3.14: Therapeutic Communication Techniques
Table 1 gives an overview of therapeutic communication techniques and provides examples of each technique [ 10 , 13 ].
| General area of issue | Therapeutic communication techniques | Rationale | Examples |
|---|---|---|---|
| To obtain information | Make broad opening remarks | This gives the patient the freedom to choose what he/she wishes to talk about | “Please tell me more about yourself” |
| Use open-ended questions | This type of question allows the patient to talk about his/her views about the subject. In this way, what the patient sees as important, what his/her intellectual capacity is and how well-orientated he/she is, becomes clear. This encourages the patient to say more and does not limit answers to a ‘yes’ or ‘no’ |
“How did you experience the pain?”
“You say you felt dizzy, and then…” “Tell me more about that” |
|
| Share observations and thoughts | This shows that you are aware of what is happening to the patient and encourages him/her to talk about it | “You seem to be upset” | |
| Confrontation | This entails confronting the patient with an observation you have made and assess his/her reaction to it. This technique is useful when verbal and non-verbal communication do not match | “You say that your ankle is very painful, but you do not react when I bend the ankle. How is it possible?” | |
| Reflection | This means that you repeat what the patient said in the same or different words. This shows you are involved in what the patient is saying and that he/she should talk more about a specific point, or explain further |
Patient: “It is sore”.
Nurse: “Very painful?” |
|
| Encourage description | This is used to obtain more information about patient’s views and feelings | “Tell me how it happened” | |
| Validate what is being said | This is to make sure that you understand the patient correctly | “Do I understand you correctly when you say…” | |
| Offer your presence | The nurse offers his/her attention and interest without making demands | “I will be with you until they come to fetch you for the operation in theater” | |
| Summarizing | By organizing and checking what the patient has said, especially after a detailed discussion. This technique is used to indicate that a specific part of the discussion is coming to an end and that if the patient wishes to say any more, she should do so | “You went for a walk and then you felt the sharp chest pains, which radiated down your arm” | |
| Use of interpretation | Draw a conclusion from the information you have gathered and discuss it with your patient to see whether it is true. The patient can then disagree with it, or confirm that your conclusions are true | “You must have been exhausted after walking a long distance from home to the hospital” | |
| To give support | Supportive remarks | Make supportive remarks to encourage the patient to participate in the conversation. Show that you are listening |
“Yes….”
“Mmmm…” “Go on, I am listening” |
| Appropriately touch the patient | Touch can assure the patient that the nurse cares and is present | Hold his/her hand. Consider the cultural belief and comfort of the patient before touching | |
| Paraphrasing | This conveys understanding of the patient’s basic message | “It sounds as though the most important problem is the diet” | |
| To assist in analysis and problem solving | Acknowledge the person | This promotes a sense of dignity | “Good morning Mr. Jones” |
| Sequencing | This helps the patient to see the connection between the parts of an occurrence. To effectively assess the patient’s needs, the nurse often needs to know the time frame within which symptom sand /or problems developed or occurred | “Did you experience this sharp pain before or after eating?” | |
| Ask for clarification | This helps the nurse to understand and the patient to communicate more clearly | “What do you mean by everybody?” | |
| Ask for alternatives | This stimulates creative thought and promotes finding solutions | “What else can you try?” | |
| Use of transition | This is used to guide the conversation to another subject, without losing the continuity of the conversation | “It seems to me that you have solved the problem of poor appetite, but I would like to hear more about your diabetes. How long have you been aware of this illness?” | |
| Comparison | Use of examples and comparisons to concrete objects. In this way, a vague or abstract concept can be more easily explained | “Does the pain feel like a sharp or a blunt object that hits you?” | |
| Use silence | This gives the patient the chance to think, and/or to his/her organize thoughts. Silence also give a nurse an opportunity to observe the patient. However, the nurse should avoid silences that last too long because they can make the patient anxious | ||
| To instruct the patient | Give information | This explains information and puts it at the patient’s disposal | “After the operation, you will have a drainage tube” |
| Orientate the patient towards reality | When the patient interprets something incorrectly, the nurse draws his/her attention to reality | “I am not your daughter, I am Nurse Jones” | |
| Query what the patient says | The patient’s observation is called into question without belittling him/her, or arguing about it | Are you sure about that?” | |
| Withhold social reward | Do not give social approval to wrong behavior so as not to encourage a repeat of the wrong behavior | Do not smile, nod or agree when the patient jeopardizes his/her recovery with wrong behavior | |
| Give social reward | Reward behavior that promotes health to encourage a repeat of the correct behavior | Nod is approval at a patient with a weight problem who declines to eat a heavy meal |
-Therapeutic communication techniques.