Given all the time nurses and therapists spend with patients, these clinicians are in the best position to:
To do all that for their patients, nurses and therapists must understand and use the best therapeutic communication techniques.
Before we look at any therapeutic communication techniques, we should understand why a nurse or therapist ought to bother with them. Because frankly, they’re hard work.
Let’s say you’re a nurse, and you want to help a patient get well. You could simply tend to tasks like changing sheets, taking vitals, bringing meds, and helping the patient to the bathroom.
But that would be basic patient care. You want to provide quality care.
Quality care goes beyond just completing tasks for your patient. Quality care means interacting with your patient to learn how their healing is progressing, then tailoring your behavior to suit the unique physical and emotional needs of your patient, at that moment.
And that’s where therapeutic communication comes in.
“Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client’s specific needs to promote an effective exchange of information. Skilled use of therapeutic communication techniques helps the nurse understand and empathize with the client’s experience.” – Nurseslabs.com
“Therapeutic communication is essential to the use of the self as an instrument of healing. It is the use of verbal and non-verbal messages to establish a professional therapeutic nurse-client relationship that will be the context for meeting the client’s physical and psychological needs.” – Therapeutic Interaction in Nursing (book)
By using therapeutic communication methods, a nurse can respectfully and compassionately lead a patient to share the most pertinent information about:
The healing process for most patients involves a collection of clinical tests and treatments. But for many patients, therapeutic communication contributes just as much to their overall healing.
You can think of it like this: Clinical tests look at physical attributes to assess the organs, structure, and systems of the physical body, and clinical treatments seek to fix problems found by the tests.
Therapeutic communication combines testing and treatment in a single process. It uses observation and empathic skills to assess and manage the patient’s emotions, determination, feelings, and attitude – their spirit and soul.
The purpose of therapeutic communication, then, is to help clinicians build trust with patients while also helping clinicians and patients collaborate efficiently and effectively toward the patient’s physical and emotional wellness.
In some interactions with patients, clinicians are simply being friendly. But in many interactions, clinicians are trying to achieve a clinical objective. Therapeutic communication techniques play a leading role in reaching the clinical objective.
To get maximum effectiveness from therapeutic communication techniques, clinicians should follow three steps:
|TECHNIQUE||REASON TO USE||EXAMPLE|
|Affirm desired behaviors||Let your patient know that you’re aware of her efforts. This recognition acknowledgment is not framed as a compliment because a compliment for doing a basic task (like going to the bathroom by herself) can be perceived as condescending.||“I see you’re wearing the blouse your daughter brought yesterday.”|
|Ask for clarification||You’re not confident you understand your patient correctly due to certain ambiguous words, gestures, or body language.||“I’m not sure I got that. What did you mean by ‘everything is different now?'”|
|Ask open-ended questions||Helps you capture your patient’s thoughts and perceptions while also assessing his attitude, awareness, and thinking abilities.||“Tell me more about that.”
“How do you cope with that?”
|Confront||You’ve established trust with your patient, and now you observe him saying or doing something inconsistent with an attitude, belief, or behavior he expressed earlier. Gently help him see the contradiction so you can help him align what he’s doing with what the results he wants.||“Mr. Jones, you said you wanted to get back to your family as fast as possible, but you’ve been in bed all morning. Will you be ready to walk the hallway in the next half hour?”|
|Encourage formulation of an action plan||Your patient needs to break a bad habit or create a good habit.||“What are some steps you think you could take to help you limit the number of donuts you eat?”|
|Focus||Your patient is jumping from topic to topic without closure on anything. You need her to focus on one key area so you can capture critical details and so she isn’t overwhelmed by everything at once.||“You’ve brought up several good points. Let’s get back to what you said about sometimes forgetting if you took your medicine.”|
|Give information||Builds trust, reduces patient anxiety, and improves patient cooperation and safety because she understands what’s happening and why it’s happening and is therefore more likely to comply.||“After the surgery, you’ll have a drainage tube in your neck. You’ll need to change the surrounding bandage every 6 hours, then come back in three days to have it removed.”|
|Make broad opening remarks||Gives your patient the freedom to talk about what she wants to talk about. She has some control over circumstances and is not just a problem to be fixed.||“What’s on your mind today?”
“Where should we start?”
|Offer your time and presence||Builds trust by demonstrating you care about and are interested in your patient.||“Is it ok if I sit with you until patient transport arrives?”|
|Place events in sequence||You need to understand what may have caused specific symptoms, and your patient should become aware of connections between his actions and his symptoms.||“Did you experience the light-headedness before or after you got up to leave the theater?”|
|Reflect||Your patient asks for advice, and you show respect for her judgment and encourage self-accountability by asking the question right back.||Patient: “Do you think I should tell my family physician?”
You: “Do you think you should?”
|Restate / paraphrase||Assures your patient you heard and understood what he said.||Patient: “This food tastes like cardboard.”
You: “Not enough flavor for you?”
|Share thoughts and observations||Shows your patient you are paying attention and encourages her to share more information.||“That must have been unpleasant.”
“You seem more tired today.”
|Suggest comparisons||You need to convert a patient’s vague or abstract experience into something understandable.||“Does it feel like pins and needles pressing against your fingertips, or more like a pencil eraser?”|
|Summarize||You or your patient provided a lot of information. You need to confirm a shared understanding and bring closure to the discussion so you can document accurately.||“Ok, so we agreed you’ll press the call button next time you either feel that pain in your arm or feel like it’s more difficult to breathe.”|
|Use active listening||Builds trust by showing your patient that what she’s saying is important to you. She knows you are paying attention and feels like it’s safe to keep going. It also contributes to mental and emotional healing.||Make and hold eye contact.
Turn to face your patient.
Nod in agreement.
“Ok, I’m with you.”
|Use silence||Your patient needs time to collect and organize his thoughts and decide what to say next.||Retain eye contact.
Continue to face your patient so he knows you’re ready for him to continue.
Allow your patient to speak next.
When a clinician is skillful with therapeutic communications, they can develop a therapeutic relationship with their patient. Through that relationship, the clinician becomes more effective at recognizing and influencing meaningful changes in the patient’s physical, mental, and emotional state.
And remember, therapeutic communications are not restricted to face-to-face encounters. Technology brings more opportunities to use therapeutic communication techniques.
We’ve been using phones and email for years. More recent developments allow clinicians and patients to connect via secure texting and video conferencing. These technologies are especially helpful for patients with chronic conditions that require routine monitoring, and also for post-op patients who need follow-up care. Clinicians can build and strengthen their relationship by using these technologies to more frequently apply their therapeutic communication skills — even when patients have left the hospital or clinic.
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According to the American Psychiatric Nurses Association, therapeutic communications are marked by “an attitude of respect, dignity, and empowerment.”
Sure, it’s a challenge. Nurses and therapists are asked to be always “on” and ready to pour their best mental and emotional energy into their communications while simultaneously offering their best clinical knowledge and skills.
But the rewards are massive. When nurses and therapists take their valuable clinical training and skills, add targeted therapeutic communication techniques, and take advantage of new ways to bring patients into the conversation, then we and the people we care about receive better care with fewer missteps, and our healing is faster and more complete.
Tags: therapeutic communication, nurse client relationship, active listening, therapeutic relationship, communication techniques, encourage the client, eye contact, recognition acknowledgment, therapeutic communication techniques