Communication: Therapeutic and Professional Communication
Chapter Overview
Effective communication is the cornerstone of nursing practice and is essential for providing high-quality patient care. As beginning nurses, mastering both therapeutic and professional communication skills is critical in establishing strong relationships with patients, families, and colleagues. This chapter will explore the foundational concepts of communication and professionalism, guiding you in developing the skills necessary to navigate the complex and dynamic healthcare environment. Communication in nursing is not just about exchanging information; it is a powerful tool that influences patient outcomes, safety, and satisfaction. Nurses must communicate effectively with patients, families, and the healthcare team to ensure the delivery of comprehensive and coordinated care. Understanding the nuances of communication, including verbal and nonverbal cues, active listening, and empathy, is vital for fostering trust and collaboration.
Therapeutic communication involves the deliberate use of communication techniques to support the physical and emotional well-being of patients. It is characterized by empathy, respect, and a genuine concern for the patient’s needs. Therapeutic communication helps nurses build rapport, gather essential information, and provide emotional support to patients and their families. This chapter will explore various therapeutic communication strategies, such as active listening, open-ended questioning, and reflective responses, to help you engage effectively with patients and families. In addition to therapeutic communication, professional communication is essential for collaborating with colleagues and other members of the healthcare team. Professional communication encompasses written, verbal, and electronic interactions that occur within the healthcare setting. It requires clarity, accuracy, and professionalism to ensure that information is conveyed effectively and efficiently. This chapter will discuss the principles of professional communication, including documentation, reporting, and interprofessional collaboration. Documentation will also be discussed in this chapter. It is a vital component of nursing practice, serving as a critical form of communication within the healthcare setting. It provides a comprehensive record of patient care, facilitating continuity, safety, and quality of care. Effective documentation ensures that all members of the healthcare team have access to accurate and up-to-date information, which is essential for making informed decisions about patient care.
As you begin to prepare for your nursing career, developing strong communication skills is a continuous process that requires practice, reflection, and feedback. By honing your ability to communicate therapeutically and professionally, you will enhance your capacity to deliver compassionate and patient-centered care. Throughout this chapter, we will provide practical exercises and scenarios to help you apply these communication techniques in real-world settings.
Learning Objectives: At the end of this chapter, the learner will
- Discuss effective therapeutic communication and professional communication.
- Demonstrate therapeutic communication skills to communicate with patients and their families.
1. Elements of Communication
Our daily example of communication maybe when a message is delivered, through communication delivery modes such as, talking to another person or texting them, However, while these are methods of communication delivery, they are not representative of a comprehensive definition of communication.
A more comprehensive understanding of communication refers to the sharing of information, ideas, and feelings, typically aimed at mutual understanding. In this way, you must consider the sender, the recipient, and the transaction. Simply put, the sender is the person sharing the message, the recipient is the person receiving and interpreting the message, and the transaction is the way that the message is delivered and the factors that influence the context and environment of the communication. As you can see, communication is a complex process. It involves more than just what you say and takes many forms as reflected in Figure 1 below:
In the figure above, what is the type of communication that you see? What could be the message?
There are three types of communication:
- Verbal communication
- Verbal communication is oral communication that happens through spoken words, sounds, vocal intonation, and pace. It can occur face-to-face, one-on-one, or in groups, over the telephone, or video conferencing. As a nurse, you will engage in verbal communication with clients, families, colleagues, and interprofessional teams.
- Non-verbal communication
- Non-verbal communication is a type of communication that occurs through facial expressions, eye contact, gestures, and body positions and movements. As a nurse, you will learn that your non-verbal communication is important because it can both reinforce or contradict what you say verbally. Additionally, non-verbal communication is used more often than verbal communication. Thus, you must become aware of your non-verbal communication.
