Written By: Darby Faubion BSN, RN
Nurses interact with people every day. Whether you talk with patients, family members, nurses, or other healthcare providers, it is vital for nurses to develop effective communication skills that promote favorable outcomes for patients and the healthcare team. Therapeutic communication should be at the core of every nurse-patient, nurse-caregiver, or interdisciplinary team relationship. Perhaps you are wondering, “What is therapeutic communication in nursing?” In this article, I will answer that question and provide you with examples of how to develop therapeutic communication skills. As you continue reading, you will find the 30 top therapeutic communication techniques in nursing + how to use them.
What Is Therapeutic Communication In Nursing?
Therapeutic communication in nursing is the process of using verbal and nonverbal communication to connect and correspond with patients. Therapeutic communication is patient-centered and should involve a holistic approach, including aspects of psychological, physiological, spiritual, and environmental care of the patient.
What Is The Difference Between Therapeutic And Non-Therapeutic Communication In Nursing?
Therapeutic and non-therapeutic communication in nursing are opposites of one another. Therapeutic nursing communication promotes good nurse-patient relationships and can help improve patient satisfaction and outcomes. Therapeutic communication in nursing can lead to a deeper insight into the patient's ability to care for himself, his perception of the reality of his health situation, and any other issues that need to be addressed.
Conversely, non-therapeutic communication can lead to miscommunication between the nurse, patient, and other healthcare team members. Non-therapeutic communication in nursing can hinder effective patient care, lead to errors or omissions in care, and have legal consequences if the patient is injured as a result of poor communication.
When Do Nurses Engage In Therapeutic Communication?
Nurses should strive to make all communication with patients a therapeutic experience. The principles associated with nursing therapeutic communication can be applied to verbal and nonverbal communication and when used correctly, can have a positive impact on patients, nurses, and the facilities they serve.
5 Reasons Why Therapeutic Communication Is Important In Nursing
Communication is a powerful tool, and when used correctly, it can significantly impact relationships between nurses, patients, caregivers, and healthcare organizations. Here are five reasons why therapeutic communication is vital in nursing.
1.Therapeutic communication in nursing helps establish strong nurse-patient relationships.
2.Nursing therapeutic communication is an essential part of interdisciplinary relationships, promoting effective and efficient collaboration among team members to promote positive patient outcomes.
3.Therapeutic communication in nursing encourages an atmosphere where patients can learn and become engaged in their care.
4.Therapeutic communication fosters trust between the patient and nurse. When patients trust their nurses, they are typically more compliant with their care plans, which improves patient outcomes.
5.When nurses implement therapeutic communication techniques, patients feel more at ease, making it easier for them to voice their opinions, feel supported, and be confident in their care.
What Are The Five 5 Essential Components Of Therapeutic Communication In Nursing?
While there are many components that make up therapeutic communication in nursing, there are five essential components all nurses should exercise. The following are essential components of therapeutic nursing communication and explanations of why they are so important.
1.Respect for the Patient’s Values and Beliefs:
Nurses must uphold and integrate the patient's personal values and beliefs into their care without exception. It is crucial for nurses to keep in mind, that the patient is the center of care, not the nurse or other healthcare providers.
2.Time:
Nurses are busy people, no doubt. It is not uncommon to be responsible for several patients who have various needs and priorities each day. One of the essential components of therapeutic communication for nurses is the wise use of time. Nurses must allow enough time for each patient to perform their assigned tasks and allow the patient to ask questions or voice concerns.
3.Patience:
No matter how many people surround your patient, whether it is a spouse, children, or friends, your patient will likely experience moments of fear or anxiety. If you desire to promote a therapeutic dialogue with your patient, you must learn to practice patience. Patience is essential to therapeutic communication in nursing. When you offer patience and understanding, your patient will feel less anxious and will be more likely to open up to you about what is bothering him.
4.Honesty:
It is never appropriate to lie to a patient. While there may be uncomfortable subjects to discuss, there are ways to deal with those situations while practicing honesty. Dishonesty inevitably leads to severe issues with the nurse-patient relationship and hinders therapeutic communication. When faced with a situation where you are uncomfortable or unsure how to answer a patient, do not lie to them. Instead, tell them you need to clarify information before you answer, and talk to your nursing supervisor for advice or direction.
5.Compassion:
The Journal of Compassionate Healthcare states, “studies show that compassion can assist in prompting fast recover from acute illness, enhancing the management of chronic illness, and relieving anxiety.”
6 Key Skills Required To Successfully Engage In Nursing Therapeutic Communication
Learning therapeutic communication in nursing takes time and should be a skill you continually build upon. While therapeutic communication is vital for nurse-patient interactions, it is also necessary to relate well with the healthcare team. No matter how long you have been a nurse, there are six skills that can help you successfully engage in nursing therapeutic communication.
1.Verbal Communication:
Excellent verbal communication is the primary key to therapeutic communication. Speak calmly and clearly. Use words that are age-appropriate and culturally respectful.
2.Nonverbal Communication:
Elements of nonverbal communication include eye contact, facial expressions, posture, and body language. Show interest in what your patient is saying by maintaining eye contact. Nod your head to acknowledge what he is saying. If you can, sit in a chair near your patient and lean forward to demonstrate you are engaged.
3.Written Communication:
Nurses use written communication, such as documenting in the patient's chart. Make sure nursing notes are completed immediately after patient care, so no details are left out. Write clearly and legibly. Use appropriate abbreviations. Note the date and time on all notes and sign with your name and title.
4.Patient Education:
One skill of therapeutic communication for nurses you may not have thought of is patient education. Nurses are responsible for communicating information about medications, treatments, and other issues related to care. To be sure you have effectively relayed the information and the patient understands your instruction, ask him to repeat the instructions to you or to explain what you discussed in his own words.
