Nursing Communication and Defense Mechanisms

Therapeutic and Non-therapeutic Communication Techniques (Group 1-3)

Empathy (Therapeutic Technique)
- Definition: Listening and communicating while imagining yourself in another person’s circumstance, which improves therapeutic communication (Sadia, Taylor p.190).
- Resource: Lippincott CoursePoint Enhanced for Taylor's Fundamentals of Nursing, page $190$ .
- Example: A classmate expresses they’ve experienced a car accident over the weekend. You listen carefully while imagining being in their shoes and say, “I’m sorry to hear that, you must have a lot on your plate right now. Is there anything I can do to help?”
Sympathy (Non-therapeutic Technique)
- Definition: Expressing feelings about one’s circumstance. This often causes the individual to feel unheard or alone
- Example: A classmate expresses sadness about not performing well on an exam. Immediately after they stop talking, you respond with, “At least you did okay on the last exam!”
Restating (Therapeutic Technique)
- Definition: Validating what the patient or family has said by posing their previous statement as a question after listening (Matt, Taylor p. $196$ ).
- Example: “So the pain in your right shoulder sometimes radiates to your elbow, when do you notice this happening?”
False Assurance (Non-therapeutic Technique)
- Definition: Telling the patient and/or family that things will turn out well when they likely may not, often involving clichés (Matt, Taylor p. $199$ ).
- Example: “Just follow the doctor’s orders and everything will be fine.”
Accepting (Therapeutic Technique)
- Definition: The act of understanding and receiving any item, action, gesture, emotion, or service. In healthcare, it involves acknowledging and understanding information being relayed (Courtney, Merriam-Webster).
- Example: A patient consenting to a medical practice or procedure.
Rejecting (Non-therapeutic Technique)
- Definition: The act of refusing a service, gesture, or deed; not acknowledging or receiving information (Courtney, Merriam-Webster).
- Example: Opting out, declining, or not consenting to a physician’s order.
Focusing (Therapeutic Technique)
- Definition: Concentrating on the patient and their specific concerns rather than just their illness (Valerie, Lippincott p. $199$ ).
- Example: Asking a patient, “How are you doing today?”
Giving Advice (Non-therapeutic Technique)
- Definition: Providing a personal opinion, which may ignore the views of others (Valerie, Lippincott p. $199$ ).
- Example: A nurse tells a patient who smokes $3$ packs of cigarettes a day: “I am going to ask the doctor if we can get you started on something for smoking cessation,” without asking the patient's opinion.
Clarifying (Therapeutic Technique)
- Definition: Asking targeted questions to gain a firm grasp of the patient's situation and gain insight for diagnosis or treatment (Laura, Lippincott Nursing Concepts p. $196$ ).
- Example: Patient states, “I’ve had a headache for $2$ days.” Nurse asks, “How would you describe the pain?” Patient explains it started in the front and expanded.
Questioning (Non-therapeutic when excessive)
- Definition: Asking too many questions in rapid succession, which can make a patient feel unheard or cause them to shut down (Laura).
- Example: Patient mentions chest pains for $2$ days. Nurse asks, “Where is the pain? How frequently? Is it dull or sharp? Has it—” causing the patient to feel overwhelmed.
Voicing Doubt (Therapeutic Technique)
- Definition: Challenging a patient’s beliefs when they do not align with reality (Yvenie, Nursing Fundamentals - NCBI Bookshelf).
- Example: Patient claims to take medication every day. Nurse asks, “Can you explain to me how you take your medication?”
Voicing Approval (Non-therapeutic Technique)
- Definition: Re-enforcing incorrect assumptions or keeping a patient in a state of delusion (Yvenie).
- Example: Patient hears voices telling them to rob a bank. Nurse asks, “Have they told you which bank to rob?”
Sharing Observations (Therapeutic Technique)
- Definition: Encouraging conversation by prompting patients to explain details, showing that the nurse is paying attention (Jessica, Lippincott p. $192-197$ ).
- Example: Nurse says, “I see you haven’t eaten much since breakfast.”
Changing the Subject (Non-therapeutic Technique)
- Definition: Leading the patient to feel their current topic is unimportant, causing loss of trust (Jessica, Lippincott p. $192-197$ ).
- Example: Patient asks about pain medication. Nurse responds, “Let's speak about your treatment plan going forward then maybe we can speak about medication for the pain.”
Giving Information (Therapeutic Technique)
- Definition: Educating a patient with facts backed by reputable data without personal bias (Brandon, Essentials of Psychiatric Nursing p. $93-98$ ).
- Example: Educating a patient on the process and possible outcomes of a procedure the nurse has personally had, without sharing the nurse's personal experience.
Giving Stereotypical or Generalized Responses (Non-therapeutic Technique)
- Definition: Responses that may have a factual base but are misconstrued by personal experience (Brandon, Essentials of Psychiatric Nursing p. $93-98$ ).
- Example: “I had a family member that had breast cancer and she ended up fine, you’ll be fine.”
Active Listening (Therapeutic Technique)
- Definition: Fully concentrating on both verbal and nonverbal communication (Ana, Google Gemini).
- Example: Facing the patient, nodding, and saying, “Tell me more.”
Using Closed-ended Questions or Comments (Non-therapeutic Technique)
- Definition: Questions that limit responses usually to "yes" or "no" (Ana, Google Gemini).
- Example: Asking a patient, “Did you eat today?”
Summarizing (Therapeutic Technique)
- Definition: Condensing information while restating the main idea and essential points (Lauryn, NCBI / Rivier University).
- Example: Patient complains medication causes fatigue and weight gain. Nurse responds, “You haven’t been taking your medications because of the side effects of fatigue and weight gain?”
Reflecting Feelings (Therapeutic Technique)
- Definition: Listening to comments and reflecting the specific feeling back to the patient (Meghan, Taylor’s Fundamentals of Nursing).
- Example: Patient expressing confusion over medication timing. Nurse responds, “I hear you telling me that managing your medications is overwhelming. Would a physical print out help?”
Asking "Why?" (Non-therapeutic Technique)
- Definition: Questions that can come across as harsh or accusatory (Meghan).
- Example: “Why would you do that?” or “Why did you eat that?”
Paraphrasing (Therapeutic Technique)
- Definition: Restating complex information into simpler terms (Katelyn, Lippincott).
- Example: Telling a patient their “blood sugar dropped” instead of stating they are experiencing “hypoglycemia.”
Showing Agreement (Non-therapeutic Technique)
- Definition: Telling the patient they are right or that you approve of their decisions, which takes a side (Katelyn, Lippincott).
- Example: “I agree with you, your doctor should have changed your medicine weeks ago.”
Showing Disagreement (Non-therapeutic Technique)
- Definition: Telling the patient they are wrong or that the nurse disagrees with their thoughts (Katelyn, Lippincott).
- Example: “I don’t agree with that statement.”