- Written communication
- Written communication is a type of communication that occurs through written words, symbols, pictures, and diagrams. You are probably familiar with some informal, written types of communication, such as texting or emailing someone, posting a picture on Instagram, or using an emoji in Twitter. You may also have engaged in more scholarly forms of written communication such as letters and papers. As a nurse, written communication also involves documentation notes and scholarly writing like essays, peer-reviewed publications, protocols, practice standards, and best practice guidelines. You may not be familiar with some of these types of written communication yet, but you will become more acquainted with them over the course of your nursing program.
II. Communication in Professional Practice
A. Therapeutic communication is at the foundation of the nurse-client relationship as reflected in the Figure 2 below. It is different than the conversations you have with friends, peers, family, and colleagues. Therapeutic communication has a specific purpose within the healthcare context. It is intended to develop an effective interpersonal nurse-client relationship that supports the client’s wellbeing and ensures holistic, client-centered, quality care.
The word “therapeutic” is related to the word therapy: it means having a restorative and healing effect on the mind and body as well as doing no harm. It is important to consider how you communicate and how this affects the client.
Key Takeaway: Learning Therapeutic Communication
- “Therapeutic communication is a learned activity that requires knowledge and continued practice and self-reflection”.
- Therapeutic communication techniques used by health professionals emphasize the importance of building trusting relationships with clients and that therapeutic healing results from health professionals’ presence with clients.
Let’s practice. There are several situations and patient encounters that will MOST require your ability to communicate therapeutically. Practice your skills and reflect on the virtual simulation below:
III. Communication Strategies
There are many communication strategies that should be used to facilitate therapeutic communication. The Table 1 lists strategies, considerations and examples. Rationales are offered on how they build therapeutic relationship.
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Strategy |
Considerations and Examples |
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Use clear and simple language so the client understands what you are saying. |
It is best to avoid or limit medical and professional language that clients may not understand. Remember, knowledge is power; when you use language that others may not understand, it can reinforce subordination and exclusion. By speaking simply and clearly, you include clients regardless of their professional or educational point of reference.
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Be an active listener. Active listening is a type of listening that shows you are engaged in the conversation and that you hear and understand what the client is saying. Active listening is important to facilitate your understanding of, and the integration of, client’s experiences, preferences, and health goals into their care. |
You might show that you are an active listener by using eye contact and having an open posture. You can also use facilitation strategies that show active listening, and also encourage the client to elaborate such as, nodding, and responding by saying “uh huh” and “tell me more.” Active listening can also be demonstrated by paraphrasing what the client says, which shows that you are listening and encourages them to elaborate.
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Use silence. Silence is a strategy that aids active listening. It can be beneficial in situations where the client is talking about something personal or is struggling to find the words for what they want to say. Clients may also need time to think and reflect after you have asked a question. |
Sometimes silence can be uncomfortable, and professionals want to fill the void with words. It is better to show interest and understanding and give the client time to think about how they best want to say what they want to say. If the client seems to be feeling awkward about taking too much time to think, you can say “It’s ok. Take your time.” |
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Be empathetic. Empathy is the action of understanding another person’s emotions and experiences while suspending your own viewpoint. You have probably heard the phrases “put yourself in someone else’s shoes” or “see the world through the eyes of another person.” Being empathetic helps the client feel understood and cultivates a trusting and therapeutic relationship. |
It is important to imagine what another person is experiencing. You need to be curious and demonstrate interest by responding to what the client is saying (e.g., “Tell me more. How do you feel about it?”). Don’t get caught up in following your interview guide – it’s important to let the client’s narrative shape the interview. When a client is talking about a difficult experience, you may say something such as, “That must be very difficult.” |
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Be honest. Part of therapeutic communication involves being authentic and truthful. In order to do so, you should be straightforward with clients while also talking to them in a compassionate manner. If you are talking about a difficult or emotionally laden topic, demonstrate compassion by sitting down, maintaining eye contact, and being aware of your vocal intonation. |
Part of being honest involves avoiding false reassurance. False reassurance is when you assure or comfort the client about something that is not based on fact. When someone voices fear or anxiety, people tend to automatically respond by assuring them that everything will be okay. An example of false reassurance is when the nurse says, “it will be okay” when a client says, “I am scared I might die.” This kind of response is not honest and does not open up communication. It is more effective and honest to say, “tell me more.” See Film Clip 2.3 demonstrating false reassurance and Film Clip 2.4 on how to avoid false reassurance. You should also avoid distancing and avoidance language. Distancing is when you attempt to create a false space/distance between a threat and the person (e.g., “the cancer has spread to your brain” as opposed to “your cancer…”). Avoidance language is unclear language (e.g., “your partner didn’t make it” or “they are now at peace”). It’s better to use specific language (e.g., “your partner died”). Being direct demonstrates honesty and ensures clarity for the client.
