ESSENTIAL THERAPEUTIC COMMUNICATION TRAINING FOR MENTAL HEALTH NURSES: A PROGRAM EVALUATION Olivia Glance A Doctor of Nursing Practice project submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice in the School of Nursing (Psychiatric-Mental Health Nursing Practice). Chapel Hill 2019 Approved by: Theresa Raphael-Grimm Grace Hubbard Juliana Galioto
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ESSENTIAL THERAPEUTIC COMMUNICATION TRAINING FOR MENTAL HEALTH NURSES: A PROGRAM EVALUATION
Olivia Glance
A Doctor of Nursing Practice project submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Nursing
Practice in the School of Nursing (Psychiatric-Mental Health Nursing Practice).
Olivia Glance: Essential Therapeutic Communication Training for Mental Health Nurses: A Program Evaluation (Under the direction of Theresa Raphael-Grimm)
Therapeutic communication is an essential skill in psychiatric nursing, and has been
shown to result in improved outcomes for mental health patients. Such outcomes include
decreased anxiety, enhanced coping ability, improved emotional management skills, and
increased adherence to treatment. However, there is no evidence indicating that mental health
facilities commonly provide training in therapeutic communication to their nurses, and, without
adequate training, psychiatric nurses may not have the knowledge to implement these skills in
their interactions with patients. The purpose of this project was to create and implement an
online training program on therapeutic communication skills for mental health nurses, with the
goal of increasing the frequency and effectiveness with which nurses implement these skills in
their interactions with patients. For this project, an online therapeutic communication training
program was created and implemented among the nurses at a residential eating disorder
treatment facility over the course of a month. The Consultation and Relational Empathy (CARE)
measure, a validated provider empathy survey, was administered to the patients at the facility
prior to and after the training to determine the effectiveness of the training program on
improving the nurses' therapeutic communication skills. Differences in average patient ratings of
nursing staff on the pre- and post-training CARE measure survey questions were analyzed, and
patient ratings of nurses' therapeutic communication skills after the training program were found
to be significantly higher. These results indicated that completion of the training program was
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associated with clinically significant improvements in the nurses' therapeutic communication
skills. Since evidence has associated effective therapeutic communication with positive
outcomes among psychiatric patients, a clinically significant improvement in the nurses'
therapeutic communication skills following this training program indicates the potential value of
the program, as well as a clinical need to provide mental health nurses with therapeutic
communication training. The results also suggest the potential value in expanding this training
program to a wider community of mental health nurses.
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ACKNOWLEDGEMENTS
Thank you to Dr. Theresa Raphael-Grimm, who served as my DNP committee chair for
this project and was instrumental in the development of the therapeutic communication training
program used in this project. I am so thankful for your expertise in therapeutic communication
and your help in developing an effective training program.
Thank you to Dr. Grace Hubbard, who served as a DNP committee member and provided
guidance throughout the design of the project and writing of this DNP paper. Your experience
working on DNP projects made navigating the process manageable, and I am thankful for all of
your help in organizing and editing this paper.
Finally, thank you to Juliana Galioto, who served as a committee member and was the
Director of Nursing at the project site. Your support throughout the implementation of the
training program was so important to the success of my project, and I appreciate your constant
support and positivity throughout the project.
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TABLE OF CONTENTS
LIST OF FIGURES ................................................................................................................... ix
LIST OF ABBREVIATIONS AND SYMBOLS ......................................................................... x
CHAPTER 1: INTRODUCTION OF THE PROJECT ................................................................ 1
Problem statement ........................................................................................................... 1
Purpose of project ........................................................................................................... 1
APPENDIX M: COMPARISON AND ANALYSIS OF PATIENT VERSUS NURSE SURVEY SCORES..................................................................................................... 63 REFERENCES ......................................................................................................................... 64
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LIST OF FIGURES
FIGURE 1 - Patient CARE measure survey results.......................................................................23
FIGURE 2 - Nurse CARE measure survey results........................................................................24
FIGURE 3 - Patient versus nurse CARE measure survey results..................................................25
x
LIST OF ABBREVIATIONS AND SYMBOLS
ADDIE analysis, design, development, implementation, and evaluation
CARE consultation and relational empathy
CINAHL Cumulative Index of Nursing and Allied Health Literature
DNP Doctor of Nursing Practice
IT information technology
LPN Licensed Practical Nurse
PRN per diem
RN Registered Nurse
UNC University of North Carolina
= equal to
≥ greater than or equal to
< less than
≠ not equal to
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CHAPTER 1: INTRODUCTION OF THE PROJECT
Problem statement
Therapeutic communication is the cornerstone of psychiatric nursing, and has been
shown to result in increased patient satisfaction and improved outcomes for mental health
supports the implementation of therapeutic communication training among mental health nurses.
