Therapeutic

Communication
 Communication
is a human, interactive process
that sends meaning,
information, message, emotions,
and/or beliefs from one human
being to another person or to a
group of people.
Connectedness and
interrelationships between and
among human beings occur
because communication
occurs.
RECEIVER SENDER
 Communication Process

Communication
is a two-way
process where an
exchange of
ideas, thoughts,
and emotions
takes place
through verbal or
nonverbal signals.
Phases of the Interview

Pre- Interaction

Introductory

Working

Summary and Closing phases.

 Introductory Phase
After introducing himself to the client, the nurse explains
the purpose of the interview, discusses the types of
questions that will be asked, explains the reason for
taking notes, and assures the client that confidential
information will remain confidential.
Working Phase

During this phase, the nurse elicits the client’s

comments about major biographic data,
reasons for seeking care, history of present
health concern, past health history, family
history, review of body systems for current health
problems, lifestyle and health practices, and
developmental level.
Summary and Closing Phase

 the nurse summarizes information obtained during

the working phase and validates problems and
goals with the client.
 She also identifies and discusses possible plans to
resolve the problem (nursing diagnoses and
collaborative problems) with the client.
 Finally, the nurse makes sure to ask if anything else
concerns the client and if there are any further
questions.
Communication During the Interview

The client interview involves two

types of communication—
nonverbal
 verbal.
Nonverbal Communication

 Nonverbal communication is as important as verbal

communication. Your appearance, demeanor, posture,
facial expressions, and attitude strongly influence how
the client perceives the questions you ask. Never
overlook this type of communication or take it for
granted.
 APPEARANCE
First take care to ensure that your appearance is
professional.
 DEMEANOR
Your demeanor should also be professional.
When you enter a room to interview a client,
display poise.
 Focus on the client and the upcoming interview
and assessment.
 FACIAL EXPRESSION
 Facial expressions are often an overlooked aspect of
communication. Because facial expression often shows
what you are truly thinking (regardless of what you are
saying),
 ATTITUDE
One of the most important nonverbal skills
to develop as a health care professional is
a nonjudgmental attitude.
 SILENCE
Another nonverbal technique to use
during the interview process is silence.
Periods of silence allow you and the
client to reflect and organize
thoughts, which facilitates more
accurate reporting and data
collection.
 LISTENING
 Listening is the most important skill to learn and develop fully in order to
collect complete and valid data from your client.
 To listen effectively, you need to maintain good eye contact, smile or
display an open, appropriate facial expression, maintain an open body
position (open arms and hands and lean forward).
2. Verbal Communication

Effective verbal communication is

essential to a client interview. The goal of
the interview process is to elicit as much
data about the client’s health status as
possible. Several types of questions and
techniques to use during the interview are
dis- cussed in the following sections.
 OPEN-ENDED QUESTIONS
Open-ended questions are used to elicit the
client’s feelings and perceptions. They typically
begin with the words “how” or “what.” An
example of this type of question is “How have
you been feeling lately?” These types of
questions are important be- cause they require
more than a one-word response from the client
and, therefore, encourage description. Asking
open- ended questions may help to reveal
significant data about the client’s health status.
 CLOSED-ENDED QUESTIONS
 Use closed-ended questions to obtain facts and to focus on spe- cific
information. The client can respond with one or two words. The questions
typically begin with the words “when” or “did.” An example of this type of
question is
“When did your headache start?”
Closed-ended questions are useful in keeping the interview on course. They can
also be used to clarify or ob-tain more accurate information about issues disclosed
in re- sponse to open-ended questions.
For example, in response to the open-ended question
“How have you been feeling lately?”
the client says,
“Well, I’ve been feeling really sick at my stomach and I don’t feel like eating
because of it.”
“When did the nausea start?”
Therapeutic communication (TC)

 is a process where
communication
techniques are
being used to
promote the
wellbeing of a
patient in a nursing
care profession..
Therapeutic Communication

is a collection of techniques that prioritize the

physical, mental, and emotional well-being of
patients
Active Listening

 Active listening involves showing

interest in what patients have to
say, acknowledging that you’re
listening and understanding, and
engaging with them throughout
the conversation.
 Nurses can offer general leads
such as “What happened next?”
to guide the conversation or
propel it forward.
Active listening
starts in the introductory period when a nurse begins
interacting with the patient. This technique requires nurses
to use their senses and attentiveness to analyze verbal and
nonverbal communication with conscientiousness to a
patient.
Active listening involves:
1.Listening to the patient
2.Comprehending or understanding what the patient is
saying
3.Retaining the information provided by the patient
4.Using the information provided by the patient to respond
in a caring and appropriate manner or propose a solution
Using Silence

Deliberate silence can give both nurses and

patients an opportunity to think through and
process what comes next in the conversation.
Accepting

