Therapeutic Communication and Interview Techniques (Video Notes)

Core ideas about humor in therapy

• Humor in a therapeutic relationship can release psychological energy and help patients engage, but it must be used carefully; misuse can be destructive.
• Humor should facilitate openness rather than masking issues; otherwise it may undermine trust.

The purpose of interviewing and why we learn interviewing techniques

• Effective interviewing is foundational for gathering accurate assessment data (health history, H and P).
• Questions should be purposeful and tailored to elicit necessary information from the patient.
• The interviewer should not be overly gentle to the point of missing information; they should encourage openness.
• Explaining why questions are asked helps patients respond more honestly and share more information (builds trust).
• Example: in a pet ER story, explaining why a protocol is asked (e.g., "do you want CPR for your pet?") helps the client understand and respond.
• The goal is to obtain data needed to plan appropriate care.

Types of questions and how to use them

• Open-ended questions: invite narrative responses; facilitate rich information but can be broad.
• Closed-ended questions: seek specific, often yes/no or single-number answers; provide precise data but can limit detail.
• Validating questions: confirm you understood emotions or statements.
• Clarifying questions: verify ambiguous information.
• Restating: repeats client’s words to show understanding and invite elaboration.
• Reflective questions: mirror feelings back to the patient to deepen understanding.
• Sequencing questions: place events in order to understand relationships and chronology.
• Direct questioning: target a specific item or fact.
• Distinction example: open-ended vs closed-ended —
  • Closed-ended: "What was your pain level on a scale of 0-10?" (specific, limited answer).
  • Open-ended: "Tell me about your day today and how you’ve been feeling since waking up."
• Practical pivot: when interviewing for a nurse position, avoid letting personal topics (e.g., five-year personal plans) overshadow professional focus; instead, frame open-ended prompts toward professional life.
• In practice, you’ll populate a table of question types for a communication paper, including definitions and examples.

The value of explaining why you’re asking questions

• Patients often want to know the purpose behind questions; transparency increases comfort and cooperation.
• Example: asking about CPR preferences for a patient or pet, as part of emergency planning, should be explained upfront.

Qualities of effective communication in nursing

• Warmth, friendliness, openness, respect.
• Honesty, authenticity, trust.
• Caring and confidence.
• Sympathy vs. empathy:
  • Sympathy: feeling concern for the other person but from your own perspective; can create distance or minimize the patient’s experience.
  • Empathy: entering the patient’s experience and feeling with them; fosters connection.
  • Theresa Wiseman’s four qualities of empathy:
  • Perspective taking: ability to view the situation from the patient’s viewpoint.
  • Staying out of judgment: avoiding predictive judgments about the patient’s feelings or actions.
  • Recognizing emotion in others: accurately perceiving what the patient is feeling.
  • Communicating the recognition: clearly conveying that you understand how they feel.
  • Quote to remember: "Empathy fuels connection. Sympathy drives disconnection."
• Empathy as a constructive, vulnerable choice that creates a safe space for patients to share: the listener must connect with their own feelings to respond genuinely.
• Real-world caution: even well-intentioned phrases like "Everything happens for a reason" or "Everything will be okay" can be harmful or dismissive in acute moments.
• When appropriate, acknowledge and validate feelings without rushing to fix the problem.

Establishing trust and its implications

• Trust facilitates deeper disclosure, improving care quality and outcomes.
• In high-stakes settings (e.g., OB/labor and delivery), trust also reduces malpractice risk.
• If patients trust you, they’re more likely to share critical information and follow care plans.

Boundaries and professional relationships

• Nursing relationships can be categorized as:
  • Social: casual, overlapping needs between people.
  • Intimate: emotional commitment with mutual needs met.
  • Therapeutic: focus is on the patient’s needs and experience.
• Nursing is fundamentally therapeutic; conversations should be patient-centered and health-focused.
• Boundaries: protect patient and professional integrity; do not share personal contact information with patients (with exceptions in special units like NICU where relationships may be longer-term, but professional boundaries still apply).
• The relationship is purpose-driven, time-limited, and clearly defined by goals and the plan of care.

Phases of the therapeutic relationship

• Orientation: establishing trust, the patient should be addressed by name; goals and plan discussed.
• Working phase: active collaboration toward mutual goals; continuous information exchange and problem-solving.
• Termination: end of shift or discharge; summarize progress and next steps; set expectations for future contact or follow-up.

Roles of the nurse in therapeutic relationships

• Roles include:
  • Teacher/educator: provide information and instruction for self-care and discharge planning.
  • Problem solver/critical thinker: assess, plan, and adjust care.
  • Caregiver: provide compassionate, patient-centered care.
  • Advocate: protect patient safety and well-being; question questionable orders.
  • Parent surrogate: in cases where patients cannot make decisions, work with a designated surrogate to support patient-centered decisions.
• The goal is to maintain professional boundaries while delivering high-quality, patient-centered care.

