Chapter 8

What are therapeutic communication techniques?

• Control your tone

• Be knowledgeable about the topic of conversation

• Be flexible

• Be clear and concise

• Avoid words that may have different interpretations

• Be truthful

• Keep an open mind

• Take advantage of available opportunities

• The means used to establish rapport and trust

• Caring, person-centered relationship

• Dynamic (both people involved are active participants)

• Purposeful and time-limited

• The person providing the assistance is professionally accountable for the outcomes

• Goals are determined cooperatively and defined in terms of the patient’s needs

• Dispositional traits: warmth, friendliness, openness, respect, empathy, honesty, authenticity, trust, caring, competence

• Rapport builders: specific objectives, comfortable environment, privacy/confidentiality, patient versus task-focused, using nursing observations, optimal pacing

Verbal communication

Depends on the understanding of language

What are therapeutic communication techniques?

• Control your tone

• Be knowledgeable about the topic of conversation

• Be flexible

• Be clear and concise

• Avoid words that may have different interpretations

• Be truthful

• Keep an open mind

• Take advantage of available opportunities

• The means used to establish rapport and trust

• Caring, person-centered relationship

• Dynamic (both people involved are active participants)

• Purposeful and time-limited

• The person providing the assistance is professionally accountable for the outcomes

• Goals are determined cooperatively and defined in terms of the patient’s needs

• Dispositional traits: warmth, friendliness, openness, respect, empathy, honesty, authenticity, trust, caring, competence

• Rapport builders: specific objectives, comfortable environment, privacy/confidentiality, patient versus task-focused, using nursing observations, optimal pacing

Verbal communication

Depends on the understanding of language

Nonverbal communication

• Facial expressions, gestures, eye contact, touch

• Space, time, boundaries

• Body movements, posture, and gait

• General physical appearance and mode of dress or grooming

• Sounds (moaning, crying, gasping, sighing)

Open-ended questions

The greatest advantage of this technique is that it prevents the patient from giving a simple yes or no answer, which can limit their response 

Example of an open-ended question

• Nurse: “What did your health care provider tell you about your need for this hospitalization?”

• Patient: “He told me that my blood pressure is dangerously high and that I need some special tests done while I am here.”

Closed-ended questions

• Used to gather specific information from a patient and to allow the nurse and patient to focus on a particular area; “yes” or “no”

• Often a barrier to effective communication

Example of a closed-ended question

• Nurse: “Did you finish your breakfast?”

• Patient: “Yes”

Validating questions

• Validating what the nurse believes they have heard or observed 

• Overusing validating questions and comments might lead the patient to think the nurse is not listening

Example of a validating question

• Nurse: “At home, you have been taking both a water pill and a blood pressure pill every day. Did you take them today?”

• Patient: “Yes, I took one of each with my breakfast.”

Clarifying questions

• The nurse should never assume understanding of the patient’s meaning; the nurse should ask for clarification if there is doubt. The use of a clarifying question or comment allows the nurse to gain an understanding of a patient’s comment.

• Can prevent possible misconceptions; however, overuse can lead the patient to believe that the nurse is not listening or lacks appropriate knowledge

Example of a clarifying question

• Patient: “I have never needed to take medicine before in my life.”

• Nurse: “Is this the first health problem you have had?”

• Patient: “Yes, I’ve always been healthy.”

Reflective questions/comments

Repeating what the person has said or describing the person’s feelings. It encourages patients to elaborate on their thoughts and feelings

Example of a reflective question/comment

• Patient: “I’ve been really upset about my blood pressure and have to take these pills.”

• Nurse: “You’ve been upset…”

• Patient: “I guess I’m worried about what could happen if my blood pressure gets too bad.”

Sequencing Questions

Place events in a chronological order to investigate a possible cause-and-effect relationship between events

Example of sequencing questions

• Nurse: “You mentioned your dad earlier. Did he develop complications related to high blood pressure?”

• Patient: “Yes.”

• Nurse: “What sort of complications?”

• Patient: “Kidney failure. He was on dialysis for years before getting a transplant.”

• Nurse: “Are you afraid this might happen to you?”

Techniques for Active Listening

• Sit when communicating with a patient

• Be alert, relaxed, and take your time

• Keep the conversation as natural as possible

• Maintain eye contact if appropriate 

• Use appropriate facial expressions and body gestures

• Think before responding to the patient

• Do not pretend to listen

• Listen for themes in the patient’s comments

• Use silence, therapeutic touch, and humor appropriately

Communication for Special Populations

• Use closed-ended questions (“yes” or “no” may be easier for them to answer)

• Watch body language 

• Face the patient directly and practice active listening 

• Use simple, direct language

• Use a translator if necessary, not the family (family may change what the patient is saying, translator will not)

• Vegetative state: talk to them normally, tell them what you are doing

Communication Techniques to Avoid in the Nurse/Patient Relationship

• Using medical jargon

• Failing to listen actively

• Displaying a lack of empathy

• Providing incomplete or confusing information

• Ignoring nonverbal cues