Psychological Defense Mechanisms (Group 4-5)

Compensation
- Definition: Attempting to overachieve in one area to offset a lack of confidence or deficiency in another area (Brittany, Lippincott).
- Example: Having difficulty with math but excelling in language arts.
Denial
- Definition: Refusing to accept or acknowledge a painful reality, thought, or feeling (Leann, simplypsychology.org).
- Example: Avoiding hard truths or blaming others to avoid acknowledging a problem exists.
Displacement
- Definition: Transferring an emotional reaction from one person or object to another (Sherene, Lippincott).
- Example: An angry patient throwing objects at the nurse.
Introjection
- Definition: An individual taking on the values and qualities of a person who has a great influence on them (Chantel, Lippincott).
- Example: An intern adopting the daily healthy eating habits taught by their mentor.
Projection
- Definition: Unconsciously displacing internal emotions onto another person (Sherene, Lippincott).
- Example: A husband who is cheating accuses his wife of cheating.
Rationalization
- Definition: Providing a logical or socially acceptable explanation for unusual behavior; behavioral justification (Ashley, Lippincott p. $43$ , $1773$ ).
- Example: Stating, “Class is always so long; that's why I'm late to it every day to eat before going.”
Regression
- Definition: Exhibiting behaviors characteristic of previous developmental levels (Lauren, Taylor p. $1773$ ).
- Example: A patient losing the ability to walk/mobility after experiencing a traumatic event.
Repression
- Definition: The involuntary suppression of stressful or anxiety-producing information from conscious memory (Lauren, Taylor p. $1773$ ).
- Example: A victim of sexual assault being unable to remember the details of the incident.
Sublimation
- Definition: Substituting a taboo or inappropriate desire for a socially acceptable one (Kaila, Taylor p. $1773$ ).
- Example 1: An individual obsessed with death becoming a mortician.
- Example 2: Going boxing after receiving a bad grade to satisfy the urge to hit something.
Suppression
- Definition: The voluntary or conscious removal of stressful or anxiety-inducing memories from the mind (Kaila).
- Example 1: A veteran with PTSD telling themselves not to think about the war or get upset at loud noises.
- Example 2: Refusing to think about a traumatic event, such as abuse or death, to avoid feelings of sadness or anger.