5.Make Personal Connections:
Nurses should develop patient-centered relationships to help patients feel safe. It is vital to get to know your patient as more than a room number or diagnosis. Spend a few minutes each day getting to know your patients. Show interest in their lives and be attentive when they want to share stories with you.
6.Learn to Be Culturally Aware:
Patients come from a variety of cultural, social, and educational backgrounds. Each patient is unique. Nurses need to be sensitive to the uniqueness of each patient or team member. Find out if there are any cultural or religious beliefs that influence the patient's decision-making and respect those beliefs.
WHAT ARE THE TOP THERAPEUTIC COMMUNICATION TECHNIQUES IN NURSING?
There are many therapeutic communication techniques in nursing. Nurses who learn to incorporate therapeutic communication into practice tend to build stronger nurse-patient and interdisciplinary relationships, which is beneficial for patient outcomes and strengthens organizations. The following is a list of the 30 top therapeutic communication techniques in nursing along with information on why they work and how to use them in nursing practice.
TECHNIQUE #1: Using Active Listening
Why this Technique Works:
Active listening is one of the most effective methods of therapeutic communication in nursing because it involves showing genuine interest in what your patient has to say. When patients feel like their thoughts and feelings are important and valued, they are more likely to talk openly with nurses. This is especially important as the patient is the most valuable source of information when developing care plans and evaluating the effectiveness of treatments.
How to Use this Technique:
Nurses demonstrate active listening by acknowledging that they are listening and understand what the patient says. To use this technique, nurses must engage clients throughout the conversation. Nonverbal cues such as nodding when the patient speaks lets them know you are listening to what they are saying. Verbal reactions such as stating, “I see,” or “What happened next?” are also ways to keep the patient engaged.
TECHNIQUE #2: Seek Clarification
Why this Technique Works:
It is normal for patients to feel anxious when talking with nurses or other healthcare providers. Being nervous can lead to confusing or unclear statements. Like active listening, seeking clarification keeps the patient engaged and gives them a sense of your desire to understand what is important to them.
How to Use this Technique:
You can seek clarification by saying, "I'm not sure I understand. Could you explain that to me again?" Repeating what you think the patient is saying and asking for clarification is another way to use this technique. For example, you could say, "If I understand correctly, you started feeling this way a few days ago and have not felt any relief."
TECHNIQUE #3: Give Broad Openings and Use Open-Ended Sentences
Why this Technique Works:
This technique of nursing therapeutic communication is effective because it allows patients to direct the flow of the conversation. Open-ended questions require patients to put effort into their answers and offer more than a yes or no answer, which can help nurses get to the bottom of what is going on with them.
How to Use this Technique:
The best way to implement this technique is to use open-ended questions. For instance, instead of saying, “Are you okay today?” ask, “What’s on your mind today?”
TECHNIQUE #4: Use Time and/or Sequence
Why this Technique Works:
Asking patients to put information in the context of time or a sequence of events is an excellent way to use therapeutic communication for nurses. This communication technique encourages patients to think about the sequence of events that led them to seek or need medical treatment. Using sequencing may prompt patients to remember something they may have otherwise thought was not significant.
How to Use this Technique:
One way to help patients create a timeline or sequence of events is to ask about when specific events occurred and try to relate them to other events. For example, if the patient reports a headache and stuffy nose, the nurse can ask when the patient first noticed the headache. Ask if the patient was exposed to allergens, such as pollen from working outside.
TECHNIQUE #5: Know When to Be Silent
Why this Technique Works:
Sometimes one of the best therapeutic communication techniques in nursing is silence. There is a difference between being silent and ignoring someone. Deliberate silence gives patients and nurses an opportunity to think about what they want to discuss next. It also allows patients time and space to approach new topics without feeling the pressure of constant engagement.
How to Use this Technique:
When using silence as part of therapeutic nursing communication, it is important to make sure your presence is known and the patient does not feel ignored or alone. If the patient needs a few moments to think or consider how to answer a question, be patient and assuring. When silence is used as a communication technique, the patient should be allowed to break the silence first.
TECHNIQUE #6: Give the Patient Recognition
Why this Technique Works:
Whether we admit it or not, everyone appreciates being recognized for a job or task well done. Patients are no exception. If you want to establish therapeutic communication with your patients, be sure to recognize their efforts. Remember, each patient is unique and may not be able to accomplish the same tasks. Instead of comparing one patient to another, recognize each patient’s accomplishments.
How to Use this Technique:
Use recognition to draw attention to a patient’s positive behavior. Recognition encourages patients to continue to do better without requiring a compliment. For example, if you tell a patient, “I see you made your bed without assistance,” that could be taken as condescending because it is related to a routine task. On the other hand, if you say, “Hey! I noticed you took all your medicine this morning,” you draw attention to the desired action and encourage the patient to repeat the behavior without the need for compliments.
TECHNIQUE #7: Use Observation Skills
Why this Technique Works:
Observation is one of the most critical skills nurses can develop. Nurses who learn to use observation can help draw the patient’s attention to things that may pose a problem for them. Observation can also indicate things that are working to benefit the patient.
How to Use this Technique:
Observation includes anything you can see about the patient. For example, what is the patient's demeanor? Is his appearance neat or unkempt? You may observe your patient has not eaten much lately, indicating a new symptom such as nausea or abdominal pain. If your patient appears tired, ask if she has been sleeping well.
TECHNIQUE #8: Encourage the Patient to Use Comparisons
Why this Technique Works:
Patients may have difficulty expressing what they think or feel. It is not uncommon for them to become frustrated trying to explain things, especially if they do not understand medical terminology. Encouraging patients to use words or ideas they are familiar with and comparing them to what they are currently experiencing makes it easier for them to communicate with the nurse.
How to Use this Technique:
To use this technique, nurses can encourage patients to draw upon previous experiences and compare them with current symptoms or problems. Ask questions about previous illnesses, medications, or situations the patient experienced and see if the patient can find a way to make it relate to what is presently happening.
