Therapeutic Communication in Nursing

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Therapeutic Communication Techniques Nursing

Therapeutic Communication in Nursing

The ability of a nursing professional to communicate is critical in establishing a good nurse-patient relationship, also known as rapport. Nurses must be effective communicators; hence, understanding and utilizing therapeutic communication practices are vital.

When a nurse concentrates on the patient’s individual requirements during the therapeutic communication process, an efficient exchange of information occurs. Through practical therapeutic communication skills, the nurse can better understand and empathize with the patient’s suffering.

This article can help health care professionals gain a fresh look at the fundamentals of therapeutic communication in the field of nursing. This study guide aims to inform nurses about problems, aims, and types of therapeutic communication, and lastly, different therapeutic communication approaches to follow and non-therapeutic communication.

Common Nursing Problems in  Therapeutic Communication

There are numerous types of therapeutic communication issues, and they might differ depending on the individual and the situation. Different concepts and aspects had been investigated and identified as potential barriers to therapeutic communication; the following is a list of those identified as potential barriers:

  • Aspects of the illness itself
  • Factors of a demographic nature like age (e.g., there may be communication difficulties or cognitive deficits in elderly patients)
  • Societal and cultural setting.
  • Patients’ personality traits (which may hamper personalized care or communication)

 Goals and Objectives of Therapeutic Communication

Nurses can use therapeutic communication to achieve a wide range of objectives, which would include:

  • Get to know the patients as individuals, not just as patients.
  • Encourage the patient’s emotional expression. It makes it easier for the patient to convey their feelings.
  • Determine the most critical matter that the patient is experiencing at the time.
  • Educate the patient and his/her family members on how to care for oneself.
  • Assist the patient in determining a course of action that will result in a positive outcome that is also acceptable to others.
  • Keep abreast of the patient’s needs and expectations.
  • Analyze the client’s view of the problem as it develops, taking into account the specific actions (behavior patterns and signals) of the persons involved, as well as the client’s emotions and opinions about the event, others, and themselves.
  • Implement strategies geared toward meeting the specific demands of the client.

Verbal Versus Non-verbal Communication

  1. Verbal Communication Skills

Verbal communication involves the use of words an individual utilizes to convey thoughts, feelings, and emotions to one or more recipients. Verbal communication between nurses and patients should be clear in order to be therapeutic. Nontherapeutic tactics, on the other hand, should be avoided by nurses since they block off communication and complicate future interactions.

Recognizing and interpreting cues or indicators are both important. Cues are verbal or nonverbal signals that indicate keywords or difficulties for the patient. Finding cues is a result of active listening often; cue words given by the patient can assist the nurse in determining the next question to ask or the appropriate response. 

There should be no ambiguity when a nurse communicates to the client; the words are clear and do not need interpretation, and the speaker uses nouns rather than pronouns when conveying a specific message.

Direct, simple, and understandable questions are the hallmark of queries.  An important nursing skill is to make use of therapeutic verbal communication methods. The nurse selects approaches that facilitate engagement and improve communication between the patient and the nurse, depending on the purpose of the conversation and the patient’s ability to talk audibly.

Nonverbal Communication Skills

Non-verbal communication is a crucial part of therapeutic communication. It refers to the actions a person exhibits while delivering a verbal message. These may include:

  1. Facial Responses/Expression. There are many nonverbal messages that may be conveyed through facial expressions, and these expressions interact with the speaker’s words to convey their meaning.
  2. Vocal cues. In nonverbal communication, vocal cues are audible indications that go along with the message being sent. These include variations in emphasis, volume, timbre, tone, pace, and pauses in the speaker’s voice. Vocal cues can convey a range of emotions, from anger and anxiety to joy and even deafness; the tone of a person’s voice can indicate whether they are calm, irritated, or bored; pitch ranges from sharp and high to frightening and low; intensity refers to the ferocity and harshness and impact of the words; a word or phrase’s enunciation helps to draw attention to the subject matter, and the rate at which something was said is known as its speed.
  3. Eye contact. During communication, eye contact, looking into the other person’s eyes, is used to evaluate the other person and the atmosphere and to indicate whose time it is to talk; it increases during receiving but decreases while expressing.
  4. Body language. An important part of nonverbal communication is the use of body language, which includes a variety of gestures, positions, stance, postures, and motions; closed body configurations, for example, arms crossed across the chest or crossed legs. If the receiver/recipient is defensive or unable to embrace the engagement, a better body position to exhibit is to have legs that are uncrossed or only crossed on one side of the body. Similarly, sit facing the patient with both feet on the ground, knees parallel to one another, with the hands at the side of the body. 

