Therapeutic communication is considered a vital of quality of nursing care. It is described as appropriate care for nurses & patients. It acts favorably on improving knowledge, attitude & practice of care by the nurses. Thereby patients can receive satisfactory care from staff in the hospital.
This study was carried out in order to determine the knowledge, attitude & practice regarding therapeutic communication among nurses in teaching hospitals in Kandy district using self-administered questionnaire.
Our findings showed that, 63.63% nurses were in strong agreement that active listening is the most important part in therapeutic communication with a patient & 36.36% nurses agreed to the fact. In comparison, another study in Western Ethiopia reported that 94% nurses were with opinion that therapeutic communication helps to succeed the nursing plans(Thanasekaran et al., 2017). A study in an Australian university had attempted assessing nursing students' listening & communication styles using paper-based versions of the listening style profile. There was only slight differences in preferences for listening and communication styles between the gender (Mckenna et al., 2014). We have identified that nurses in teaching hospitals in Kandy district consider active listening is the most important part in therapeutic communication with a patient. None of the participants stated that active listening is not important in the process. The results could be attributed to the fact that majority of participants were females.
When attitude towards therapeutic communication was considered, majority of participants agreed that therapeutic communication prevents medical errors of patients. According to a study in western Ethiopia, most of the nurses strongly agreed to the fact that therapeutic communication improves their care (Thanasekaran et al., 2017) .The results are favorable towards our findings as prevention of medical errors of patients is one part of improving care.
Our study showed that, 59.29% nurses were always involved in applying therapeutic communication in pre-operative & post-operative care. Another study showed that majority of nurses utilized therapeutic communication & results highlighted that 52% of the nurses always applied the technique in clinical settings (Thanasekaran et al., 2017). Our findings are consistent with their observations.
Our results showed that there was a statistically significant association between socio demographic statuses and knowledge of therapeutic communication. A study in Western Ethiopia reported that there was no statistically significant association between socio-demographic variables and knowledge of therapeutic communication (Thanasekaran et al., 2017).However, we identified that there is an association between attitude towards therapeutic communication and socio demographic variables among study participants. Variables in statistical significant association were age,educational status,graduate form, position, number of years in service and monthly income. The Study in Western Ethiopia showed a significant association between professional status & attitude of therapeutic communication (Thanasekaran et al., 2017). Furthermore, we also observed an association between socio-demographic variables & knowledge, attitude and practice regarding therapeutic communication among nurses in our study.
There was a statistically significant association between age & knowledge that arguing with a patient is not suitable in therapeutic communication. Majority of our participants were aged >=30 years. Most of nurses in Sri Lanka join with Ministry of Health at their young age. Their high level of knowledge could be explained as they improve their skills & knowledge with years of experience.
Further, there was a statistically significant association between education status & knowledge that therapeutic communication technique isn't false reassurance of patient. Education status is an important qualification to improve patient management skills. Report by Shafakhah et al in 2015 to evaluate nursing students' communication abilities in clinical courses in hospitals in Fatemeh school of nursing & midwifery in Shiraz, Iran had shown that nursing students who had completed higher semester had better communication skills than students in lower semesters(Shafakhah et al., 2015). Similarly another study in Greek had confirmed that there is a statistically significant association between nurses learning at the university and those with two years training. Nurses at the University responded with higher number of correct answers about communication than others(Kounenou, Aikaterini and Georgia, 2011). As a result of the changes in the curriculum, continuing education programs, nurses in our country too have improved their skills & knowledge on patient care including facts on therapeutic communication. There was also a statistically significant association between positions & the knowledge that arguing with a patient is not suitable in therapeutic communication.
We observed a statistically significant association between number of years of service & knowledge that therapeutic communication helps to encourage expression of feelings & ideas of patients and exchange of information in verbal or non-verbal manner and nurses must protect the privacy of patient in order to achieve therapeutic communication. Furthermore, according to our study, there was a statistically significant association between number of years in service and knowledge of therapeutic communication. However, another study had shown that there is no statistically significant association between years of service & knowledge of therapeutic communication. We consider number of years in service is an important tool to show the level of experience of nursing practice.
In addition, there was a statistically significant association between socio-demographic variables and attitude of therapeutic communication. Our finding also showed that, there was a statistically significant association between age & attitude that trust, respect & privacy are important in therapeutic communication. Interestingly, we observed a statistically significant association between educational status and the nurse feeling that he/ she has a responsibility to improve therapeutic communication. There was also a statistically significant association between graduate form and attitude that therapeutic communication improves self-satisfaction of nurses. A statistically significant association was identified between position & number of years in service with attitude that therapeutic communication decreases anxiety and fear of patient. Shafakhah et al in their study showed that there was a significant association between nursing students' clinical communication behavior scores & treatment communication ability(Shafakhah et al., 2015) .It also has highlighted that there was a significant association between the students’ educational semester & their clinical communication behavior & treatment communication (Shafakhah et al., 2015). The findings are confirming our results. We can intrepret statistically significant association between age,educational status,graduate form,position & service year and attitude of therapeutic communication of nurses in Kandy district as most of the participants were married and living with families bound with Sri Lankan culture understand patients’ feelings and emotional levels than individuals living isolated like in some countries.
There was a statistically signifiacant association between education status and applying therapeutic communication to patients with impaired hearing problems. We also identified a statistically significant association between position and applying therapeutic communication in health education and a statistically significant association between number of years in service and discussion with family members of patients. We can summerize that there was a statistically significant association between educational status,position & number of years in service and knowledge, attitude & practice of therapeutic communication among study participants.
Our finding showed that majority of participants in Teaching hospital in Kandy think that therapeutic communication will increase their workload. However, over 60%of participants from Peradeniya & SBSCH were favorbale towards the fact that therapeutic communication will not increase their workload during shift. Similarly, 39% of the nurses had complained of lack of time as the reason for their poor practice (Thanasekaran et al., 2017). Maame et al.,2018 had also identified that high workload is the major barrier for successful therapeutic communication by nurses(Maame et al., 2018). We an describe the similar reason for the Teaching hospital in Kandy as its patient output is higher than other two hospitals. We consider it as a positive fact that almost all participants from all three hospitals agreed to promote therapeutic communication. We consider this study is an important step in assessing various aspects of therapeutic communication in Sri Lankan hospitals.