Document Type : Research articles


1 Associate Professor, Department of Community Health Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran

2 MSc, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran

3 MSc, Department of Psychiatric Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran


Background: Effective communication is considered a key factor affecting patients and their family satisfaction. The Therapeutic Communication Helping Model (TCHM) facilitates comprehensive care delivery by focusing on effective communication.
Objectives: Evaluate the effects of nursing care based on the Therapeutic Communication Helping Model (TCHM) on patient and family satisfaction in the coronary care unit (CCU).
Methods: This quasi-experimental was conducted based on the posttest-only design between June and October 2017 in the Educational and Treatment Center of Mousavi in Zanjan, Iran. In this study, the time sequence sampling method was used. A total of 58 patients and 58 family members from CCU with inclusion criteria were included through the convenience method in each sequence as the control and intervention groups. One week after the end of the control group sampling, the sampling of the intervention group began. In the meantime, a 4-hour workshop was conducted twice for the ward nurses to get acquainted with TCHM. Trained nurses provided holistic nursing care based on TCHM for patients (n=58) and their family members (n=58). Data were collected using the Patient Satisfaction Instrument, and the Family Members Satisfaction Questionnaire for adult patients. The satisfaction rate of both control and intervention groups were assessed at the time of discharge. Data were analyzed using the Chi-square test, independent t-test, and paired t-test in the SPSS software (version 22) at the significance level of 0.05.
Results: The mean scores of patient and family satisfaction were respectively 3.47±0.84 and 3.91± 0.67 in the intervention group. In the control group, these values accounted for 3.14±0.5 and 3.20±0.78, respectively. The mean scores of patient and family satisfaction and their subscales in the intervention group were significantly greater than those in the control group (P<0.05).
Conclusion: The TCHM significantly improved patient and family satisfaction. It is suggested that by incorporating this model into nursing practice the delivery of care will be enhanced.