Sometimes it’s necessary to acknowledge what

patients say and affirm that they’ve been
heard.
Giving Recognition

Recognition acknowledges a patient’s behavior

and highlights it without giving an overt
compliment.
 Offering Self

Hospital stays can be

lonely, stressful times;
when nurses offer their
time, it shows they
value patients and that
someone is willing to
give them time and
attention.
Giving Broad Openings

 Therapeutic communication is often most effective

when patients direct the flow of conversation and
decide what to talk about.
 To that end, giving patients a broad opening such
as
 “What’s on your mind today?” or
 “What would you like to talk about?” can be a
good way to allow patients an opportunity to
discuss what’s on their mind.
 Seeking Clarification
asking patients for clarification when they say
something confusing or ambiguous is important.
 Saying something like “I’m not sure I
understand.
Can you explain it to me?” helps nurses ensure
they understand what’s actually being said and
can help patients process their ideas more
thoroughly.
Placing the Event in Time or Sequence

Asking questions about when certain events

occurred in relation to other events can help
patients (and nurses) get a clearer sense of the
whole picture.
It forces patients to think about the sequence of
events and may prompt them to remember
something they otherwise wouldn’t.
Making Observations
 Observations about the appearance, demeanor, or
behavior of patients can help draw attention to
areas that might pose a problem for them.
 Observing that they look tired may prompt patients
to explain why they haven’t been getting much
sleep lately; making an observation that they
haven’t been eating much may lead to the
discovery of a new symptom.
Encouraging Descriptions of Perception

For patients experiencing sensory issues or

hallucinations, it can be helpful to ask about
them in an encouraging, non-judgmental way.
Phrases like “What do you hear now?” or “What
does that look like to you?” give patients a
prompt to explain what they’re perceiving
without casting their perceptions in a negative
light.
Encouraging Comparisons

Often, patients can draw upon experience to

deal with current problems. By encouraging
them to make comparisons, nurses can help
patients discover solutions to their problems.
Summarizing

 It’s frequently useful for nurses to summarize what

patients have said after the fact.
 This demonstrates to patients that the nurse was
listening and allows the nurse to document
conversations.
 Ending a summary with a phrase like “Does that
sound correct?” gives patients explicit permission to
make corrections if they’re necessary.
Reflecting

Patients often ask nurses for advice about what

they should do about particular problems or in
specific situations.
Nurses can ask patients what they think they
should do, which encourages patients to be
accountable for their own actions and helps
them come up with solutions themselves.
Focusing

Taking notice of a single idea expressed or even

a single word.
An example is “On a scale of 0 to 10 tell me the
level of the pain you are experiencing in your
great toe right now.”
Confronting

Nurses should only apply this technique after

they have established trust. It can be vital to the
care of patients to disagree with them, present
them with reality, or challenge their assumptions.
Confrontation, when used correctly, can help
patients break destructive routines or
understand the state of their situation.
Voicing Doubt

Voicing doubt can be a gentler way to call

attention to the incorrect or delusional ideas
and perceptions of patients.
 By expressing doubt, nurses can force patients
to examine their assumptions.
Offering Hope and Humor

Because hospitals can be stressful places for

patients, sharing hope that they can persevere
through their current situation and lightening the
mood with humor can help nurses establish
rapport quickly.
This technique can keep patients in a more
positive state of mind.
Sharing Empathy

The ability to understand and accept another

person’s reality, to accurately perceive feelings,
and to communicate understanding.
Example “It must be very frustrating to know
what you want and not be able to do it”.
Sharing Feelings

Nurses can help clients

express emotions by
making observations,
acknowledging feelings,
and encouraging
communication, giving
permission to express
“negative” feelings and
modeling healthy anger.
Using Touch

Most potent form of communication.

 Comfort touch such as holding a hand, is
especially important for vulnerable clients who
are experiencing severe illness.
Providing Information

Relevant information is important to make

decisions, experience less anxiety, and feel safe
and secure.
Example “Susie is getting an echocardiogram
right now which is a test that uses painless sound
waves to create a moving picture of her heart
structures and valves and should tell us what is
causing her murmur”.
Paraphrasing

Restating another’s message more briefly using

one’s own words.
It consists of repeating in fewer and fresher
words the essential ideas of the client.
 For example the client says “I can’t focus. My
mind keeps wandering.” The student nurse
says,” You’re having difficulty concentrating?”
Asking Relevant Questions

 To seek information needed for decision making.

 Asking only one question at a time and fully
exploring one topic before moving to another area.
 Open-ended questions allows for taking the
conversational lead and introducing pertinent
information about a topic.
 For example “What is your biggest problem at the
moment?” or “How has your pain affected your life
at home?”