Analyzing Therapeutic Communication in Nurse-Patient Vignettes

This report critically examines therapeutic communication within the context of nursing, focusing on the development of strong nurse-patient relationships. It begins by defining therapeutic communication and its essential elements, including verbal and non-verbal cues, active listening, empathy, and the importance of establishing trust. The report analyzes two vignettes that depict nurse-patient interactions, highlighting both effective and ineffective communication strategies. The analysis identifies communication barriers such as lack of empathy, time constraints, and heavy workloads, while also showcasing best practices like clear explanations, active listening, and compassionate touch. The discussion section delves into the impact of body language, eye contact, and facial expressions on patient perception and the importance of avoiding rushed interactions. The report concludes with recommendations for overcoming communication barriers, such as training programs and addressing nursing shortages, to promote better patient outcomes and satisfaction. The report emphasizes the importance of continuous improvement in communication skills to enhance the quality of patient care.

Running head: COMMUNICATION
COMMUNICATION
Name of the student:
Name of the university:
Author note:

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Abstract:
This assignment mainly helps in shedding light on different aspects of therapeutic
communication that nurses need to adopt for establishing strong bonds with patients.
Communication begins when every time a nurse enters a client’s room and is considered to be a
dynamic and ongoing procedure that occurs throughout the delivery of the care. Therapeutic
communication helps in transferring information and interacting with the patient through verbal
and non-verbal messages. It is the central of developing nurse-client relationships resulting in
positive client outcomes. Tone, eye contact, body posture, facial expressions, silence, active
listening and many others are some of the important element of therapeutic communication that
nurses need to master to provide effective care to the patients. This ensures developing a string
relationship with patients based on trust and mutual respect helping the patient to overcome
stress and anxiety. However, nurse perceived barriers that impact communication are lack of
skills and knowledge required for effective communication as well as time-constraints, nursing
shortage and heavy workload. This assignment will be shedding light on each of the attributes of
therapeutic communication in details after analyzing two vignettes that show two episodes of
communication between nurses and patients. This would help in developing a better idea about
the aspects one should avoid or follow to ensure better relationship development with patients

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Contents
Introduction:....................................................................................................................................3
Results:............................................................................................................................................3
Discussion:.......................................................................................................................................5
Conclusion:......................................................................................................................................6
Recommendations:..........................................................................................................................7
References:......................................................................................................................................9

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Introduction:
The quality of therapeutic relationship that nurses develop with patients depends on the
ability of the nurses to communicate effectively. Therapeutic communication is indeed one of the
most difficult attributes for nurses to master when they are caring for people who are trying to
cope with stressors of the disorders, different ailments along with the loss of life (Arnold &
Boggs, 2019). Finding the right thing to say in the right time with the appropriate approach and
body langue is one of the most important in establishing of therapeutic relationships. Unlike
verbal communication, non-verbal communication is seen to include all forms of communication
that include all forms of communication that do not involve any true spoken word or written
word. This is one of the powerful forms of communication which have the ability to build or
destroy the chance of developing a trustworthy relationship with patients. Studies opine that
therapeutic communication increases adherence of the patients with the treatments and helps
them to rely on nurses and increases their participation in their care (MacLean et al., 2017). This
assignment would mainly show how therapeutic communication can help in effective patient
care and higher patient satisfaction. Two vignettes would be critically analyzed about the
approach of the nurses in therapeutic communication with patients. This report would also
identify the communication barriers that affect smooth therapeutic communication. Following
these, the various aspects of the effective communication would be discussed followed by proper
recommendations to help nurses overcome the barriers.
Results:
One of the most concerning communication issue noted down from the first vignette is
the lack of empathy among the nurse who was attending the patient. She seemed only completing
her responsibilities without really feeling the pain and suffering of the patients. She was quite