The implementation of this online therapeutic communication training program for mental health
nurses led to a clinically significant improvement in the use of therapeutic skills among the
nurses at the project site. It is recommended that this training program be incorporated into the
facility's required training courses for all nurses within the facility, in order to continue to
develop and maintain proficiency in therapeutic communication skills among the nursing staff.
In the future, proficiency in therapeutic communication skills among the nursing staff may be
measured using a combination of the CARE measure survey, simulations in which the nursing
staff must demonstrate the effective use of therapeutic communication techniques, and direct
observation of the nurses' interactions with patients. This training program should also be
considered for required training among other staff members who have regular interactions with
patients, such as residential patient assistants. Although the training program led to clinically
significant improvements in therapeutic communication among the nurses in this study, the
results were only measured short-term, immediately after completion of the training. The long-
term impact of this training should be evaluated by re-administering the CARE measure survey
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periodically over time.
Since the literature indicates a general lack of therapeutic communication training for
nurses in mental health facilities, this training should also be adapted to and implemented in
other mental health facilities. The online nature of this training program will make it easy to
disseminate to other facilities. The video demonstrations used in this training program were
filmed using the project members as actors. Prior to future implementation of this training
program across other facilities, the video demonstrations may be re-filmed using actual
performing artists to ensure the most impactful and accurate video demonstrations. The impact of
the training across a wider array of facilities should be evaluated using the same CARE measure
empathy survey, and the training program should continue to be evaluated and modified to best
meet patient needs at whatever mental health facility it is being implemented in.
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APPENDIX A: SCRIPT FOR RECRUITMENT OF NURSE PARTICIPANTS
For my doctoral project within the School of Nursing at the University of North Carolina
at Chapel Hill, I have created a therapeutic communication training program for mental health
nurses, which I will be implementing at the facility over the next couple months. Therapeutic
communication is an essential part of mental health nursing, and good therapeutic
communication has been shown to increase satisfaction and improve outcomes for psychiatric
patients. Patient outcomes associated with good therapeutic communication are decreased
anxiety, enhanced coping ability, improved self-care and emotional management skills, and
increased adherence to treatment. My research has shown a general lack of therapeutic
communication training in psychiatric facilities, and our facility is no different. In attempts to
improve therapeutic communication skills among our nurses, I will be implementing an online
therapeutic communication training program. The program will be presented on HealthStream,
and will consist of three different modules. Each module should take about 30 minutes to
complete. The modules will be released one at a time in consecutive order, and each module will
be available for 10 days before the next is released. You will receive an email notification when
each module is released. Please do your best to get each module completed in a timely manner.
The modules will teach you the basics of therapeutic communication in mental healthcare, and
will have video demonstrations of both effective and ineffective communication techniques. My
hope is that you are able to apply some of these techniques in your interactions with patients, and
that this training makes your interactions with patients easier and more effective. After all of the
training modules have been completed, you will be sent a survey to complete. This will be a self-
rating survey asking you to reflect back and rate your therapeutic communication skills prior to
completing the training, and then rate your current skills after completing the training.
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Completion of the training and the survey are both completely voluntary and anonymous, but I
hope to recruit as many nurses as possible to complete both. My intention is to improve the
training methods for our staff and add to our nurses’ therapeutic skills, in order to improve
patient care within our facility. I will address any questions or concerns at this point.
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APPENDIX B: SCRIPT FOR PATIENT RECRUITMENT TO COMPLETE INITIAL SURVEY
My name is Olivia Glance and, in addition to being a nurse at Carolina House, I am
working on a Doctorate of Nursing Practice at the University of North Carolina at Chapel Hill.
For my doctoral project, I am creating a therapeutic communication training program for mental
health nurses. Over the next couple months, our nurses will be completing this therapeutic
communication training. My goal is to improve our nurses’ therapeutic skills in their interactions
with patients. In order to measure the success of the training program, I need your input as
patients. I will be asking you to complete a survey rating your recent interactions with nursing
staff, in order to get an understanding of their current effectiveness in providing therapeutic care.