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Demonstrate unconditional positive regard, which means accepting and respecting that each client has agency to believe and behave how they want, or feel is best. You don’t have to agree or approve, but your acceptance of their self-determination should not be conditional on its alignment with your beliefs or behaviors. |
Using this approach involves accepting that clients are generally doing the best they can. Avoid judging or blaming them for their beliefs, behaviors, or conditions. You should avoid questions that begin with “why” as this can imply blame. For example, avoid “why do you smoke?” You can reframe this inquiry as, “tell me about the reasons that you smoke.” |
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Use permission statements to open conversations that may be difficult to talk about. Permission statements are a combination of statements and questions that suggest to the client that an experience or feeling is expected or normal. |
One example of a permission statement is: “Often, children your age experience changes in their body that they have questions about.” Another example is: “Clients that have experienced your type of surgery often have questions about sex. Do you have any questions for me?” Another example is: “Many people your age begin to experience problems with urinary incontinence, have you had any issues?” |
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Ask one question at a time so that the client understands it and so that you are more likely to receive a clear answer. |
You should avoid asking multiple questions at once because this can be confusing for clients. Here is an example: “Tell me about your support system. Your brother seems like he’s a great help, right? Do you have anyone else to support you?” Instead, try it this way to start: “Tell me about your support system?” – then, wait for an answer. You can probe with follow-up questions depending on what the client says. |
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Be conscious of how your vocal qualities influence nurse-client communication. Vocal qualities refer to intonation, speed, and rhythm. |
These vocal qualities influence the communication process in terms of the emotions you convey and your interest in the conversation, as well as how a client interprets what is important. For example, speaking quickly can be interpreted as the nurse being in a rush to leave. |
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Work collaboratively with the client during the interview so that they are an active agent with self-determination. By using a relational inquiry approach and working collaboratively, you can focus on what is important to the client. |
Part of focusing on what is important to the client involves providing information that they identify as relevant to them. Avoid being authoritative and giving unwanted advice, but it’s a good idea to ask if the client is interested in learning more about a topic. |
Therapeutic communication techniques are specific methods used to provide patients with support and information while focusing on their concerns. Nurses assist patients to set goals and select strategies for their plan of care based on their needs, values, skills, and abilities. It is important to recognize the autonomy of the patient to make their own decisions, maintain a nonjudgmental attitude, and avoid interrupting. Depending on the developmental stage and educational needs of the patient, appropriate terminology should be used to promote patient understanding and rapport. When using therapeutic communication, nurses often ask open-ended statements and questions, repeat information, or use silence to prompt patients to work through problems on their own.[7] Table 2 describes a variety of therapeutic communication techniques.
