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Synthesis Paper
Synthesis Paper
Synthesis Paper
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other staff to understand the needs of patients and plan how to improve their psychological
therapeutic relationship, especially with patients presenting with moderate to severe mental
illnesses (Kyaw et al.,2019). The nurses either lack knowledge or competency in maintaining
a therapeutic nurse-patient relationship. Sharma & Gupta (2021) state that therapeutic
implies that nurses and other staff should learn how to communicate effectively with patients
to help them achieve quality outcomes. Still, some nurses experience problems
communicating with patients due to a lack of adequate skills or being incompetent when
dealing with psychiatric patients. Cheraghi et al. (2021) state that educating nurses could help
improve how they communicate with patients. More research is needed to determine how
education can improve therapeutic communication. This literature synthesis paper will search
for evidence on the effectiveness of education modules in improving nurses' knowledge and
Search Methodology
CINAHL, and PsycINFO to identify studies that addressed how an education module on
criteria involved articles published in the previous five years, published in English,
systematic reviews and RCTs, and articles that addressed education modules on therapeutic
incorporated in the search to specify results. For example, Education module “AND”
Therapeutic communication “AND” nurses’ knowledge and competence. The search resulted
in 5126 studies. 4987 studies were excluded remaining 139 studies. Abstracts of the
remaining studies were reviewed and 128 were removed since they did not apply
recommended methodologies. The remaining 11 articles were analyzed and six were
excluded, leaving five articles; Gutiérrez-Puertas et al. (2020), Kyaw et al. (2019), Li et al-
(2019), Talevski et al. (2020), Hartley et al. (2020). These studies are explained below.
Literature Review
September 2019 and January 2020 to determine the impact of educational interventions on
nursing students and mental health staff nurses who provided regular care to psychiatric
patients. The search was performed on PubMed, CINAHL, and Web of Science. Articles
published in English between 2000 to 2020 were included. RCTs and quasi-experimental
studies were given priority. The study population included mental health nurses and
5,845 studies were retrieved from the search. 19 quantitative studies met the inclusion criteria
and were further included in the meta-analysis. An overall sample of 1295 participants
engaged in the included studies. Most studies were conducted in the mental health setting.
studies, three studies applied role-playing, and five applied development courses to promote
therapeutic communication. More than half (n=11) of the studies that used simulation as an
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communication since it provides realistic scenarios that enabled them to practice and evaluate
their skills in therapeutic communication. Participants also learn to interact with patients in
clinical settings, and this could help improve the quality of patient outcomes. The study has
strengths and limitations. Firstly, the systematic review enabled researchers to conduct a
broad search of studies that addressed communication between nurses and patients. Research
methods were systematically applied in the reviewed studies to improve the quality of
findings. A two-person analysis of the studies to include in the studies was done as well to
improve the reliability of findings. Some of the limitations that faced the study included the
elimination of studies not published in English. This might increase the level of bias by
ignoring other languages. Also, variability in the sample size, duration of studies, and
competencies among nurses and nursing students. PBL was compared with the traditional
teaching and learning approach. A literature search was performed on PsycINFO, EMBASE,
PubMed, and MEDLINE. RCTs and quasi-experiments that involved nurses and nurse
students as participants were eligible for inclusion. Only students that applied PBL as a
primary intervention and evaluated communication as an outcome were selected. The search
resulted in 1388 abstracts. 1001 studies were excluded and 84 were chosen for full-text
review. 12 articles remained for a comprehensive review. Eleven studies showed PBL
improved communication skills among nurses and nursing students. The approach equipped
them with the necessary skills to develop a therapeutic relationship with patients and solve
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presenting health issues. Eleven studies also displayed no difference in outcomes between
PBL and traditional teaching methods. Only one study showed that PBL differs from the
traditional teaching method. These findings implied that PBL has no specific variations over
literature to compare PBL and other education modules. Different databases were researched
resulting in many studies which were narrowed down based on the inclusion criteria. RCTs
were given priority during the selection and this improved the quality of evidence. Still, the
study had some limitations that affected the nature of the outcomes. For instance, there was a
lack of consistency in the length of intervention in different studies. Outcome indicators were
not consistent as well. The Sample size was also small to draw quality and accurate
outcomes. Finally, PBL intervention was too specific such that researchers could not identify
guidelines. A literature search using EMBASE, CINAHL, MEDLINE, and Cochrane Central
was done. Eligibility criteria were applied whereby RCTs, nonrandomized trials, case-
control trials, and quasi-experiments were prioritized. All studies were supposed to have
teach-back intervention in either the control or intervention group. The study aimed to test the
between practitioners and patients. Quality assessment was done to determine if the studies
met the quality standards. The search resulted in 2,738 studies, of which 20 studies met the
inclusion criteria. Nine studies were RCTs, four pre-post studies, two controlled clinical, and
one before and after study. Teach-back intervention was implemented by different
practitioners, including nurses (n=9), PCPs (n=2), and pharmacists (n=1). Five studies
applied brochures and written content for teaching, four studies applied a less structured
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technique, and two studies applied the teach-back method during patient discharge. Findings
showed that the teach-back strategy was the most applied teaching method (n=8). Five studies
applied group education modules, three applied interactive role-playings, and one applied
Evaluative and iterative strategies were incorporated into four studies. Nurses
received weekly emails to remind them to apply a teach-back strategy when communicating
with patients. Nineteen studies showed positive outcomes following the implementation of
the teach-back intervention. Nurses and other practitioners were satisfied with the teach-back
approach and they viewed it as a simple approach that could harness positive communication
with patients. Nurses were trained to assess patient needs and reflect on the best-practice
communication techniques. This study showed that teaching practitioners about the teach-
back method improved how they interacted with patients, hence improving therapeutic
communication. The study has several strengths. It applied a strong and comprehensive
search approach which made researchers identify all the possible studies that addressed the
topic. Also, only studies that addressed the teach-back method were considered and this
improved specificity and quality findings. The study has limitations as well. Only published
articles were included and this increased potential for publication bias. Half of the articles did
not give a detailed description of how the intervention was implemented. This made it
difficult to relate the intervention with health outcomes and participants’ experiences.
