Effective Therapeutic Communication Research Articles

An assessment of nurse-patient therapeutic communication and patient satisfaction with nursing care in multiple healthcare settings: A Study in Saudi Arabia

Background: Effective therapeutic communication between nurses and patients is a fundamental element of high-quality healthcare. This study examines factors influencing therapeutic communication, including professional, contextual/situational, and patient-related aspects, while also assessing patient satisfaction with nursing care and the communication process.Methods: Employing a correlational cross-sectional design, a sample of 80 nurses and 99 patients under their care was selected using purposive sampling methods. This study encompassed diverse healthcare settings in Hail, Saudi Arabia. Data were collected through two survey questionnaires: the Nurse-Patient Therapeutic Communication Questionnaire for nurses and the Patient Satisfaction with Nursing Care Quality Questionnaire for patients. The data analysis was conducted using SPSS v29.0, with findings presented using descriptive and inferential statistics.Results: The professional dimension had a mean score of 5.56 ± 1.38, the contextual and situational dimension had a mean score of 5.69 ± 1.42, and the patient-related dimension had a mean score of 5.60 ± 1.46. Age, education level, and workplace significantly influenced all dimensions (all p < .001). Patient satisfaction scores ranged from 1.87 to 5.00, with an average score of 4.07 ± 0.72. Interestingly, patient satisfaction tended to increase with longer stays, r(97) = .23, p = .024, with the length of stay explaining 5.11% of the variability in patient satisfaction.Conclusions: This study identifies three key dimensions—professional, contextual/situational, and patient-related—as significant factors in nurse-patient communication. Demographic variables, including age, education, and workplace, also played pivotal roles. Notably, patient satisfaction levels were consistently high and positively correlated with longer stays. To foster patient-centred care, it is recommended to prioritize customized communication training and sustain nurturing interactions throughout the patient's care journey.

The Needs of Nurses to Improve Nursing Care for HIV-Positive MSM in Indonesia: A Qualitative Descriptive Study.

The existence of HIV-positive men who have sex with men (HIV-positive MSM) in Indonesia is controversial because it goes against current norms. As a result, they are unable to confide in themselves about their identities. Therefore, it is often difficult for nurses to identify those who need treatment. This study aimed to explore the needs of nurses to improve nursing care for HIV-positive MSM. The qualitative study with a purposive sample of 15 nurses participated in semi-structured and in-depth interviews. The data is analyzed by thematic analysis. Three key themes emerged:(1) effective therapeutic communication techniques for HIV-positive MSM, (2) increasing the skills and knowledge of nurses; (3) continuity of care. The need to improve the knowledge and skills of nurses in caring for HIV-positive MSM will impact the quality of nursing care and lead to better patient's center care. Furthermore, it will increase satisfaction with the nursing care provided.

THE RELATIONSHIP OF LENGTH OF STAY FACTORS WITH ANXIETY LEVEL OF THE PATIENT'S FAMILY IN THE EMERGENCY INSTALLATION OF IMMANUEL HOSPITAL BANDUNG

Introduction: The increasing number of patient visits in the Hospital Emergency Room (IGD) causes the phenomenon of overcrowding. The phenomenon of overcrowding is associated with an increase in unexpected events, service delays, increased mortality and length of hospitalization. The throughput factor is the main focus of crowding handling in the ER and an important indicator of the patient throughput process in the ER is the Emergency Department Length Of Stay (EDLOS). Too long a patient's time in the ER in getting special treatment, can give the patient's family a response to feel anxious and afraid. The purpose of this study was to analyze the relationship between the factors of length of stay and the level of anxiety of the patient's family in the Emergency Room at Immanuel Hospital.
 Method: uses quantitative research methods. The research design uses correlational analysis with a Cross Sectional approach. The population of patients who visited the ER in July-August 2022 was 1097 and the sample used was non-probability random sampling, through the calculation of the slovin formula, the number of samples was 91 respondents. The instruments used are observation sheets and questionnaires.
 Results: of the spearmen rank test obtained a p value of 0.000 <0.05, which means Ha is accepted, which means that there is a relationship between the factors of length of stay and the level of anxiety of the patient's family in the ER Immanuel Hospital.
 Conclusion: Emergency Department Length Of Stay (EDLOS) at Immanuel Hospital in the fast category includes; time for laboratory examination, review and consultation time, waiting time for transfer, while anxiety in families in the category of not having anxiety. recommendation are expected that health workers who carry out effective therapeutic communication in the ER can be further improved so that there is no prolonged length of stay which causes the patient's family to experience severe anxiety.
 
