Have you ever had students in clinical tell you they “don't know what to say” to patients? Or, have you overheard an interaction that students were having with their patients that was devoid of all therapeutic communication skills you thought they knew? The fear of not knowing what to say to patients is associated with increased anxiety among students during their mental health clinical rotations, according to Melrose and Shapiro (1999, p. 1455). Therapeutic communication skills are “fundamental to good nursing care and therefore important for nursing students to develop,” according to Grant and Jenkins (2014, p. 1375). Other than teaching the therapeutic versus nontherapeutic techniques outlined in textbooks, how can we improve student comfort and delivery of therapeutic communication skills? The purpose of this article is to share a communication assignment used in my mental health nursing course that yielded positive student feedback.
Grant and Jenkins (2014) conducted a literature review from 2002 until 2013 on how communication skills were being taught to prelicensure students. Several instructional strategies such as simulation, video clips of actors, standardized patients, and other cooperative learning activities were found, yet the use of instructional methods affording a more “realistic clinical situation” (Grant & Jenkins, 2014, p. 1379), such as simulation and standardized patients, were recommended. Pedagogical changes related to how communication skills are taught to prelicensure students has been recommended (Shorey, Siew, & Ang, 2018) as a solution to improve this vital skill set in nursing.
Are learning opportunities beyond the classroom available that would increase student comfort in knowing what to say before they begin their clinical rotations? The use of an online therapy and support website was incorporated into the mental health nursing course to facilitate student therapeutic communication skills. 7 Cups ( https://www.7cups.com/) is an online emotional support website that anyone can anonymously access to chat, via texting, with trained active listeners. Third-semester nursing students were required to complete the online training program to become an “active listener” volunteer. The training program reviews basic communication skills and incorporates interactive practice exercises that volunteers must complete and pass before receiving their certificate of completion. Initial training takes between 45 minutes to 1 hour to complete all required active listening modules online. Students were required to upload proof of their active listener status after the first week of their mental health nursing course. Individuals log onto the 7 Cups site anonymously to communicate with active listeners via text messages regarding various stressors and concerns, and actual trained therapists are available for individuals requiring counseling services. Trained active listeners are taught which circumstances require escalation to a therapist.
Students were required to submit weekly proof of at least one text chat interaction for 6 weeks throughout the course by uploading a screenshot showing date and time of their volunteer hours. Submissions were counted toward student clinical paperwork points. No personal identifying information can be exchanged between active listeners and those seeking emotional support. Students reported increased comfort with communicating online because they could access their textbook for leads of how best to respond to messages received during the chat. Not being directly in front of the person they were interacting with decreased their anxiety about the communication exchange. Some of student qualitative comments on the post-course survey include “I really enjoyed 7 Cups. It made me feel like I really helped someone,” “Having my list of communication skill examples helped me decide what to say back to the person,” and “I will continue to serve as an active listener even after this course.” Common issues encountered by students included having individuals make sexually explicit comments during the interaction and not knowing how to limit the amount of time they remained online with individuals. During the fall 2019 semester, this learning activity will be expanded on to compare student knowledge of therapeutic versus nontherapeutic techniques before implementing 7 Cups as a weekly assignment, and then at the end of the course to determine whether student active listener exchanges improve their understanding of communication skills.
Debbie T. Fitzgerald, PhD, RN, CNE
Joliet Junior College
- Grant, M.S. & Jenkins, L.S. (2014). Communication education for pre-licensure nursing students: Literature review 2002–2013. Nurse Education Today, 34, 1375–1381.
- Melrose, S. & Shapiro, B. (1999). Students' perception of their psychiatric mental health clinical nursing experience: A personal construct theory exploration. Journal of Advanced Nursing, 30(6), 1451–1458.
- Shorey, S., Siew, A. L. & Ang, E. (2018). Experiences of nursing undergraduates on a redesigned blended communication module: A descriptive qualitative study. Nurse Education Today, 61, 77–82. doi:10.1016/j.nedt.2017.11.012 [CrossRef]