TECHNIQUE #9: Focus
Why this Technique Works:
One of the best things you can do to promote nursing therapeutic communication is to deliberately focus on your patient. Sometimes, even in general conversations, patients may mention things that are significant to the situation. By focusing on what your patients say and how they act, you may find things that need to be discussed or be clued in on ways you can prompt them to be more engaged in communication and their care.
How to Use this Technique:
Implementing focus into therapeutic nursing communication requires being purposefully attentive to what the patient is doing and saying as well as being aware of what is happening in the care environment. Listen carefully to the words your patient speaks and the tone of voice with which he speaks to them. Focus on any words the patient uses that may signify pain, discomfort, satisfaction, dissatisfaction, fear, dread, or anxiety.
TECHNIQUE #10: Summarize
Why this Technique Works:
It is always a good idea to summarize what patients have said. This technique helps promote therapeutic communication in nursing by ensuring the nurse clearly understands what the patient tried to say and keeps the dialogue open for clarification. Summarizing gives the patient a feeling of permission to make corrections if needed. It helps them feel like they have control over the communication related to their care, which supports patient autonomy.
How to Use this Technique:
Summarizing a conversation can be as simple as repeating things the patient said and ending with a phrase like, “Does that sound correct?” or “I want to make sure I understood everything correctly.”
TECHNIQUE #11: Reflect
Why this Technique Works:
Patients often feel uncertain about their situations and don’t know what to do about a particular problem. They may ask nurses for advice on how to handle a situation. Reflection can be a positive technique in therapeutic communication for nurses to use. It works because, instead of telling patients what to do, you can ask the patient what they think they should do. This encourages patients to be accountable for their own healthcare decisions and actions and promotes autonomy, which is a patient right.
How to Use this Technique:
The easiest way to use reflection in therapeutic communication is to take what the patient asks you and answer with a question. Keep in mind, this is not to confuse the patient but to encourage thoughtfulness on their part. Consider this conversation and how the nurse uses reflection to get the patient to think.
Patient: “What do you think I should tell my kids about my diagnosis?”
Nurse: “What are your thoughts about approaching your children?” or “Have you considered how much you are comfortable sharing with them?”
TECHNIQUE #12: Use Touch
Why this Technique Works:
Touch can be a powerful tool in developing therapeutic communication for nurses. Appropriate touch can promote a feeling of calm, ease anxiety, and be quite effective in providing comfort.
How to Use this Technique:
Touch is a form of nonverbal communication that many nurses use. Nurses may hold a child's hand while another nurse checks vital signs or starts an IV. They may hug a patient who is crying to offer comfort. Nurses need to know when it is appropriate to touch a patient and how and to practice cultural awareness when providing patient care. Some patients may value having their hand held or someone placing an assuring hand on their shoulder. If, however, the patient's cultural beliefs find touch offensive, this technique should be avoided. Also, if the patient or patient's caregiver seems uncomfortable with touch as a form of communication, avoid it and use other methods to promote therapeutic communication.
TECHNIQUE #13: Confronting
Why this Technique Works:
Confrontation can be an effective tool for therapeutic communication between nurses and patients, but it should only be used once a relationship of trust is established. Confronting, when done properly, can present patients with reality or challenge misconceptions. It can help break counterproductive routines and assist patients in understanding their situations.
How to Use this Technique:
Confronting is not about arguing but more about helping patients face the reality of inconsistencies in their beliefs, behaviors, feelings, or attitudes. When using confrontation to demonstrate therapeutic communication, the nurse should state facts in a manner that allows the patient to think and respond. For instance, if a patient previously stated he knows how is going to proceed with his treatment plan, but he continually asks questions and wants to discuss other options, the nurse could say, "You said you have already decided which treatment option you want. However, you are still talking about other options. Is there anything you would like to discuss to get a clearer understanding and help you decide?”
TECHNIQUE #14: Be Available
Why this Technique Works:
Hospital stays leave patients feeling lonely and afraid. When nurses put forth the effort to show patients they value them and are willing to give them their time and attention, it can reduce feelings of fear or anxiety, making communication easier.
How to Use this Technique:
It’s no secret that nurses are busy people. Sometimes it can feel like there are not enough hours in the day to get everything done. Still, when nurses take even a few extra minutes to be available for patients, it can make a big difference. Stop by a patient’s room just to say hi and ask if there is anything they need. If your work is caught up or things are not quite so hectic on your shift, offer to spend some extra time sitting and talking with your patient, stay with them through lunch or watch a short tv-series with them. While all these options may not be something you can do every day with every patient, there are some circ*mstances when a little extra time can make a significant difference for your patient.
TECHNIQUE #15: Offer Hope
Why this Technique Works:
Have you ever had a patient who seemed to always be in a bad mood, no matter what you did to try and make her smile? It can leave you feeling frustrated when you don’t know what to say or do to help someone. Now, imagine being the patient who is lonely, afraid, and not knowing what to expect because of their illness or disease. No matter how grouchy or ornery a patient may seem, one thing that seems to make a difference in their outlook is hope. Hope gives patients something to look forward to. It helps patients develop a more positive mindset, which helps improve emotional well-being and improves overall outcomes.
How to Use this Technique:
Therapeutic communication techniques in nursing do not have to be difficult. For example, offering hope has a lot more to do with your attitude and the way you conduct yourself when caring for your patient and discussing their health issues. Speak encouraging words. Ask your patient about their hobbies and interests. Tell them you look forward to the day when they are well enough to get back to the things that make them happy. You don’t have to be dishonest to offer hope. Simply find something positive to focus on and let that be a source of hope for recovery and getting life back to normal.
TECHNIQUE #16: Find and Share Humor
Why this Technique Works:
Naturally, there are some situations when it feels like laughter or humor is inappropriate or difficult. In those times, don’t force it. However, in times when the situation is a little lighter, laughter and humor can reduce anxiety and promotion mental/emotional well-being.
