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Communication and therapeutic communication.

Communication is an extremely powerful therapeutic tool required by all health professionals.
Communication facilitates the expression of thoughts, feelings and attitudes, assists in gathering
important information, and supports therapeutic relationships.

In view of this statement:

(i) Define the terms communication and therapeutic communication. [The definitions should be in your
own words but supported by scholarly references]

(ii) Identify two (2) barriers to communicating with clients/patients.

(iii) Discuss strategies to effectively manage the two (2) barriers you have identified.



It is important to maintain good communication between the patients and nurses with the
aim of achieving the positive outcome of the individualized nursing care offered. To achieve this
objective requires the understanding of the patients by the nurses through demonstration of
sincerity, kindness, and courtesy. The necessary confidentiality should be adopted which
indicates the devotion of the healthcare providers while communicating with the patients. The
healthcare providers should also remember that communication also requires the involvement of
the person or people surrounding the patients such as the family members or the care providers at
home (Meuter et al 2015). In this case, the communication language should be understood by all
those involved in the process. Experience and education also matter during the process of
communication. During the process of interaction, there is a special kind of communication
identified as psychotherapy which involves one or more patients with the therapist with the aim
of acquiring the desired results among the patients (Boddy et al, 2013).
Despite the fact that verbal interaction is involved in therapeutic communication, it is
different from other social conventions because of its focus, objectives, topics, settings and roles.
The therapeutic relationships are supported by the active communication between the patients

and the healthcare providers. However, there are barriers that hinder the effective communication
and the maintenance of the therapeutic relationships between the patients and the healthcare
providers. These factors that hinder the effective communication can either be classified as
patient barriers or the healthcare professional barriers (Swei et al, 2016). The healthcare
professional barriers include the high workload, lack of support or the staff conflict while the
patient barriers include environmental items such as lack of privacy and control or the emotional
weakness. In this paper, a better exploration of the barriers to communication and therapeutic
communications would be done while also identifying the best strategies to address the barriers
thus enhancing effectiveness during healthcare related interactions (Yelland et al, 2016).


Communication is considered to be essential in the nursing field especially in areas
concerned with education, health promotion, rehabilitation, therapy, treatment and prevention
interventions. In this case, communication is identified as the exchange of feelings, thoughts, and
information between two people either through speech or other means when interacting (Wong et
al, 2015). The message creation and transaction process occur in the context that consists
psychological conditions, social values and cultural values and physical space. Through
communication, the consistent and accurate performance and the easy nursing work is enhanced.
Therefore, the healthcare professionals are protected, and patient satisfaction is also increased.
The importance of communication during the healthcare interactions makes it necessary for the
healthcare professionals to be properly trained in communications skills. The nature of
relationship created during communication depends on how the sequence of communication is
understood by the parties’ involved (Suurmond et al, 2016).

Effective communication requires the understanding of the experiences expressed by the
patients carefully. The sincere intention of the healthcare providers to understand and handle the
patient’s concerns through the application of the necessary skills is required to ensure
communication is effective in nature. The negative conclusions and attitudes are at most times
the results of failing to recognize the two-way communication. The interactions through
communication results to the therapeutic relationship between the healthcare providers and the
patients. Therapeutic relationships are thus considered important during the communication
between the patients and healthcare providers.

Therapeutic Communication

Therapeutic communication entails the strategies adopted with the focus on advancing
the emotional and physical well-being of the patients. The psychotherapy form of
communication uses both the verbal and non-verbal techniques (Shahid et al, 2013). It is
important for the nurses to learn the principles of therapeutic communication as it helps them in
best meeting the patient’s needs. The main objective of therapeutic communication is providing
the best care environment for the patient where they feel understood, well cared for and thus
leading to the establishment of a strong long lasting relationship where they can freely express
their concerns. Through the therapeutic communication, psychological distress is decreased
while increasing the self-worth through assessment and modification of behavior, determination
of illness after collecting information and also through the provision of health education. The
therapy should be patient-centered while it is the role of the therapist to build the effective
therapeutic relationship (Shwei et al, 2016). Expressing the thoughts and feelings by sharing of
observations is a method adopted in therapeutic communication.

Silence is also used as the method where observation of the non-verbal cues among the
patient is done by the therapist. A mutual understanding has to be there for the therapeutic
communication to be successful thus preventing cases of misunderstanding. The continual and
genuine concern for what is expressed by the patient is promoted through open communication.
Constant understanding of the human behaviors and possessing the observational skills are
essential for any healthcare provider that seeks to develop the therapeutic communication skills
by verbal or non-verbal cues. The proper adoption and implementation of the therapeutic
communication impacts the health of the patients positively.