could improve the therapeutic alliance between nurses and patients. As the search was done
using Embase, MEDLINE, CINAHL, and PsycINFO. Eligibility criteria were applied
original, peer-reviewed, and articles written in English were included. Articles with an
intervention that aimed to improve therapeutic alliance between nurses and patients were
included. All studies were assessed for methodological quality before selection. A total of
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8,275 articles were retrieved and analyzed. Only eight met the inclusion criteria. The studies
that targeted nurses’ attitudes, such as group-based programs and staff training improve staff
knowledge but did not improve the nurse-patient therapeutic alliance. The study showed that
other factors, other than nurses' knowledge of improving therapeutic alliance might affect
The study had strengths and limitations which changed the outlook of findings. The
only strength is that it tested different interventions making it easier to compare and identify
different ways to promote the therapeutic alliance between nurses and patients. However,
several limitations make the study unreliable. For example, most of the studies applied weak
methodologies which affected the quality of findings. The number of selected articles was
also small such that it could not give realistic outcomes. Lastly, the study does not discuss a
as education modules.
Kyaw et al. (2019) performed a systematic review of RCTs and cluster RCTs to
health nurses. The research aimed to observe and analyze if digital education could help
mental health nurses develop quality communication skills in the future. A literature search
was performed based on PRISMA guidelines. Electronic databases used included MEDLINE,
Ovid, EBCSO, and Cochrane Central. Two reviewers were involved in data extraction.
Eligibility criteria were applied on RCTs that researched digital or blended education were
applied. Studies that compared digital education with other forms of learning were included
as well. Study participants were not excluded based on gender, age, or other
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sociodemographic factors. Assessment of the risk of bias was done using the Cochrane Risk
of Bias Tool. Data synthesis and analysis were done using SD and mean.
44,054 records were identified during the search whereby 43,287 were excluded since
they did not meet the eligibility criteria. Abstracts of the remaining articles were reviewed
and 28 of them were retrieved for further review. 12 articles were in the review, consisting of
2,101 participants. The remaining articles applied different modules of digital education such
as VP and online modules. Some studies applied traditional learning. The content of the
basic communication, ethical reasoning, and suicide risk management, among others.
Different tools were used to measure study outcomes, including Likert scales, OSCE, and
surveys. Four studies showed no significant statistical differences between digital education
and traditional learning in promoting communication skills among participants with patients.
Findings from one study favored online modules such as tutorials and virtual patient
simulation over traditional methods. One study found that medical students were more
analysis of results implied that all education modules can improve communication skills
One strength of the study is that it applied the systematic review and meta-analysis
regarding the language or robust screening. The study also involved risk assessment of
retrieved studies which eliminated possible articles that could weaken the quality of evidence.
The study has limitations as well. Most of the retrieved studies were conducted in high-
income countries which might affect the applicability and transferability of the analyzed
evidence in low- and middle-income countries. Secondly, most studies focused on skill
Literature Synthesis
Gutiérrez-Puertas et al. (2020) and Kyaw et al. (2019) state that education modules
learning can improve skills and knowledge among mental health nurses and nursing students
as they communicate with patients in the clinical setting. Simulation provides nurses with
realistic scenarios that enabled them to practice and evaluate their skills in therapeutic
communication. Li et al- (2019) and Talevski et al. (2020) state that teaching nurses about
specific approaches that promote therapeutic communication can improve how to interact
with patients. For instance, nurses should be reminded to apply learned methods, such as
problem-based learning and teach-back methods, when communicating with patients until
they develop the habit. Finally, Hartley et al. (2020) state that while there are different ways
to promote a therapeutic relationship between nurses and patients, interventions that targeted
nurses’ attitudes, such as group-based programs and staff training improve staff knowledge.
The authors of the five studies acknowledge the importance of educating nurses in improving
should be thoroughly reviewed so that it can be incorporated into staff training to improve the
qualitative studies
Overall Conclusion
The synthesis of literature has shown that education modules can improve therapeutic
should assess how nurses and staff interact with patients so that they can implement
evidence-based education programs that would help equip them with the necessary
knowledge and skills to improve their competence. The reviewed studies have recommended
skills among mental health patients. Further research can help identify different education
Intervention
The literature review and synthesis have shown that education modules can improve
therapeutic communication among nurses and patients. Several education modules were
learning, and traditional learning. Although two studies recommend simulation as the most
effective teaching approach, mental health facilities should identify their resources and select
the most applicable education module to implement to improve nurses' knowledge and
References
Cheraghi, F., Hooshangian, M., Doosti-Irani, A., & Khalili, A. (2021). The effect of peer
https://doi.org/10.1016/j.nepr.2021.102984
https://doi.org/10.3390/ijerph17072241
Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse-patient relationships
https://doi.org/10.1016/j.ijnurstu.2019.103490
Kyaw, B. M., Posadzki, P., Paddock, S., Car, J., Campbell, J., & Car, L. T. (2019).
https://doi.org/10.2196/12967
Li, Y., Wang, X., Zhu, X. R., Zhu, Y. X., & Sun, J. (2019). Effectiveness of problem-based
https://doi.org/10.1016/j.nepr.2019.04.015
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https://www.ncbi.nlm.nih.gov/books/NBK567775/
Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-
e0231350. https://doi.org/10.1371/journal.pone.0231350