How to Use this Technique:
Using humor in communication takes tact and, sometimes, creativity. The first step in using humor to develop therapeutic communication is knowing when it is appropriate. If a patient has just learned about a devasting diagnosis, that is not the best time to joke around. Perhaps the most appropriate time to incorporate humor in patient communication is during the education process. Use simple examples that patients can relate to. For example, if a patient needs education about a new medication that has a side effect of abdominal discomfort or diarrhea, you may make a joke about how it can be awkward to take the medicine before an important meeting or event because they may spend a lot of time in the restroom. It may seem uncomfortable at first to make jokes about things like this, but remember, if you can lighten the mood and help the patient relax, you are doing a good job.
TECHNIQUE #17: Voice Doubt, When Appropriate
Why this Technique Works:
Voicing doubt about something a patient says may not have crossed your mind when thinking of examples of therapeutic communication techniques in nursing. However, it is not uncommon for nurses to find themselves in a situation where they need to call attention to incorrect perceptions, ideas, or details. This technique is helpful in establishing therapeutic nurse-patient communication because it helps bring patients back to reality when they are confused and can help encourage patients to look at a situation on a broader scale. Keep in mind, this technique is not supposed to be an attempt to get the patient to change his point of view, but to draw attention to the possibility that there may be more to the picture than he sees.
How to Use this Technique:
It is okay to voice doubt, but it is never okay to call a patient a liar (even if you know she is being dishonest). If you a patient is misrepresenting facts, whether intentionally or unintentionally, you can use this technique to redirect thoughts and correct misconceptions. Use simple statements such as, “Wow, that’s hard to believe,” “Really? Can you tell me more about that?” or “Do you think that’s a bit unusual?”
TECHNIQUE #18: Encourage Patients to Describe Their Feelings
Why this Technique Works:
Patients can sometimes feel apprehensive about sharing their feelings or explaining their perspectives about what's going on with them physically or emotionally. By asking the patient to verbalize things from her perspective, you create an atmosphere conducive to open dialogue and self-expression, which helps build trust between the patient and nurse.
How to Use this Technique:
When using this therapeutic communication technique, the objective is to get the patient to express her thoughts without fear of rejection. The most effective way of using this technique is to use open-ended questions or statements that require the patient to describe something to you. For example, “What is happening right now?” or “What are you thinking when you feel anxiety?”
TECHNIQUE #19: Suggest Options (Not Medical Advice)
Why this Technique Works:
A willingness to discuss options is another one of the therapeutic communication techniques in nursing which should be handled carefully. It is normal for patients to feel more comfortable talking to and sharing things with nurses than doctors, typically because nurses usually spend more one-on-one time with patients. With that in mind, it is not uncommon for patients to ask nurses to explain care or treatment options to them.
How to Use this Technique:
If you choose to use this technique, be careful to stay within your scope of practice, knowledge, and the limits of your role as established by your employer. You may need to talk with the physician or charge nurse to find out what options are available for your patients and explain that you want to be prepared in case the patient asks questions. When your patient asks for your advice, you can begin statements with phrases like, “Have you thought about......?” or “Other patients in your situation have tried......, perhaps you could discuss this option with your doctor.”
TECHNIQUE #20: Use General Leads
Why this Technique Works:
General leads are simple statements the nurse makes that encourage the client to continue talking and sharing. Using general leads promotes therapeutic communication in nursing because it shows the nurse is interested in knowing what the patient will say next.
How to Use this Technique:
Using general leads requires only a few words. Statements or phrases such as, “Can you tell me more about that?” “And then what happened?” or “Go on, I’d like to know more” engage the patient by showing your interest and keeping them talking.
TECHNIQUE #21: Offer Acceptance
Why this Technique Works:
No doubt, everyone wants to believe their thoughts or feelings are important and that others are willing to accept them. Offering acceptance is an excellent way to promote therapeutic communication for nurses. This technique works because when patients feel accepted, they are generally more at ease and likely to participate in communication and care planning.
How to Use this Technique:
Acceptance does not mean you have to agree with everything the patient says. Instead, acceptance is more a sense of indicating you understand what the patient is trying to say and approaching communication with them in a nonjudgmental manner. This is another technique that requires the nurse to say little. Simple words or phrases like, “Oh, I see.” “I’m following what you’re saying” or nodding when your patient talks signals that they have your attention, and that you value what they are saying.
TECHNIQUE #22: Exploration
Why this Technique Works:
Every part of the nursing process involves some sense of exploration. Therapeutic communication requires nurses and patients to explore ideas, relationships, and experiences more fully.
How to Use this Technique:
As you talk with your patients, listen attentively to what they say and try to relate it to the current situation. You can demonstrate exploration as part of therapeutic communication by asking direct questions or making specific statements. For instance, "What is your relationship like with your family?" or "Do you feel comfortable talking about how you felt when you were diagnosed with cancer?" A simple statement such as, "Please tell me more about that," encourages open communication and allows the patient to explore his feelings in more depth with you.
TECHNIQUE #23: Rephrase What the Patient Says
Why this Technique Works:
When we repeat what someone else says in our own words, or paraphrase, it creates an opportunity for both the patient and the nurse to reflect upon the message and ensure clear understanding. Restating what the patient says to you is a great way to promote therapeutic communication in nursing because it keeps the dialogue open between the patient and nurse and allows room for correction or reevaluation.
How to Use this Technique:
This technique of communication is simple in that all you need to do is listen to what the patient says and repeat it in a different format.
For instance, if Mr. Jeselink, “I’ve been overweight for years and my health has been fine. I don’t know why the doctor wants me on this new diet,” the nurse can respond by saying, “Since you’ve been healthy for so many years, you’re not really convinced you need to be on a special diet, are you?”
In this example, the nurse acknowledges what the patient says. By rephrasing his words as a question back to him, he keeps the dialogue open, creating an opportunity for patient education.