  1. Mohammadi A, Vanaki Z, Mohammadi A. Effect of Implementation of Motivational Program Based on “Expectancy Theory” by Head Nurses on Patients’ Satisfaction. Hayat. 2013;18(4):47-60.
  2. Joolaee S, Hajibabaee F, Jafar Jalal E, Bahrani N. Assessment of Patient Satisfaction from Nursing Care in Hospitals of Iran University of Medical Sciences. Hayat. 2011;17(1):35-44.
  3. Kardanmoghadam V, Movahednia N, Movahednia M, Nekoei-Moghadam M, Amiresmaili M, Moosazadeh M, et al. Determining patients' satisfaction level with hospital emergency rooms in Iran: a meta-analysis. Glob J Health Sci. 2015;7(4):260-9. doi: 10.5539/gjhs.v7n4p260. [PubMed: 25946934].
  4. Mortazavi S, Kazemi M, Shirazi A, Azizabadi A. The relationships between patient satisfaction and loyalty
  5. in the private hospital industry. Iran J Public Health. 2009;38(3):60-69.
  6. Ravaghi H, Salemi M, Behzadifar M, Mirghaed MT, Behzadifar M, Farhadi Z. Patients' satisfaction with medical emergency services in Iran from 2000 to 2017: A Systematic Review and Meta-Analysis. Iran Red Crescent Med J. 2018;20(1):1-12. doi: 10.5812/ircmj.58128.
  7. Ghamari-Zareh A, Hagi Zadeh V. The effect of peer review evaluation on quality of nurse's performance and patient's satisfaction. Iran J Nurs Res. 2010;22(62):8-21.
  8. Rajabpour S, Rayyani M, Mangolian shahrbabaki P. The relationship between Iranian patients’ perception of holistic care and satisfaction with nursing care. BMC Nurs. 2019;18(1):1-7. doi: 10.1186/s12912-019-0374-7. [PubMed: 31673246].
  9. Shafiei F, Zarei B, Tabiei S. the effect of primary nursing care on patient satisfaction after coronary angioplasty. S J Nursing, Midwifery and Paramedical Faculty. 2019;5(3):43-53.
  10. Karaca A, Durna Z. Patient satisfaction with the quality of nursing care. Nurs Open. 2019;6(2):535-45. doi: 10.1002/nop2.237. [PubMed: 30918704].
  11. Adistie F, Mediani HS, Nurhidayah I, Hendrawati S. The Implementation of therapeutic communication of nurses to the parents of pediatric patients in pre-operative stage. Belitung Nurs J. 2018;4(4):356-65 doi: 10.33546/bnj.439.
  12. Kwame A, Petrucka PM. Communication in nurse-patient interaction in healthcare settings in sub-Saharan Africa: A scoping review. Int J Africa Nurs Sci. 2020;12:1-22. doi: 10.1016/j.ijans.2020.100198.
  13. Ebrahimnia M, Ameriun A, Azizabadi Farahani M, Khodami Vishte HR. Satisfaction rate of hospitalized patients in military hospitals from presented services. J Mil Med. 2010;12(2):101-5.
  14. Nazari R, Babaalipour Mouziraji F, Sharif Nia H, Amini J, Akbari S. A comparative study on patient satisfaction with hospital services in Amol. Nurs Midwifery J. 2011;9(3):1-8.
  15. Papathanasiou I, Sklavou M, Kourkouta L. Holistic nursing care: theories and perspectives. Am J Nurs Sci. 2013;2(1):1-5. doi: 10.11648/j.ajns.20130201.11.
  16. Riley JB. Communication in nursing. United States: Elsevier Health Sciences; 2015.
  17. Khoshnodi Z, Reza Masouleh S, Seyed Fazelpour F, Kazem Nezhad Leyli E. The importance of fulfillment of family needs at critical care. J Holist Nurs Midwifery. 2017;27(3):67-73. doi: 10.18869/acadpub.hnmj.27.3.67.
  18. Kynoch K, Chang A, Coyer F, McArdle A. Developing a model of factors that influence meeting the needs of family with a relative in ICU. Int J Nurs Pract. 2019;25(1):12693 doi: 10.1111/ijn.12693. [PubMed: 30091252].
  19. McConnell B, Moroney T. Involving relatives in ICU patient care: critical care nursing challenges. J Clin Nurs. 2015;24(7-8):991-8 doi: 10.1111/jocn.12755. [PubMed: 25597494].
  20. Peplau HE. Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. New York: Springer Publishing Company; 1991.
  21. Knapp ML, Hall JA, Horgan TG. Nonverbal communication in human interaction: Cengage Learning. Boston: Cengage Learning; 2013.
  22. Potter PA, Perry AGE, Hall AE, Stockert PA. Fundamentals of nursing. United States: Elsevier; 2021.
  23. McCarthy B, O’Donovan M, Trace A. A new therapeutic communication model “TAGEET” to help nurses engage therapeutically with patients suspected of or confirmed
  24. with COVID-19. J Clin Nurs. 2021;30(7-8):1184-91 doi: 10.1111/jocn.15609. [PubMed: 33350012].
  25. Dossey BM. Core curriculum for holistic nursing. United States: Jones & Bartlett Learning; 1997.
  26. Labrague LJ, McEnroe-Petitte DM. Influence of music on preoperative anxiety and physiologic parameters in women undergoing gynecologic surgery. Clin Nurs Res. 2014;25(2):
  27. -73 doi: 10.1177/1054773814544168. [PubMed: 25078946].
  28. Madarshahian F, Hasanabadi M, Khazaei S. The Effect of preoperative cares with holistic approach prior to surgical procedure on the patient’s anxiety and fulfillment. J Holist Nurs Midwifery. 2015;25(1):45-53.
  29. Selimen D, Andsoy, II. The importance of a holistic approach during the perioperative period. Aorn J. 2011;93(4):482-7. doi: 10.1016/j.aorn.2010.09.029.
  30. Taylor D, Kennedy MP, Virtue E, McDonald G. A multifaceted intervention improves patient satisfaction and perceptions of emergency department care. Int J Qual Health Care. 2006;18(3):238-45 doi: 10.1093/intqhc/mzl002. [PubMed: 16537580].
  31. Zakeri moghadam M, Sadeghi S, ghyasvandian S, Kazemnejad A. Effects of comprehensive-care program on patients’ satisfaction with trauma in emergency department. J Cardiovasc Nurs. 2013;2(3):54-62.
  32. Dolatyari A, Sharififar S, Zareiyan A, Tadrisi D. Family satisfaction with care in the intensive care unit: Results of a multiple center study in selected military hospitals. Mil. Caring Sci. 2014;1(1):18-26. doi: 10.18869/acadpub.mcs.1.1.18.
  33. Vakili MM, Hidarnia AR, Niknami S. Development and Psychometrics of an Interpersonal Communication Skills Scale (A.S.M.A) among Zanjan Health Volunteers. Hayat. 2012;18(1):5-19.
  34. Azizi F, Hanifi N, Rabie Siahkali S, Haghani S. Investigating the Factors Affecting the Triple Dimensions of Patients’ Satisfaction of Those referred to the Emergency Department in -Zanjan, Iran in 2017. J Mil Med. 2018;20(5):538-45.
  35. Sarhadi M, Navidiyan A, Fasihi Harandi T, Kheykhaee A. Assessment of psychosocial needs of the family members of the patients hospitalized in ICU and CCU. Jccnursing . 2014;6(4):251-60.
  36. Karimi V, Hanifi N, Bahraminejad N, Faghihzadeh S. The effect of family-centered orientation program on prevention of delirium prevalence in patients with coronary artery disease:
  37. a clinical trial. Mil Caring Sci. 2015;2(2):104-14. doi: 10.18869/acadpub.mcs.2.2.104.
  38. Meadows C, Bastin A, Kaul S, Finney S. Family satisfaction on the intensive care unit. Crit Care. 2010;14(1):1-202. doi: 10.1186/cc8829.