I will then ask you to complete the same survey after the nurses have completed the training
program, in order to see if the nurses’ skills have improved. The survey is 10 questions and
should take less than 5 minutes to complete. These surveys are voluntary and will be completely
anonymous. The nursing staff will have no access to your survey responses. I will be the only
individual at the facility with access to the surveys, and they will not impact your care negatively
in any way. My hopes are to improve the training for nurses in the facility so that we can provide
the best care possible for our patients, and I need your help to understand how we are doing.
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APPENDIX C: SCRIPT FOR PATIENT RECRUITMENT TO COMPLETE FOLLOW-UP SURVEY
A couple months ago, I asked all of the patients to complete a survey as a part of my
doctoral project with the School of Nursing at UNC-Chapel Hill. This was a survey asking you
to rate the helpfulness your recent interactions with nursing staff. The nurses have since
completed a therapeutic communication training program, and I am asking you to complete this
survey again, so that I can determine how effective the training program was in improving their
skills. As before, this survey is completely voluntary and anonymous. The nursing staff will have
no access to these surveys, and they will not negatively impact your care in any way. It is solely
intended to help me determine how to most effectively improve the skills of our nursing staff, in
order to provide you with the best care possible.
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APPENDIX D: OUTLINE OF TRAINING CURRICULUM
Module 1 – The Foundation of Therapeutic Communication
• “Humans thrive on relationships. Positive interactions are the essence of our happiness.
Often positive interactions occur in very brief encounters, even with relative strangers,
where people share a moment of connectedness. Connecting to others, in a positive way,
is affirming. It allows us to feel like we belong to our community, and it decreases our
sense of isolation. There is perhaps no more important time for people to feel connected
to and supported by others as when they face serious illness or trauma.” (Raphael-
Grimm, 2015)
• Therapeutic communication is defined as the use of verbal and non-verbal messages with
the goal of developing trust and respect in the nurse-patient relationship and assisting
patients to successfully meet physical and psychological needs (American Psychiatric
Nurses Association, 2017).
• Studies have found that 85% of patients believe that strong therapeutic relationships,
which include good communication and emotional support, are very important to
successful medical treatment. (Raphael-Grimm, 2015)
• Patients have reported that good and helpful therapeutic communication with healthcare
providers fostered feelings of hopefulness, and a sense that they were active participants
in their own care. (Raphael-Grimm, 2015)
• Patients have reported that experiences involving poor and unhelpful communication
with healthcare providers led to psychological distress and feeling dehumanized.
(Raphael-Grimm, 2015)
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• Patient outcomes associated with effective therapeutic communication are decreased
anxiety, enhanced coping ability, improved self-care and emotional management skills,
and increased adherence to treatment. (Stickley & Freshwater, 2006; Street, Makoul,
Arora, & Epstein, 2009)
• “Every encounter provides an opportunity for the patient to experience the healing power
of our full attention, to feel valued, cared, for, respected, and understood.” (Raphael-
Grimm, 2015)
• However, staff often get caught up in the culture of healthcare, which is time-pressured,
procedure-driven, and productivity-focused. (Raphael-Grimm, 2015)
• Nurses often fall into the trap of believing their value to patients primarily rests in their
medical knowledge and mastery of various skills and treatments. Although these are
valuable, emotional intelligence and interpersonal skills are where the true power to heal
lies. Mindfully developing empathy for the patient, and communicating an interest in,
respect for, and desire to understand the patient, are essential to creating a healing
encounter. (Raphael-Grimm, 2015)
• Elements that characterize therapeutic communication are (APNA, 2018):
• Developing an attitude of respect and dignity
• Being fully present
• Listening with the whole self
• Communicating hope
• Developing trust
Module 2 – Mindfulness in Therapeutic Communication
o It is important to practice mindfulness in our therapeutic interactions with patients.