 Keywords : Length of Stay, Level of Anxiety, Emergency Room

Therapeutic Communication in Elderly Patients: A Systematic Literature Review

The aging process can cause changes in physical, cognitive, and social aspects. Some seniors may experience memory problems, speech difficulties, or hearing difficulties. These factors can affect their ability to communicate effectively, especially in a medical environment that is often complex and full of technical terms. In addition to physical challenges, older adults may also face feelings of loneliness, social isolation, or feelings of being unappreciated. This study aimed to explore the principles and strategies of effective therapeutic communication in interacting with the elderly. The literature search process was carried out on various databases (PubMed, Web of Sciences, EMBASE, Cochrane Libraries, and Google Scholar) regarding therapeutic communication in the elderly. This study follows the preferred reporting items for systematic reviews and meta-Analysis (PRISMA) recommendations. Therapeutic communication with the elderly is a communication approach that is empathetic, caring, respects patient autonomy, and uses language that is simple, clear, and easy to understand. Honesty and openness in conveying information about health conditions and prognosis are also important. Avoid giving false hope, but keep focusing on efforts and steps that can be taken to improve the quality of life for the elderly.

Effective Characteristics of Iranian Oncology Nurses in Their Therapeutic Communication With Cancer Patients

Objectives: Therapeutic communication is a central element of the nurse-patient interaction in providing quality care to cancer patients. The present study aimed to evaluate effective characteristics of Iranian oncology nurses in their therapeutic communication that might determine the nature of nurses’ communication patients with cancer. Materials and Methods: This was a qualitative study performed with a conventional content analysis method in 2020. The participants included 18 nurses working in oncology wards of educational and medical centers in northwestern Iran, selected by purposive sampling. In addition, data were collected using semi-structured interviews. Results: The qualitative data analysis led to the extraction effective characteristics of oncology nurses encompassed related of inner views and beliefs, family upbringing regarding therapeutic communication and personality characteristics. This is based on caringparticipatory attitude, empathy, trust, mutual respect. Inner satisfaction (Nurse’s and patient satisfaction), improved positive mutual approach (patient comfort and satisfaction with patient’s good feeling) positive outcomes of therapeutic communication nurses with cancer patients were. Conclusions: The establishment of effective therapeutic communication with cancer patients requires a change in the philosophy and attitude of nurses toward the potential skills of this area. In addition, nurses must have self-awareness of the importance of therapeutic communication in the improvement of patient quality care and consequences. Moreover, they should receive proper education in this area to meet their needs and encourage holistic and patient-centered approaches in these individuals.

Therapeutic Communication Strategies in Nursing Process of Angry, Anxious, and Fearful Schizophrenic Patients

Schizophrenia is a group of psychotic disorders with primary personality disorders, characteristic distortions of thought processes. Schizophrenic disorders are characterized by fundamental and characteristic distortions of thought and perception and incompatible or blunted effects. Anger, anxiety, and fear are the most common hallucinations in Schizophrenic patients. These feelings drive the continued negative behaviour of the Schizophrenic patient. The therapeutic communication technique in the nursing process is one of the techniques in the healing process of patients, especially those with mental disorders nursing problems. This study was conducted based on anxiety about the results of observations, preliminary research, and reports obtained about the number of therapy failures for Schizophrenic patients caused by communication errors during treatment. In this study, researchers aimed to determine the Therapeutic Communication of Nurses to Patients. This qualitative research uses a Quasy-experimental design using a One-Group Pre-Post Test Design research design. The conclusion emerged in the study that 22 people (88%) of respondents were in the Bad category in controlling negative thoughts. Meanwhile, three respondents (12%) have an excellent ability to control negative thoughts. There are also research results that show 3 variables that support effective and efficient therapeutic communication. These are Build Trust, Troubleshooting with Constructive Coping, and Giving Appreciation.