Therapeutic Communication Techniques

Therapeutic Communication Nursing Scenerios

Determining the best therapeutic communication approach is crucial to the nurse-patient relationship. Here are several examples:

Therapeutic Communication Techniques Therapeutic Communication Nursing Examples  Rationale
Trying to find out more information/Seeking information  “I’m not sure I understand what you’re saying. Could you elaborate?”  Trying to make sense of the meaningless or ambiguous The nurse should ask for information to better understand the situation through contact with patients.
Acceptance Denotes acknowledgment and acceptance“I get what you’re saying.”   Nodding in agreementThe nurse’s acceptance implies that she has heard and understood what the patient is saying or extending.
Acknowledgment or giving credit where credit is due Indicating an understanding or commendation of, through recognition.  “Pleasant day, Ms…”   “You’ve accomplished everything on your to-do list.”  To show that the patient is valued as a person and an individual, the nurse may greet them by name, express awareness of their improvement, or point out specific efforts made by the client.
Validation based on mutual agreement or consent Trying to find common ground, to agree on the definition of words  “Let me know if what I’ve got is right or wrong.”  There must be a shared understanding of what each word means for a spoken conversation to be meaningful.
Giving oneself up for the sake of others Making oneself accessible.  “I want to sit down and talk with you for a while.”  The nurse can contribute their availability, curiosity, and eagerness to learn and understand the patient. 
Summarizing Sorting and synthesizing what has come before.       “So, to summarize…” “Did I understand correctly?”  A concise summary highlights the most significant parts of a debate and promotes participants’ knowledge and comprehension.  
Observational work Putting what the nurse sees into words.  “You appear to be highly anxious.”   “Do you feel uneasy…?”   “At what points in time do you find yourself particularly tense…?”Patients may find themselves unable to communicate verbally or clearly in some situations. Recognition of this pattern of behavior permits the patient to understand that his/her worry will be taken into consideration.
Translating thoughts and emotions into words Attempting to put into words the patient’s feelings that they only convey inferentially       Patient: “I am no longer alive.”    Nurse: “Do you mean to say that you feel lifeless?”   The patient’s words can appear meaningless or detached from reality when interpreted literally.  
Open-ended statements or questions The client is prompted to proceed via incomplete statements. Concerns that can’t be addressed in a single-word answer.“Explain your discomfort in further detail.”   “Can you describe your family to me?”  The patient is given the option of selecting the information that is most accurate to him/her and disclosing information in accordance with their capabilities.
Promoting expression Requesting that the client rate the quality of their experiences  “How would you describe your feelings on…?”   “Does this add to your frustration?”The nurse encourages the patient to think about people and situations through the lens of their values.  
Exploration and Inquisition Taking a deeper look at a topic or situation.   “Explain that more for me.”   “Could you give us a more detailed description?”It may be beneficial for patients to investigate if they’re dealing with issues in a superficial approach.
Formulating a plan of action or developing a strategy Encourage the patient to think about what kind of behavior would be suitable in different future scenarios.“What might you do to let off some steam in a healthy way?”  It may be beneficial for the patient to consider what they would do in similar circumstances in the future.    
Confrontation.  Responding to a mismatch between the patient’s statements and actions  Patient: “Her actions have caused a great deal of distress for me” While smiling.    Nurse: “You’ve mentioned that you’re upset, but you’re grinning as if nothing has happened.”It helps the client to identify possible areas for improvement.  
Reflecting Giving the patient all of their thoughts and actions back to themPatient: “Should I notify my doctor about this?” Nurse: “Do you believe you should?”Rationalizing one’s thoughts and feelings helps the client realize and embrace them.  
Restating Reiterating the basic point made  Patient: “I can’t go to sleep. I remain up throughout the night.”   Nurse: “You’re having trouble sleeping.” The nurse repeats the client’s statements in almost the same order that the client spoke to them.  
Setting boundaries Indicating what is expected of a person’s conduct         Nurse: “It appears that you are unclear about your actions at this moment.”   Patient: “It’s not clear what you’re referring to.”   Nurse: “There are a lot of personal queries you’re bringing up to me. You’ve come to see us because you’re having health problems, to treat you. I need to know more about what brought you here to the clinic?”Behavioral boundaries are established.  
Verbalizing what is implied Putting into words what the patient has implied or extended  Patient: “I’m unable to communicate with anyone, not even you. It’s pointless.”   Nurse: “Do you feel like no one understands?” Translating what the client has conveyed or said implicitly into words helps to clarify the conversation.  
Voicing doubt. Showing a lack of confidence in the client’s perceptions as true  “Isn’t that strange?”   “That’s a stretch to believe.” “Really?”  Doubt is another way of responding to misconceptions of truth.  