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o “Mindfulness is a state of awareness, or consciousness, that is fostered by the consistent and
deliberate effort to take notice of what is occurring in one’s inner and outer worlds, with a
capacity to be fully engaged in the present moment, rather than distracted, preoccupied with,
or focused on the past or future. To be mindful is to be attuned to one’s internal climate and
with that awareness, make more conscious decisions about how to respond to everyday
events in the here and now. It enhances the capacity to take notice of the subtle shifts in our
emotions and thoughts and consider how those emotions and thoughts might influence our
attitudes and drive our behaviors.” (Raphael-Grimm, 2015)
o “When mindfulness shifts from an internal focus (ourselves) to an external focus (others), it
fosters a capacity for openness that allows us to be more sensitive to others and to monitor
how our own behavior is impacting them. It fosters a curiosity and a drive to understand the
lived experience of others, and to offer thoughtful responses that meet the unique demands of
those interpersonal situations.” (Raphael-Grimm, 2015).
o In mental healthcare, mindfulness cultivates the desire to understand the thoughts, feelings,
and needs of patients. Practicing mindfulness allows us to be fully present in our interactions
with patients, and also allows us to self-monitor so that we are able to respond effectively to
patients to meet their needs.
o Mindfulness is taking a step back and examining our own underlying thoughts and emotions,
and analyzing how these might affect our interactions with patients. This allows us to better
prevent our own emotions from getting in the way of meeting our patients’ needs.
o Domains of mindfulness:
• The Emotion Mind
• This is where emotional thinking dominates.
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• Can be positive or negative.
• Ex. “I hate this situation. Why should I have to put up with this?”
• The emotion mind can be problematic when our emotions take over and drive our
behaviors, causing us to act reactively.
§ The Body Mind
• This is our awareness of physical experiences.
• Ex. “I’m tired and hungry and haven’t had time to go to the bathroom in 4 hours.”
• If we are not mindful of what our bodies are telling us, these physical experiences
can take over and interfere with our ability to focus.
§ The Reason Mind
• These are our rational, analytical, controlled thoughts.
• Ex. “Patients who are newly diagnosed may have a lot of concerns and questions, so
it is important for me to make extra time for these patients to address their
concerns.”
• Ex. “I know I get irritable when I don’t get enough sleep, so I can understand why
this patient with insomnia is irritable today.”
§ The Wise Mind
• The wise mind is where the emotion mind, body mind, and reason mind overlap.
• This is a place of mindfulness where we are able to evaluate and monitor our
emotions, motives, desires, and biases, in order to prevent them from influencing and
sabotaging our interactions with patients.
o The Mindfulness Process through the Patient Interaction
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§ First step-back, take a deep breath, and look inward, focusing on one state of mind at a
time.
§ Assess your emotional temperature, or Emotion Mind:
• What emotions am I experiencing in this situation?
o Ex. anger, anxiety, disgust, resentment
• How intense are these emotions?
• What thoughts am I experiencing related to these emotions?
o Ex. “Stop asking so many questions, I’ve got work to do.”
o Ex. “I’m so annoyed with how often this patient gets upset and needs support. I
don’t want to deal with them anymore.”
§ Assess your physical sensations, or Body Mind:
• Are you tired, hungry, or in pain?
• Is your pulse elevated?
• Is your stomach in knots?
• Is your jaw tense?
• Does your head feel full?
• What is your facial expression?
• How might these physical sensations influence how you interact with the patient?
§ Assess your capacity to reason (Reason Mind):
• Can you think clearly and objectively in this moment?
• What do you need to consider to shift your focus back to the patient?
• What facts can you draw from that would make sense of the situation with the
patient?
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• What information do you have about the patient that could help make sense of the
situation?
• What is the patient likely thinking and feeling right now?
• What questions do you need to ask the patient that would help you better understand
the situation?
§ Enter a place of wisdom (Wise Mind):
• How could your current emotions interfere with caring for this patient?
• How much of your reactivity is coming from your own biases or assumptions?
• How can you challenge your biases or assumptions?
• What do you need to do to self-regulate and meet your own needs (ex. deep
breathing, eating, slowing down and doing one thing at a time)
• Given your current state of mine (emotionally, physically, and logically), what
makes sense for you to do first in this situation?
• If you were in the patient’s situation, what might you need from your nurse? How
can you best provide that for them?
• Videos demonstrations of mindfulness:
o Scenario 1 – A nurse is overwhelmed with physician orders and charting and a
patient comes to the nurse complaining that she doesn’t want to go to group, none of
the other patients like her, and she doesn’t think anything is going to help her. The
nurse is visibly annoyed with the patient and is short and dismissive, telling the
patient she has to go to group and sending her away.
o Scenario 2 – In the same scenario, the nurse takes a moment to practice
mindfulness. The video shows the nurse having an internal dialogue with herself.
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She recognizes that she is feeling stressed with the amount of work she has to do.
