Therapeutic Communication

Therapeutic communication promotes understanding and can help establish a constructive relationship between the nurse and the client. Unlike the Social relationship, where there may not be a specific purpose or direction, the theraoeutic helping relationship is clinet and goal directed. A distinguished aspect of a therapeutic communication is it’s application to long-term communication interactions. Therapeutic Communication is is defined as face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient. Purposes: • To gather data and information to determine the client’s illness. • To assess and modify the client’s behavior. • To provide health education among clients. Therapeutic Communication Techniques Techniques Description Examples Using Silence Accepting pauses or Sitting quietly and waiting silences that may extend attentively until the client is for several seconds or able to put thoughts and minutes without feelings into words. interjecting any verbal response. Providing Using statements or can you tell me how it’s for you? General questions that (a) Perhaps you would like to talk Leads encourage a client to about.. verbalize (b) put a topic Would it help to discuss your for conversation and (c) feelings? facilitate continued Where would you like to begin? verbalization. And then what? Being Making statements that Rate your pain on a scale 1-10. specified and are specific rather than (specoific statement) tentative general and tentative Are you in pain? (general rather than absolute. statement) Yoou seemed unconcerned about your Diabetes. (tentative

Using openended question

Asking abroad questions that lead or invite the client to explore (elaborate, clarify, describe, compare or illustrate) thoughts or feelings. Open-ended questions specify only the topic to be discussed and invite answers that are longer than one or two words.

statement) You dont care about your diabetes anf you will never will. (absolute statement) I’d like to here more about that Tell me about... How have you been feeling late? What brought you to the hospital? What is your opinion? You said you were frightened yesterday. How do you feel now?

Providing appropriate forms of touch to reinforce caring feelings. Because tactile contacts vary considerably among individuals, families and cultures, the nurse must be sensitive to the differences in attitudes and practices of clients and self. Restating or Actively listening for the Paraphrasing clients basic message and then repeating those thoughts and feelings in similar words. This conveys that the nurse has listened and understood the clients basic message and also offers clients a clearer idea of what they have said. Seeking A method of making the clarification client’s broad over all

Using touch

Putting an arm over a clients shoulder. Placing your hand over the clients hand.

Client: I couln’t manage to eat any dinner last night not even the dessert. Nurse: You had difficulty eating yesterday. Client: Yes, I was very upset after my family left. Client: I have trouble taking to strangers. Nurse: You find it difficult taking to people you do not know? I’m puzzled. I’m not sure I understand that .

Perception checking or seeking consensual validation

meaning of message more understandable. It’s used when paraphrasing is difficult or when the communication is rambling or garbled. To clarify the message or confess confussion and ask the client to repeat or restate the message. A method similar to calrifying that verifies the meaning of specific words rather than the over all meaning of the message.

Would you please say that again? Would you tell me more?

Client: My husband never gives me any presents. Nurse: You mean he has never given you a present for your Bday and Christmas? Client: Well-not never. He does gets me something for my B-day and Christmas, but he never thinks of giving me anything at any other time. I’ll stay with you until your daughter arrives. We can sit here quitely for a while; we dont need to talk unless u want to. I’ll help you to dress to go home, if you like. Your surger is scheduled for 11am tomorrow You will feel a pulling sensation when a tube is remove from your abdomen. I do not know the answer to that, but I will find out to Mr. King, the nurse incharge. You trimmed yor beard and mustache and washed your hair I noticed you keep squinting your eyes are you having

Offering Self

Giving Information

Suggesting one’s presence, interest, or wish to understand the client without making any demands or attaching conditions that the client must comply with to receive the nurse’s attention. Prividingin a simple and direct manner, specific factual

Acknowledgi ng

Giving recognition, in a nonjudgemental way, of a change of behavior, an effort the client has

Clarifying time or sequence

made, or a contribution to a communication. Acknowledgement may be with or without understanding, verbal or nonverbal. Helping the client clarify an event, situation or happening in relationship to time. Helping the client to differentiate the real from the unreal

difficulty seeing?

Presenting reality


Helping the client expand on and develop a topic of important for the nurse to wait until the client finishes starting the main concerns before atempting to focus.


Directing ideas, feelings, questions or content back to clients enable to them to explore their own ideas and feelings about the situation.

Summarizing Stating the main point of and planning a discusion to clarify the relevant points discussed. This technique is useful at the end of an interview or to review a health teaching session.

