Active Listening Techniques

SOLER

S — encourages the listener to sit (if possible) at a slight angle to the person
O — reminds the nurse to maintain an open stance or posture while listening
L — suggests that the listener lean toward the speaker, positioning the body in an open stance
E — refers to maintaining eye contact without staring
R — reminds the nurse to relax to encourage the speaker to continue sharing

Verbal Therapeutic Communication Techniques

Technique	Examples	Rationale
Offering self	“I’ll sit with you for a while.” “I’ll stay with you until your family member arrives.”	Demonstrates compassion and concern for the patient Establishes a caring relationship
Calling the patient by his or her preferred name	“Good morning, Mr. Trimble.” “Hi, Ms. Martin. How are you feeling this evening?”	Conveys that the nurse sees the patient as an individual Shows respect and helps to establish a caring relationship
Sharing observations	“You look tense.” “You seem frustrated.” “You are smiling.”	Raises the patient’s awareness of his or her nonverbal behavior Allows the patient to validate the nurse’s perceptions Provides an opening for the patient to share possible joys or concerns
Giving information	“It is time for your bath.” “My name is Pam, and I will be the RN taking care of you until 7 p.m.” “Your surgery is scheduled for 10:30 a.m. tomorrow.”	Informs the patient of facts needed in a specific situation Provides a means to build trust and develop a knowledge base on which patients can make decisions
Using open-ended questions or comments	“What are some of your biggest concerns?” “Tell me more about your general health status.” “Share some of the feelings you experienced after your heart attack.”	Gives the patient the opportunity to share freely on a subject Avoids interjection of feelings or assumptions by the nurse Provides for patient elaboration on important topics when the nurse wants to collect a breadth of information
Using focused questions or comments	“Point to exactly where your pain is radiating.” “When did you start experiencing shortness of breath?” “How has your family responded to your being hospitalised?” “What is your greatest fear?” “Where were you when the symptoms started?” “Tell me where you live.”	Encourages the patient to share specific data necessary for completing a thorough assessment Asks the patient to provide details regarding various concerns Focuses on the immediate needs of the patient
Providing general leads	“And then?” “Go on.” “Tell me more.”	Encourages the patient to keep talking Demonstrates the nurse’s interest in the patient’s concerns
Conveying acceptance	“Yes.” Nodding. “I follow what you are saying.” “Uh huh.”	Acknowledges the importance of the patient’s thoughts, feelings, and concerns
Using humor	“You are really walking well this morning.” “I’m going to have to run to catch up!”	Provides encouragement May lighten heavy moments of discussion Used properly, allows a patient to focus on positive progress or better times and does not change the subject of a conversation
Verbalizing the implied	Patient: “I can’t talk to anyone about this.” Nurse: “Do you feel that others won’t understand?”	Encourages a patient to elaborate on a topic of concern Provides an opportunity for the patient to articulate more clearly a complicated topic or feeling that could be easily misunderstood
Paraphrasing or restating communication content	Patient: “I couldn’t sleep last night.” Nurse: “You had trouble sleeping last night?”	Encourages patients to describe situations more fully Demonstrates that the nurse is listening
Reflecting feelings or emotions	“You were angry when your surgery was delayed?” “You seem excited about going home today.”	Focuses on the patient’s identified feelings based on verbal or nonverbal cues
Seeking clarification	“Help me to better understand what you are saying.” “What do you mean by your last statement?”	Encourages the patient to expand on a topic that may be confusing or that seems contradictory
Summarizing	“There are three things you are upset about: your family being too busy, your diet, and being in the hospital too long.”	Reduces the interaction to three or four points identified by the nurse as being significant Allows the patient to agree or add additional concerns
Validating	“Did I understand you correctly that…?”	Allows clarification of ideas that the nurse may have interpreted differently than intended by the patient

