Therapeutic Communication

 the hallmark of the nurse-client

relationship
 directed toward a specific outcome
 nonjudgmental and client-centered
 BASIC PRINCIPLES FOR BUILDING
THERAPEUTIC COMMUNICATION:
 Time and Place  Setting the stage
The amount of time introduce and
and timing of an clarify the purpose
interaction and expected
duration.

 Accepting the client  Active Listening

 remains aware of his own
biases and to approach
each client from a
perspective of
acceptance.
 communicates
acceptance of the
person’s thoughts
and emotions
 ElementsofTherapeuticCommunication

EMPATHY
CARING

TRUST

ACTIVE LISTENING
HONESTY
VALIDATION
Techniques
1. Acknowledging
giving recognition, in a non-
judgmental way, of a change in
behavior, an effort that client has
made or a contribution to a
communication
2. Offering information/ Giving
information / Educating
 providing, in a simple & direct
manner, specific factual information
the client may or may not request
3. Offering self
 suggesting one’s presence, interest or
wish to understand the client without
making any demands or attaching
conditions that the client must comply
with to receive the nurse’s attention
“I’ll stay with
you until your
daughter
arrives”
 4. Stating observation
 “You appear hungry.”
 “You look uncomfortable when…”
 I notice you are clenching your fists.”

5. Being specific and

tentative “Are you
in pain?”
making statements
that are specific rather
than general, and
tentative rather than a
bsolute
6. Clarifying/Seeking
clarification
 method of making the client’s broad
overall meaning of the message more
understandable
 used when paraphrasing is difficult
or when the communication is
rambling or garbled
 facilitates correct communication of
information by asking the client to
restate information or provide an
example
7. Providing general leads
 using statements or questions
that:
encourage the client to verbalize
choose a topic of conversation
facilitate continued verbalization

“And then… you

may go on…”
8. Using open-ended
questions
asking broad questions that lead or invite
the client to explore thoughts or feelings
“I’d like to
“I had a hear more
wonderful dream about that”
last night”
9. Clarifying time or
sequence
 helping the client clarify an event,
situation, or happening in relationship to
time
“I vomited “Was that
this after
morning” breakfast?”
10. Perception checking or
seeking consensual
validation
a method similar to clarifying that verifies
the meaning of specific words rather than
the overall meaning of a message “You mean he
has never given
“My wife you a present for
never gives your birthday or
me any Christmas?”
presents”
 “What
11. Reflecting can I do?”

directing ideas,
feelings,
questions or “What do you
content back to think would be
helpful?”
clients to enable
them to explore
their own ideas
& feelings about
situation
12. Focusing
 helping the client expand on &
develop a topic of importance
 eliminates vagueness

 limits the area of discussion

 helps the interviewer to direct
attention to the pertinent aspect
of client’s message
Nurse must wait until client thinks
about main concerns before attempting
13. Using Touch
providing appropriate forms of touch to
reinforce caring feelings
14. Presenting Reality
 offering a view of what is real without
arguing with the patient
“Somebody
“I hear no is calling
voices” me!”
15. Paraphrasing or
restating
 actively listening for the client’s basic
message & then repeating those thought
and/or feelings in similar words
 provides opportunity for the interviewer
to validate information by asking the
client to restate information or provide
an example
“I had problem “You had
eating dinner last difficulty
night” eating dinner
last night?”
16. Using Silence
 accepting pauses / silence for
several seconds / minutes without
interjecting verbal response
 promotes observations about the
client and allows time for the client
to organize thoughts
17. Summarizing & Planning
stating the main points of a
discussion to clarify the relevant
points discussed
useful at the end of interview or to
review a health-teaching session
condenses data to further validate
information & to end a component
of the interview or the interview
“During the past
itself half hour, we have
talked about…”
18. Attentive Listening
facilitates eye contact with the
client and communicates interest
in the client’s needs, concerns,
and problems
BARRIERS TO COMMUNICATION

or
Non-therapeutic Responses
 “If I were you, I’ll
1.Giving an just go home &
have my recovery
opinion or there”
common advice
 takes decision-
making away
from the client
 inhibits
spontaneity,
stalls problem-
solving &
creates doubt
“This shot will 2. Offering
make you feel
better. Trust False
me.”
Reassuranc
e
 using cliches or
comforting
statements of
advise as a
means to
reassure the
client
3. Being defensive
 Defensiveness in response to
criticisms suggests that the
interviewee has no right to an opinion.

4. Showing approval or
disapproval
 Expressing excessive approval can be as
harmful to an interviewee-interviewer
relationship as stating disapproval.
 Offering excessive praise implies that the
behavior being praised is the only
5. Stereotyping “Patients here
usually die!”
Stereotypes are generalized
beliefs held about people.

“Why are you not

6. Probing feeling well?”

 asking for information chiefly out of

curiosity, rather than with the intent to
asist the client
 “Why” questions can cause
resentment, insecurity &
mistrust.
 “I think, you have to
have your hair dyed.”

i s my blood
“ Wh y ted?”
e le va
pressure

7. Changing
the subject
inappropriatel
y
• stalls progress of
the
communication
process
8. Rejecting
refusing to discuss certain topics with the client

“Shut up! We’re

“Nurse, why do I
having an
have difficulty
endorsement
urinating?”
here.”
9. Challenging
giving a response that makes clients prove
their statement or point of view
“I felt nauseated
“Surely you after that red
don’t think I pill”
gave you the
wrong pill”
10. Testing
 asking questions that make the client
admit to something
“Do you think
I am not
busy?”
11. Passing judgement
imply
that the client must think
as the nurse thinks, fostering client
dependence
“You should
not do that!”
 TRANSCULTURAL THERAPEUTIC
COMMUNICATION

 Communication and culture are closely interconnected.

 Communicating effectively with clients of various
ethnic and cultural background is critical to providing
culturally competent nursing care.
 Consider cultural differences in expressing nonverbal
communication.
 VERBAL COMMUNICATION WITH CLIENTS WHO
HAVE LIMITED KNOWLEDGE OF ENGLISH

 Avoid slang words, medical terminology and

abbreviations
 Augment spoken conversation with gestures or
pictures.
 Speak slowly, in a respectful manner, and at a
normal volume. Speaking loudly does not help
the client understand and may be offensive.
 Frequently validate the client’s understanding
of what is being communicated.
 Peace I leave with
27 

you; my peace I give

you. I do not give to
you as the world gives.
Do not let your hearts
be troubled and do not
be afraid.
John 14:27(NIV)