TECHNIQUE #24: Verify Impressions of What the Patient Says
Why this Technique Works:
This technique of therapeutic communication is like rephrasing the patient’s statement, but the context of the technique is different.
How to Use this Technique:
Verifying impressions of what the patient says requires the nurse to listen to what the patient says and then ask a question based on their impression of the patient’s statement. The following is an example.
Patient Sarah states, “It’s a waste of time talking to you or anyone else. I don’t know why I even bother.” The nurse responds by saying, “Do you feel like no one understands what you are saying or feeling?”
TECHNIQUE #25: Present Reality
Why this Technique Works:
When patients seem confused about what is imagined and what is reality, it is necessary for the nurse to help them see the reality of the situation. This method of therapeutic communication in nursing helps direct the patient toward the facts of a situation.
How to Use this Technique:
It is never appropriate to argue with a patient. Instead, if what the patient perceives as reality is not real, the nurse must indicate what is real in a calm, nonjudgmental way. For example, if the nurse enters Patient Thomas’ room and Mr. Thomas refers to her as “Mother,” the nurse should respond by saying, “Good afternoon, Mr. Thomas. Your mother is not here. I am the nurse, Sharon.”
TECHNIQUE #26: Share Personal Experiences
Why this Technique Works:
Sharing personal experiences can be a great therapeutic communication technique in nursing. Nurses who are open to self-disclosure may seem more approachable to patients, making it easier for patients to talk about difficult subjects.
How to Use this Technique:
While sharing personal experiences is sometimes appropriate, nurses should be sure to use generalized sharing. Avoid going into too much detail, which could overwhelm the patient. Do not embellish your story or experience. Be honest and provide only the necessary information to create therapeutic dialogue. For example, if the physician has suggested counseling to help the patient deal with a traumatic experience and you have been in a similar situation and had counseling, you can talk about it.
One way to share your experience without disclosing too much would be to say, “I went through a traumatic experience a few years ago. It was difficult for me to deal with my emotions on my own. I decided to see a counselor to help me work through the trauma, and it was quite helpful. What are your thoughts about going to counseling?”
TECHNIQUE #27: Asking Patients to Describe Their Perception of a Situation/Event
Why this Technique Works:
All patients should feel safe communicating with their nurses. Unfortunately, some situations cause patients to feel apprehensive, despite the nurse’s efforts to help them be at ease. For instance, patients experiencing hallucinations, delusions, or other sensory issues may find it difficult to relay their thoughts or feelings. Asking patients to describe their perception of what is happening gives the nurse insight into what the patient is experiencing.
How to Use this Technique:
This technique of therapeutic communication for nurses must be carried out carefully. Nurses must understand that patients experiencing sensory issues that cause them to see or hear things that are not there typically do not respond well when told there is “nothing there” or “this isn’t real.” Instead, nurses should encourage patients to describe their perception of the situation. Ask questions like, “Can you tell me what you hear?” “What did the voice sound like?” or “What does it look like to you?” Asking open-ended questions prompts the patient to explain what they are perceiving without feeling as though their perceptions are being invalidated.
TECHNIQUE #28: Attempt to Translate What the Patient Says in the Form of His Feelings
Why this Technique Works:
Patients often say things that have a different meaning, which is a way of indirectly expressing feelings. When nurses listen to what the patient says and attempts to translate his words to understand his feelings, it makes the patient feel validated. If a patient feels her feelings are valid and important to the nurse, she is more likely to express thoughts and feelings more freely.
How to Use this Technique:
The first step in using this technique for therapeutic communication in nursing is to understand that the words a patient says may not be what he means. Then, the nurse must try to translate or get to the bottom of what the patient is trying to say.
Example: Patient Madison states, “I’m way out in the ocean and can’t see land no matter how hard I try to find it.” The nurse responds with, “It sounds like you are lonely and may feel deserted. Would you like to talk about what you’re feeling?”
TECHNIQUE #29: Show Empathy
Why this Technique Works:
The ability to demonstrate empathy is one of the most essential skills a nurse can develop. Showing empathy is an effective tool for therapeutic communication in nursing because it lets the patient know their feelings are accepted and understood.
How to Use this Technique:
The best way to show empathy when communicating with patients is to listen to what they say and follow up their comments with some response that validates their feelings.
For example, let’s say Mr. Kimball was recently admitted to a long-term care facility because his wife is unable to care for him on her own.
Mr. Kimball states, “I hate it here! I just want to go home.”
The nurse responds by saying, “Mr. Kimball, I realize it must be difficult for you to not be at home. Is there anything I can do to help you be more comfortable here?”
TECHNIQUE #30: Encourage Participation in Care Planning
Why this Technique Works:
Being diagnosed with an illness or disease can leave even the strongest among us feeling hopeless and as if we have no say so in our own lives. Some patients become so overwhelmed that they withdraw from everyone and everything. It is important for patients to realize the thoughts, feelings, and desires they have about their care matter. When we implement the technique of encouraging patient participation in care planning, we give our patients a sense of control in a situation where they may otherwise feel powerless. In so doing, we as nurses foster therapeutic communication that becomes a powerful tool to improve nurse-patient relationships and patient outcomes.
How to Use this Technique:
Nurses encourage patient participation in care planning by asking questions. The first step is to find out how the patient feels about their diagnosis. Ask them if there is someone they want to be included in the planning process with them. Find out if religious or cultural beliefs may influence the patient's decision about treatments or medications. Anything you can do to consult with the patient and include the patient's preference in planning care will be helpful in promoting this technique for therapeutic communication in nursing.
15 Non-Therapeutic Communication Techniques Nurses Should Avoid
As nurses learn about communication skills and discover what works best to establish strong relationships and effective communication, it is equally as important to recognize non-therapeutic communication techniques. The following are fifteen examples of non-therapeutic communication techniques nurses should avoid.