Client: I vomited this morning. Nurse: was that after breakfast Client: I feel that I have been asleep for a weeks. Nurse: You had your operation Monday, and today is Tuesday. That telephone ring came from the program on television . I see shadows from the window covering. Your magazine is here in the drawer. It has not been stolen. Client: My wife says she will look after me, but I dont think she can, what with the children to care of, and they’re always after her about something-clothes, homework, what’s for dinner that night. Nurse: Sounds like you are worried about how well she can manage. Client: What can I do? Nurse: What do you think would be helpful? Client: Do you think I should tell my husband? Nurse: You seem unsure about telling your husband. During past hour we have talk about.... Tomorrow afternoon we have to explore this further In a few days I’ll review what you have learned about the actions and effects of your

It often acts as an insulin. introduction to future Tomorrow, I will look at your care planning. feeling journal. Barriers to Communication Aspects or conditions in a workplace that interfere with effective exchange of ideas or thoughts. Such barriers include (1) status differences, (2) gender differences, (3) cultural differences, (4) prejudices, and (5) the organizational environment. Technique Stereotyping Barriers to Communication Description Examples Offering generalizedand Two years old are brats. oversimplified beliefs about Women are complainers. groups of people that are Men dont cry. based on experiences too Most people dont have any limited to be valid. These pain after this type of responses categorize clients surgery. uniqueness as individual. Akin to judgemental Client: I dont think Dr. response, agreeing and Broad is a very good disagreeing imply that the Doctor. He doesnt seem client is either right or intersted to his patients. wrong and that the nurse is Nurse: Dr. Broad os head of in a position to judge this. a Department of Surgery These responses deter and is an excellent clients from thinking surgeon. through their position and may cause a client to become defensive. Atempting to protect a Client: Those night nurses person or health care must sit around and talk all services from negative night. They didn’t answer comment. These responses my call light for over an prevent client to express hour. true concerns. Nurse: I’ll have you know we literally ran around onnights. You’re not the only client you know.

Agreeing and Disagreeing

Being defensive


Giving a response that make clients prove their statement or point of view. This responses indicate that the nurse is failing to consider the clients feelings, making the clienr feel it necessary to defend a position.




Asking for information chiefly out of curiosity rather than with the intent to assist the client. These responses are considered prying and violate the clients privacy. Asking WHY” is often probing and places the client in a defensive position. Asking the questions that make the client admit to something. These responses permit the client only limited answers and often meet the nurse’s need rather than the client’s. Refusing to discuss certain topics with the client. These responses often make client feel that the nurse is rejecting not only their communication but also the client themselves.

Client: I feel nauseated after that red pill. Nurse: Surely you dont think I gave you the wrong pill? Client: I feel as if I’m dying. Nurse: How you feel that way when your pilse got 60? Client: I believe my husband doesnt love me. Nurse: You can’t say that, Why he visits you everyday? Client: I was speeding along the street and didn’t see the stop sign. Nurse: Why were you speedy? Client: I didn’t ask the doctor when he was here. Nurse: Why didn’t you? Who do you think you are? Do you think, I’m not busy?

I dont want to discuss that. Lets talk about... I can’t talk now. I’m on my way for cofee break.

Changing Topics and subjects

Directing the Client: I’m separated from communication into areas my wife. Do you think I of self-interest rather than should have sexual relation

Unwarranted reassurance

Passing judgement

Giving common advice

considering the clients concerns is often a self protective response to a topic that causes anxiety. These responses imply that what the nurse considers important will be discussed and the clients should be not discuss certain topics. Using Cliches or comforting statements of advice as a means to reassure the client. These response block the fears, felings and other thought of the client. Giving opinions and approving or disapproving responses imply that the client must think as the nurse thinks fostering clients dependents. Telling the client what to do. These responses deny the clients right to be an equal partner. Note that giving expert rather than common advice is therapeutic.

with another woman? Nurse: I see that you’re 36 and that you like gardening. This sunshines is good for my roses. I have beautiful rose garden.

You’ll feel beter soon. I’m sure everything will turn out alright. Dont worry. Thats good. (bad) You should’nt do that. That’s not good enough. What you did was wrong (right)? Client: Should I move from my home to nursing home? Nurse: If I were you, I’d go to a nuring home, where you’ll get your meals cooked for you.

Cognitive Impairements: Any disorders that impairs cognitive functioning (eg. Cerebrovascular disease, Alzheimers disease, and Brain tumors or injuries) may afect the clients ability to use and understand language. These clients may develop total loss of speech, impaired articulation or the inability to find or name words. The nurse assessess wether these clients respond when ask a question and, If so, assesess the following: Is the client speech hesitant or fluent? Does the client use words correctly? Can the client comprehend instructions as evidenced by following directions? Can the

client repeat words or phrases? In adition, the client the nurse asesess the the clients ability to understant writen words: can the client follow the written directions? Can the client respond correctly by pointing a writen word? Can the client read aloud? Can the client recognize words or leters of unable to read a whole sentence? The nurse use large clearly writen words when trying to establish abilities in this area. Physically Impairements: Speech difficulties and disorders are those that are related to an individual’s ability to verbally communicate. In some cases speech difficulties and disorders are in and of themselves, however, in some cases these difficulties and disorders are the result of an associated condition or impairment. For some individuals it is a physical impairment such as a cleft lip, cleft palate or vocal cord disorder that results in the speech difficulties, which makes verbal communication inefficient. In theory, if these impairments are treated or corrected then the speech difficulty will improve or even disappear, however in reality the prognosis for each individual will be unique.

Sign up to vote on this title
UsefulNot useful