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Active Listening |
By using nonverbal and verbal cues such as nodding and saying “I see,” nurses can encourage patients to continue talking. Active listening involves showing interest in what patients have to say, acknowledging that you’re listening and understanding, and engaging with them throughout the conversation. Nurses can offer general leads such as “What happened next?” to guide the conversation or propel it forward. |
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Using Silence |
At times, it’s useful to not speak at all. Deliberate silence can give both nurses and patients an opportunity to think through and process what comes next in the conversation. It may give patients the time and space they need to broach a new topic. |
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Accepting |
Sometimes it is important to acknowledge a patient’s message and affirm that they’ve been heard. Acceptance isn’t necessarily the same thing as agreement; it can be enough to simply make eye contact and say, “Yes, I hear what you are saying.” Patients who feel their nurses are listening to them and taking them seriously are more likely to be receptive to care. |
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Giving Recognition |
Recognition acknowledges a patient’s behavior and highlights it. For example, saying something such as “I noticed you took all of your medications today” draws attention to the action and encourages it. |
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Offering Self |
Hospital stays can be lonely and stressful at times. When nurses are present with their patients, it shows patients they value them and are willing to give them time and attention. Offering to simply sit with patients for a few minutes is a powerful way to create a caring connection. |
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Giving Broad Openings/Open-Ended Questions |
Therapeutic communication is often most effective when patients direct the flow of conversation and decide what to talk about. To that end, giving patients a broad opening such as “What’s on your mind today?” or “What would you like to talk about?” can be a good way to allow patients an opportunity to discuss what’s on their mind. |
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Seeking Clarification |
Similar to active listening, asking patients for clarification when they say something confusing or ambiguous is important. Saying something such as “I’m not sure I understand. Can you explain it to me?” helps nurses ensure they understand what’s actually being said and can help patients process their ideas more thoroughly. |
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Placing the Event in Time or Sequence |
Asking questions about when certain events occurred in relation to other events can help patients (and nurses) get a clearer sense of the whole picture. It forces patients to think about the sequence of events and may prompt them to remember something they otherwise wouldn’t. |
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Making Observations |
Observations about the appearance, demeanor, or behavior of patients can help draw attention to areas that may indicate a problem. Observing that they look tired may prompt patients to explain why they haven’t been getting much sleep lately, or making an observation that they haven’t been eating much may lead to the discovery of a new symptom. |
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Encouraging Descriptions of Perception |
For patients experiencing sensory issues or hallucinations, it can be helpful to ask about these perceptions in an encouraging, nonjudgmental way. Phrases such as “What do you hear now?” or “What does that look like to you?” give patients a prompt to explain what they’re perceiving without casting their perceptions in a negative light. |
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Encouraging Comparisons |
Patients often draw upon previous experiences to deal with current problems. By encouraging them to make comparisons to situations they have coped with before, nurses can help patients discover solutions to their problems. |
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Nontherapeutic Responses
Nurses and nursing students must be aware of potential barriers to communication. In addition to considering common communication barriers discussed in the previous section, there are several nontherapeutic responses or communication blocks/barriers to avoid. These responses often block the client’s communication of their feelings or ideas. See Table 3 for a description of nontherapeutic responses.
Table 3 Nontherapeutic Responses
| Nontherapeutic Response | Description |
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| Asking Personal Questions | Asking personal questions that are not relevant to the situation is not professional or appropriate. Don’t ask questions just to satisfy your curiosity. For example, asking, “Why have you and Mary never married?” is not appropriate. A more therapeutic question would be, “How would you describe your relationship with Mary?” |
| Giving Personal Opinions | Giving personal opinions takes away the decision-making from the client. Effective problem-solving must be accomplished by the client and not the nurse. For example, stating, “If I were you, I’d put your father in a nursing home” is not therapeutic. Instead, it is more therapeutic to say, “Let’s talk about what options are available to your father.” |
| Changing the Subject | Changing the subject when someone is trying to communicate with you demonstrates lack of empathy and blocks further communication. It implies you don’t care about what they are sharing. For example, stating, “Let’s not talk about your insurance problems; it’s time for your walk now” is not therapeutic. A more therapeutic response would be, “After your walk, let’s talk some more about what’s going on with your insurance company.” |
