CHAPTER II

RELATED REVIEW OF LITERATURE

This chapter presents a review of foreign and local literature relevant to the study on

nursing students' use of therapeutic communication during clinical rotations. The purpose is

to explore the key concepts, communication techniques, and challenges associated with

therapeutic communication, which is essential for developing nursing competencies and

enhancing patient care.

Foreign Literature

Therapeutic Communication Skills in Nursing Students

According to the Journal of Caring Sciences, therapeutic communication is

“purposeful and goal-directed interactions by nurses to support patients’ physical and

psychological well-being.” Their study explains that effective communication skills are

crucial for delivering high-quality nursing care and fostering patient trust. Nursing students

often encounter significant difficulties in acquiring these skills, which can lead to reduced

confidence and affect their ability to build effective nurse-patient relationships during clinical

rotations. The article discusses how insufficient training and a lack of practical opportunities

may impede students’ communication development. It emphasizes the need for educational

curricula that comprehensively integrate communication skill-building to prepare students for

the complexities of clinical interactions. (Abdolrahimi et al., 2017)

Simulation to Enhance Therapeutic Communication Skills

Another study shows present simulation as an experiential learning strategy proven to

improve nursing students’ competency in therapeutic communication. Their investigation,

demonstrate “higher confidence and competence” in patient interactions, which reflects the

effectiveness of active practice in controlled, realistic environments. The article discusses

how simulation replicates real clinical challenges, allowing students to experiment with

communication techniques, receive immediate feedback, and refine their skills in preparation

for actual clinical encounters. This supports the goal of linking theoretical knowledge to

practical application and identifies simulation as a valuable pedagogical tool in nursing

education. (Blake and Blake, 2023)

Evaluation of Nursing Students’ Therapeutic Communication Skills

According to Nurse Education in Practice, assessing nursing students’ proficiency in

therapeutic communication reveals persistent difficulties in mastering vital skills such as

active listening, empathy, and non-verbal communication. Despite these challenges, students

acknowledge the important role that therapeutic communication plays in fostering patient

trust and improving healthcare outcomes. The study suggests that educational approaches

incorporating simulated patient interactions could enhance students’ proficiency in

communication. This article underlines the gap between theoretical understanding and

practical skill execution, emphasizing the necessity of iterative, hands-on learning to cultivate

effective communication abilities relevant to clinical nursing practice. (Mercan et al.,2025)

Therapeutic Communication with Pediatric Patients

In accordance with the Journal of Pediatric Nursing, addressing the communication

demands posed by pediatric patients, noting the importance of modifying both verbal and

non-verbal communication to align with children’s developmental stages. Their study reports

that successful therapeutic communication with pediatric patients hinges on building trust

through age-appropriate language, tone, and body language, as well as recognizing cues that
convey the child’s emotional state. The authors recommend targeted training in pediatric

communication during clinical practicums to ensure nursing students are equipped to engage

children effectively, which supports the broader research aim of understanding how students

tailor communication across different patient age groups. (Chang et al.,2024)

Nursing Educator's Role in Therapeutic Communication

Another study also explains that nursing educators play an essential role by providing

constructive feedback and modeling effective communication behaviors, thereby facilitating

student learning in therapeutic communication. Their presence and guidance contribute to

skill acquisition in clinical settings and assist students in overcoming challenges such as

nervousness and lack of confidence, aligning closely with the research objective to explore

ways education can enhance communication competencies during clinical rotations. (Mercan

et al.,2025)

Local Literature

Nursing Students’ Use of Therapeutic Communication during Clinical Rotations

According to the Divine Word College of Laoag Research Journal, it describes how

nursing students perceive therapeutic communication as a fundamental skill for clinical

practice. Their qualitative findings show that students actively adjust their communication

strategies according to patient age groups and cultural backgrounds, which improves clinical

confidence and strengthens patient rapport. This local perspective contextualizes how nursing

students apply various verbal and non-verbal techniques in real clinical environments,
directly coinciding with the research focus on communication adaptations to different patient

populations. (Reyes et al., 2022),

Barriers to Therapeutic Communication among Filipino Nursing Students

According to the International Scholars Conference Journal, nursing students in the