1.Asking Irrelevant Personal Questions:
The nursing assessment includes a patient interview. Nurses must learn what information is necessary to obtain an accurate patient history and complete the nursing assessment without crossing the line and asking for personal information irrelevant to the patient’s care. If a question serves to satisfy the nurse’s curiosity instead of providing a source of information to develop a care plan, it is irrelevant and should be avoided.
2.Using Stereotypical Comments or Cliches:
One of the most common non-therapeutic communication techniques in nursing is the use of cliches or stereotypical comments. These types of statements seem to minimize the significance of what the patient is thinking and feeling. Patients may feel as if the nurse is belittling their situation, which can lead to an abrupt halt in communication altogether.
Nurses should avoid statements like, “God knows what you can handle,” “Sometimes things just
happen,” or “Keep your chin up. It will get better.”
3.Giving Unsolicited Personal Opinions:
Sometimes patients ask nurses their thoughts about an illness, medication, or treatment. They may even ask if you have been in a similar situation before. If they ask, great. If they don’t, do not assume they want your advice or opinions. Imposing unsolicited personal opinions on your patients can lead to a block in effective communication which could negatively impact your patient’s outcome later.
4.Changing the Subject:
A common barrier to therapeutic communication in nursing is when the nurse changes the subject during a conversation. This behavior makes the patient feel like his feelings are not important and takes the desire for interaction away from the patient.
Example: Patient Marcus states, “I am so scared about starting chemo tomorrow.”
The nurse responds by saying, “Why don’t we take a walk and see if it helps you feel better?”
5.Pressuring the Patient:
One of the fastest ways to shut down therapeutic nurse-patient communication is to impose pressure on a patient. Patients may or may not have knowledge about medical treatment options, medications, or other remedies to their situation. It is the nurse's job to provide enough information so the patient can make an informed decision without feeling pressured to choose an option they are unsure of or uncomfortable with.
6.Imposing the Nurse’s Approval or Disapproval About a Patient’s Choice:
Earlier in the article, I mentioned that giving recognition is a great way to foster therapeutic communication in nursing. That is true when it comes to recognizing a patient’s effort to do something that she may have previously not felt like doing like putting on make-up or making her bed. Those types of compliments can help build stronger communication. However, the nurse should never assume her approval or disapproval about a patient’s choice is appropriate. Instead of promoting positive communication in the nurse-patient relationship, imposing one’s personal approval or disapproval about a patient’s personal decisions can impede communication and sow discord in the nurse-patient relationship.
7.Arguing with the Patient:
Arguing with a patient will never produce a therapeutic nurse-patient relationship. Even if you know the patient’s perception of an event was inaccurate, it is important to respect what they say. For example, Mr. Jones may report that he feels famished and hasn’t eaten for two days, but you know he ate 100% of breakfast and lunch trays today. Mr. Jones may truly be hungry and may have forgotten that he ate earlier. Instead of arguing, offer him a snack and ask if his meals are enough to satisfy him.
8.Using Passive Responses:
When someone is passive, they tend to avoid conflict or sidestep important issues. Patients are typically nervous when it comes to healthcare issues and most desire straightforward answers from honest nurses and doctors. Nurses must learn to use assertive communication delivered in a respectful way.
9.Giving Aggressive or Defensive Responses:
It is normal for patients to feel anxious or afraid. Sometimes their fear or anxiety may lead to them doing or saying something that offends the nurse. It is an instinct for anyone to want to defend themselves or someone else if they feel the person has been unjustly accused or verbally attacked.
For example, a nurse may hear a patient talking badly about a doctor and feel the need to defend the doctor. The nurse could respond by saying, “The doctor is trying his best to care for you.” While this may be true, because the nurse acted with a defensive response, the patient may feel like she cannot express her feelings or opinions. The nurse’s statement may reinforce the patient’s opinion and lead to further breakdown in communication.
10.Questioning the Patient “Why”:
There are times when nurses need to understand the reason for a patient’s statement or behavior, but not every circ*mstance demands an explanation or gives you the right to question your patient.
Questions like, “Why did you do that?” “Why didn’t you take your medicine?” or “What made you think that?” can sound threatening or make the patient feel intimidated.
If a situation requires you to ask questions, present them in a tactful manner, so the patient feels more at ease. For instance, you can rephrase each of the questions in this example to sound more appealing like this: “I saw your bandage was removed from your arm and was wondering if it was irritating you?” “If you feel like some of your medicine is not working or agreeing with you, I’d be happy to talk with the doctor and see if there is something else you feel more comfortable taking,” or “What are your thoughts about that?”
11.Imposing Sympathy:
Both empathy and sympathy can be effective tools when used appropriately and in the right context. Empathy involves putting yourself in your patient’s shoes and trying to understand why he may have particular thoughts or feelings. Sympathy, on the other hand, involves an understanding from your own perspective and is described as feeling sorry for someone. Sympathy can be counterproductive because it can impair the nurse’s judgement and is, therefore, not effective as a means of therapeutic communication in nursing.
12.Underloading:
In communication, underloading is the term used to describe unresponsiveness, remaining silent, or failing to give feedback. Underloading is a major barrier to therapeutic communication in nursing. For example, if a patient makes a statement about being depressed or not wanting to live and the nurse does not address the statement because the patient is smiling, the nurse is underloading the communication process. Underloading can lead to dire consequences, especially if the patient’s status worsens or he causes self-harm.
13.Making the Patient Feel Like What He Is Saying Is Not Important:
Therapeutic communication in nursing requires the nurse to be attentive to what the patient says. It involves active listening, observation, and appropriate interaction. Nurses jeopardize effective therapeutic communication when they minimize the importance of what the patient says. For example, failing to maintain eye contact, working on a task such as charting while the patient is talking, or being easily distracted create an atmosphere of non-therapeutic communication.
14.Offering False Reassurances:
When patients are seriously ill or emotionally stressed, nurses may want to offer hope by making reassuring statements. It is essential for nurses to understand the difference between being supportive and offering false reassurance.