PENGARUH PELATIHAN KOMUNIKASI EFEKTIF TERHADAP CARING PERAWAT DI RUANG RAWAT INAP RUMAH SAKIT UMUM BALI ROYAL

Caring is a factor that affects the quality of nursing services and patient satisfaction. Caring behavior is not innate, but can be learned and practiced. Communication as a basic capital in caring behavior, it is very important to provide effective communication training or therapeutic communication to all nurses. This study aimed at determine the effect of effective communication training towards nurse caring in the ward at Bali Royal Hospital.
 The research method used is quantitative with Pre-Experimental One-Group Pretest- Postest Design. The research sample consisted of 50 nurses in the ward at Bali Royal Bali Hospital with a purposive sampling technique. Data were collected using a questionnaire and analyzed using the Wilcoxon Signed Rank Test statistic test.
 The results of the study were obtained from 50 respondents, the majority of respondents experienced an increase in caring behavior after the intervention / treatment of effective communication training as many as 49 people and the results of statistical tests showed that there was an effect of effective communication training towards caring nurses in ward at Royal Bali Hospital. Suggestions to nurses to improve the ability of caring behavior to increase patient satisfaction with services. Nurses should actively participate in training and be active in finding information related to caring behavior.

A Cross-Sectional Qualitative Study of Barriers to Effective Therapeutic Communication among Nurses and Patients

ABSTRACT Effective communication between patients and nurses is cardinal to health care The study seeks to explore barriers to effective therapeutic communication between patients and nurses in randomly selected health facilities in the Kumasi metropolis, Ashanti region, Ghana. The study employed an exploratory study to interview 60 respondents comprising 30 nurses and patients each, using an unstructured interview guide. In addition to nurses' and patients'perceived barriers, the study revealed the health environment–related barriers. Patients-related barriers include individual sociodemographic attributes, patient–nurse relationship, erroneous impression, and language barrier. Other identified nurses-related barriers include human resource challenges, patients' distrust in nurses’ competency, interference from patients’ relations, inadequate knowledge, patient’s dissatisfaction with output, patients’ emotional fluctuations. Health environment–related barriers also include excessive workload, unconducive environment, and environmental changes. Given the relevance of therapeutic communication to health service, the study, among other things recommends that efforts be exerted by sector actors to address the challenges and help promote quality in health-care service and delivery.

What Do Nursing Students Tell Us About Their Communication With People With Mental Illness? A Qualitative Study.

Communication with individuals with mental disorder (IMDs) may often be a nonlinear, complex, and variable situation. In general, the first contact of nurses with IMDs occurs during training rotations at a psychiatric clinic. Psychiatric nursing students' initial communication experiences with IMDs may be critical to their thinking of psychiatric nursing as a career. To determine the communication experiences of psychiatric nursing students with IMDs. A qualitative interview study was conducted with psychiatric nursing students studying at a nursing faculty in the east of Turkey in 2019 who completed the clinical practice. Semistructured interviews were conducted by an independent researcher. The data were analyzed using content analysis with an inductive approach. In this study, maximum effort was made for data saturation criteria, and data saturation was achieved with 26 students. As a result of the data analysis, four main themes and 11 categories were developed. The main themes were as follows: (1) restrictions caused by psychological barriers, (2) restrictions caused by thinking and perceptions, (3) restrictions caused by personal and behavioral barriers, and (4) effective communication and therapeutic environment. In this study, although it is seen that nursing students encounter many communication barriers with IMDs, it is an important development that they implement approaches to provide effective therapeutic communication. The results show the importance of effective nurse-patient communication skills as the first step in improving the clinical practice of nurses in psychiatry clinics.

A qualitative assessment of perceived barriers to effective therapeutic communication among nurses and patients

BackgroundTherapeutic communication is essential in the provision of quality healthcare to patients. The purpose of this study was to explore the perceived barriers to effective therapeutic communication among patients and nurses at Komfo Anokye Teaching Hospital,Kumasi.MethodsAn exploratory study design was employed using a qualitative approach. A purposive sampling technique was used to select 13 nurses and patients who were interviewed using an unstructured interview guide. Interviews were audio-taped, transcribed verbatim and analyzed using thematic content analysis.ResultsPatient-related characteristics that were identified as barriers to effective therapeutic communication included socio-demographic characteristics, patient-nurse relationship, language, misconception, as well as pain. Nurse-related characteristics such as lack of knowledge, all-knowing attitude, work overload and dissatisfaction were also identified as barriers to effective therapeutic and environmental-related issues such as noisy environment, new to the hospital environment as well as unconducive environment were identified as barriers to effective therapeutic communication among patients and nurses at Komfo Anokye Teaching Hospital,Kumasi.ConclusionNurse-patient communication is an inseparable part of the patients’ care in every health setting; it is one of the factors that determine the quality of care. Several patient-related characteristics, nurse- related characteristics and environmental-related issues pose as barriers to effective therapeutic communication at Komfo Anokye Teaching Hospital,Kumasi and have ultimately; resulted in reducing effective communication at the wards. Therefore, all the barriers must be eradicated to promote effective therapeutic communication.