Philippines face notable obstacles that hinder effective therapeutic communication during

clinical practice. Language barriers are a significant challenge, as many students struggle

with patients speaking Tagalog or various regional dialects, which complicates verbal

exchanges. To mitigate this, students often rely on Filipino-speaking peers or clinical

instructors to facilitate communication. Non-verbal communication, such as gestures, facial

expressions, and the use of audiovisual aids, becomes essential to bridge gaps. Additionally,

students reported difficulty in establishing patient trust due to these linguistic challenges,

which sometimes led to feelings of dissatisfaction and decreased confidence in their

communicative abilities. The study also highlighted that institutional and peer support, along

with efforts such as informal language lessons, are crucial in helping students overcome these

barriers. This underscores the need for enhanced linguistic and cultural competence training

to improve therapeutic communication and patient-centered care among nursing students

(Santos & Cruz, 2024)

Therapeutic Communication in Filipino Nursing Practice

According to Vivo and Flores in the Bulatlat Health Section, therapeutic

communication serves as a mechanism for establishing trust and cooperation between nurses

and patients. It addresses not only the physical but also the psychosocial needs of patients,

which is crucial for delivering holistic care. The authors describe how nursing students

develop the ability to balance empathy with professionalism during therapeutic interactions,

fostering relationships that contribute significantly to patient satisfaction and overall well-
being. This balance is essential for effective nursing practice, enabling students to engage

authentically with patients while maintaining appropriate clinical boundaries (Vivo & Flores,

2022).

Tailoring Communication to Psychosocial Development Stages of Patients

According to the Philippine Nursing Review, the role of adapting communication

techniques according to the psychosocial developmental stages of patients is explained, based

on Erik Erikson’s theory of psychosocial development. Erikson's theory outlines eight

sequential stages from infancy to old age, each characterized by a psychosocial crisis that

influences an individual's emotional and social growth, such as trust versus mistrust in

infancy and identity versus role confusion during adolescence. Nursing students are

encouraged to modify their language, tone, and attitudes when caring for patients across

different stages—children, young adults, and older adults—to ensure that communication

aligns with the patients’ developmental needs and psychosocial contexts. This tailored

approach facilitates more effective therapeutic relationships, helping patients feel understood

and supported in a manner appropriate to their developmental phase. Consequently, Erikson’s

theoretical framework underpins the study’s categorization of communication strategies by

patient age groups, enhancing students’ ability to deliver personalized and context-sensitive

care (Lopez & Reyes, 2023).

Educational Interventions to Improve Therapeutic Communication among Nursing

Students

According to GMA News, reports on various educational interventions aimed at

helping nursing students overcome psychological barriers, particularly nervousness, which

can negatively affect their therapeutic communication skills. These interventions include
structured training sessions focused on building self-confidence and communication

competence before and during clinical rotations. Through workshops, role-playing, and

guided practice, students are better prepared to manage internal anxieties, thereby improving

their interactions with patients. The programs demonstrate that addressing emotional and

psychological factors within nursing education significantly contributes to cultivating

students' readiness for clinical practice environments. As a result, nursing students gain

greater effectiveness and assurance in their communication, which positively influences

patient outcomes and professional development (Cabuenas, 2022).

SYNTHESIS

Therapeutic communication is a fundamental skill for nursing students that enables

purposeful interactions that promote patient health, trust, and emotional support. Studies

emphasize that effective communication strengthens students’ clinical confidence and patient-

centered care. Despite this, students face several barriers, such as fear of making errors,

nervousness, lack of confidence, and challenges in adapting their communication style to

diverse patient needs. These obstacles can hinder the formation of effective therapeutic

relationships essential for quality nursing care.

The use of simulation and experiential learning techniques has been shown to improve

students’ confidence and competence by providing realistic practice in controlled

environments. Students often struggle with core skills like active listening, empathy, and non-

verbal cues, revealing a gap between theoretical knowledge and application. Successful

therapeutic communication requires adjusting verbal and non-verbal techniques according to

patient age, developmental stages, and psychosocial needs to foster trust and understanding.
 Challenges such as language barriers, cultural differences, time constraints, and

patients’ emotional states complicate communication in clinical settings. Students frequently

rely on peers and instructors for support in overcoming linguistic hurdles, and developing

cultural competence is crucial for effective patient engagement. Educational interventions

focusing on psychological readiness—such as workshops and role-playing—help students

manage anxieties and improve their communication effectiveness.

Thus, nursing students’ ability to tailor communication techniques to patient age

groups and psychosocial development, employ verbal and non-verbal methods, and overcome

diverse challenges is essential for building therapeutic relationships. Enhancing these skills

through comprehensive education and practical experience supports the development of

students’ clinical competence, patient trust, satisfaction, and holistic care quality.