Therapeutic

Communication with
Patients
Erika, M.Kep, Sp.Mat, PhD
Definition
• Therapeutic communication is a process in which the nurse
consciously influences on the patient or helps the patient in
better understanding through verbal and non-verbal
communication
• Therapeutic communication is a collection of techniques that
prioritize the physical, mental, and emotional well-being of
patients.
• In practical terms T communication in health care means
the use of certain strategies that encourage the patient to
express feelings and ideas
• face-to-face process of interaction that focuses on advancing
the physical and emotional well-being of a patient.
• From the psychological point of view therapeutic
communication is aimed at establishing a relation of trust and
mutual cooperation between nurses and users of health care
• type of communication is also known as communication of
feeling, support, understanding, compassion
• One of the main ways nurses establish trust with patients is
through communication Because nurses are likely to have
the most direct contact with patients, effective nurse-patient
communication is critical.
• Nurses use therapeutic communication techniques to provide
education and support to patients, while maintaining
objectivity and professional distance.
• Nurses also can utilize proven therapeutic communication
techniques that promote quality care
• The process of communication has various purposes or roles:
receiving and providing information, problem solving, decision
making, meeting the needs for affiliation, pleasure, escape
from other activities, rest and control over other people
Techniques of therapeutic communication
• Active listening
• Accepting
• Giving Broad Openings
• Encouraging Comparisons
• Making observations
• Sharing empathy
• Offering Hope and Humor
• Sharing feeling
• Touch
• Using Silent
• Providing information
• Seeking Clarification
• Focusing
• Paraphrasing
• Asking relevant questions
• Summarizing
• Confrontation
Active Listening

• Being attentive to what the client is saying, verbally and non-

verbally.
• Sit facing the client, open posture, lean toward the client, eye
contact, and relax.
• By using nonverbal and verbal cues such as nodding and
saying “I see,” nurses can encourage patients to continue
talking. 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.
Accepting
• Sometimes it’s necessary to acknowledge what patients say
and affirm that they’ve been heard.
• Acceptance isn’t necessarily the same thing as agreement; it
can be enough to simply make eye contact and say “Yes, I
understand.”
• Patients who feel their nurses are listening to them and taking
them seriously are more likely to be receptive to care.
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.
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.
Making Observations
• Making observations by commenting on how the other person
looks, sounds, or acts. Example:” you look tired” or “I haven’t
seen you eating anything today”
• 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.
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”.
Offering Hope and Humor
• Communicating a “sense of possibility” to others.
• Encouragement when appropriate and positive feedback.
• Example “I believe you will find a way to face your situation,
because I have seen your courage in the past”.
• Contributes to feelings of togetherness, closeness and
friendliness. Promotes positive communication in the following
ways; prevention, perception, perspective
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.
Silence
• At times, it’s useful to not speak at all. Deliberate silence can
give both nurses and patients an opportunity to think through
and process what comes next in the conversation. It may give
patients the time and space they need to broach a new topic.
Nurses should always let patients break the silence.
• Time for the nurse and client to observe one another, sort out
feelings, think of how to say things, and consider what has
been verbally communicated. The nurse should allow the
client to break the silence.
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”.
Seeking Clarification
• Similar to active listening, asking patients for clarification when
they say something confusing or ambiguous is important
• To check whether understanding is accurate, or to better
understand, the nurse restates an unclear or ambiguous message
to clarify the sender’s meaning. “I’m not sure I understand what
you mean by ‘sicker than usual’, 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.
Focusing
• Sometimes during a conversation, patients mention something
particularly important. When this happens, nurses can focus on
their statement, prompting patients to discuss it further.
• Patients don’t always have an objective perspective on what is
relevant to their case; as impartial observers, nurses can more
easily pick out the topics to focus on.
• 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
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?”
Summarizing
• Pulls together information for documentation. Gives a client a sense
you understand. It is a concise review of key aspects of an
interaction. Summarizing brings a sense of closure.
• Example “It is my understanding that your arm pain is a level 1 since
you’ve taken a Vicodin one hour ago. Taking your pain medication
before physical therapy seems to help you complete the activities
the doctor wants you to do for your rehabilitation. Is this correct?”
• Client responds “Yes It really helps to take the medicine before I do
my physical therapy because it helps reduce the pain in my arm.
• 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.
Confrontating
• 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.
• Helping the client become more aware of inconsistencies in
his or her feelings, attitudes, beliefs, and behaviors.
• Only to be used after trust has been established, & should be
done gently, with sensitivity: “You say you’ve already decided
what to do, yet you’re still talking a lot about your options.”
Happy learning