Communication Issues and Challenges of Information Sharing, Care Plans and Treatment Modalities for Cancer Patients and Families Accessing Hospice and Palliative Care Services in Nigeria and South Africa

Background: The recent upsurge in the prevalence of cancer cases in Nigeria and other African countries is fast becoming a great challenge for the clinicians and urgently required holistic interventions. Most patients (60%–70%) usually present at an advanced incurable stage. Communication issues such as breaking bad news, discussions around treatment options, prognosis and advance care plans are often neglected. Cancer diagnosis is often synonymous to a death sentence and inadequate knowledge about disease trajectories and information sharing with patients and their families is often responsible for patients' frustration. A supportive palliative oncology teams play a critical role in facilitating and communicating between clinicians, patients and their families to bridge the gap and ensure effective therapeutic communication. Aim: In preparation for the forthcoming UICC African Cancer fellowship visit to the Life Abundant Palliative Care, Victoria Hospital in Wynberg, South Africa, a preliminary study will be made to identify relevant challenging issues and data among cancer patients at the Federal Medical Center Abeokuta Nigeria. Methods: A retrospective and prospective study will be performed of diagnosed cancer patients referred to the Pain and Palliative Medicine Department of the Federal Medical Centre Abeokuta, Nigeria between 2016 and 2017. Their diagnosis, treatment options, treatment compliance and defaults, offer of advance care plans, extent of interdisciplinary team and family involvement will be evaluated using the patients' case-notes. For surviving patients attending the pain and supportive palliative oncology clinic, their knowledge of the disease, treatment challenges, prognostication and family support will be identified and documented. Results: The observational gaps in the retrieved information and data about the treatment outcomes and interdisciplinary team support and challenges will form the basis or rather the prestudy platform for the planned fellowship visit on to the Life Abundant Palliative Care, Victoria Hospital in Wynberg, South Africa. The identified knowledge and skills gap would be used to design the final study in South Africa in August 2018. Conclusion: It is expected that the two studies will reflect communication issues and the approach to cancer patients' management in two different African clinical settings. The acquired lessons or experience during the second phase studies in the South Africa clinical setting would be translated to Nigeria practice and also shared at the 2018 UICC World Congress.

THE RELATIONSHIP OF NURSE KNOWLEDGE ABOUT THERAPEUTIC COMMUNICATION WITH IMPLEMENTATION OF THERAPEUTIC COMMUNICATION IN CHILDREN AGE OF PRASEKOLAH (6 YEARS) IN THE CARE ROOM 1 POLEWALI MANDAR RSUD

Background: Therapeutic communication is a way to foster therapeutic relationships between nurse-clients. In the communication process occurs the delivery of information, which can be used as an effective tool in providing nursing care to children. There are several possibilities of less successful therapeutic communication in children such as influenced by lack of knowledge of therapeutic communication, nurse attitude, education level, experience, environment, number of perceived power less and others. Treatment room 1 is a children's disease room with a bed capacity of 10 pieces with the number of preschool children as many as 18 people. According to Minister of Health Decree No. 262 year 2000 Ratio of number of beds with number of nurses in non-educational C type RS, 2 beds versus 3-4 nurses. Looking at the data on the number of nurses and the number of bed capacity in the treatment room 1 RSDU Polewali Mandar is very unbalanced, so the likelihood of successful therapeutic communication in children is reduced and can affect the knowledge and attitude of nurses in therapeutic communication in preschoolers. To overcome the problem one of them is by using effective therapeutic communication that will and is being done nursing actions such as digging perassaan, mind, behavioral changes so that will be able to solve psychological problems in preschool age children.The purpose of this study is to know the relationship nurse knowledge level about communication therapeutic with the implementation of therapeutic communication in 6-year-old preschool children in the treatment room 1 RSUD Polewali Mandar. with type of research using cross sectional study The population of this research is mother of balita which is in sub district of Matakali district Polewali Mandar with number 2389 mother of toddler. Sampling is done by total sampling method that is all nurses who work in treatment room I as much as 21 implementing nurses.wwwwwwThe results showed that there was a correlation between the level of nurse knowledge about therapeutic communication with the implementation of therapeutic communication in preschool age children (6 years) in the treatment room 1 RSUD Polewali Mandar. Means there is a tendency that the higher knowledge the better the implementation of therapeutic communication itself, especially in children with significant degree of significance p = 0.007> 0.05 means H1 is rejected and H0 received. Expected to the Public Hospital dareah Polewali Mandar In order to get the maximum service improvement, so that patients and visitors feel satisfied with the services provided.