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fast in her approach and wanted to leave the situation to attend the other patients which made her
fidgety. She was also not compassionate towards the patient when she revealed that she was
suffering from pain. She seemed least interested in her approach which affected the patient
making her ask how nurses can be so adamant and rude. Her body language was not appropriate
that also made the patient anxious about whether she would be getting the pain management
interventions which she wanted. Another negative aspect was that the nurse was standing over
the patient and talking with her not from the same eye level. This is considered disrespectful by
many patients making them feel powerless. One of the communication barriers that had been
seen here are lack of knowledge among the nurse about the procedures of interacting with a
patient in pain and how to develop therapeutic relationship with the patients. Other
communication barrier can be the workloads which are mentioned by the nurse again repeatedly.
It might have made her feel distracted and so she could no concentrate on communication with
the patient.
In comparison, the nurse of the following vignettes showed the best competence in
initiating effective communication with the patient. Studies are of the opinion that effective
communication can help the patients to get over their anxiety and stress and make them feel
comfortable in the hospital environment (Marie et al., 2016). Similar had been seen in the case
scenario. Empathy and compassion showed by the nurse while communicating with the patient
had positive impact on the confidence level of the patient over the nurse. This helped in making
the patient calm and helped her develop trust over the healthcare professionals. Another very
important aspect that the nurse was seen to adapt was the clear description of the surgery
procedure before taking informed consent of the patient. Studies are of the opinion that when
patients are aware about what interventions would be applied on them and the procedures that

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would be adopted; it results in reducing the stress they suffer in the hospital environment (Lewis
et al., 2016). Moreover, the nurse also followed another element of the non-verbal
communication which is touch. When the patient was seen to express her disappointment with
the previous nurse who did not care her properly, the nurse touched her hands gently and
promised her that such negative and poor treatment would never happen with her. This was yet
another factor that culminated to a therapeutic relationship with patient that helped in developing
mutual trust and respect between the nurse and the patient.
Discussion:
Studies are of the opinion that body language reveals the interest and engagement of a
nursing professional in her communication with the patient (McCarthy, 2017)). It is important
that nurses maintain the correct body posture along with eye contact and facial expression and
touch. It is important for nursing professionals to communicate with patients by bringing their
face to the same level to that of the patient and never tower on them. This was not followed by
the nurse in first vignette. Nursing professionals need to be relaxed, impatient and not fidgety
unlike the nurse of the first vignette. Studies are of the opinion that it is extremely important to
adopt an open stance with the patient as was seen in the nurse with the second vignette (Ozcan et
al., 2018). When nurses show that they want to be there for the patient and do not show the
desperateness to rush away and perform something else, patients can develop a level of
connection with the nurse. Nurses should never stand with their arms closed and flick their eyes
constantly at the door as it cannot encourage good communication but rather males the patient
feel that she has become a burden to them. This affects their self respect and self-esteem making
them withdrawn from the care process (Bell, 2016). Touch is yet another powerful mean of
communication where lightly touching the hand or a patient can convey the concern and

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affection of the nurse for the patient. Studies state that touches can convey emotional support,
affection, encouragement, personal attention and tenderness to the patients along with a sense of
safety (Kim et al., 2015). Hence, the patient in second vignette was found to be happier and
satisfied. This is one of the best methods of showing empathy apart from the verbal means. Apart
from that maintaining a good eye contact with the patient and proper facial expressions with a
caring smile may make the patient feel comfortable and at the same time help the patient to
develop confidence on the professionals. Another important aspect which was also noticed in the
nurse of the second vignette is active listening. It is one of the best ways of showing compassion
making the patients feel that the nurses are interested in knowing about their concerns in details
without interrupting them (Bach & Grant, 2015). The nurse was also seen to share hope that is a
positive aspect of communicating and developing therapeutic relationship. At the end the nurse
assured her complete safety in the surgery procedures that helped in raising a sense of hope of
better living in the patient. Empathy makes patients feel that the nurses are genuinely interested
in their care. When the nurse stated that she could understand how patients feel in hospital
environment, the patient was seen to be pleased as she felt that nurse could understand her pain
and suffering (Sibiya, 2018).
Conclusion:
From the above discussion, it can be seen that the nurse in the first vignette had exhibited
poor communication skill whereas the nurse is the second vignette had provided appropriate
communication skills. Apart from appropriate modes of verbal communication, non-verbal
communication attributes among the nurses play an important role in establishing therapeutic
relationships with patients. Proper body posture, smiling, appropriate facial gestures are some of
the preliminary non-verbal cues which can contribute to effective communication with nurses.