| Stating Generalizations and Stereotypes | Generalizations and stereotypes can threaten nurse-client relationships due to preconceived assumptions about clients that may or may not be true. For example, it is not therapeutic to state the stereotype, “Older adults are always confused.” A more therapeutic response is to focus on the client’s concern and ask, “Tell me more about your concerns about your father’s confusion.” |
| Providing False Reassurances | When a clientis seriously ill or distressed, the nurse may be tempted to offer hope with statements such as “You’ll be fine,” or “Don’t worry; everything will be alright.” These comments tend to discourage further expressions of feelings by the client. Additionally, these comments may not present reality. If a client is terminally ill, telling them, “You’ll be fine in no time” is not realistic and provides false reassurance. The client may perceive these statements as a minimization of their situation and associated feelings. A more therapeutic response would be, “It must be difficult not to know what the surgeon will find. What can I do to help?” |
| Showing Sympathy | Sympathy focuses on the nurse’s feelings rather than the client. Saying “I’m so sorry about your amputation; I can’t imagine losing a leg.” This statement shows pity rather than trying to help the client cope with the situation. A more therapeutic response would be, “The loss of your leg is a major change; how do you think this will affect your life?” |
| Asking “What” or “Why” Questions | A nurse may be tempted to ask the client to explain “why” they believe, feel, or act in a certain way. However, clients and family members may interpret “what” or “why” questions as accusations and become defensive. It is best to phrase a question by avoiding the words “what” or “why.” For example, instead of asking, “Why are you so upset?” it is more therapeutic to rephrase the statement as, “You seem upset. Tell me more about how you are feeling.” |
| Showing Approval or Disapproval | Nurses should not impose their own attitudes, values, beliefs, and moral standards on others while in the professional nursing role. Judgmental messages contain terms such as “should,” “shouldn’t,” “ought to,” “good,” “bad,” “right,” or “wrong.” Agreeing or disagreeing sends the subtle message that nurses have the right to make value judgments about the client’s decisions. Approving implies that the behavior being praised is the only acceptable one, and disapproving implies that the client must meet the nurse’s expectations or standards. Instead, the nurse should help the client explore their own values, beliefs, goals, and decisions. For example, it is nontherapeutic to state, “You shouldn’t consider elective surgery; there are too many risks involved.” A more therapeutic response would be, “So you are considering elective surgery. Tell me more about the pros and cons of surgery” gives the client a chance to express their ideas or feelings without fear of being judged. |
| Giving Defensive Responses | When clients or family members express criticism, nurses should listen to what they are saying. Listening does not imply agreement. To discover reasons for the client’s anger or dissatisfaction, the nurse should listen without criticism, avoid being defensive or accusatory, and attempt to defuse anger. For example, if the client states, “Everyone here is lying to me,” it is not therapeutic to state, “No one here would intentionally lie to you.” Instead, a more therapeutic response would be, “You believe people have been dishonest with you. Tell me more about what happened.” (After obtaining additional information, the nurse may elect to follow the chain of command at the agency and report the client’s concerns for follow-up.) |
| Providing Passive or Aggressive Responses | Passive responses serve to avoid conflict or sidestep issues, whereas aggressive responses provoke confrontation. Passive responses serve to avoid conflict or sidestep issues, whereas aggressive communication provokes confrontation. Nurses should use assertive communication. For example, it is not therapeutic to state, “It’s your fault you are feeling ill because you don’t take your medication.” A therapeutic response would be, “Taking your prescribed medications every day can prevent symptoms from returning.” Nurses should use assertive communication as described in the “Basic Communication Concepts” section. |
| Arguing | Challenging or arguing against client perceptions denies that they are real and valid to the other person. They imply that the other person is lying, misinformed, or uneducated. The skillful nurse can provide information or present reality in a way that avoids argument. For example, it is not therapeutic to state, “How can you say you didn’t sleep a wink when I heard you snoring all night long!” A more therapeutic response would be, “You don’t feel rested this morning? Let’s talk about ways to improve your rest.” |
Examples: Here are some examples of false reassurances and how to deal with a similar situation therapeutically. After watching the clips, reflect on the following questions and share your take-aways with your fellow learners:
- Provide 2-3 examples of false reassurance statements by the nurse
How to Avoid False Reassurance
- Provide an example how you would avoid false reassurance to a patient if you had a similar situation at clinical
In addition to using therapeutic communication techniques, avoiding nontherapeutic responses, and overcoming common barriers to communication, there are additional strategies for promoting effective communication when providing patient-centered care. Specific questions to ask patients are as follows:
- What concerns do you have about your plan of care?
