Therapeutic Communication NUR 3051 Rochelle Roberts MS RN

 Therapeutic Communication – – Undertaken to carry out the nursing care plan – Purposeful – Has one or more goals – Aimed at meeting the needs of one of the participants –Self-disclosure by the interviewer is limited

Social Communication –May not have any specific goal –May not be purposeful –Meets the needs of all the participants –May be significant self-disclosure of all participants

Aids to Communication  Active listening –Expression of interest –Leaning forward –Nodding head –Verbalizations such as “Uh-huh” and “Go on…” –Frequent validation –Attempt to fully understand

 Silence –If you don’t know what to say, say nothing –Gives patient time to think –Gives nurse time to think –May allow patient to expand upon what he was saying or think of a new topic to discuss –As anxiety grows, patient is more likely to say something

 Exploring –Trying to get the patient to expand upon a topic or bring up another topic –“Would you tell me more about that?” –“What else makes you feel that way?”

 Restating –Pt.: “I couldn’t sleep all night.” –Nurse:”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.” –Nurse:”Your husband is very worried about you.” “Your husband is very worried about you?” “Your husband is very worried about you?”

 Theme Identification  “I’ve noticed that in all of the relationships that you have described, you’ve been hurt or rejected by the man. Do you think this is an underlying issue?”

 Paraphrasing –Repeating what the patient says in different words –Pt.: “I’m worried about my operation tomorrow.” –Nurse: “You’re concerned about tomorrow’s surgery.” (or ?)

 Suggesting  “Have you thought about responding to your boss in a different way when he raises that issue with you?”

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

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

 Focusing –  “Can we continue talking about your mother right now?”

 Clarifying, validating  “I’m having some difficulty. Could you help me understand?”

 Humor  “That gives whole new meaning to the word nervous,” (said with shared kidding between the nurse and the patient).

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

 Informing  “I think you need to know more about how your medication works.”

Non-therapeutic Communication  False Reassurance –“Everything’s going to be all right.” –“You’re doing just fine.” –Pt.: “I’m afraid I won’t wake up from the surgery.” –Nurse:”Sure you will.”

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

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

Barriers cont.  Defending –Pt.: “The nurses were very slow answering my light last night.” –Nurse:”I don’t know how you can say that. This floor has the best nurses in the hospital.”

Barriers cont.  Minimizing feelings –Pt.: “I’m quite scared about this surgery.” –Nurse:”Oh, everyone feels that way before an operation.” –Pt.: ”I really hate shots.” –Nurse.”Don’t be silly. It’s just a little stick.”

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

 Social response -nurse uses superficial social conversation that is not client-centered. -“How does the coffee taste today?”

Responsive dimensions  Genuineness- the nurse is open, honest, and sincere.  Respect- unconditional positive regard. The nurse’s attitude is nonjudgmental.  Empathy- sensitivity to the pt’s current feelings and the verbal ability to communicate this understanding.