THERAPEUTIC COMMUNICATION

Overview

1. Therapeutic communication
a. Relationship
b. Communication
c. Patient needs
d. Response

Nursing Points
General

1. Connection
a. Build report
b. Be aware of own values
c. Remove biases
d. Common ground
2. Communication
a. Active listening
b. Rephrase
c. Clarify
d. Summarize
e. Empathize
3. Understanding patient needs
a. Venting and expression
b. Reaffirmation
c. Advice vs unsolicited advice
4. Response
a. To feelings
b. To words
c. To expressions

Nursing Concepts

1. Communication
2. Professionalism
3. Interpersonal relationships

In this lesson, we’re going to talk about therapeutic communication.

This is an awesome quote by Carl Rogers, one of the pioneers to

psychology. He was a humanist, so most, if not all of his theories hinged on
this idea that we are all very unique individuals. The reason I use this quote
is because I think that it helps to encourage the idea of therapeutic
communication. It says “We think we listen, but very rarely do we listen with
real understanding, true empathy. Yet listening, of this very special kind, is
one of the most potent forces for change that I know.” Let’s look at how we
can use what Rogers said to help out our patients.

When we communicate with our patients, we want to focus on connecting

with them. It doesn’t do us any good to try to treat a patient or do
procedures if they don’t trust us, or if they feel like a pin-cushion. You have
to connect.

We always talk about “building rapport,” so what do I mean? I mean, create

a relationship. It’s this two way street where you are privileged to care for a
patient, and they trust you to provide that care.

By going in trying to at least gain a better understanding of what your

patient is going through, then it changes the way you care for them, which
can make all of the difference for that patient and their family.

And here are a couple of ways to do that. Remove biases. When the nurse
you get report from says your patient is “grumpy,” ignore it. It puts this idea
in your head that is far worse than grumpy.

Be aware of your own values, especially when you find common ground.
When you find a common interest, you recognize that you and the patient
have something in common - and you can connect with them. And when
you connect, it really helps to foster that trust between you.

When we talk about communicating therapeutically with a patient, what do I

mean? What tools can you use?

Let’s look at those. First off, you can listen actively. Pull a chair up and sit
down next to the patient. Look at them in their eyes and listen really
intently. They may not get to have great conversation with people because
everyone is so focused on the patient being sick - really listen to them, and
only respond when they stop talking. And be silent if you have to - that’s ok.
That gives you the opportunity to act instead of react. Because once those
words come out, you can’t put them back in.

Also paraphrase, summarize and clarify. By that I mean, take Memaw’s 5

minute long conversation about how she went to the store to pick up
groceries and she saw a good sale on pickles and that one nice gentleman
she always sees was restocking the fruits and she didn’t see the spilt milk
on the ground that caused her to slip, humor Memaw, but then summarize
it. So you can say something like “So you went to the store and slipped, is
that right?” You’re asking for clarity, summarizing and paraphrasing it. And
by asking a question, it gives them the opportunity to let you know if you
missed something important to them. So listen carefully, and tell them what
you heard.

Also, do this with empathy. Don’t be mundane, engage your patient and
show you care for them by feeling what they’re feeling.

Sometimes, you’ll come across patients that just want to vent, and that’s
ok. They use it as a way to process grief or disgust, or sometimes that’s
just part of who they are. And until you figure out how to navigate that, ask
them, “Would you prefer I just listen? Because I’ll be glad to.”

And sometimes they’ll just be ok with that. Other times, they’re asking for
advice or reaffirmation. For instance, if they grow frustrated with the
multiple times they’re woken up in the middle of the night for bloodwork,
they want to hear from someone else that they’re justified in believing what
they do. Hell, I’d hate to be woken up, so I’ll surely empathize with them. I’ll
reaffirm their beliefs.

This is a tricky area though - be careful not to just give unsolicited advice.
“What would you do?” is a great time to tell them what you think. But if not,
then go back to using those communication tools we just talked about to
help communicate with them.

Knowing when to respond is tricky. Since a majority of communication is

nonverbal, you have to pay attention to more than just words.

But do pay attention to words, but also to feelings, to expressions, to tone

and volume and inflection. These give you ideas as to how people actually
feel. If their tone changes to soft, or sad, pay more attention to their body
language and what they’re talking about - it could cue you in on the
opportunity to be extra-caring in a time that the patient may need it. It might
show you the opportunity to consider any other changes in the patient’s
overall behavior. So just don’t listen to words, watch your patient as a
whole.
Today, we really focused on the ideas behind communication,
professionalism and interpersonal relationships for our therapeutic
communication with our patients.
Ok, so let’s recap.

Connect with your patient. There are multiple ways to do this. Remove your
bias and start each interaction with a clean slate.

Use the tools of communication. Summarize or paraphrase what your

patient said, and if you need a second to find the right words, do so.

Your patient sometimes looks to you to vent about an issue. Just listen.
You could make all the difference.

Watch your patient. Communication is also nonverbal, and that can give
you the opportunity to embrace what your patient is saying because they
did something that tells you how the patient REALLY feels.

That’s it for our lesson on therapeutic communication. Make sure you

check out all the resources attached to this lesson. Now, go out and be
your best selves today. And, as always, happy nursing!!