Nonverbal Therapeutic Communication Techniques

Technique	Examples	Rationale
Active listening	Maintaining intermittent eye contact Matching eye levels Attentive posturing Facing the patient Leaning toward the person who is speaking Avoiding distracting body movement	Conveys interest in the patient’s needs, concerns, or problems Provides the patient with undivided attention Sends a clear message of concern and interest
Silence	Being present with a person without verbal communication	Provides the patient time to think or reflect Communicates concern when there is really nothing adequate to say in difficult or challenging situations
Therapeutic touch	Holding the hand of a patient Providing a back rub Touching a patient’s arm lightly Shaking hands with a patient in isolation	Conveys empathy Provides emotional support, encouragement, and personal attention Relaxes the patient

Non-therapeutic Communication

Action	Examples	Rationale
Asking “why” questions	“Why did you do that?” “Why are you feeling that way?” “Why do you continue to smoke when you know it is unhealthy?”	Implies criticism May make the patient defensive Tends to limit conversation Requires justification of actions Focuses on a problem rather than a possible solution
Using closed-ended questions or comments	“Do you feel better today?” “Did you sleep well last night?” “Have you made a decision about radiation yet?” “Are you ready to take your bath?” “Will you let me give you your medicine now?”	Results in short, one-word, yes or no responses Limits elaboration or discussion of a topic Allows patient to refuse important care Differs from focused questions that direct an interview
Changing the subject	Patient: “I’m having a difficult time talking with my daughter.” Nurse: “Do you have grandchildren?” Patient: “I just want to die.” Nurse: “Did you sleep well last night?”	Avoids exploration of the topic raised by the patient Demonstrates the nurse’s discomfort with the topic introduced by the patient
Giving false reassurance	“Everything will be okay.” “Surgery is nothing to be concerned about.” “Don’t worry; everything will be fine.”	Discounts the patient’s feelings Cuts off conversation about legitimate concerns of the patient Demonstrates a need by the nurse to “fix” something that the patient just wants to discuss
Giving advice	“If it were me, I would…” “You should really exercise more.” “You should absolutely have chemotherapy to treat your breast cancer if you expect to live.” “Of course you should tell your coworkers that you’ve been diagnosed with cancer.”	Discourages the patient from finding an appropriate solution to a personal problem Tends to limit the patient’s ability to explore alternative solutions to issues that need to be faced Implies a lack of confidence in the patient to make a healthy decision Removes the decision-making authority from the patient
Giving stereotypical or generalized responses	“It’s for your own good.” “Keep your chin up.” “Don’t cry over spilt milk.” “You will be home before long.”	Discounts patient feelings or opinions Limits further conversation on a topic May be perceived as judgmental
Showing approval or disapproval	“That’s good.” “You have no reason to be crying.”	Limits reflection by the patient Stops further discussion on patient decisions or actions Implies a need for patients to have the nurse’s support and approval Conveys judgmental attitude
Showing agreement or disagreement	“That’s right.” “I disagree with what you just said.”	Discontinues patient reflection on an introduced topic Implies a lack of value for patient’s thoughts, feelings, or concerns
Engaging in excessive self-disclosure or comparing the experiences of others	“I had the same type of cancer 2 years ago.” “I have several family members who drink too much, too.” “I go to that restaurant every Friday for fish.”	Implies that experiences related to a disease process are similar for all patients Takes the focus away from the patient Limits further reflection or problem solving by the patient
Comparing patient experiences	“The lady in room 250 just had this surgery last week and did just fine.” “My uncle had this type of inflammatory bowel disease and ended up having to have a colostomy.”	Removes the focus of conversation from the patient Invalidates each individual patient experience as being unique and important Breaches confidentiality
Using personal terms of endearment	“Honey.” “Sweetie, it is time to take your medicine.” “Sport, how about if you show me how well you can walk across the room?”	Demonstrates disrespect for the individual Diminishes the dignity of a unique patient May indicate that the nurse did not take the time or care enough to learn or remember the patient’s name
Being defensive	“The nurses here work very hard.” “Your doctor is extremely busy.” “This is the best hospital in the area.” “You won’t get any better care anywhere else.”	Moves the focus from the patient Discounts the patient’s feelings and thoughts on a subject Limits further conversation on a topic of patient concern