Statements like, “Everything will be okay” or “Don’t worry; you’re going to be fine” are assurances the nurse cannot ethically give. These statements may become a barrier to therapeutic communication in nursing by discouraging the patient’s expression of his feelings. Instead of offering false reassurance, it is more appropriate to say something like, “I know you must feel anxious about your upcoming surgery. What can I do to help?”
15.Incongruence:
Incongruence is defined as a lack of appropriateness or consistence. Incongruence leads to failure in nursing therapeutic communication because the verbal and non-verbal messages from the nurse to the patient contradict one another. For instance, if a nurse tells a newly admitted patient, “I’d love to spend some time with you while you get settled in,” but she walks away and does not return to check on the patient, her actions have contradicted her words.
7 Most-Common Barriers To Therapeutic Communication In Nursing And How To Overcome Them
There are several barriers that affect therapeutic communication in nursing. When nurses recognize and acknowledge barriers, it is possible to overcome them and develop effective, therapeutic nurse-patient communication. The following are seven examples of barriers to therapeutic nursing communication and ideas about how you can overcome them.
BARRIER #1: Physical Barriers
About the Barrier:
Physical barriers are one of the most common barriers to therapeutic communication in nursing. Physical barriers include background noise, the physical distance between the nurse and patient, speech impediments, poor eyesight, or impaired hearing.
How to Overcome:
The first and usually most effective measure to overcome physical barriers in communication is to provide a quiet place to communicate with the patient. You may need to close the door to the patient’s hospital room or pull a draw curtain between patients who are rooming in the same room. Bring a chair close to where the patient is sitting or lying to reduce the physical distance between you. Talk calmly and clearly. Avoid shouting and do not rush the patient when he is trying to answer questions.
BARRIER #2: Language Barriers
About the Barrier:
In some cases, patients may speak a foreign language or have a limited understanding of the English language. Differences in language can be a significant barrier to therapeutic communication in nursing. It is especially important to implement whatever measures possible to overcome language barriers as misunderstanding what the patient says can lead to misdiagnosis and medication or treatment errors.
How to Overcome:
According to Title VI of the Civil Rights Act of 1964, discrimination based on race, color, or national origin is prohibited. Because of this law, healthcare providers that receive federal funding are required to provide language access services for their clients. If you are faced with a situation where language is a barrier to communication with your patient, ask your charge nurse if there is someone in your facility who can interpret. If no one is available in-house, management should direct you on how to proceed with contacting the appropriate person. Whatever you do, remember to protect yourself and your license. If you do not understand your patient, do not attempt to formulate a nursing care plan on information that may be misunderstood.
BARRIER #3: Information Overload
About the Barrier:
Patients can become overwhelmed easily, especially if they are alone or in pain. The more information you pile on, the more confused they can become. While it is important to present the facts to patients and to give them the opportunity to answer and make decisions, it is equally important to avoid information overload.
How to Overcome:
Take the time to explain procedures before doing them. Give your patient time to process what you say and ask questions. If your patient does not ask questions, clarify her understanding before proceeding.
BARRIER #4: Avoiding Eye Contact
About the Barrier:
One of the easiest ways to show a person you are interested in what they are saying is by making eye contact with them. When nurses avoid eye contact when talking with patients, it creates a barrier to nursing therapeutic communication. The patient may feel as if you don’t care enough to pay attention to him or think you are distracted by something else.
How to Overcome:
When possible, sit near eye level with the patient so you don’t appear to be hovering over him. Look at your patient when he talks, making soft eye contact. Do not glare, as that can leave your patient feeling intimidated.
BARRIER #5: Talking Too Much
About the Barrier:
Therapeutic communication in nursing requires talking, but it also means knowing when you are talking too much. When you’re talking, you are not listening, and you need to listen to your patients.
How to Overcome:
Therapeutic communication is a balance of give and take. Of course, you should ask questions and converse with your patient. Just be sure to give your patient the chance to voice her opinion and ask questions. Listen to what she says. Pay attention to her body language and facial expressions. All of these are ways of communicating that you may miss if you are the only one talking.
BARRIER #6: Not Being Prepared
About the Barrier:
Patients expect nurses to act in a professional manner, which means being prepared for your interactions with them. Preparedness is one of the most vital therapeutic communication techniques in nursing. If you enter a patient’s room without knowing their diagnosis, what supplies you need to take, or don’t bring the necessary equipment, you will likely have to leave the room to retrieve necessary supplies which can cause a break in communication.
How to Overcome:
Being prepared to communicate with your patient means bringing necessary supplies or equipment with you when you enter their room. Read your patient's chart or get the report, whichever is most appropriate for the situation, so you know what is going on with the patient. Take something to write on and with. Be sure you have your nursing supplies such as your stethoscope and penlight, in case you need it. Nurses who show up prepared help put patients at ease which helps them feel more comfortable when it comes time to talk about important details.
BARRIER #7: Allowing Personal Conflicts to Affect Your Outlook
About the Barrier:
I know, I know... Nurses are people, too. We have good days and bad days like everyone else. It’s not always easy to ignore personal issues or conflicts. However, successful nurses must learn how to separate personal issues from personal responsibilities.
How to Overcome:
If you experience a bad day or feel overwhelmed, take a few minutes to gather your thoughts and calm down before you initiate communication with your patients. If your personal situation is too much to bear at the moment, talk to your nursing supervisor and ask for help. As a nursing instructor and nurse manager, I can assure you, that I would rather have a nurse or nursing student come to me and ask for help when they are struggling than to have to resolve problems that could have been avoided.
BONUS! 5 Expert Tips To Help Nurses Improve Their Therapeutic Communication Skills
It is essential to always keep improving your therapeutic communication skills in nursing. Here are a few tips on how nurses can improve and successfully implement therapeutic nursing communication.