Verbal and Nonverbal Communication Modalities (Group 6)

Verbal Therapeutic Communication
- Definition: The exchange of information through words in a caring, respectful, and purposeful manner that promotes understanding (Sara, nightingale.edu, Lippincott p. $236$ ).
- Example 1: Providing informed consent. Instead of saying “I’m going to check your cervix now,” saying, “I would like to check your cervix because we would like more information about where your body is at in the labor process. Would that be okay?”
- Example 2: Showing empathy: “I understand how hard this must be. We are going to work together to come up with a plan that you are comfortable moving forward with.”
- Example 3: Clarification: “What do you mean?” or “Can you explain that again for me?”
- Example 4: Summarizing information for patients overwhelmed by data.
Nonverbal Therapeutic Communication
- Definition: Signals sent through body language, tone, facial expressions, and pace (Zariah, NCBI/Lippincott p. $176-177$ ).
- Techniques:
  - Maintaining eye contact and facing the patient when speaking.
  - Leaning slightly forward.
  - Giving patients sufficient time to speak.
  - Using touch to show understanding for patients who cannot communicate verbally.
Verbal Non-therapeutic Communication
- Definition: Communication that is unclear, judgmental, or lacking compassion, thereby blocking effective interaction (Cydnie, Lippincott p. $198$ ).
- Barriers:
  - Questions requiring only "yes" or "no" answers.
  - Giving unsolicited personal advice.
  - Making judgmental comments.
  - Minimizing the patient's feelings.
Nonverbal Non-therapeutic Communication
- Definition: Interactions that obstruct or impede a patient’s ability to express themselves via non-spoken means (Christine, NCBI/Lippincott p. $175-176, 198$ ).
- Examples:
  - Passive or Competitive Listening: Disengagement where the nurse is more focused on their own tasks or point of view than the patient.
  - Inappropriate Use of Personal Space: This includes improper proxemics.
  - Stress-induced Cues: Lack of eye contact, acting in a hurried pace, or using a short, impatient tone.
  - Judgmental Manners: Expressing bias through facial expressions or demeanor.
  - Poor Physical Positioning: Standing over a patient who is lying down or sitting, which creates an imbalance of power.
  - Failure to Recognize Humanity: Failing to treat the patient as a human being or failing to actively listen.

A nurse is listening to a patient express concerns about an upcoming surgery. Which therapeutic technique is the nurse using when she responds, "I can understand how you feel; this is a big decision for you"?
- A) Sympathy
- B) Empathy
- C) Focusing
- D) Active Listening
  Correct answer: B) Empathy
During a patient assessment, the nurse says, "So, you mentioned that you often feel sad after the treatment. Can you tell me more about this?" What therapeutic technique is the nurse demonstrating?
- A) Questioning
- B) Clarifying
- C) Restating
- D) Summarizing
  Correct answer: C) Restating
A patient is upset about a recent diagnosis. The nurse says, "You’ll be just fine; you have nothing to worry about." Which communication technique is the nurse using?
- A) Giving False Assurance
- B) Giving Information
- C) Voicing Doubt
- D) Active Listening
  Correct answer: A) Giving False Assurance
When a patient expresses feelings of anxiety, the nurse responds, "It’s normal to feel that way during this time". Which technique is this an example of?
- A) Accepting
- B) Voicing Approval
- C) Paraphrasing
- D) Sharing Observations
  Correct answer: A) Accepting
While assessing a patient with chest pain, the nurse asks, "Did you eat today?" What type of communication is this an example of?
- A) Open-ended question
- B) Closed-ended question
- C) Clarifying question
- D) Restating
  Correct answer: B) Closed-ended question
Which of the following behaviors indicates non-therapeutic communication?
- A) The nurse nods while the patient speaks
- B) The nurse interrupts the patient frequently to ask questions
- C) The nurse maintains eye contact with the patient
- D) The nurse provides information about treatment options
  Correct answer: B) The nurse interrupts the patient frequently to ask questions
A nurse is working with a patient who is not following their treatment plan. The nurse asks, "Why won't you take your medications?" What is the therapeutic response?
- A) Acknowledging the patient’s fear
- B) Asking a leading question
- C) Challenging the patient
- D) Voicing Doubt
  Correct answer: B) Asking a leading question
A nurse reflects back a patient’s feelings by saying, "It sounds like you're feeling very frustrated about your health situation." What therapeutic technique is the nurse using?
- A) Reflecting Feelings
- B) Summarizing
- C) Clarifying
- D) Paraphrasing
  Correct answer: A) Reflecting Feelings
What defense mechanism is exemplified by a patient who says, "I don’t have any problems; everything is fine" despite evidence to the contrary?
- A) Repression
- B) Projection
- C) Denial
- D) Rationalization
  Correct answer: C) Denial