- What questions do you have about your medications?
- Did I answer your question(s) clearly or is there additional information you would like?
Listen closely for feedback from patients. Feedback provides an opportunity to improve patient understanding, improve the patient- care experience, and provide high-quality care. Other suggestions for effective communication with hospitalized patients include the following:
- Round with the providers and read progress notes from other health care team members to ensure you have the most up-to-date information about the patient’s treatment plan and progress. This information helps you to provide safe patient care as changes occur and also to accurately answer the patient’s questions.
- Review information periodically with the patient to improve understanding.
- Use patient communication boards in their room to set goals and communicate important reminders with the patient, family members, and other health care team members. This strategy can reduce call light usage for questions related to diet and activity orders and also gives patients and families the feeling that they always know the current plan of care. However, keep patient confidentiality in mind regarding information to publicly share on the board that visitors may see.
- Provide printed information on medical procedures, conditions, and medications. It helps patients and family members to have multiple ways to provide information.
Adapting Your Communication
When communicating with patients and family members, take note of your audience and adapt your message based on their characteristics such as age, developmental level, cognitive abilities, and any communication disorders. For patients with language differences, it is vital to provide trained medical interpreters when important information is communicated.
Adapting communication according to the patient’s age and developmental level includes the following strategies:
- When communicating with children, speak calmly and gently. It is often helpful to demonstrate what will be done during a procedure on a doll or stuffed animal. To establish trust, try using play or drawing pictures.
- When communicating with adolescents, give freedom to make choices within established limits.
- When communicating with older adults, be aware of potential vision and hearing impairments that commonly occur and address these barriers accordingly. For example, if a patient has glasses and/or hearing aids, be sure these devices are in place before communicating. See the following box for evidence-based strategies for communication with patients who have impaired hearing and vision.
- For clients with language differences, it is vital to provide trained medical interpreters when important information is communicated. Family members should not be used as translators because medical terms may not translate directly in the native language and there is no way to determine if the information is being translated accurately. It is also possible that certain information is withheld from the client in the event the family does not want to burden them with upsetting information.
Strategies for Communicating With Clients With Impaired Hearing and Vision
Impaired Hearing
- Gain the client’s attention before speaking (e.g., through touch)
- Minimize background noise
- Position yourself 2-3 feet away from the client
- Facilitate lip-reading by facing the client directly in a well-lit environment
- Use gestures, when necessary
- Listen attentively, allowing the client adequate time to process communication and respond
- Refrain from shouting at the client
- Ask the client to suggest strategies for improved communication (e.g., speaking toward better ear and moving to well-lit area)
- Face the client directly, establish eye contact, and avoid turning away mid-sentence
- Simplify language (i.e., do not use slang but do use short, simple sentences), as appropriate
- Note and document the client’s preferred method of communication (e.g., verbal, written, lip-reading, or American Sign Language) in plan of care
- Assist the client in acquiring a hearing aid or assistive listening device
- Refer to the primary care provider or specialist for evaluation, treatment, and hearing rehabilitation
Impaired Vision
- Identify yourself when entering the client’s space
- Ensure the client’s eyeglasses or contact lenses have current prescription, are cleaned, and stored properly when not in use
- Provide adequate room lighting
- Minimize glare (i.e., offer sunglasses or draw window covering)
- Provide educational materials in large print
- Apply labels to frequently used items (i.e., mark medication bottles using high-contrasting colors)
- Read pertinent information to the client
- Provide magnifying devices
- Provide referral for supportive services (e.g., social, occupational, and psychological)
- Identify item locations on a meal tray using the clock method. For example, the nurse states, “Your milk is at 2:00, the potatoes are at 3:00, and the meat is at 9:00. on your plate.”