Perceived barriers to effective therapeutic communication among nurses and patients at Kumasi South Hospital

Effective and skillful communication is a crucial and an important element when it comes to the quality of care. The aim of the study was to examine the perceived barriers to effective therapeutic ...

ACC/AHA/AACVPR/AAFP/ANA concepts for clinician-patient shared accountability in performance measures: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.

References 1992 Appendix 1. Author Relationships With Industry and Other Entities (Relevant) 1993 Appendix 2. Reviewer Relationships With Industry and Other Entities (Relevant) 1994 ### 1.1. Structure and Membership of the Writing Committee Members of the Writing Committee included experienced clinicians and specialists in cardiology, cardiac rehabilitation, quality improvement, outcomes research, epidemiology, and performance measures (PMs) methodology, as well as patient advocates. The Writing Committee also included representatives from the American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American Academy of Family Physicians (AAFP), the American Medical Association–Physician Consortium for Performance Improvement (AMA-PCPI), the American Nurses Association (ANA), the American Society of Health-System Pharmacists (ASHP), the National Committee for Quality Assurance …

Effective therapeutic communication knowledge of professional dental program students

Introduction: World Health Organization (WHO) declared the ultimate goal of medical education is to produce the five-star doctor, that doctor as a care provider, decision maker, manager, community leader, and communicator. Effective therapeutic communication can be learned and trained mainly on the professional program students. The purpose of this research was to obtain the data and information about effective therapeutic knowledge of professional communication dental program students. Methods: This research was a descriptive research with survey techniques. The sampling methods was simple random sampling from the questionnaire on 132 respondents. Results: The results of this research from the questionnaire shows the average level of effective therapeutic communication professional knowledge at student’s program in Dental Hospital Faculty of Dentistry Universitas Padjadjaran is 85%, 56% and classified as good level. Conclusion: Effective therapeutic knowledge of professional communication dental program students relatively good.

Effectiveness of Structured Teaching Module on Therapeutic Communication among staff nurses

Back ground: Effective therapeutic communication is the foundation of a mutually beneficial nurse- patient relationship, because it minimizes psychological difficulties during the care process and positively affects patient recovery. Studies have shown that 90 percent of all difficulties in nurse-patient interaction have resulted from miscommunication.As professionals spending the most time with patients and nursing home residents, nurses ultimately hold a position of obvious importance in the health-care team to satisfy the communication needs of patients. Objective: The present study aimed to determine the effectiveness of structured teaching module on therapeutic communication among staff nurses in selected hospital in Mangalore. Materials and methods: A pre - experimental research approach with one group pre-test post-test design was adopted for the study. The samples were selected by using non-probability convenient sampling technique. The sample consisted of 50 staff nurses. Results: The overall pretest mean knowledge score in the area of therapeutic communication was (42%) and interpersonal relationship was (33%) and post test score in the area of therapeutic communication (72%) and interpersonal relationship was (65.6%) and the obtained paired ' t' value is 24.11 which is significant at p<0.005 level. Conclusion: The findings of the study showed that the structured teaching module was effective in improving the knowledge on therapeutic communication among staff nurses. The nurse administrators have to plan for educational interventions and provide opportunities for staff nurses and student nurses to attend training programmes on therapeutic communication.