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Apart from that, touch, eye contacts and not being fidgety and impatient should be also other
aspects which nurses need to maintain to communicate effectively with patients. Showing
empathy and compassion can help in developing an emotional bond with the patient which
increases adherence to treatment and increases patient satisfaction. However, various barriers
may affect the smooth flow of communication between patients and nurses. These may be lack
of knowledge and skills to initiate effective communication among nurses as well as nursing
shortage and busy wards. It is the duty of the nurses to report such barriers so that nurse leaders
and managers can initiate strategies to overcome the barriers and maintain mot flow of
communication between nurses and patients.
Recommendations:
One of the communication barriers that had been found in the first vignette is the lack of
effective knowledge about the important of therapeutic communication or the lack of
communication skills required for developing therapeutic knowledge. Poor communication with
the patient may affect the building of an emotional relationship with the patient and this would
impact the healthcare outcomes. It would also impact the participation of the patient in her own
care (Spenney et al., 2018). The nursing leaders should initiate an observational study to find out
the nurses with poor communication attributes, they can also initiate patient satisfaction
questionnaires where they can put sections about the feedback of the patients on communication
skills of the nurses. After identification of the nurses with poor communication attributes, they
can be advised to join workshops or training sessions provided by expert and skilled trainers.
They would be assessed from time to time in the training sessions and scored accordingly so that
they can identify their improvement and develop proper communication skills (Younis et al.,
2015)

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Another communication barrier that had been also noted is the busy wards where more
patients had to be handled within a short period of time. Often high nurse-patient ratio signifies
nursing shortage that can impact the communication done by a nurse with patient. Studies are of
the opinion that due to lack of nurses and higher patient demands, only limited things can be
successfully done by a nurse for each patient. Nurses are able to allocate very short time to attend
to the patient and do not have enough time to talk or listen to the doubts and questions of the
patient. In such situation, a high nurse-to-patient ratio can become a significant contributor to
ineffective therapeutic communication making them fidgety in their appearance (Oh et al., 2015).
In such situations, it is the duty of the nurses to report the issues to the nurse managers or the
higher authority with advocating the impacts that poor communication may have on patient
health. Along with the human resource department, the nurse managers should allocate enough
nurses so that each nurse can get sufficient nurse to engage in effective communication with
patients (Crawford et al., 2017).

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References:
Arnold, E. C., & Boggs, K. U. (2019). Interpersonal Relationships E-Book: Professional
Communication Skills for Nurses. Saunders.
Bach, S., & Grant, A. (2015). Communication and interpersonal skills in nursing. Learning
Matters.
Bell, J. M. (2016). The central importance of therapeutic conversations in family nursing: Can
talking be healing?.
Crawford, T., Candlin, S., & Roger, P. (2017). New perspectives on understanding cultural
diversity in nurse–patient communication. Collegian, 24(1), 63-69.
Kim, J., Heo, N., Jeon, H. J., & Jung, D. (2015). Effects of simulation education on the
communication competence, academic self-efficacy, and attitude about the elderly for
nursing students: A learning approach based on an elderly-with-cognition-disorder
scenario. The Journal of Korean Academic Society of Nursing Education, 21(1), 54-64.
Lewis, P., Gaffney, R. J., & Wilson, N. J. (2017). A narrative review of acute care nurses’
experiences nursing patients with intellectual disability: Underprepared, communication
barriers and ambiguity about the role of caregivers. Journal of Clinical Nursing, 26(11-
12), 1473-1484.

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MacLean, S., Kelly, M., Geddes, F., & Della, P. (2017). Use of simulated patients to develop
communication skills in nursing education: An integrative review. Nurse education
today, 48, 90-98.
Marie, T., & Jaroslav, P. (2016). Provision of Nursing Care with or without Therapeutic
Communication Intervention. US-China L. Rev., 13, 75.
McCarthy, B. (2017). Communication and Interpersonal Competencies for Undergraduate
Nursing Students. Millenium, (03), 25-28.
Oh, E. J., Ko, S. H., Kim, J. Y., & Kim, S. R. (2015). Self-awareness, other-awareness and
communication ability in nursing students. Journal of Korean Academy of Nursing
Administration, 21(4), 426-434.
Ozcan, C. T., Öksüz, E., & Oflaz, F. (2018). Improving Empathy in Nursing Students: A
Comparative Longitudinal Study of Two Curricula. Journal of Korean Academy of
Nursing, 48(5), 497-505.
Sibiya, M. N. (2018). Effective Communication in Nursing. In Nursing. IntechOpen.
Speeney, N., Kameg, K. M., Cline, T., Szpak, J. L., & Bagwell, B. (2018). Impact of a
standardized patient simulation on undergraduate nursing student knowledge and
perceived competency of the care of a patient diagnosed with schizophrenia. Archives of
psychiatric nursing, 32(6), 845-849.
Younis, J. R., Mabrouk, S. M., & Kamal, F. F. (2015). Effect of the planned therapeutic
communication program on therapeutic communication skills of pediatric nurses. Journal
of nursing Education and Practice, 5(8), 109.

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