Clients with communication disorders require additional strategies to ensure effective communication. For example, aphasia is a communication disorder that results from damage to portions of the brain that are responsible for language.
Read more about aphasia.
Strategies to Improve Communication With Clients With Impaired Speech
- Modify the environment to minimize excess noise and decrease emotional distress
- Phrase questions so the client can answer using a simple “Yes” or “No,” being aware that clients with expressive aphasia may provide automatic responses that are incorrect
- Monitor the client for frustration, anger, depression, or other responses to impaired speech capabilities
- Provide alternative methods of speech communication (e.g., writing tablet, flash cards, eye blinking, communication board with pictures and letters, hand signals or gestures, and computer)
- Adjust your communication style to meet the needs of the client (e.g., stand in front of the client while speaking, listen attentively, present one idea or thought at a time, speak slowly but avoid shouting, use written communication, or solicit family’s assistance in understanding the client’s speech)
- Ensure the call light is within reach and central call light system is marked to indicate the client has difficulty with speech
- Repeat what the client said to ensure accuracy
- Instruct the client to speak slowly
- Collaborate with the family and a speech therapist to develop a plan for effective communication
Exercises: Application in Practice
- What strategies would you implement when communicating with patients with impaired hearing and vision?
- What strategies would you implement to improve communication with your patient with impaired speech?
Maintaining Confidentiality
When communicating with clients, their friends, their family members, and other members of the health care team, it is vital for the nurse to maintain client confidentiality. The Health Insurance Portability and Accountability Act (HIPAA) provides standards for ensuring privacy of client information that are enforceable by law. Nurses must always be aware of where and with whom they share client information. For example, information related to client care should not be discussed in public areas, paper charts must be kept in secure areas, computers must be logged off when walked away from, and client information should only be shared with those directly involved in client care.
Exercises
Type your exercises here.
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Watch the first part of the video “Nontherapeutic vs therapeutic communication” https://www.youtube.com/watch?v=Ik_hwMHVHM4
Part 1
- Students to work independently or in groups to answer the following questions(#3).
- Get back together and discuss the students’ responses.
- Discuss appropriate therapeutic techniques to correct the observed nurse patient interaction. Explore students’ thoughts and reflections.
Part 2
- Watch the second part of the video demonstrating appropriate therapeutic communication.
- Remember that communication in the nurse-patient relationship should focus on the patient and patient needs, not on the nurse or an activity in which the nurse is engaged.
Key Takeaways
- Therapeutic communication techniques are specific methods to provide clients with support and information while focusing on their concerns. Health professionals assist clients in setting goals and selecting strategies for their plan of care based on their needs, values, skills, and abilities.
- Nontherapeutic responses should be avoided, as these responses often block the client’s communication of their feelings or ideas.
These are learning resources that can help improve your communication skills and hone your professional practice:
1. Reflect on the often invisible needs of those around us and the difference nurses can make by creating caring human connections. While watching the video, write your thoughts, impressions, feelings in your journal. Reflecting with others and with your faculty/instructor guiding the process is an effective learning experience:
View this video: The Human Connection to Patient Care
2. Nurses optimize communication through active listening to patients and families. Sometimes there are invisible needs of those around us
IV. Barriers to Effective communication:
Effective communication is an important part of nursing skill. There are several barriers for effective communication. Some of those example are language, culture, noise, perception, special needs such as hearing/vision difficulty and medication. For more information: https://med.libretexts.org/Bookshelves/Nursing/Nursing_(Ulutasdemir)/03%3A_Effective_Communication_in_Nursing/3.07%3A_Barriers_to_Effective_Communication
Exercises: Take a quiz and check your knowledge of Therapeutic Communication
Review: Documentation/charting guidelines:
Please review Documentation: Using Technology to Access Information : https://batch.libretexts.org/print/url=https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/02%3A_Communication/2.05%3A_Documentation.pdf
Review Documentation/charting guidelines for Montgomery college nursing students. You can find this document in the Blackboard under this week content.