Barriers to communication and strategies to overcome them

• Barriers include:
  • Failure to perceive the patient as a human being; failure to listen.
  • Nontherapeutic comments and questions; changing the subject.
  • Giving false reassurance (e.g., "Everything will be okay").
  • Impaired verbal, auditory, or physical communication (language barriers, hearing impairment).
• Impact of language and hearing barriers:
  • Non-English-speaking patients require a translator; do not rely on family members for translation.
  • Using translators can double the communication time, but accuracy is essential.
  • Video interpreters can improve interaction when in-person translators are not available.
  • Always verify translation quality and ensure the patient understands.
• Visual or cognitive barriers:
  • For vision impairment: announce your presence, identify yourself, speak to the patient directly, orient to sounds, ensure glasses/contacts are accessible.
  • For hearing impairment: use clear speech, avoid masking mouth with hands, consider sign language or written cues; ensure hearing aids are worn if applicable.
  • For cognitive impairment: simplify language, avoid open-ended questions; offer choices (e.g., apples vs oranges) and allow extra processing time.
  • For speech of different developmental levels: tailor the language to the patient’s developmental stage; give time to respond.
• Practical tips:
  • Keep call lights within reach; verify the bed is plugged in so the call system works.
  • Orient patients to sounds they’ll hear (BP cuff, pulse oximeter, alarms).
  • Maintain eye contact where culturally appropriate; be mindful of cultural differences in eye contact.
  • Speak in a normal tone; avoid shouting; if using a translator, speak to the patient and allow the translator to relay.
  • Do not chew gum or cover your mouth excessively when speaking.

Nonverbal communication, sign language, and accessibility

• Sign language is a form of communication; it is not nonverbal in this context.
• Nonverbal cues are important, but rely on clear verbal communication when possible.
• For patients with sensory impairments, provide alternative communication methods (whiteboards, pictures, simple pads, flashcards).

The denotative vs connotative meanings of words

• Denotative meaning: literal, dictionary definition of a word.
• Connotative meaning: associations and emotional overtones that the word evokes; highly subjective and culturally influenced.
• Be aware that connotations vary between individuals and cultures; avoid assuming shared connotations.

Verbal and nonverbal safety in communication

• Nonverbal dynamics and eye contact vary by culture; always consider the patient’s background.
• When using interpreters or translators, ensure the tone remains respectful and clear; avoid ambiguous phrasing.

Role of patient education and setting expectations

• Patient education is an ongoing process; align education with patient goals and the plan of care.
• Use clear, direct language; avoid unnecessary fluff in professional communications (e-mails, notes).

Examples and cautionary anecdotes from practice

• A nurse explains to a nervous young patient about an IV and delivery; empathy and clear explanation are essential.
• An example of a hard truth: a young patient dies after delivery; avoid platitudes like "everything will be okay" in that moment; acknowledge the gravity of the situation and offer support.
• A generational example about a mother in a ED triage situation underscores the need for honesty, clarity, and compassionate communication.

Cultural and ethical considerations in communication

• Cultural background affects communication preferences (eye contact, directness, touch, etc.).
• Always use interpreters for non-English speakers; do not rely on family members to translate for medical decisions.
• Ethics of care include respecting autonomy, beneficence, non-maleficence, and justice; patient-centered care aligns with these principles.

Practical daily takeaways for clinical practice

• Start every encounter by orienting the patient to what will happen and what sounds they’ll hear.
• Introduce yourself by name; acknowledge the presence in the room; ensure patients see and hear you.
• Use simple language; avoid long, complex explanations; check for understanding.
• Build trust through consistency, honesty, and showing genuine care.
• Maintain professional boundaries; guard personal information; keep goals posted and updated on patient boards.
• Self-awareness: acknowledge your own values, culture, and biases; ensure they do not interfere with patient care.

Summary connections to foundational principles

• Therapeutic communication is central to patient-centered care and holistic health.
• Effective communication supports ethical practice, reduces malpractice risk, and improves patient outcomes.
• The patient-nurse relationship is a dynamic, goal-oriented process that progresses through defined phases and requires ongoing boundary management.

Quick glossary

• Open-ended question: invites detailed responses.
• Closed-ended question: yields specific, limited responses.
• Validating question: confirms understanding of patient feelings.
• Clarifying question: removes ambiguity.
• Restating: repeats patient’s words for clarity.
• Reflective question: echoes patient feelings to encourage more sharing.
• Sequencing question: orders events in time to reveal cause-effect.
• Direct questioning: targets a specific data point.
• Denotative meaning: literal meaning of a word.
• Connotative meaning: emotional associations tied to a word.
• Empathy: feeling with someone; perspective-taking; nonjudgment; emotion recognition; clear communication of understanding.
• Sympathy: feeling concern for someone without fully entering their experience; can create distance.
• Therapeutic relationship: patient-centered, health-focused interaction built to meet patient needs; differs from casual social interactions.
• Boundary: professional limit to protect patient and provider.