Non-Therapeutic Communication

Words, phrases, behaviors, and tones that are offensive to the patient’s mental and physical health may contribute to non-therapeutic communication, which might aggravate the patient’s condition. The following table shows some examples of non-therapeutic communication.

Non-Therapeutic ResponsesExamplesRationale
Giving reassurance“I wouldn’t be concerned about that.”Suggesting that there can be no reason to be concerned
Approving  “Wonderful!”  Giving unwarranted approbation implies that the behavior being commended is the only permissible behavior in society at large.
Probing or being inquisitive“When did you fall in love? tell me everything about it!”Asking the patient incessantly, which is so intrusive and threatening to privacy and confidentiality, should be avoided at all costs. In no situation should the patient be subjected to unrelated queries about their health.
DenyingPatient: “I’m worthless!”    Nurse: “Don’t be ridiculous!” Failing to admit the existence of an issue  
Interpreting  “What you’re really saying is…”   “What you are implying is…”   “This is what you’re saying inadvertently…”Helping the patient understand what he or she is experiencing by pointing out its implications  
Disapproval  “This is not good at all!”  The patient’s views and activities are being contested or objected to.
Agreement  “You’re right!”   “I concur!”Signifying agreement with the patient
Disagreement  “In no way, shape, or form do I agree with anything you say.”   “There’s no way that’s true!”Objecting to the patient’s suggestion  
Belittling sentiments voicedPatient: “I have no purpose in life. I’d rather be dead!”   Nurse: “Everybody is depressed.” Misreading the patient’s level of pain. Misinterpreting the level of discomfort felt by the patient.
Giving rejection“There is no need to talk about that!”Unwillingness to engage in or be involved in the patient’s beliefs, thoughts, and actions
Introduction of an unrelated topicPatient: “I wish I could die!”    Nurse: “Did you have any guests this weekend?” Shifting the focus  

Therapeutic Communication Nursing Scenarios

Whether they are facing a life-threatening disease, expecting a child, or preparing for surgery, most patients find it difficult to articulate their emotions. Having a nursing response that produces these kinds of feelings is beneficial in the long run. Make sure to pay special attention to any signals that the patient presents.

Scenario 1: Cancer: Responding in a manner that de-escalates the patient’s worry

The patient was taken to the hospital four days ago and was diagnosed with cancer. His doctor advised him that radiation and chemotherapy would be the ideal course of action. When asked about the proposed treatment, he stated his unhappiness as well as his concern and indicated that he was undecided as to whether or not he would proceed with it. This is the nurse’s most therapeutic answer to the situation:

  1. “There’s nothing to be scared of.” 
  2. “It is normal to be afraid. We’re doing everything in our power to help you.”
  3. “Everything is going to work out just great. We’ll make sure you’re well taken care of.”
  4. “I’ll call your family so you can discuss it with them.”

Option 1 and Option 3 are reactions that convey “don’t be concerned.” Fears expressed by the patient are not taken into consideration or acknowledged. On the other hand, option 4 intervention is not therapeutic since the nurse delegated responsibility to the family instead of taking responsibility or commitment to the care of the patient. The statement “It is normal to be afraid. We’re doing everything in our power to help you.” shows understanding and prevents emotional upheavals from arising.

