2.3 Therapeutic CommunicationTherapeutic communication has roots going back to Florence Nightingale, who insisted on the importance of building trusting relationships with patients. She taught that therapeutic healing resulted from nurses’ presence with patients.[1] Since then, several professional nursing associations have highlighted therapeutic communication as one of the most vital elements in nursing. is a type of professional communication defined as the purposeful, interpersonal, information-transmitting process that leads to client understanding and participation.[2] Read an example of a nursing student using therapeutic communication in the following box. Show
Example of Nurse Using Therapeutic Listening Ms. Z. is a nursing student (as simulated in Figure 2.1)[3] who enjoys interacting with patients. When she goes to patients’ rooms, she greets them and introduces herself and her role in a calm tone. She kindly asks patients about their problems and notices their reactions. She provides information and answers their questions. Patients perceive that she wants to help them. She treats patients professionally by respecting boundaries and listening to them in a nonjudgmental manner. She addresses communication barriers and respects patients’ cultural beliefs. She notices patients’ health literacy and ensures they understand her messages and patient education. As a result, patients trust her and feel as if she cares about them, so they feel comfortable sharing their health care needs with her.[4] Figure 2.1 Nursing Student Using Therapeutic CommunicationTherapeutic communication is different from social interaction. Social interaction does not have a goal or purpose and includes casual sharing of information, whereas therapeutic communication has a goal or purpose for the conversation. An example of a nursing goal before using therapeutic communication is, “The client will share feelings or concerns about their treatment plan by the end of the conversation.” Therapeutic communication includes active listening, professional touch, and a variety of therapeutic communication techniques. Active ListeningListening is an important part of communication. There are three main types of listening, including competitive, passive, and active listening. Competitive listening occurs when we are mostly focused on sharing our own point of view instead of listening to someone else. Passive listening occurs when we are not interested in listening to the other person, and we assume we understand what the person is communicating correctly without verifying their message. During , we communicate both verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with them. For example, an active listening technique is to restate what the person said and then verify our understanding is correct. This feedback process is the major difference between passive listening and active listening.[5] Nonverbal communication is an important component of active listening. is a mnemonic for establishing good nonverbal communication with clients. SOLER stands for the following[6]:
TouchProfessional touch is a powerful way to communicate caring and empathy if done respectfully while also being aware of the client’s preferences, cultural beliefs, and personal boundaries. Nurses use professional touch when assessing, expressing concern, or comforting patients. For example, simply holding a patient’s hand during a painful procedure can effectively provide comfort. For individuals with a history of trauma, touch can be negatively perceived, so it is important to ask permission before touching. Inform the person before engaging in medical procedures requiring touch such as, “I need to hold down your arm so I can draw blood.” Nurses should avoid using touch with individuals who are becoming agitated or experiencing a manic or psychotic episode because it can cause escalation. It is also helpful to maintain a larger interpersonal distance when interacting with an individual who is experiencing paranoia or psychosis. Therapeutic Communication TechniquesThere are a variety of therapeutic techniques that nurses use to engage clients in verbalizing emotions, establishing goals, and discussing coping strategies. See Table 2.3a for definitions of various therapeutic communication techniques discussed in the American Nurse, the official journal of the American Nurses Association. Table 2.3a Therapeutic Communication Techniques[7]
Nontherapeutic ResponsesNurses must be aware of potential barriers to communication and avoid nontherapeutic responses. Nonverbal communication such as looking at one’s watch, crossing arms across one’s chest, or not actively listening may be perceived as barriers to communication. Nontherapeutic verbal responses often block the client’s communication of feelings or ideas. See Table 2.3b for a description of nontherapeutic responses to avoid. Table 2.3b Nontherapeutic Responses[8],[9]
See the following box for a summary of tips for using therapeutic communication and avoiding common barriers to therapeutic communication. Tips for Effective Therapeutic Communication
Common Barriers to Therapeutic Communication
Recognizing and Addressing EscalationWhen communicating therapeutically with a client, it is important to recognize if the client is escalating with increased agitation and becoming a danger to themselves, staff, or other patients. When escalation occurs, providing safety becomes the nurse’s top priority, and the focus is no longer on therapeutic communication. Read more information in the “Crisis and Crisis Intervention” section of the “Stress, Coping, and Crisis Intervention” chapter. Cultural ConsiderationsRecall the discussion from Chapter 1 on how cultural values and beliefs can impact a client’s mental health in many ways. Every culture has a different perspective on mental health. For many cultures, there is stigma surrounding mental health. Mental health challenges may be considered a weakness and something to hide, which can make it harder for those struggling to talk openly and ask for help. Culture can also influence how people describe and feel about their symptoms. It can affect whether someone chooses to recognize and talk openly about physical symptoms, emotional symptoms, or both. Cultural factors can determine how much support someone gets from their family and community when it comes to mental health.[10] Nurses can help clients understand the role culture plays in their mental health by encouraging therapeutic communication about their symptoms and treatment. For example, a nurse should ask, “What do you think is wrong? How would you treat your symptoms?” Read more about providing culturally responsive care in the “Diverse Clients” chapter of Open RN Nursing Fundamentals. What is the main purpose of therapeutic communication?The purpose of therapeutic communication, then, is to help clinicians build trust with patients while also helping clinicians and patients collaborate efficiently and effectively toward the patient's physical and emotional wellness.
What are the three main purposes of therapeutic communication?Therapeutic communication focuses on advancing the physical and emotional well-being of a patient. it involves three general objectives: collecting information to determine illness, assessing and modifying behavior, and pro- viding health education.
How does therapeutic communication influence patient care?When you communicate in a therapeutic manner, you allow your patient to feel safe and at ease. That openness and trust inevitably creates a safe space, which gives your patients the best experience possible.
What is therapeutic communication in healthcare?Therapeutic communication is a purposeful interaction between health professionals and patients that helps to achieve positive health outcomes. There is a pressing need for research examining factors influencing effective implementation of therapeutic communication in relation to patient-centered care and satisfaction.
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