Implementation and Preliminary Evaluation of a Therapeutic Communication Educational Module for Nursing Trainees in a Low-Resource Setting

This one-group pre-post quasi-experimental study demonstrates that a therapeutic communication educational module significantly improved the knowledge, confidence, and practical skills of nursing trainees in a low-resource setting in Kampala, Uganda.

The Gist

Imagine you are a nurse. Your job isn't just about giving medicine or changing bandages; it's about connecting with a scared, hurting human being. You need to know what to say, how to say it, and when to just listen. This is called Therapeutic Communication.

However, in Uganda, many nursing students felt like they were being asked to perform a high-wire act without a safety net. They were stressed, unsure, and only about 3.5% felt they were truly good at it. It was like trying to learn how to drive a car only by reading the manual, never actually getting behind the wheel.

This paper is the story of a new "driving school" designed specifically for these nursing students to fix that problem.

The Problem: The "Silent" Nurse

The authors noticed that while nursing students in Uganda were learning medical facts, they weren't getting enough practice on the art of talking to patients. Without these skills, patients feel ignored, get more anxious, and the nurses feel burnt out. It's like a chef who knows how to cook a perfect steak but has no idea how to talk to the customer who ordered it.

The Solution: The "Therapeutic Communication Module"

The researchers built a special training course (a module) to teach these skills. Think of this module as a gym for the heart and the voice.

They didn't just lecture the students. They used a recipe called the ADDIE model (Analysis, Design, Development, Implementation, Evaluation). Imagine building a house:

1. Analysis: Checking the foundation (What do students need?).
2. Design: Drawing the blueprints (Planning the lessons).
3. Development: Gathering the bricks (Creating the materials).
4. Implementation: Actually building the house (Teaching the class).
5. Evaluation: Checking if the roof leaks (Did it work?).

The Training: A Mix of Theory and Practice

The training lasted 45 hours and was a "blended" experience, meaning it mixed:

• Classroom time: Learning the rules of the road.
• Role-playing: Acting out scenarios (like breaking bad news) in a safe "skills lab" where mistakes are okay.
• Real-world observation: Watching experienced nurses handle difficult conversations.

It was like teaching someone to swim by first explaining the theory, then practicing in a shallow pool with a life jacket, and finally watching the pros swim in the deep end.

The Experiment: Before and After

The researchers gathered 41 nursing students (mostly women, with a few years of work experience already) and tested them before the training and after the training.

They measured three things:

1. Knowledge: Did they know the rules?
2. Confidence: Did they feel brave enough to speak up?
3. Skill: Could they actually do it in a practice session?

The Results: A Massive Leap Forward

The results were like watching a student go from failing math to acing the final exam.

• Knowledge: Their scores doubled, jumping from a median of 4 to 8.
• Confidence: They felt much more secure, with scores rising from 144 to 164.
• Skills:
  • Their ability to start a relationship with a patient improved from 12 to 17.
  • Their ability to deliver bad news (a very hard task) jumped from 9 to 16.

Basically, the training turned nervous, unsure students into much more capable communicators.

The Catch (Limitations)

While the results were great, the authors admit this was just a "preliminary" look.

• The "One-School" Problem: They only tested this at one specific nursing school. It's like testing a new recipe at one family dinner; it might taste great there, but we don't know if it works for everyone else yet.
• The "Short-Term" Problem: They tested the students immediately after the course. We don't know if they will remember these skills six months from now, or if they will actually use them when they are tired and stressed in a real hospital.

The Bottom Line

This study proves that you can teach nurses how to be better communicators if you give them the right tools and practice. It's not just about knowing medicine; it's about knowing how to connect.

The authors suggest that nursing schools should adopt this "gym" for communication skills, but they also need to keep watching the students over time to make sure the skills stick. If they do, the next generation of nurses will be better equipped to heal not just bodies, but spirits too.

Technical Summary

1. Problem Statement

Therapeutic communication (TC) is the foundation of nursing care, yet it is often a source of significant stress for student nurses. In the context of Uganda, specifically among Diploma Nursing Extension (DNE) students in Kampala, competence in TC is critically low, with only 3.5% of students exhibiting optimum skills. This deficiency is attributed to inadequate, unstructured training that typically occurs only during clinical rotations. Poor communication leads to sentinel incidents, job dissatisfaction, and compromised patient safety. There is an urgent need for structured educational interventions to equip nursing trainees with these essential interpersonal skills before they enter clinical practice.