Defence Mechanisms

Defense Mechanism	Definition
Compensation	Using personal strengths or abilities to overcome feelings of inadequacy
Denial	Refusing to admit the reality of a situation or feeling
Displacement	Transferring emotional energy away from an actual source of stress to an unrelated person or object
Introjection	Taking on certain characteristics of another individual’s personality
Projection	Attributing undesirable feelings to another person
Rationalization	Denying true motives for an action by identifying a more socially acceptable explanation
Regression	Reverting to behaviors consistent with earlier stages of development
Repression	Storing painful or hostile feelings in the unconscious, causing them to be temporarily forgotten
Sublimation	Rechanneling unacceptable impulses into socially acceptable activities
Suppression	Choosing not to think consciously about unpleasant feelings

Communication in Special Circumstances

Hearing Impaired

Encourage individuals who normally wear hearing aids to place them in their ears during morning care.
Check or replace hearing aid batteries regularly to avoid most associated mechanical difficulties.
Make sure areas for interaction are well lit with as little background noise as possible.
Stay within 3 to 6 feet of hearing-impaired patients while conversing.
Raise voice level slightly.
Face the hearing-impaired person, and avoid turning away.
Speak clearly.
Contact a sign language interpreter to assist with communication of critical information.
Use written communication on a whiteboard or tablet when providing or reinforcing detailed information.

Visually Impaired

Announce your arrival and/or tell the visually impaired person who you are when beginning interaction.
Alert visually impaired patients of potential hazards or object locations.
Use the analog clock position to describe the location of food on a plate or tray or the location of objects in a room.
Access large-print, Braille, audio, or e-books as needed.
Gently touch visually impaired patients on the arm if they are sleeping or if the environment is noisy before initiating interaction.

Physically or Cognitvely Impaired

Head nods, physical touch, or hand squeezes may be used to assist with communication.
Whiteboards or tablets may facilitate communication based on individual needs.
Utilize eye movement technology or electronic transducers when indicated.
Observe nonverbal signs for indications of discomfort or needs.
Adapt to a demented patient’s thought process rather than confront or correct.

Communication

Active Listening Techniques

SOLER

S — encourages the listener to sit (if possible) at a slight angle to the person
O — reminds the nurse to maintain an open stance or posture while listening
L — suggests that the listener lean toward the speaker, positioning the body in an open stance
E — refers to maintaining eye contact without staring
R — reminds the nurse to relax to encourage the speaker to continue sharing