She also recognizes she is tired and hungry, since she hasn’t had time to eat lunch
yet. She realizes these things have nothing to do with the patient, but could make her
more irritable and less empathetic with the patient. She thinks about what she knows
about the patient and recognizes that the patient has only been in treatment two days
and could be struggling to adapt to the environment. She also remembers that the
night shift nurse told her the patient was struggling to sleep in a new place, and was
up a lot throughout the night. The nurse recognizes that people often get irritable and
more emotional when they don’t get enough sleep, and also recognizes that the first
few days in treatment can be scary and difficult, and the patient may need more
emotional support during this time. The nurse decides to take a break from working
to listen to the patient for a few minutes.
Module 3 – Non-verbal and Verbal Communication Skills in the Therapeutic Interaction
• Listening
§ “Listening isn’t just an absence of talk, where we merely stand by silently until the
patient finishes speaking so that we can jump in and tend to the next question on our
checklist. It means fully, deeply, and attentively attending to patients’ efforts to
deliver their thoughts and ideas. We are listening not for information alone, but for
understanding. We are attempting to get a sense of what it is like for this patient to
experience his or her illness within the context of this patient’s life circumstances.
To attentively listen requires that we be fully present in the here and now, focused on
the patient and only the patient, and able to put other concerns aside, at least for a
moment.” (Raphael-Grimm, 2015)
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§ In order to actively listen, we need to temporarily turn off and tune out all
distractions. Be mindful of anything that may distract you from listening to the
patient.
§ In order for a patient to feel as if they are being heard, they have to be deeply, fully,
and thoughtfully listened to. Fully listening to a patient makes them feel valued and
respected, and they are more likely to be open and honest with you.
• Non-verbal Communication
§ It is important to be mindful of how you are communicating non-verbally to patients
during your interactions. Your body language can communicate to a patient that you
are fully attentive, interested in them, and value what they have to say. Conversely, it
can also communicate that you are distracted or uninterested, regardless of what you
are saying to them verbally.
• SOLER (APNA, 2018):
§ Sit squarely facing the client (unless ethnic/cultural background of client
discourages direct eye contact).
§ Observe an open posture.
§ Lean forward toward the client.
§ Establish eye contact (unless ethnic/cultural background of client discourages
direct eye contact).
§ Relax
• Video demonstrations:
§ Scenario 1 – A nurse is performing an admission assessment with a patient at
the nursing station. The nurse is asking the patient questions and responding
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to what the patient is saying but she is turned towards the computer and not
looking at the patient. The patient looks uncomfortable and anxious, and is
guarded in talking to the nurse.
§ Scenario 2 – Patient is talking to the nurse and she is facing the client, with an
open, relaxed posture and good eye contact. The nurse is turned away from
the computer monitor. The patient appears comfortable and relaxed, and
answers the nurses questions open and honestly.
• Verbal Communication
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(Raphael-Grimm, 2015) Video Demonstrations:
• Scenario 1 – An eating disorder patient is talking to the nurse about her anxiety
related to food and meals, and the nurse responds in nontherapeutic ways described
previously in the module. The patient gets visibly more upset and frustrated in
response to the nurse, and storms away, stating “You just don’t understand what I’m
going through. No one understands.”
• Scenario 2 – An eating disorder patient is talking to the nurse about her anxiety
related to food and meals, and the nurse responds using therapeutic communication
techniques described previously in the module. The patient is able to calm down and
thanks the nurse for listening to her and understanding what she is struggling with.
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APPENDIX E: EMAIL NOTIFICATION FOR MODULE RELEASE
You are receiving this notification because Module ___(insert module number)___ of
Essential Therapeutic Communication Training for Mental Health Nurses has been released for
your completion. Please complete this module within the next 10 days, prior to the next module
being released.
Please access the training module using the following link: [Insert link to access module]
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APPENDIX F: THE CARE MEASURE FOR PATIENT COMPLETION
Please think about your recent interactions with the nursing staff. Please tick one box for each statement and answer every statement.
