1. Therapeutic CommunicationTherapeutic Communication
NUR 3051NUR 3051
Rochelle Roberts MS RNRochelle Roberts MS RN

2.  Therapeutic Communication –Therapeutic Communication –
– Undertaken to carry out the nursing care planUndertaken to carry out the nursing care plan
– PurposefulPurposeful
– Has one or more goalsHas one or more goals
– Aimed at meeting the needs of one of theAimed at meeting the needs of one of the
participantsparticipants
– Self-disclosure by the interviewer is limitedSelf-disclosure by the interviewer is limited

3. Social CommunicationSocial Communication
– May not have any specific goalMay not have any specific goal
– May not be purposefulMay not be purposeful
– Meets the needs of all the participantsMeets the needs of all the participants
– May be significant self-disclosure of allMay be significant self-disclosure of all
participantsparticipants

4. Aids to CommunicationAids to Communication
 Active listeningActive listening
– Expression of interestExpression of interest
– Leaning forwardLeaning forward
– Nodding headNodding head
– Verbalizations such as “Uh-huh” and “Go on…”Verbalizations such as “Uh-huh” and “Go on…”
– Frequent validationFrequent validation
– Attempt to fully understandAttempt to fully understand

5.  SilenceSilence
– If you don’t know what to say, say nothingIf you don’t know what to say, say nothing
– Gives patient time to thinkGives patient time to think
– Gives nurse time to thinkGives nurse time to think
– May allow patient to expand upon what he wasMay allow patient to expand upon what he was
saying or think of a new topic to discusssaying or think of a new topic to discuss
– As anxiety grows, patient is more likely to sayAs anxiety grows, patient is more likely to say
somethingsomething

6.  ExploringExploring
– Trying to get the patient to expand upon a topicTrying to get the patient to expand upon a topic
or bring up another topicor bring up another topic
– ““Would you tell me more about that?”Would you tell me more about that?”
– ““What else makes you feel that way?”What else makes you feel that way?”

7.  RestatingRestating
– Pt.: “I couldn’t sleep all night.”Pt.: “I couldn’t sleep all night.”
– Nurse:”You couldn’t sleep all night.” orNurse:”You couldn’t sleep all night.” or
““You couldn’t sleep all night?”You couldn’t sleep all night?”
– Pt.: “My husband is very worried about me.”Pt.: “My husband is very worried about me.”
– Nurse:”Your husband is very worried aboutNurse:”Your husband is very worried about
you.”you.”
““Your husband is very worried about you?”Your husband is very worried about you?”

8.  Theme IdentificationTheme Identification
 ““I’ve noticed that in all of the relationshipsI’ve noticed that in all of the relationships
that you have described, you’ve been hurtthat you have described, you’ve been hurt
or rejected by the man. Do you think this isor rejected by the man. Do you think this is
an underlying issue?”an underlying issue?”

9.  ParaphrasingParaphrasing
– Repeating what the patient says in differentRepeating what the patient says in different
wordswords
– Pt.: “I’m worried about my operation tomorrow.”Pt.: “I’m worried about my operation tomorrow.”
– Nurse: “You’re concerned about tomorrow’sNurse: “You’re concerned about tomorrow’s
surgery.” (or ?)surgery.” (or ?)

10.  SuggestingSuggesting
 ““Have you thought about responding to yourHave you thought about responding to your
boss in a different way when he raises thatboss in a different way when he raises that
issue with you?”issue with you?”

11.  Reflecting or validatingReflecting or validating
- signifies understanding, empathy, interest,- signifies understanding, empathy, interest,
and respect for the patient. It consists ofand respect for the patient. It consists of
repeating in fewer and different words therepeating in fewer and different words the
essential ideas of the patient. (similar toessential ideas of the patient. (similar to
paraphrasing) Reflection can refer toparaphrasing) Reflection can refer to
content or feelings.content or feelings.

12.  Open-ended questionsOpen-ended questions
 ““Tell me what happened?”Tell me what happened?”
 ““How are you today?”How are you today?”

13.  Focusing –Focusing –
 ““Can we continue talking about your motherCan we continue talking about your mother
right now?”right now?”

14.  Clarifying, validatingClarifying, validating
 ““I’m having some difficulty. Could you helpI’m having some difficulty. Could you help
me understand?”me understand?”

15.  HumorHumor
 ““That gives whole new meaning to the wordThat gives whole new meaning to the word
nervous,” (said with shared kidding betweennervous,” (said with shared kidding between
the nurse and the patient).the nurse and the patient).

16.  SummarizingSummarizing
-”So far we have talked about..”-”So far we have talked about..”

17.  InformingInforming
 ““I think you need to know more about howI think you need to know more about how
your medication works.”your medication works.”

18. Non-therapeutic CommunicationNon-therapeutic Communication
 False ReassuranceFalse Reassurance
– ““Everything’s going to be all right.”Everything’s going to be all right.”
– ““You’re doing just fine.”You’re doing just fine.”
– Pt.: “I’m afraid I won’t wake up from thePt.: “I’m afraid I won’t wake up from the
surgery.”surgery.”
– Nurse:”Sure you will.”Nurse:”Sure you will.”

19. Barriers cont.Barriers cont.
 Giving approval or disapproval; beingGiving approval or disapproval; being
judgmental; agreeing or disagreeingjudgmental; agreeing or disagreeing
– ““I wouldn’t say that.”I wouldn’t say that.”
– ““Of course; I agree.”Of course; I agree.”

20. Barriers cont.Barriers cont.
 Giving adviceGiving advice
– ““If I were you…”If I were you…”
– ““I think you should…”I think you should…”
– ““It seems to me the best course of action is…”It seems to me the best course of action is…”

21. Barriers cont.Barriers cont.
 DefendingDefending
– Pt.: “The nurses were very slowPt.: “The nurses were very slow
answering my light last night.”answering my light last night.”
– Nurse:”I don’t know how you can say that. ThisNurse:”I don’t know how you can say that. This
floor has the best nurses in the hospital.”floor has the best nurses in the hospital.”

22. Barriers cont.Barriers cont.
 Minimizing feelingsMinimizing feelings
– Pt.: “I’m quite scared about this surgery.”Pt.: “I’m quite scared about this surgery.”
– Nurse:”Oh, everyone feels that way before anNurse:”Oh, everyone feels that way before an
operation.”operation.”
– Pt.: ”I really hate shots.”Pt.: ”I really hate shots.”
– Nurse.”Don’t be silly. It’s just a little stick.”Nurse.”Don’t be silly. It’s just a little stick.”

23. Barriers cont.Barriers cont.
 Changing the subjectChanging the subject
– Pt.: “I hope someone comes to visit me today.”Pt.: “I hope someone comes to visit me today.”
– Nurse:”It’s such a beautiful day today.”Nurse:”It’s such a beautiful day today.”

24.  Social responseSocial response
- nurse uses superficial social conversationnurse uses superficial social conversation
that is not client-centered.that is not client-centered.
- ““How does the coffee taste today?”How does the coffee taste today?”

25. Responsive dimensionsResponsive dimensions
 Genuineness- the nurse is open, honest,Genuineness- the nurse is open, honest,
and sincere.and sincere.
 Respect- unconditional positive regard. TheRespect- unconditional positive regard. The
nurse’s attitude is nonjudgmental.nurse’s attitude is nonjudgmental.
 Empathy- sensitivity to the pt’s currentEmpathy- sensitivity to the pt’s current
feelings and the verbal ability tofeelings and the verbal ability to
communicate this understanding.communicate this understanding.