An Investigation of Undergraduate Nursing Students’ Therapeutic Communication with Patients : Iranian Journal of Nursing and Midwifery Research

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An Investigation of Undergraduate Nursing Students’ Therapeutic Communication with Patients

Ghiyasvandian, Shahrzad1; Abdolrahimi, Mahbobeh2,; Zakerimoghadam, Masoumeh3; Ebadi, Abbas4,5

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Iranian Journal of Nursing and Midwifery Research 28(2):p 220-221, Mar–Apr 2023. | DOI: 10.4103/ijnmr.ijnmr_32_21
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Therapeutic Communication (TC) is the process of exchanging care information with patients in a purposeful manner to facilitate providing quality and comprehensive care.[1] Besides promoting positive physical and mental outcomes in patients,[2] establishing TC improves self-esteem and professional performance in nursing students.[3] Therefore, professional nursing guidelines emphasize improving TC to train competent and ethical nurses.[1]

The first essential step to improving TC is conducting assessments to identify needs and overcome shortcomings through academic training.[4] The results of similar studies, showing the weakness of nursing trainees in performing TC, cannot be generalized due to the assessment of a single ethnicity,[2,5,6] and the use of instruments without reporting psychometric properties.[4,6] In 2013, according to the patient’s rights charter and healthcare reform,[1] the “professional ethics and communication course” was integrated into the nursing curriculum. Therefore, it seems necessary to investigate nursing students’ TC with patients and its related factors in Tehran, with the greatest cultural diversity in Iran,[7] using valid and reliable tools in 2018.

Materials and Methods

The study population in this descriptive-analytical research included all undergraduate nursing students of Tehran University of Medical Sciences (TUMS), Tehran, Iran, in 2018. The minimum sample size was 234 at a 95% confidence interval and 10% attrition rate (d = 0.67). The inclusion criteria were as follows: 1) nursing students of TUMS in different semesters, 2) passing at least one clinical apprenticeship, and 3) willingness to participate in the study.

The research instruments included a demographic questionnaire and a TC questionnaire for nursing students. The demographic questionnaire collected the students’ background information, such as gender, marital status, age, semester, part-time employment, and workshop attendance. The TC questionnaire consisted of 35 items and five subscales: “Cooperation Attraction” (CA), “Maintaining Dignity” (MD), “Preparedness” (P), “Empathic Understanding” (EU), and “Responsiveness” (R). The items were rated on a five-point Likert scale, ranging from one “never” to five “always.” After summing item marks, the students’ TC was classified into three categories: weak (scored <50% of total mark), moderate (scored 50-75% of total mark), and good (scored >75% of total mark).[8]

The second researcher distributed the questionnaires among the participants using convenience sampling in three months. After appraising the normality of the data using the Kolmogorov-Smirnov test, descriptive and inferential statistics were analyzed using the Statistical Package for Social Science (SPSS, IBM, USA) version 19A.

Ethical considerations

The participants were asked to sign consent forms after the researcher explained voluntary participation. Tehran University of medical science Ethics Committee accepted the research protocol (IR.TUMS.REC.1394.807).


Most of the students were female (59.17%), single (86.25%), and in the second to sixth semester (88.30%), with the mean (SD) age of 22.13 (3.02). The TC of the students was moderate (CA: 21.70%, MD: 19.20%, p: 11.30%, EU: 27.50%, R: 41.70%) and good (CA: 77.90%, MD: 80.80%, P: 88.80%, EU: 72.50%, R: 56.30%), with the mean (SD) of 143.07 (12.86), except for one student (0.40%) in the CA subscale and five students (2.10%) in the R subscale.

A comparison of different subscales of TC concerning gender showed a significant difference between males and females in the EU (Χ2 = 8.02, p ≤ 0.005) and R (Fisher = 7.28, p ≤ 0.05) subscales. Further, the Chi-square test revealed no significant difference in the participants’ TC scores regarding marital status and age (p > 0.05). However, the Chi-square test demonstrated a significant correlation between all the TC subscales and the participants’ semesters (CA: Χ2 = 12.12, p ≤ 0.05; MD: Χ2 = 7.51, p ≤ 0.05; P: Χ2 = 4.01, p ≤ 0.05; EU: Χ2 = 9.10, p ≤ 0.05; R: Fisher = 23.68, p ≤ 0.05). Also, Pearson’s test confirmed the positive correlation of TC with employment (r = 0.49, p ≤ 0.01) and workshop attendance (r = 0.80, p ≤ 0.01).


Our results regarding the participants’ moderate and good TC scores align with another study’s results, in which TC was good in nearly 80% of students and moderate in the rest (20%).[4] The low scores of the CA and R subscales may be because some students lacked the knowledge and motivation to create patient self-care plans.[3] Therefore, nursing lecturers, as role models, must accept patients unconditionally and give them timely, jargon-less feedback to solve their problems.[1] The female students’ better performance in the EU and R subscales could be due to their flexibility and responsibility in modifying communication barriers.[2,6] The irrelevancy of the students’ marital status and age to TC, which is inconsistent with some studies,[2,4] may be attributed to a limited number of married students and practical nurses in our research. The success of the internship students in forging TC was probably related to their higher academic preparedness, which increased patients’ trust and adherence to patient-centered care.[3,5] Also, the higher TC scores of trainees who had a clinical job or previously participated in workshops were perhaps attributed to the systematic practice of socialization.[4,6]

Reversed questionnaire items were employed, and confidentiality was assured to reduce social desirability limitation.


Influencing factors, including gender, semester, employment, and workshop attendance, should be considered in TC education. Further studies with a larger sample size from all nursing schools are recommended.

Financial support and sponsorship


Conflicts of interest

Nothing to declare.


My article has been derived from a thesis research project. [(IR.TUMS.REC.1394.807)].


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8. Ghiyasvandian S, Abdolrahimi M, Zakerimoghadam M, Ebadi A Development and validation of a therapeutic communication questionnaire for nursing students. Contemp Nurse 2020;56:49–61.

Communication; nursing; patients; students

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