Therapeutic CommunicationTherapeutic Communication

NUR 3051NUR 3051

Rochelle Roberts MS RNRochelle Roberts MS RN

Therapeutic Communication –Therapeutic Communication –– Undertaken to carry out the nursing care planUndertaken to carry out the nursing care plan– Purposeful Purposeful – Has one or more goalsHas one or more goals– Aimed at meeting the needs of one of the Aimed at meeting the needs of one of the

participantsparticipants– Self-disclosure by the interviewer is limitedSelf-disclosure by the interviewer is limited

Social CommunicationSocial Communication

– May not have any specific goalMay not have any specific goal– May not be purposefulMay not be purposeful– Meets the needs of all the participantsMeets the needs of all the participants– May be significant self-disclosure of all May be significant self-disclosure of all

participantsparticipants

Aids to CommunicationAids to Communication

Active listeningActive listening– Expression of interestExpression of interest– Leaning forwardLeaning forward– Nodding headNodding head– Verbalizations such as “Uh-huh” and “Go on…”Verbalizations such as “Uh-huh” and “Go on…”– Frequent validationFrequent validation– Attempt to fully understandAttempt to fully understand

SilenceSilence– If you don’t know what to say, say nothingIf you don’t know what to say, say nothing– Gives patient time to thinkGives patient time to think– Gives nurse time to thinkGives nurse time to think– May allow patient to expand upon what he was May allow patient to expand upon what he was

saying or think of a new topic to discusssaying or think of a new topic to discuss– As anxiety grows, patient is more likely to say As anxiety grows, patient is more likely to say

somethingsomething

ExploringExploring– Trying to get the patient to expand upon a topic Trying to get the patient to expand upon a topic

or bring up another topicor bring up another topic– ““Would you tell me more about that?”Would you tell me more about that?”– ““What else makes you feel that way?”What else makes you feel that way?”

RestatingRestating– Pt.: “I couldn’t sleep all night.”Pt.: “I couldn’t sleep all night.”– Nurse:”You couldn’t sleep all night.” orNurse:”You couldn’t sleep all night.” or

“ “You couldn’t sleep all night?”You couldn’t sleep all night?”– Pt.: “My husband is very worried about me.” Pt.: “My husband is very worried about me.” – Nurse:”Your husband is very worried about Nurse:”Your husband is very worried about

you.”you.”

“ “Your husband is very worried about you?”Your husband is very worried about you?”

Theme IdentificationTheme Identification ““I’ve noticed that in all of the relationships I’ve noticed that in all of the relationships

that you have described, you’ve been hurt or that you have described, you’ve been hurt or rejected by the man. Do you think this is an rejected by the man. Do you think this is an underlying issue?”underlying issue?”

Paraphrasing Paraphrasing – Repeating what the patient says in different Repeating what the patient says in different

words words – Pt.: “I’m worried about my operation tomorrow.”Pt.: “I’m worried about my operation tomorrow.”– Nurse: “You’re concerned about tomorrow’s Nurse: “You’re concerned about tomorrow’s

surgery.” (or ?) surgery.” (or ?)

SuggestingSuggesting ““Have you thought about responding to your Have you thought about responding to your

boss in a different way when he raises that boss in a different way when he raises that issue with you?”issue with you?”

Reflecting or validatingReflecting or validating

- signifies understanding, empathy, interest, - signifies understanding, empathy, interest, and respect for the patient. It consists of and respect for the patient. It consists of repeating in fewer and different words the repeating in fewer and different words the essential ideas of the patient. (similar to essential ideas of the patient. (similar to paraphrasing) Reflection can refer to paraphrasing) Reflection can refer to content or feelings.content or feelings.

Open-ended questionsOpen-ended questions ““Tell me what happened?”Tell me what happened?” ““How are you today?”How are you today?”

Focusing –Focusing – ““Can we continue talking about your mother Can we continue talking about your mother

right now?”right now?”

Clarifying, validatingClarifying, validating ““I’m having some difficulty. Could you help I’m having some difficulty. Could you help

me understand?”me understand?”

HumorHumor ““That gives whole new meaning to the word That gives whole new meaning to the word

nervous,” (said with shared kidding between nervous,” (said with shared kidding between the nurse and the patient).the nurse and the patient).

SummarizingSummarizing

-”So far we have talked about..”-”So far we have talked about..”

InformingInforming ““I think you need to know more about how I think you need to know more about how

your medication works.”your medication works.”

Non-therapeutic CommunicationNon-therapeutic Communication

False ReassuranceFalse Reassurance– ““Everything’s going to be all right.”Everything’s going to be all right.”

– ““You’re doing just fine.”You’re doing just fine.”

– Pt.: “I’m afraid I won’t wake up from the Pt.: “I’m afraid I won’t wake up from the surgery.”surgery.”

– Nurse:”Sure you will.”Nurse:”Sure you will.”

Barriers cont.Barriers cont.

Giving approval or disapproval; being Giving approval or disapproval; being judgmental; agreeing or disagreeingjudgmental; agreeing or disagreeing– ““I wouldn’t say that.”I wouldn’t say that.”– ““Of course; I agree.” Of course; I agree.”

Barriers cont.Barriers cont.

Giving adviceGiving advice– ““If I were you…”If I were you…”– ““I think you should…”I think you should…”– ““It seems to me the best course of action is…” It seems to me the best course of action is…”

Barriers cont.Barriers cont.

DefendingDefending

– Pt.: “The nurses were very slow Pt.: “The nurses were very slow answering my light last night.”answering my light last night.”

– Nurse:”I don’t know how you can say that. This Nurse:”I don’t know how you can say that. This floor has the best nurses in the hospital.”floor has the best nurses in the hospital.”

Barriers cont.Barriers cont.

Minimizing feelingsMinimizing feelings– Pt.: “I’m quite scared about this surgery.”Pt.: “I’m quite scared about this surgery.”– Nurse:”Oh, everyone feels that way before an Nurse:”Oh, everyone feels that way before an

operation.”operation.”– Pt.: ”I really hate shots.”Pt.: ”I really hate shots.”– Nurse.”Don’t be silly. It’s just a little stick.”Nurse.”Don’t be silly. It’s just a little stick.”

Barriers cont.Barriers cont.

Changing the subjectChanging the subject– Pt.: “I hope someone comes to visit me today.”Pt.: “I hope someone comes to visit me today.”– Nurse:”It’s such a beautiful day today.”Nurse:”It’s such a beautiful day today.”

Social responseSocial response

- nurse uses superficial social conversation nurse uses superficial social conversation that is not client-centered.that is not client-centered.

- ““How does the coffee taste today?”How does the coffee taste today?”

Responsive dimensionsResponsive dimensions

Genuineness- the nurse is open, honest, Genuineness- the nurse is open, honest, and sincere.and sincere.

Respect- unconditional positive regard. The Respect- unconditional positive regard. The nurse’s attitude is nonjudgmental.nurse’s attitude is nonjudgmental.

Empathy- sensitivity to the pt’s current Empathy- sensitivity to the pt’s current feelings and the verbal ability to feelings and the verbal ability to communicate this understanding.communicate this understanding.