Exploring the Predictive Ability of Two New Complementary Instruments for Assessing Effective Therapeutic Communication Skills of Dental and Dental Hygiene Students

Research on the development of effective therapeutic communication skills for oral health providers is slowly evolving. One of the initial steps in this research is to identify and address gaps in the work of previous researchers. Ultimately, the educational goal of competence in communications skills development is to provide improved patient care including improved patient satisfaction. This article is the third in a series describing the development of and findings from the new complementary Patient Communication Assessment Instrument (PCAI) and Student Communication Assessment Instrument (SCAI). The aim of the study reported here was to look at the relationship between communication skills and patient and student clinician gender interactions, sociodemographic factors (e.g., age, income), and changes in these interactions with length of treatment. A total of 410 patient assessments (PCAI) and 410 matching student self-assessments (SCAI) were used for further data analysis. Patients of female student clinicians, female patients, patients of a higher and the lowest income range, and older patients reported statistically significant higher student communication scores. The PCAI identified that certain groups of patients consistently report higher scores than other groups, whereas the SCAI identified differences between male and female student clinicians. The results have implications for educational protocols, communication strategies, and the need for continued research regarding sociodemographic factors and their relationship to patient satisfaction.

The Use of Hi Fidelity Simulation to Enhance Nursing Students' Therapeutic Communication Skills

Nursing students entering psychiatric settings for clinical practice need a solid foundation of therapeutic communication skills. This article presents an innovative strategy for nursing students to practice therapeutic communication skills with psychiatric patients by using hi fidelity simulation with Laerdal SimMan. Using the SimMan vocal function enabled nurse educators to develop communication algorithms that allowed students to interact with SimMan as they would with psychiatric patients. The SimMan algorithms can be designed to mimic many scenarios typically found in psychiatric settings. Nursing students can use this technology to take the therapeutic communication skills they have learned in the classroom and practice them in a safe laboratory environment before entering actual psychiatric settings. The ability of students to practice communication skills prior to entering psychiatric settings can promote effective therapeutic communication skills and decrease student anxiety.

The nutritional dimension of physical assessment.

To prepare for the new millennium, dietitians, along with other health care professionals, are analyzing their roles and becoming cross trained in other, less traditional roles. One important aspect of the changing role of the dietitian is the incorporation of physical assessment skills into daily practice. Many dietitians are already using these skills, while others may find them a new challenge. Nutrition-focused physical assessment skills, as an addition to a professional background in dietetics, could be an important attribute in the next century, in view of the changing nature of the health care system. Why should dietetic professionals learn how to perform a nutrition-focused physical assessment? Because, in order to efficiently and effectively assist patients in meeting individualized nutrition goals and outcomes—whether those patients are in an acute care facility, home, or clinic environment—one must be able to completely assess and apply information obtained from several interrelated sources. These include the medical and dietary history, dietary intake, laboratory data, and the results of physical examination. The clinician cannot form a complete nutrition assessment with only one piece of this puzzle; rather all components must be carefully and methodically pieced together to make a complete picture.1–3 Dietetic professionals are the least familiar, in many cases, with the “physical,” hands-on aspects of care, which are so familiar to physicians and nurses and, therefore, may find it difficult to get a complete picture of the patient in order to develop the most effective nutritional plan of care. The nutrition-focused physical assessment includes the health history and physical examination. Before conducting the physical examination itself, an accurate nutrition health history is essential. The health history provides information that will lead to a focused physical evaluation by identifying underlying mechanisms that may place an individual at nutritional risk. Subjective findings are provided during the health history interview by the client, or by a family member or friend. Past and present factors affecting nutritional health, as well as nutrition-related health promotional measures, are assessed.4 The interview is begun with an opening question to find out the nature of the patient’s complaints, if any, and the present illness. It is important to utilize effective therapeutic communication techniques, such as facilitation, to encourage the patient to say

Humor in nursing practice: a phenomenological study

Humor is an important but underutilized resource in nurse-patient interaction. The multidimensional value of humor in providing nursing care has recently begun to receive attention. The purpose of this phenomenological study was to describe the meaning of nurses' use of humor in their nursing practice. Twenty-one registered nurses enrolled in a graduate nursing program described in detail an experience they had using humor in providing nursing care. The 21 written descriptions were analyzed using Colaizzi's phenomenological method. Five themes emerged in which humor was found to (a) help nurses deal effectively with difficult situations and difficult patients, (b) create a sense of cohesiveness between nurses and their patients and also among the nurses themselves, (c) be an effective therapeutic communication technique that helped to decrease patients' anxiety, depression, and embarrassment, (d) be planned and routine or be unexpected and spontaneous, and (e) create lasting effects beyond the immediate moment for both nurses and patients.