1.Learn to use nonverbal signs to show you are listening:
You can acknowledge what others are saying without interrupting them. Smile and nod to show you are engaged with what they are saying. You can also interject short words that demonstrate interest like, “I see,” or “Oh, I understand.”
2.Become a reader:
I can imagine all my nursing students saying, “When I get out of nursing school, I’ll never read another book!” Trust me, I know exactly how you feel. However, you can enhance your communication skills by reading. Reading can help enrich your vocabulary and impacts your writing skills. Remember, nurses should be lifelong learners, so pick up a book and read!
3.Learn to use your peripheral vision:
It may sound odd to say that using your peripheral vision is a way to help improve therapeutic communication. However, being a good communicator means being aware of your surroundings. For example, you may have a patient in the emergency room who appears to have been physically assaulted. By being aware of your surroundings, you can see if there is someone in the room who appears to be the aggressor and implement measures to get your patient to a safe place.
4.Be aware of how you demonstrate nonverbal communication:
Body language, eye contact, gestures, and other nonverbal actions can impact whether your communication with patients is therapeutic or not. Learn to control your facial expressions. Stand or sit calmly. Avoid crossing your arms or towering over your patients.
5.Respect your patient's decisions:
You don't have to agree with your patient's decisions to respect them. Therapeutic communication in nursing requires nurses to be respectful of patient choices and to offer feedback without prejudice, stereotypes, or judgment.
My Final Thoughts
Therapeutic communication is the key to strong nurse-patient and interprofessional relationships. Throughout this article, we addressed answers to the question, “What is therapeutic communication in nursing?” Nurses who desire to strengthen communication skills can use the 30 top therapeutic communication techniques in nursing + how to use them shared in this article to help develop techniques for any patient situation. I want to encourage you to take steps daily to improve your communication skills and find ways to implement measures to develop therapeutic communication in your nursing practice and professional relationships.
FREQUENTLY ASKED QUESTIONS ANSWERED BY OUR EXPERT
1.What Is The Main Goal Of Therapeutic Communication In Nursing?
The main goal of therapeutic communication in nursing is to help nurses build trust with patients while also helping establish collaborative efforts to promote efficient and effective patient care, improving patient outcomes.
2.Is Nursing Therapeutic Communication An Intervention?
Because it focuses on patient well-being, the promotion of positive patient outcomes, and building strong nurse-patient relationships, nursing therapeutic communication is considered an intervention.
3.What Is Constructive Criticism In Nursing Therapeutic Communication?
Constructive criticism in nursing therapeutic communication is the process of offering well-reasoned and valid opinions about a situation. It usually involves both positive and negative comments but is offered in a friendly tone, not in an argumentative or oppositional manner.
4.Is Therapeutic Communication Necessary For All Types Of Nurses?
Absolutely! All nurses should strive to develop, implement, and constantly improve therapeutic communication skills.
5.Which Nurse Would Most Likely Be The Best Therapeutic Communicator?
All nurses have the ability to develop therapeutic communication skills. The nurse who finds it easy to develop a rapport with clients typically finds it easier to implement therapeutic communication techniques than nurses who struggle with interpersonal communication and relationships.
6.How Do Nursing Schools Teach Therapeutic Communication?
Nursing students learn the basics of communication in classroom lectures and build upon the knowledge gained to establish rapport with one another, instructors, preceptors, and patients.
7.How Does Body Language Play A Role In Therapeutic Communication In Nursing?
Body language can play a significant role in therapeutic communication in nursing. The range of signals patients receive from body language can communicate the nurse’s feelings and intentions. Therefore, nurses should be keenly aware of how they carry themselves, their facial expressions, and the gestures they use when communicating with patients and others.
8.How Does Therapeutic Communication Affect Patient Care?
Therapeutic communication creates an atmosphere of trust and a feeling of safety for patients. It can have a positive effect on patient care and promote positive patient outcomes.
9.How Do Nurses Communicate Therapeutically With Alcoholic Patients?
All patients, regardless of their history of alcohol or substance abuse, should be treated with the same level of respect and compassion. The patient should be approached in the same manner as other patients, with the nurse speaking calmly and rationally. If a patient is intoxicated upon arrival for treatment, it may be difficult to establish an open line of communication. In that situation, the safety of the patient as well as other patients and the healthcare team is the priority, and communication can commence when the patient is able to understand clearly.
10.How To Therapeutically Communicate With Pediatric Patients?
It is just as important to communicate therapeutically with pediatric patients as with any other patient. Nurses can therapeutically communicate with pediatric patients by making the environment comfortable and inviting, using age-appropriate terms, giving the patient time to warm up to you, and communicating on their level.
11.Is Empathy A Nursing Therapeutic Communication Technique?
Yes, empathy is a technique that can be used in therapeutic nursing communication.
12.Which Communication Technique Is Demonstrated When The Nurse Connects With A Patient On A Social Level?
When a nurse connects with a patient on a social level, the communication technique demonstrated is rapport. A few ways this is accomplished are by getting to know patients personally, actively listening to patients, and showing respect for their wishes and beliefs.
13.Are There Any Disadvantages Of Therapeutic Communication In Nursing?
When implemented correctly, therapeutic communication in nursing is usually advantageous for everyone involved.
14.What Happens When Nursing Therapeutic Communication Fails?
Despite even the best efforts, some barriers result in the failure of therapeutic communication techniques. When therapeutic communication fails, it can result in difficulty establishing and following effective care plans, building strong nurse-patient or peer relationships, and can negatively impact patient outcomes. For this reason, it is important for nurses to be aware of problems in communication as they arise and try to address the issues as soon as possible.
Darby Faubion BSN, RN
Darby Faubion is a nurse and Allied Health educator with over twenty years of experience. She has assisted in developing curriculum for nursing programs and has instructed students at both community college and university levels. Because of her love of nursing education, Darby became a test-taking strategist and NCLEX prep coach and assists nursing graduates across the United States who are preparing to take the National Council Licensure Examination (NCLEX).