Review sample and discuss importance of different types of notes.
Exercise: SAMPLE DOCUMENTATION
Sample Documentation of Expected Findings
Patient denies cough, chest pain, or shortness of breath. Denies past or current respiratory illnesses or diseases. Symmetrical anterior and posterior thorax. Anteroposterior-transverse ratio is 1:2. Respiratory rate is 16 breaths/minute, unlabored, regular, and inaudible through the nose. No retractions, accessory muscle use, or nasal flaring. Chest rise and fall are equal bilaterally. Skin is pink, warm, and dry. No crepitus, masses, or tenderness upon palpation of anterior and posterior chest. Lung sounds clear bilaterally in all lobes anteriorly and posteriorly. No adventitious sounds. SpO2 saturation 99% on room air.
Sample Documentation of Unexpected Findings
Patient reports shortness of breath for five to six hours. Patient has labored breathing at rest. Nail beds are cyanotic. Respiratory rate is tachypneic at 32/minute with neck and abdominal accessory muscle use. Lung expansion is symmetrical. Pursed-lip breathing noted with intermittent productive cough. Reports coughing up blood-tinged green sputum for two days. Anterior and posterior chest walls have no tenderness, masses, or crepitus upon palpation. On auscultation bilateral coarse crackles over lung bases. Expiratory wheezes are audible and heard with stethoscope scattered throughout lung fields. Pulse oximetry 93% on room air.
Exercises : Practice Writing Nursing Documentation
Patient Scenario
Mr. Hernandez is a 47-year-old patient admitted to the neurological trauma floor as the result of a motor vehicle accident two days ago. The patient sustained significant facial trauma in the accident and his jaw is wired shut. His left eye is currently swollen, and he had significant bruising to the left side of his face. The nurse completes a visual assessment and notes that the patient has normal extraocular movement, peripheral vision, and pupillary constriction bilaterally.
Additional assessment reveals that Mr. Hernandez also sustained a fracture of the left arm and wrist during the accident. His left arm is currently in a cast and sling. He has normal movement and sensation with his right hand.
Mrs. Hernandez is present at the patient’s bedside and has provided additional information about the patient. She reports that Mr. Hernandez’s primary language is Spanish but that he understands English well. He has a bachelor’s degree in accounting and owns his own accounting firm. He has a history of elevated blood pressure, but is otherwise healthy.
The nurse notes that the patient’s jaw is wired and he is unable to offer a verbal response. He does understand English well, has appropriate visual acuity, and is able to move his right hand and arm.
Based on the assessment information that has been gathered, the nurse plans several actions to enhance communication. Adaptive communication devices such as communication boards, symbol cards, or electronic messaging systems will be provided. The nurse will eliminate distractions such as television and hallway noise to decrease sources of additional stimuli in the communication experience.
Practice writing admission nurse’s note. Share your notes with the class for further discussion.
Activity: Check Your Understanding
What are your key-take away from today? Share your thoughts with the class
Assignment
Review assignment instructions in the Blackboard.
V. Recommended Resources
Read the American Nurses Association’s Principles for Nursing Documentation.
COMMUNICATION INTRODUCTION: https://www.ncbi.nlm.nih.gov/books/NBK591817/
Civility and Incivility in the Nursing Workplace MODULE: https://softchalkcloud.com/lesson/serve/6r942KvBmMQDx3/html
Complete the following activities and reflect on what you learned and how this knowledge can be applied to your professional practice area.
Therapeutic Communication—Sexual Orientation:
NIH: Health Topics:https://medlineplus.gov/healthtopics.html
References and Attributions
1.Professional Communication: Retrieved from: http://Introduction: Therapeutic Communication. Creative Commons Attribution-NonCommercial 4.0 International License
2. Communicating with Patients: Retrieved from: https://batch.libretexts.org/print/url=https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/02%3A_Communication/2.03%3A_Communicating_with_Patients.pdf
