Therapeutic communication

Communication is a complex process of ______, _______, and ________ messages between two or more people. It is dynamic and ongoing, with each communication experience being unique between participants.

sending, receiving, and comprehending

basics of communication - 4 types - Communication that occurs within an individual, also known as “self-talk” or “internal monologue”. Your thoughts that you feed yourself all day long without saying anything out loud. - directly related to mental health

intrapersonal communication

basics of communication - 4 types -

Communication that occurs one-on-one with another individual. In nursing, this may be used when the nurse is obtaining a psychosocial history or when listening to a client discuss their feelings. Most of your communication with your patients will be considered interpersonal communication and will be the primary focus of this lecture.​

interpersonal communication

basics of communication - 4 types - Communication that occurs between two or more people in a group. As nurses, you may use small-group communication during daily “rounds” with the healthcare team or while discussing concerns with patients during a group therapy session. For those of you seeking a specialty certification such as a diabetes nurse or wound care nurse, you will likely lead education sessions.

small-group

basics of communication - 4 types -

Communication that occurs within large groups of people. What we traditionally may refer to as “public speaking”. Depending on where you are working as a nurse, you may have some opportunities for speaking in front of large groups at seminars or conferences – or maybe even as a professor someday!

public communication

The chosen words used to communicate a message. Always communicate in a patient’s preferred language (via interpreter), as well as avoid using medical jargon which can confuse patients.​

vocabulary

​meanings are objective, factual, and agreed upon by most people. Think of the literal, dictionary definition of a word.

denotative

emotional, cultural, or personal associations people attach to words.

connotative meaning

the ease of which a message can be understood. Are you speaking at the patient’s intellectual or cognitive level? Are you using slang words or abstract phrases?

clarity

the conciseness in which a message is spoken. In general, you want to aim to be clear and have _____ in your communication. This means you want to use the shortest, simplest communication while still delivering the complete message necessary.​

brevity

This refers to knowing when to communicate so that the patient is able to be attentive and receive the message. For example, if a patient is in pain, it will be difficult for the patient to accurately receive the message the nurse is trying to convey. From a mental health standpoint, we need to be aware of their cognitive state when communication. For example, if a patient is actively in mania or experiencing psychosis, they are not going to be able to focus or be oriented enough to receive many verbal messages.​

timing/relevance

the rate of speech, which communicates meaning to the receiver. Speaking rapidly may communicate the impression that the nurse is in a rush and does not have the time for the patient.​

pacing

The tone of voice, which can communicate a variety of feelings such as acceptance, judgment, and dislike. Be very careful and aware of yours when speaking with patients.​

intonation

how close should we stand to others when speaking

3-6 ft

engaged, empathic nonverbal cues from the nurse, not the patient.​

therapeutic presence

The use of communication to build and maintain a helping relationship with a client and their family - the purposeful use of communication to build and maintain a helping relationship with a client and their family.

therapeutic communication

purpose of therapeutic communication

• Explore thoughts, feelings, concerns, needs​

• Demonstrate empathy and concern​

• Obtain information for assessment​

• Promote positive behavior changes​

• Evaluate progress

usually require simple, straightforward language as they lack the ability to think abstractly.

They are also sensitive to nonverbal messages, so being especially mindful of nonverbal cues is important.

also respond well to communication at eye level, and bonus points if you are able to incorporate play into your interactions! ​

children

important to assess whether the client needs amplification to hear you, such as hearing aids or increasing the volume of your voice. It is important to face the client when speaking and minimize distractions. You may also need to allow extra time for the patient to respond to your statements.​

older adults

considerations to consider when communicating with your patients such as the presence of eye contact, amount of personal space, and use of touch.​

cultural

non-negotiables of therapeutic communication

adequate time, active listening, caring, empathy, nonjudgemental attitude, trustworthy/reliable, purposeful/planned

therapeutic communication is not _______, meaning the flow is not you share and then i share

reciprocal

clarifying techniques - Uses the client’s exact words.

Client – “I’m scared I’m going to relapse after I go home.”

Nurse – “You’re scared about relapsing after you go home.”

This technique shows you are listening, allows the patient to confirm or correct what was said, and encourages continuation of the conversation.​

restating

clarifying techniques - Directs the focus back to the client in order for the client to examine their feelings. Focuses on emotions rather than facts, and names or highlights feelings.

Client – “I don’t think anyone understands how stressed and overwhelmed I am.”

Nurse – “You’re feeling very stressed and overwhelmed.”

Helps the patient recognize and explore their emotions, encourages emotional expression, and demonstrates empathy.​

reflecting

Restates the client’s feelings and thoughts for the client to confirm what has been communicated. It typically involves rephrasing what the client said in your own words and is usually more concise.

Client – ““Since my diagnosis, I haven’t been able to sleep well. I’ve lost my appetite and have barely been able to eat a single thing. It’s all too much and I just feel exhausted all the time.”

Nurse – “It sounds like your diagnosis has really disrupted your sleep, appetite, and energy.”

Can help organize a patient’s thoughts, demonstrates understanding, and clarifies the meaning of what the patient is saying.

paraphrasing

Allows the nurse to gather more information regarding important topics mentioned by the client. Often involves open-ended questions to gain more depth, understanding, or meaning.

Client – “I’m not sure I can handle this.”

Nurse – “What part of this feels most difficult for you right now?”

encourages the client to elaborate, clarifies vague or incomplete statements, and can help uncover concerns.​

exploring

“Did I hear you correctly?”​

restating

“This is how you seem to feel.”​

reflecting

“This is what I understand you mean.”​

paraphrasing

“Tell me more about that.”

exploring

Allows time for reflection; careful of nonverbal behavior while utilizing

silence

Can be comforting and demonstrate caring; used cautiously in mental health

touch

Helping bring the client back to the most important/pressing issue = narrows the conversation

focusing

Reviews key points, themes, or decisions; reviews what has been discussed

summarizing

barriers to effective communication

• offering personal opinions

• giving advice

• minimizing feelings

• asking “why” questions

• giving false reassurance

• changing the topic

• asking irrelevant personal questions

• giving approval or disapproval

• excessive questioning

what makes communication therapeutic

purposeful, client-centered, and goal-directed