How were the nurses at ... Poor Fair Good Very Excellent Does Good Not Apply 1. Making you feel at ease... (being friendly and warm towards you, treating you with respect; not cold or abrupt)
2. Letting you tell your “story”... (giving you time to fully describe your illness inyour own words; not interrupting or diverting you)
3. Really listening... (paying close attention to what you were sayings; not looking at the notes or computer as you were talking)
4. Being interested in you as a whole person... (asking/knowing relevant details about your life,your situation; not treating you as “just a number”)
5. Fully understanding your concerns... (communicating that he/she had accurately understood your concerns; not overlooking or dismissing anything)
6. Showing care and compassion... (seeming genuinely concerned, connecting with you on a human level; not being indifferent or “detached”)
7. Being Positive... (having a positive approach and a positive attitude;being honest but not negative about your problems)
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8. Explaining things clearly... (fully answering your questions, explaining clearly, giving you adequate information; not being vague)
9. Helping you to take control... (exploring with you what you can do to improve your health yourself; encouraging rather than “lecturing” you)
10. Making a plan of action with you ... (discussing the options, involving you in decisions asmuch as you want to be involved; not ignoring your views)
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APPENDIX G: INFORMED CONSENT FOR PATIENTS
INFORMED CONSENT FOR ANONYMOUS SURVEY
You are invited to participate in a program evaluation titled “Essential Therapeutic Communication Training for Mental Health Nurses: A Program Evaluation.” This program evaluation is being conducted by Olivia Glance for her doctoral project within the School of Nursing at the University of North Carolina at Chapel Hill. The purpose of this program evaluation is to determine the effectiveness of a program providing therapeutic communication skills training to mental health nurses. Participation in this program evaluation is entirely voluntary at all times. You can choose not to participate at any time. If you decide not to participate there will be no penalty or loss of benefits to which you are entitled, or any effect on your relationship with the investigator, or any other negative consequences. You are being asked to take part in this program evaluation because you are a patient at Carolina House and we would like to see how you would rate the helpfulness of the nursing staff in various aspects of your treatment. If you agree to participate, you will be asked to fill out the following survey rating various aspects of your recent interactions with nursing staff. The survey is 10-questions, and will ask you to rate your recent interactions with the nursing staff across ten categories: 1) making you feel at ease, 2) allowing you to tell your story, 3) really listening, 4) being interested in you as a whole person, 5) fully understanding your concerns, 6) showing care and compassion, 7) being positive, 8) explaining things clearly, 9) helping you take control, and 10) making a plan of action with you. The survey will take approximately 5 minutes to complete. The survey will be completed and returned today during this meeting. All of your responses to this survey will remain anonymous and cannot be linked to you in any way. No identifying information about you will be collected at any point. You are free to withdraw from this program evaluation at any time. However, once you submit your completed
52
survey, there will be no way to withdraw your responses because the survey contains no identifying information. Completed surveys will be kept in paper format in a locked file cabinet in the principal investigator’s office. Data collected from completed surveys will be kept on the principal investigator’s laptop. Access to survey data will be password protected, and only the principal investigator and her project committee will have access to this data. There are no risks associated with completing this survey. Your responses are anonymous and the nursing staff at the facility will not have access to any of the completed surveys at any point. Your survey responses cannot negatively impact the quality of your care in any way. While you will not experience any direct benefits from participation, information collected in this program evaluation may benefit you or others in the future by helping us to improve the quality of nursing care provided in the facility. If you have any questions regarding the survey or this program evaluation in general, please contact the principal investigator, Olivia Glance, at 919-441-6663 or [email protected]. If you have any questions about your rights as a participant, please contact the IRB and Office of Human Research Ethics at the University of North Carolina At Chapel Hill at (919) 966-3113 or [email protected]. By completing and submitting this survey, you are indicating your consent to participate in this program evaluation.
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APPENDIX H: THE CARE MEASURE ADAPTED FOR NURSE COMPLETION
Please complete the following demographic information: Age: 18-29 30-39 40-49 50-59 60-69 70-79 80+ Years of nursing experience: < 5 5-10 11-15 16-20 21-25 > 25 Years of experience specifically in psychiatric nursing: < 5 5-10 11-15 16-20 21-25 > 25 Level of education: LPN RN – Associate’s Degree RN – Bachelor’s Degree MSN
Please think about your patient interactions BEFORE completing the training program.
Please tick one box for each statement and answer every statement.
