Unit 2.1: Therapeutic Communication

• Topic 01

  Verbal and Non-Verbal Communication Skills

  45 questions
• Topic 02

  Active Listening and Empathy

  45 questions
• Topic 03

  Communicating with Patients with Communication Difficulties

  45 questions
• Topic 04

  Breaking Bad News — The SPIKES Protocol

  45 questions

A few questions from this unit, with the answer and a full explanation. The complete bank is available when you start practising.

1. Which of the following correctly identifies a risk of failing to make reasonable adjustments for a patient with a communication disability?

   • A
     The risk is reputational rather than clinical; patients are unlikely to experience clinical harm from communication barriers
   • B
     The patient may be unable to communicate pain, consent, or refusal of treatment, creating direct patient safety and legal risks
     Correct answer
   • C
     The risk is primarily to staff confidence rather than patient safety
   • D
     Communication adjustments are only legally required when the patient has formally requested them in writing
   Explanation

   Communication barriers create multiple clinical and legal risks:

   • The patient cannot effectively communicate symptoms, concerns, pain, or preferences
   • Consent and refusal of treatment may be invalidated if the patient cannot fully understand or express their decision
   • Safeguarding disclosures may be missed
   • Care plans may not reflect the patient's true wishes

   The Mencap 'Death by Indifference' report (2007, updated 2013) documented deaths arising from communication failures in patients with learning disabilities. The Equality Act 2010 and MCA 2005 both create legal obligations that reasonable adjustments are not merely good practice but a statutory duty.

2. What does the Accessible Information Standard (NHS England, 2016) require of healthcare organisations?

   • A
     To provide BSL interpreters for all deaf patients on admission to any NHS service
   • B
     To ask patients about communication needs, record and flag these in the patient record, share information in accessible formats, and provide appropriate support including interpreters
     Correct answer
   • C
     To document communication difficulties only when they affect the patient's ability to consent to treatment
   • D
     To translate all written patient information into the 10 most commonly spoken languages in the UK
   Explanation

   The Accessible Information Standard (SCCI1605), mandated since August 2016 under the Health and Social Care Act 2012, requires NHS and social care organisations to:

   1. Ask patients about their communication needs
   2. Record these in the patient record
   3. Flag communication needs prominently
   4. Share information in the patient's required format
   5. Provide appropriate support (interpreters, alternative formats)

   It is a legally mandated standard, not optional guidance.

3. A patient begins to cry while describing their diagnosis. Which nursing response best demonstrates empathy?

   • A
     'I know exactly how you feel — I had a family member with the same diagnosis.'
   • B
     'Don't worry, lots of people recover from this condition — you'll be fine.'
   • C
     'Let me get the doctor — they'll be able to answer your questions better than I can.'
   • D
     'I can see this has been really difficult to hear. Would you like to take a moment, and we can talk about how you're feeling?'
     Correct answer
   Explanation

   An empathic response acknowledges the patient's emotional experience without minimising it or centring the nurse's own feelings. Offering space and naming the difficulty ('really difficult to hear') reflects the patient's experience back to them and invites further disclosure. Saying 'I know exactly how you feel' is considered presumptuous. Premature reassurance ('You'll be fine'), deflection to the doctor, and deferring the emotional conversation are all barriers to therapeutic communication.