Barriers of therapeutic relationship: The therapeutic relationship between patient and nurse is often filled with barriers that can generate obstacles for the relationship and, in the end, the health system as a whole (Sfoggia et al.,2014). There are many factors that hinder building a therapeutic relationship: language, professional jargon, communication impairment, and cultural diversity (ibid). Language: Language can be an obstacle to nurse-patient communication because a patient may not be able to speak the same language and therefore communication is not possible (Levin,2006). The best way to overcome this barrier is providing a translator who can explain a professional facilitator's message easily to the patient(ibid). For instance, if the nurse only speaks English but the patient is only able to speak Arabic, a translation to the patient of what the professional facilitator is saying leads to less chance of misunderstanding (ibid). Translation also allows a patient to feel comfortable through being able to speak in their own language (ibid). Medical jargon: Jargon is a technical language that is comprehended by people in a specific industry or area of work (Leblanc et al.,2014). Health professionals often use jargon to communicate with each other(ibid). For example, T.B. disease stands for tubercle bacillus and HIV stands for human immunodeficiency virus (Mccrary & Christensen,1993). Jargon often makes sense to health professionals but a patient who does not understand these acronyms will not understand such communication, leading to a barrier in therapeutic relationship between patient and health professional (Leblanc et al.,2014). Communication impairment: Patients with communication impairment such as blindness, deafness and speech impairment often feel isolated, frustrated and self-conscious (O’Halloran et al.,2009). Some patients are born with such disabilities or have developed them as a result of disease (ibid). Therefore, nurses should provide enough time in order to describe any issue to such patients so that they do not feel uncomfortable or censured by health professionals, who must remain impartial (ibid). Cultural diversity: Patients often have various differences (Leblanc et al.,2014).Some of these differences are due to a patient's illness, social status, economic class, education and personality(ibid). However, according to Kirkham (1998), the deepest differences might be cultural diversity. Beheri (2009) points out that many nurses believe if they just treat patients with respect, they will avoid most cultural issues. Nevertheless, avoiding misunderstanding can be achieved through some knowledge of cultural customs, which might help and enable nurses to provide better health care to patients (ibid). Facilitators of therapeutic relationship: UNCRPD (2006) states that the most fundamental human right in hospital is communication. Patients are required to be provided with an effective communication method by nurs ...

1. Barriers of therapeutic relationship:
The therapeutic relationship between patient and nurse is often
filled with barriers that can generate obstacles for the
relationship and, in the end, the health system as a whole
(Sfoggia et al.,2014). There are many factors that hinder
building a therapeutic relationship: language, professional
jargon, communication impairment, and cultural diversity
(ibid).
Language:
Language can be an obstacle to nurse-patient communication
because a patient may not be able to speak the same language
and therefore communication is not possible (Levin,2006). The
best way to overcome this barrier is providing a translator who
can explain a professional facilitator's message easily to the
patient(ibid). For instance, if the nurse only speaks English but
the patient is only able to speak Arabic, a translation to the
patient of what the professional facilitator is saying leads to
less chance of misunderstanding (ibid). Translation also allows
a patient to feel comfortable through being able to speak in their
own language (ibid).
Medical jargon:
Jargon is a technical language that is comprehended by people
in a specific industry or area of work (Leblanc et al.,2014).
Health professionals often use jargon to communicate with each
other(ibid). For example, T.B. disease stands for tubercle
bacillus and HIV stands for human immunodeficiency virus
(Mccrary & Christensen,1993). Jargon often makes sense to
health professionals but a patient who does not understand these
acronyms will not understand such communication, leading to a
barrier in therapeutic relationship between patient and health
professional (Leblanc et al.,2014).

2. Communication impairment:
Patients with communication impairment such as blindness,
deafness and speech impairment often feel isolated, frustrated
and self-conscious (O’Halloran et al.,2009). Some patients are
born with such disabilities or have developed them as a result of
disease (ibid). Therefore, nurses should provide enough time in
order to describe any issue to such patients so that they do not
feel uncomfortable or censured by health professionals, who
must remain impartial (ibid).
Cultural diversity:
Patients often have various differences (Leblanc et
al.,2014).Some of these differences are due to a patient's
illness, social status, economic class, education and
personality(ibid). However, according to Kirkham (1998), the
deepest differences might be cultural diversity. Beheri (2009)
points out that many nurses believe if they just treat patients
with respect, they will avoid most cultural issues. Nevertheless,
avoiding misunderstanding can be achieved through some
knowledge of cultural customs, which might help and enable
nurses to provide better health care to patients (ibid).
Facilitators of therapeutic relationship:
UNCRPD (2006) states that the most fundamental human right
in hospital is communication. Patients are required to be
provided with an effective communication method by nurses,
which depends on many factors relating to the patient as well as
skillful nurses who take time to communicate (Hemsley,
Balandin&Worrall, 2012). Not only does effective
communication permit patients to maintain control(ibid), it also
helps them to communicate effectively, exchange information,
manage pain, show politeness and enhance their relationships
for social convergence (Happ et al.,2004). In addition, patients
play a major role in maintaining their tone of voice through
indicating stress (Cruz et al.,2013). Tone of voice should

3. always be harmonious, comforting and present a sense of
situation constraints (ibid). Furthermore, body language
communication is a fundamental factor that facilitates a
therapeutic relationship (O’Brien& Shea,2011). Through
reading body language, nurses know what a patient is thinking
and feeling (ibid). Body language is like a polygraph machine
(ibid) in that it can be used to reveal hidden feelings and to
hinder nurses from sending out false or accidental messages to
others (ibid). Explication of body language requires nurses to
note and understand what certain postures and gestures are
likely to mean (ibid) in order to communicate smoothly and
effectively with patients. Touch is another form of non-verbal
communication (UNCRPD,2006). It is a very influential style of
non-verbal communication (ibid) as it generates a sense of
peace and increases the importance of exchanging information
(ibid). Touch is a fundamental tool in delivering a sense of
safety and has a powerful ability to relax patients (ibid). For
instance, when a patient is upset, a nurse would automatically
react by touching them in order to show care and let them feel
comfort (ibid).