Language Barrier to Communicating with Patients

There are instances where communication between the patients and the healthcare
providers is faced with barriers thus negatively affecting the interaction process. The language
barrier is one of the hindrances that affects the communication process thus making it a growing
concern among the healthcare providers and the patients. The language communication barrier
has resulted in the adverse effects such as poor adherence to the treatment services, less access to
quality care which results in the increased health disparities (Paternotte et al, 2015). The issue is
vital among the healthcare providers because of the need for the lengthy and frequent patient
interactions and intimate contact. The healthcare providers have continuously reported language
barrier as a great impediment provision of quality health care and also making their work more
challenging during delivery of services. An example is the impediment caused when the patients
have limited English proficiency. Such a case has been said to result in the misunderstood
medical information and incomplete nursing assessments in the healthcare field (O’Halloran,
2015). The limited English language proficiency among the patients has also led to the poor

therapeutic relationships between the patients and the healthcare providers. The language barrier
between the patients and the healthcare professionals has also affected the ability of the patients
to explain their symptoms and also making appointments in their bid to seek the healthcare
Due to the limited interactions, the patients experiencing the language barriers also
report the lower use of the preventative type of care and fewer visits to the healthcare providers.
An example is where the non-English speaking women are likely to receive the less Pap tests,
breast examination or mammogram. In such a case, the language barrier to effective
communication acts as a major impediment to the women from receiving the regular primary
care (O’hagan et al, 2014). The language barriers have also been identified to contribute to the
poor nurse-patient relationship which has the negative impact on the services delivered by the
healthcare providers.
The poor therapeutic relationships attributed to the language barrier of communication
leads to the low patient satisfaction rates for the health care services provided. The use of the
second language by the healthcare providers or the patients in the health sector is a major factor
for miscommunication which can be life threatening. The communication errors due to the
language barriers could be as a result of the rising number of foreign trained staff or the
immigration of the patients in a particular health center or area. In this case, the language barriers
to communication result in the poor therapeutic relationships and also affects the efficient
delivery of healthcare services (Mole et al, 2016).

Management Strategies for Language Barrier

The linguistically diverse populations amongst the healthcare providers and the patients
make it necessary for the adoption of the right strategies with the aim of addressing the
communication problems caused by the language barrier. The need for adopting the effective
strategies is due to the adverse effects that arise during the language-discrepant communication.
Choosing aid so as to enhance communication is one of the strategies to transcend the language
barrier to communication. These materials include the translated or culturally appropriate which
are also written well in a plain language. According to (Meuter et al, 2015) the use of the visuals
such as graphs and pictures could also be used as essential materials that enhance communication
thus addressing the language barrier of communication effectively. The use of the qualified
medical interpreters can be helpful in dealing with the language barrier to communication. These
interpreters can be the trained bilingual clinical staff, workers for the language agencies or the
community-based medical interpreters among others.
The qualified medical interpreters are efficient in according the necessary support to the
patients with limited English proficiency. In this case, they help in translation of instructions
from the healthcare providers to the patients, interpretation of languages and also ensuring that
ethical standards are followed during the communication process (Merlo et al, 2015). It is
important to ensure that qualified medical interpreters are used for translations since they are
more conversant with the scientific or technical language, diverse in nature and less likely to
commit the medical errors. Such actions would efficiently address the language barriers to
communication experienced by the healthcare providers and the patients.
The provision of the language classes to the healthcare providers would help in
enhancing the proficiency of their language skills. Such strategy would help lessen the language
barriers between the patients and the healthcare providers (McGrath, 2013). It is also important

to encourage the healthcare providers to participate in the microscopic and macroscopic activities
making them more aware of the language services in healthcare. The adoption and
implementation of these strategies would be efficient in addressing disparities caused by
language barrier of communication.

Health Literacy Barrier to Communicating with Patients

Health literacy is another barrier to communication which affects the smooth interaction
between the healthcare providers and the patients. Health literacy is identified to be the degree to
which a person or individuals can obtain, understand or process the basic services and
information provided to them by the healthcare providers (Mother, 2014). The understanding is
required when making the appropriate health decisions. Health literacy is identified to be a major
obstacle during the provision of healthcare. Health literacy is a dynamic process involving both
the healthcare provider and the patients. Health literacy is identified to be a major hindrance to
the communication or interaction since the individuals with the inadequate health literacy are
more likely to misunderstand the information provided to them.
They would face difficulty to follow the instructions provided for medical purposes by
their care providers. The patients with low health literacy would not be able to consult or interact
with their healthcare providers well thus they might end up infrequently or inappropriately using
the health care services (Hamrosi, 2014). Effective communication could be affected by the
tendency of health care providers stereotyping the patients by either under or over estimating
their health literacy. One of the major challenges that should be considered by the healthcare
providers while communicating with the low health literacy individuals is gaining their trust.