Scenario 2: Dementia: Truthful and direct responses

An elderly woman was sent to the hospital because she was getting increasingly forgetful and unable to carry out her daily routine. When the nurse offers her a meal, she says: “My spouse and I will be having our meal together” This is the nurse’s most therapeutic answer to the situation:

  1. “That is not going to happen.”
  2. “Why do you think your husband is still alive?”
  3. “I’ve told you countless times that he had already passed away. It’s time for your meal now.”
  4. “Your husband is no longer with us. Please allow me to prepare your meal.”

Option 4 is the answer since it relatively addresses the patient’s signs of dementia. The patient needs to get back in touch with reality and stay focused on what is happening right now. Option 1 demonstrates attitude. Option 2 is related to the patient’s cognitive impairment, rendering her incapable of explaining. And because of the patient’s short-term memory or dementia, option 2 is ineffective.

Scenario 3: Mental Illness: Responses that pay attention to or are in some way connected to the client’s signals

A recently hospitalized OCD patient washes his hands repeatedly. This prevents unit activity attendance. Which of the following nursing statements is most appropriate in this situation?

  1. “We need to find a solution for you to engage in activities and wash your hands at the same time.”
  2. “Your ritualistic behaviors must be stopped immediately.”
  3. “How can I help you if you don’t want to participate in the therapy?”
  4. “Those with OCD must learn to regulate their ritualistic tendencies.”

Option 1 is the most appropriate response. Therapeutic communication involves coming up with a course of action and communicating it to the patient. This is done in a way that does not jeopardize the care activities and exacerbate their anxiety. Option 2 disregards the patient’s condition. Option 3 incites the patient’s negative thoughts. While option 4 lacks the ability to tolerate and comprehend

Scenario 4: Alcoholism: Helpful response to a sensitive situation

A male patient tells the nurse that drinking is the only thing that helps him relax when he’s nervous or anxious. What do you think would be the most helpful response?

  1. “What other methods have you tried to alleviate your stress besides drinking?”
  2. “It’s best if you try not to think about what is causing you stress.”
  3. “What makes you turn to alcohol as a coping mechanism?”
  4. “Don’t be alarmed, though. The weight of your troubles will lift, and you’ll no longer have to worry about getting drunk.”

Option 2 is not advisable as it invalidates the patient’s feelings. The statement “What makes you turn to alcohol as a coping mechanism?” in option 3 incites restatement. And option 4 is an example of a nontherapeutic approach that provides the patient false comfort and reassurance.

The statement “What other methods have you tried to alleviate your stress, besides drinking?” or option 1 is chosen as the most appropriate one for the given situation. The nurse is employing a therapeutic communication strategy known as a plan of action in order to help the client consider alternatives to drinking.

Scenario 5: Emotional/Physical Abuse: Responding in a manner that is sensitive to the patient’s emotions

The medical staff is called to the hospital to treat a 20-year-old college student who suddenly loses the ability to walk due to the abrupt development of paralysis of both legs. During the interview, Miya discloses that her boyfriend has coerced her into premarital sexual acts. The nurse’s most therapeutic answer is to say:

Nursing Stat Facts x
Nursing Stat Facts
  1. “Don’t let anyone force you into sex.”
  2. “It sounds like your paralysis is causing this problem.”
  3. “Do you mind if I ask how you feel about your lover pressuring you into sexual relations?”
  4. “If you’d like, I can put you in touch with a spiritual counselor.”

In this case, 3 is the correct answer to this question. People who need help can benefit from this remark because of the emphasis it places on being able to express their feelings. Option 1 does not further the therapeutic process because it effectively puts an end to the discussion. Option 2 only addresses the latent cause. Option 4 is not therapeutic due to the nurse’s delegation of responsibility to the counselor instead of taking ownership of the situation herself.

Conclusion

As a nurse, the ability to effectively convey and assist the patients in communicating their thoughts and feelings is a lifelong endeavor that positively impacts their well-being and therapy interactions. However, communication is also likely impaired by many health conditions and situations such as mental illness, acute confusion, psychosis, and terminal illness, while working in these situations, it is still critical to employ therapeutic communication techniques when interacting with each patient.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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