2. Methodology

• Study Design: A single-group, pre-post quasi-experimental pilot study.
• Framework: The intervention was developed and evaluated using the ADDIE model (Analysis, Design, Development, Implementation, and Evaluation).
• Setting & Participants:
  • Location: St. Francis School of Nursing and Midwifery (SoNM), Nsambya Hospital, Kampala, Uganda.
  • Population: 41 Diploma Nursing Extension students (post-certificate trainees with ≥2 years of clinical experience).
  • Sampling: Census sampling (all eligible students enrolled).
• Intervention:
  • A 45-hour Therapeutic Communication (TC) module was developed using the Nominal Group Technique and validated via three rounds of the Delphi technique.
  • Content: Covered 5 topics and 22 subtopics, including verbal/non-verbal skills, relationship building, breaking bad news, and managing specific scenarios (e.g., emergency, palliative care).
  • Delivery: A blended learning approach combining face-to-face classroom sessions, online learning, and active teaching strategies (role-play, simulations, demonstrations, and guided clinical observations).
• Data Collection & Instruments:
  • Knowledge: 10-item multiple-choice questionnaire.
  • Perceived Confidence: A validated 49-item Likert scale (Cronbach's α = 0.96; Content Validity Index = 0.98).
  • Practical Skills: Observation checklists used in a skills laboratory to assess two specific competencies: (1) establishing a nurse-patient relationship and (2) breaking bad news.
  • Timing: Assessments were conducted immediately before and after the intervention.
• Statistical Analysis: Data were analyzed using STATA v17.0. Continuous variables were summarized using Median and Interquartile Range (IQR). The Wilcoxon-signed rank test was used to compare pre- and post-intervention scores, with significance set at p < 0.05.

3. Key Contributions

• Curriculum Development: Creation and validation of a culturally sensitive, 45-hour TC module specifically tailored for DNE students in a low-resource setting.
• Pedagogical Integration: Demonstration of how the ADDIE framework can be effectively applied to nursing education in developing countries, moving beyond theoretical instruction to include simulation and clinical observation.
• Validation of Tools: Utilization and confirmation of high psychometric properties for existing TC assessment tools within the Ugandan context.
• Evidence Base: Providing preliminary empirical evidence that structured educational interventions can bridge the gap in therapeutic communication skills among experienced nursing trainees.

4. Results

The study demonstrated statistically significant improvements across all primary outcome measures following the intervention:

Outcome Measure	Pre-Intervention Median (IQR)	Post-Intervention Median (IQR)	P-value
Knowledge Score (0-10)	4.0 (3.0, 5.0)	8.0 (7.0, 9.0)	<0.001
Perceived Confidence (Total Score)	144.0 (136.0, 153.0)	164.0 (155.0, 174.0)	<0.001
Nurse-Patient Relationship Skills (0-20)	12.0 (10.0, 14.0)	17.0 (15.0, 18.0)	<0.001
Breaking Bad News Skills (0-20)	9.0 (7.0, 12.0)	16.0 (14.0, 18.0)	<0.001

• Sub-group Analysis: Significant improvements were observed across sex, program (Nursing vs. Midwifery), and semesters 2 and 3.
• Exception: Participants in Semester 1 did not show statistically significant improvements in knowledge, confidence, or practical skills (p > 0.05), suggesting that the intervention may be less effective for students in the earliest stages of their diploma extension program or that sample size in this subgroup was insufficient.

5. Significance and Conclusion

• Clinical Impact: The study confirms that a structured, blended-learning educational module can significantly enhance the therapeutic communication competence of nursing trainees. Improved TC skills are directly linked to better patient outcomes, reduced anxiety, and enhanced patient safety.
• Policy Implication: The findings support the integration of dedicated, structured TC coursework into nursing curricula in low-resource settings, rather than relying solely on unstructured clinical exposure.
• Limitations: As a pilot study, it utilized a single-group design without a control group, limiting causal inference. The short timeframe prevents assessment of long-term skill retention or transfer to actual clinical practice. The sample was drawn from a single institution, affecting generalizability.
• Future Directions: The authors recommend longitudinal studies to assess sustained effectiveness and further research to evaluate the module's impact from the patient's perspective. They also suggest that training institutions adopt and adapt this module for broader implementation.

In conclusion, this study offers preliminary but robust evidence that targeted educational interventions are a viable strategy to address the critical deficit in therapeutic communication skills among nursing students in Uganda.