The communication process is built on a trusting relationship with a client and the client’s support people. Effective communication is essential for the establishment of an effective nurse-client relationship. Therapeutic communication promotes understanding and can help establish a constructive relationship between the nurse and the client. This relationship is client-centered and goal-oriented.
Attentive listening or active listening is a major component of therapeutic communication. This involves the use of mindfulness, using all the senses to pay attention to what the client says, does, and feels. Active listening skills are among the most important skills to develop as a nurse.
- Many responses of a nurse utilizing active listening is reflective, empathic, or propulsive in the sense that it allows the client to express more of what they’re feeling and to indulge in sharing information with the nurse.
- These techniques involve the use of silence, nodding, using words such as “uh huh” or “mmm”, repeating/reflecting statements, and verifying or validating feelings with statements such as “I see what you mean”.
- The nurse is able to display empathy, concern, and commitment to the patient.
Therapeutic Communication Techniques
- Silence: the use of pausing or silence to permit the client the time to express their thoughts into words.
- Providing General Leads: encouraging the client to verbalize by presenting a topic or facilitating continued verbalization.
- “Where would you like to begin?”
- Close-Ended Questions: specific and tentative questions that elicit specific information with predetermined potential answers.
- “Rate your pain from 1 to 10, 1 being no pain”
- Open-Ended Questions: general questions that encourage the client to explore thoughts or feelings. Topics may or may not be specified.
- “Tell me more.”
- Therapeutic Touch: an appropriate form of touch to reinforce caring. The nurse must use this with discretion and with sensitivity to attitudes and practices.
- Placing the arm over the client’s shoulder, or hand over the client’s hand.
- Restating/Paraphrasing: actively listening for the essence of a client’s message, and then repeating those thoughts and feelings in the nurse’s own words.
- Client: “I couldn’t manage to eat any dinner last night. Not even dessert.” Nurse: “You had difficulty eating yesterday.”
- Seeking Clarification: focusing on the client’s overall meaning to make them more understandable.
- “Would you please say that again?”
- Perception Checking: verifying the meaning of specific words used within a message.
- Client: “My husband never gives me any presents.” Nurse: “You mean he has never given you a present for your birthday or Christmas?” Client: “Well, not never. He gets me something for my birthday and Christmas, but not in any other time.”
- Offering Self: suggesting one’s presence without making any demands that the clients must comply with.
- “Suggesting one’s presence without making any demands that the clients must comply with.”
- Giving Information: simple, direct, and specific information given for purposes of consent, relieving anxiety, and to give the client a sense of control over the situation.
- “You’ll feel a pulling sensation when the tube is removed from your abdomen.”
- Acknowledging: similar to validating, but for recognition of positive changes such as changes in behavior or an effort that the client has made.
- “I see you trimmed your mustache and washed your hair.”
- Clarifying Time or Sequence: for context to the client’s statements, or as orientation for a disoriented client.
- Client: “I vomited this morning.” Nurse: “Was that before or after you had breakfast?”
- Presenting Reality: aid the client in differentiating the real from the unreal, especially useful in patients with altered sensorium or cognition.
- “Your magazine is here in the drawer. It has not been stolen.”
- Focusing: honing on an idea or a feeling, emphasizing a feeling to help clients recognize an emotion.
- Client: “My wife says she will look after me, but I don’t think she can, what with the children to take care of, and they’re always after her about something— clothes, homework, what’s for dinner that night.” Nurse: “Sounds like you are worried about how well she can manage.”
- Reflecting: directing ideas, feelings, or content back to clients to enable them to explore their own ideas. This allows them to explore their own ideas and feelings about the situation.
- Client: “What can I do?” Nurse: “What do you think would be helpful?” Client: “Do you think I should tell my husband?” Nurse: You seem unsure about telling your husband.”
- Summarizing and Planning: stating the main points of a discussion to clarify all relevant points discussed. This is done at the end of an interview or a health teaching to review the discussion and to plan future meetings.
- “During the past half hour, we have talked about…”
- “Tomorrow afternoon, we may explore this further…”
Barriers to Communication
- Stereotyping: generalizing beliefs about groups of people. This negates the uniqueness of individuals.
- “Men shouldn’t cry.”
- “Most people don’t have any pain after this type of surgery.”
- Agreeing and Disagreeing: implies that the client is either right or wrong and that the nurse is qualified to judge this. Clients can be deterred and may become defensive.
- Client: “I don’t think Dr. Broad is a very good doctor. He doesn’t seem interested in his clients.” Nurse: “Dr. Broad is the head of the department of surgery and is an excellent surgeon.”
- Being Defensive: attempting to protect an individual or organization from negative comments can prevent clients from expressing their true concerns or grievances.
- Client: “Those night nurses must just sit around and talk all night. They didn’t answer my call light for over an hour.” Nurse: “I’ll have you know we literally run around even at night. You’re not the only client, you know.”
- Challenging: making clients prove their statement or perspective. This disregards the feelings of the client, and makes the client feel as thought it is necessary to defend their position. This can also make them double-down.
- Client: “I feel as if I am dying.” Nurse: “How can you feel that way when your pulse rate is 60?”
- Probing: asking for information chiefly out of curiosity rather than for the intention of assistance. These often take on the form of “Why” questions that can place the client in a defensive position.
- Client: “I didn’t ask the doctor when he was here.” Nurse: “Why didn’t you?”
- Testing
- Rejecting
- Changing Topics and Subjects: directing the communication into areas of self-interest rather than the client’s concerns
- Unwarranted Reassurance: clichés or other comforting statements of advice that reassure the patient can block the fears, feelings, and other thoughts of the client.
- “Everything will turn out alright.”
- “You’ll be fine. Don’t worry.”
- Passive Judgment: giving opinions and approving responses, moralizing, or implying one’s own values. These imply that the client must follow the nurse’s thinking, fostering client dependence.
- “That’s good.” “That’s bad.”
- “You shouldn’t do that.”
- “That’s not good enough.”
- “What you did was wrong/right.”
- Giving Common Advice