Verbal Therapeutic Communication Techniques

Technique	Examples	Rationale
Offering self	“I’ll sit with you for a while.” “I’ll stay with you until your family member arrives.”	Demonstrates compassion and concern for the patient Establishes a caring relationship
Calling the patient by his or her preferred name	“Good morning, Mr. Trimble.” “Hi, Ms. Martin. How are you feeling this evening?”	Conveys that the nurse sees the patient as an individual Shows respect and helps to establish a caring relationship
Sharing observations	“You look tense.” “You seem frustrated.” “You are smiling.”	Raises the patient’s awareness of his or her nonverbal behavior Allows the patient to validate the nurse’s perceptions Provides an opening for the patient to share possible joys or concerns
Giving information	“It is time for your bath.” “My name is Pam, and I will be the RN taking care of you until 7 p.m.” “Your surgery is scheduled for 10:30 a.m. tomorrow.”	Informs the patient of facts needed in a specific situation Provides a means to build trust and develop a knowledge base on which patients can make decisions
Using open-ended questions or comments	“What are some of your biggest concerns?” “Tell me more about your general health status.” “Share some of the feelings you experienced after your heart attack.”	Gives the patient the opportunity to share freely on a subject Avoids interjection of feelings or assumptions by the nurse Provides for patient elaboration on important topics when the nurse wants to collect a breadth of information
Using focused questions or comments	“Point to exactly where your pain is radiating.” “When did you start experiencing shortness of breath?” “How has your family responded to your being hospitalised?” “What is your greatest fear?” “Where were you when the symptoms started?” “Tell me where you live.”	Encourages the patient to share specific data necessary for completing a thorough assessment Asks the patient to provide details regarding various concerns Focuses on the immediate needs of the patient
Providing general leads	“And then?” “Go on.” “Tell me more.”	Encourages the patient to keep talking Demonstrates the nurse’s interest in the patient’s concerns
Conveying acceptance	“Yes.” Nodding. “I follow what you are saying.” “Uh huh.”	Acknowledges the importance of the patient’s thoughts, feelings, and concerns
Using humor	“You are really walking well this morning.” “I’m going to have to run to catch up!”	Provides encouragement May lighten heavy moments of discussion Used properly, allows a patient to focus on positive progress or better times and does not change the subject of a conversation
Verbalizing the implied	Patient: “I can’t talk to anyone about this.” Nurse: “Do you feel that others won’t understand?”	Encourages a patient to elaborate on a topic of concern Provides an opportunity for the patient to articulate more clearly a complicated topic or feeling that could be easily misunderstood
Paraphrasing or restating communication content	Patient: “I couldn’t sleep last night.” Nurse: “You had trouble sleeping last night?”	Encourages patients to describe situations more fully Demonstrates that the nurse is listening
Reflecting feelings or emotions	“You were angry when your surgery was delayed?” “You seem excited about going home today.”	Focuses on the patient’s identified feelings based on verbal or nonverbal cues
Seeking clarification	“Help me to better understand what you are saying.” “What do you mean by your last statement?”	Encourages the patient to expand on a topic that may be confusing or that seems contradictory
Summarizing	“There are three things you are upset about: your family being too busy, your diet, and being in the hospital too long.”	Reduces the interaction to three or four points identified by the nurse as being significant Allows the patient to agree or add additional concerns
Validating	“Did I understand you correctly that…?”	Allows clarification of ideas that the nurse may have interpreted differently than intended by the patient

Nonverbal Therapeutic Communication Techniques

Technique	Examples	Rationale
Active listening	Maintaining intermittent eye contact Matching eye levels Attentive posturing Facing the patient Leaning toward the person who is speaking Avoiding distracting body movement	Conveys interest in the patient’s needs, concerns, or problems Provides the patient with undivided attention Sends a clear message of concern and interest
Silence	Being present with a person without verbal communication	Provides the patient time to think or reflect Communicates concern when there is really nothing adequate to say in difficult or challenging situations
Therapeutic touch	Holding the hand of a patient Providing a back rub Touching a patient’s arm lightly Shaking hands with a patient in isolation	Conveys empathy Provides emotional support, encouragement, and personal attention Relaxes the patient