How would you rate yourself BEFORE completing the training ... Poor Fair Good Very Excellent Does Good Not Apply 1. Making patients feel at ease... (being friendly and warm towards patients, treating them with respect; not cold or abrupt)
2. Letting patients tell their “story”... (giving them time to fully describe their illness intheir own words; not interrupting or diverting)
3. Really listening... (paying close attention to what patients were saying; not looking at the notes or computer as they were talking)
4. Being interested in the patient as a whole person... (asking/knowing relevant details about their life,their situation; not treating them as “just a number”)
54
5. Fully understanding patient concerns... (communicating that you had accurately understoodtheir concerns; not overlooking or dismissing anything)
6. Showing care and compassion... (seeming genuinely concerned, connecting with patients on a human level; not being indifferent or “detached”)
7. Being Positive... (having a positive approach and a positive attitude;being honest but not negative about patients' problems)
8. Explaining things clearly... (fully answering patients' questions, explaining clearly, giving patients adequate information; not being vague)
9. Helping patients to take control... (exploring with patients what they can do to improve their health themselves; encouraging rather than “lecturing” patients)
10. Making a plan of action with patients ... (discussing the options, involving patients in decisions asmuch as they want to be involved; not ignoring patients' views)
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Please think about your recent patient interactions AFTER completing the training program.
Please tick one box for each statement and answer every statement.
How would you rate yourself AFTER completing the training... Poor Fair Good Very Excellent Does Good Not Apply 1. Making patients feel at ease... (being friendly and warm towards patients, treating them with respect; not cold or abrupt)
2. Letting patients tell their “story”... (giving them time to fully describe their illness intheir own words; not interrupting or diverting)
3. Really listening... (paying close attention to what patients were saying; not looking at the notes or computer as they were talking)
4. Being interested in the patient as a whole person... (asking/knowing relevant details about their life,their situation; not treating them as “just a number”)
5. Fully understanding patient concerns... (communicating that you had accurately understoodtheir concerns; not overlooking or dismissing anything)
6. Showing care and compassion... (seeming genuinely concerned, connecting with patients on a human level; not being indifferent or “detached”)
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7. Being Positive... (having a positive approach and a positive attitude;being honest but not negative about patients' problems)
8. Explaining things clearly... (fully answering patients' questions, explaining clearly, giving patients adequate information; not being vague)
9. Helping patients to take control... (exploring with patients what they can do to improve their health themselves; encouraging rather than “lecturing” patients)
10. Making a plan of action with patients ... (discussing the options, involving patients in decisions asmuch as they want to be involved; not ignoring patients' views)
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APPENDIX I: INFORMED CONSENT FOR NURSES
INFORMED CONSENT FOR ANONYMOUS SURVEY
You are invited to participate in a program evaluation titled “Essential Therapeutic Communication Training for Mental Health Nurses: A Program Evaluation.” This program evaluation is being conducted by Olivia Glance for her doctoral project within the School of Nursing at the University of North Carolina at Chapel Hill. The purpose of this program evaluation is to determine the effectiveness of a program providing therapeutic communication skills training to mental health nurses. Participation in this program evaluation is entirely voluntary at all times. You can choose not to participate at any time. If you decide not to participate there will be no penalty or loss of benefits to which you are entitled, or any effect on your relationship with the investigator, or any other negative consequences. You are being asked to take part in this program evaluation because you are a nurse at Carolina House that completed the online therapeutic communication training. We would like to see how you would self-rate your therapeutic communication skills prior to completing the training versus after completing the training. If you agree to participate, you will be asked to fill out the following survey, which will ask you to self-rate your therapeutic communication skills before you completed the training, and to self-rate your skills now after you have completed the training. There are a total of 24-questions and the survey will take approximately 5-10 minutes to complete. All of your responses to this survey will remain anonymous and will not be linked to you in any way. The survey will not ask for your name; however, it will ask several demographic questions, including your age, years of experience, and level of education. You are not required to provide this information if you do not want to, and may leave the demographic section blank if you are not comfortable providing this information. You are free to withdraw from this program evaluation at any time. Data collected from completed surveys will be kept on the principal investigator’s laptop. Access
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to survey data will be password protected, and only the principal investigator and her project committee will have access to this data. There are no risks associated with completing this survey. Your responses are anonymous, and no one else at the facility will have access to any of your survey responses. Your responses will not negatively impact your job in any way. While you will not experience any direct benefits from participation, information collected in this program evaluation will be used to improve staff training methods, and to improve patient care. If you have any questions regarding the survey or this program evaluation in general, please contact the principal investigator, Olivia Glance, at 919-441-6663 or [email protected]. If you have any questions about your rights as a participant, please contact the IRB and Office of Human Research Ethics at the University of North Carolina At Chapel Hill at (919) 966-3113 or [email protected]. By completing and submitting this survey, you are indicating your consent to participate in this program evaluation.
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