Writing therapeutic letters in undergraduate nursing education: promoting relational skill development.

Although therapeutic letters (TLs) have been included in graduate nursing programs, studies have not examined the impact of TLs on the clinical learning of undergraduate students. This qualitative study was part of a larger project that introduced TLs into already established undergraduate clinical courses. Instructors prepared students for writing TLs by discussing their purpose and by providing a relevant article and examples. In all, 74 students participated in 12 focus group interviews. Interviews were audiotaped, professionally transcribed, and analyzed using qualitative description. Results suggest that TLs cultivate rapport building and the development of students' relational skills. Although the assignment promoted clinical learning and reflection on helping relationships for the vast majority of students, a few students treated TLs as an instrumental activity. Implications for educating health professionals are described.