Non-therapeutic Communication

Action	Examples	Rationale
Asking “why” questions	“Why did you do that?” “Why are you feeling that way?” “Why do you continue to smoke when you know it is unhealthy?”	Implies criticism May make the patient defensive Tends to limit conversation Requires justification of actions Focuses on a problem rather than a possible solution
Using closed-ended questions or comments	“Do you feel better today?” “Did you sleep well last night?” “Have you made a decision about radiation yet?” “Are you ready to take your bath?” “Will you let me give you your medicine now?”	Results in short, one-word, yes or no responses Limits elaboration or discussion of a topic Allows patient to refuse important care Differs from focused questions that direct an interview
Changing the subject	Patient: “I’m having a difficult time talking with my daughter.” Nurse: “Do you have grandchildren?” Patient: “I just want to die.” Nurse: “Did you sleep well last night?”	Avoids exploration of the topic raised by the patient Demonstrates the nurse’s discomfort with the topic introduced by the patient
Giving false reassurance	“Everything will be okay.” “Surgery is nothing to be concerned about.” “Don’t worry; everything will be fine.”	Discounts the patient’s feelings Cuts off conversation about legitimate concerns of the patient Demonstrates a need by the nurse to “fix” something that the patient just wants to discuss
Giving advice	“If it were me, I would…” “You should really exercise more.” “You should absolutely have chemotherapy to treat your breast cancer if you expect to live.” “Of course you should tell your coworkers that you’ve been diagnosed with cancer.”	Discourages the patient from finding an appropriate solution to a personal problem Tends to limit the patient’s ability to explore alternative solutions to issues that need to be faced Implies a lack of confidence in the patient to make a healthy decision Removes the decision-making authority from the patient
Giving stereotypical or generalized responses	“It’s for your own good.” “Keep your chin up.” “Don’t cry over spilt milk.” “You will be home before long.”	Discounts patient feelings or opinions Limits further conversation on a topic May be perceived as judgmental
Showing approval or disapproval	“That’s good.” “You have no reason to be crying.”	Limits reflection by the patient Stops further discussion on patient decisions or actions Implies a need for patients to have the nurse’s support and approval Conveys judgmental attitude
Showing agreement or disagreement	“That’s right.” “I disagree with what you just said.”	Discontinues patient reflection on an introduced topic Implies a lack of value for patient’s thoughts, feelings, or concerns
Engaging in excessive self-disclosure or comparing the experiences of others	“I had the same type of cancer 2 years ago.” “I have several family members who drink too much, too.” “I go to that restaurant every Friday for fish.”	Implies that experiences related to a disease process are similar for all patients Takes the focus away from the patient Limits further reflection or problem solving by the patient
Comparing patient experiences	“The lady in room 250 just had this surgery last week and did just fine.” “My uncle had this type of inflammatory bowel disease and ended up having to have a colostomy.”	Removes the focus of conversation from the patient Invalidates each individual patient experience as being unique and important Breaches confidentiality
Using personal terms of endearment	“Honey.” “Sweetie, it is time to take your medicine.” “Sport, how about if you show me how well you can walk across the room?”	Demonstrates disrespect for the individual Diminishes the dignity of a unique patient May indicate that the nurse did not take the time or care enough to learn or remember the patient’s name
Being defensive	“The nurses here work very hard.” “Your doctor is extremely busy.” “This is the best hospital in the area.” “You won’t get any better care anywhere else.”	Moves the focus from the patient Discounts the patient’s feelings and thoughts on a subject Limits further conversation on a topic of patient concern

Defence Mechanisms

Defense Mechanism	Definition
Compensation	Using personal strengths or abilities to overcome feelings of inadequacy
Denial	Refusing to admit the reality of a situation or feeling
Displacement	Transferring emotional energy away from an actual source of stress to an unrelated person or object
Introjection	Taking on certain characteristics of another individual’s personality
Projection	Attributing undesirable feelings to another person
Rationalization	Denying true motives for an action by identifying a more socially acceptable explanation
Regression	Reverting to behaviors consistent with earlier stages of development
Repression	Storing painful or hostile feelings in the unconscious, causing them to be temporarily forgotten
Sublimation	Rechanneling unacceptable impulses into socially acceptable activities
Suppression	Choosing not to think consciously about unpleasant feelings

Communication in Special Circumstances

Hearing Impaired

Encourage individuals who normally wear hearing aids to place them in their ears during morning care.
Check or replace hearing aid batteries regularly to avoid most associated mechanical difficulties.
Make sure areas for interaction are well lit with as little background noise as possible.
Stay within 3 to 6 feet of hearing-impaired patients while conversing.
Raise voice level slightly.
Face the hearing-impaired person, and avoid turning away.
Speak clearly.
Contact a sign language interpreter to assist with communication of critical information.
Use written communication on a whiteboard or tablet when providing or reinforcing detailed information.

Visually Impaired

Announce your arrival and/or tell the visually impaired person who you are when beginning interaction.
Alert visually impaired patients of potential hazards or object locations.
Use the analog clock position to describe the location of food on a plate or tray or the location of objects in a room.
Access large-print, Braille, audio, or e-books as needed.
Gently touch visually impaired patients on the arm if they are sleeping or if the environment is noisy before initiating interaction.

Physically or Cognitvely Impaired

Head nods, physical touch, or hand squeezes may be used to assist with communication.
Whiteboards or tablets may facilitate communication based on individual needs.
Utilize eye movement technology or electronic transducers when indicated.
Observe nonverbal signs for indications of discomfort or needs.
Adapt to a demented patient’s thought process rather than confront or correct.