There are instances where patients hide the fact that they are facing difficulties when told
to interpret some information because they feel embarrassed or do not seem to be challenging the
health care providers (Clark et al, 2014). Such a case is the perfect example of how the low
health literacy levels of individuals hinders the effective communication with the healthcare
providers. According to (Darlton et al, 2014) the most unfortunate thing is that the patients with
the low health literacy might not receive care from the same person over time which makes it
cumbersome for the development and maintenance of the good relationships. In this case, there is
ineffective therapeutic communication and poor interaction between the healthcare provider and
the patient. The healthcare providers can assess the health literacy of the patients by evaluating
their cultural norms and linguistic skills which are essential for integration during the patient’s
care plan with the aim of addressing the communication problems brought about by low health
literacy levels (Cochrane, 2016). The importance of assessments using the linguistic skills and
cultural norms is because they have some relationship with the health literacy barrier to
communication. The low health literacy is a significant barrier to communication and effective
patient care. The full spectrum of health literacy should be understood by the healthcare
providers in the context of the roles they play. Therefore, the problem of health literacy should
be acknowledged as a major obstacle to the effective interactions during provision of healthcare

Management Strategies of Health Literacy Communication Barrier
There are various strategies adopted to address the health literacy barrier to
communication (Clark et al, 2014). Development of the patient-friendly education materials and
plain language is identified to be effective in addressing the issue of low literacy among the
patients thus enhancing effective communication. These education materials include the printed

health information in the form of books, brochures, and articles. It is also important to educate
the healthcare providers about health literacy and its related issues since inadequate knowledge
by the professionals makes it more challenging to handle cases of low health literacy that hinder
the effective interactions (Clark et al, 2014). Redesigning the patient informed consent forms is
important in increasing the literacy levels of the patients thus making it an effective strategy to
manage the barrier (Chedid, 2013). The teach-back technique which is considered to be an
established communication method can be adopted during the communication process with the
patient which makes it possible to manage the low health literacy issues. These communication
methods and educational resources would be efficient in easing the health literacy burden that
affects the interactions. Allowing the healthcare providers more time with their patient with low
health literacy in a bid to create room for the fruitful interactions is essential in managing the
issue. In this case, the environment where the interactions or the therapeutic relationships been
created is taking place is a vital factor to be considered by the healthcare providers who should
ensure it does not fault the process of communication which is essential in enhancing the
appropriate healthcare procedures and outcomes ( Boddy et al, 2013). The effective
implementation of these strategies would result in positive outcomes during communications
(Boddy et al, 2013).



In a nutshell, effective communication and maintenance of the therapeutic relationships
are essential in ensuring the services provided to the patients are quality and efficiently
delivered. It is the role of the patients and healthcare providers to cooperate and interact
appropriately. The main objective of therapeutic communication is providing the best care
environment for the patient where they feel understood, well cared for by the healthcare
providers. There has been cases where the healthcare providers do not allow room for
communication. Such cases have been said to result in the adverse effects thus making it
impossible to build and maintain the therapeutic relationships. Various barriers to effective
communication such as language and health literacy should be appropriately managed through
the effective strategies to ensure the interaction process is smooth (Boddy et al, 2013). Some of
the major strategies adopted to manage the communication barriers between the patients and
healthcare providers include the use of qualified interpreters to help solve the language problem

and use of education materials for the patients and training nurses for addressing health literacy
issue. The adoption of these strategies would promote the effective communication between the
healthcare providers and patients which also improves delivery of healthcare services.


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health care practitioner perspectives on barriers to advance care planning. Australian
journal of primary health, 19(1), 38-45.
Chedid, R. J., Dew, A., & Veitch, C. (2013). Barriers to the use of Information and
Communication Technology by occupational therapists working in a rural area of New
South Wales, Australia. Australian Occupational Therapy Journal, 60(3), 197-205.

Clark, A., Gilbert, A., Rao, D., & Kerr, L. (2014). ‘Excuse me, do any of you ladies speak
English?’Perspectives of refugee women living in South Australia: barriers to accessing
primary health care and achieving the Quality Use of Medicines. Australian journal of
primary health, 20(1), 92-97.

Cochrane, F. C., Brown, L., Siyambalapitiya, S., & Plant, C. (2016). “… Trial and error…”:
Speech-language pathologists’ perspectives of working with Indigenous Australian adults
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pathology, 18(5), 420-431.
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Clifton, V. L. (2014). “Who’s afraid?”: Attitudes of midwives to the use of information
and communication technologies (ICTs) for delivery of pregnancy-related health
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information in Australia: pharmacist, general practitioner and consumer perceptions of
the barriers and facilitators. BMC health services research, 14(1), 183.
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information in health care environments in australia: a survey

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