Therapeutic

Communication
 A lifelong learning process for nurses
Therapeutic communication promotes personal growth and
Communication attainment of patients’ health-related goals

and Nursing Key to nurse-patient relationships

Practice Patient safety requires effective communication

Improves patient outcomes and increases patient
satisfaction
Communication establishes
caring, healing relationships.
The ability to relate to others Communication and
is important for interpersonal Interpersonal
communication.
Communication, including
Relationships
posture, expressions,
gestures, words, and
attitudes, has the power to
hurt or heal.
 Critical thinking
Developing Perseverance and creativity
Communication Self-confidence
Skills Humility

Integrity
Developing Communication
Skills (Cont.)
Thinking is influenced by perception
• Five senses
• Culture
• Education

Perceptual bias
Emotional intelligence
Levels of Communication

Intrapersonal
Interpersonal
Small group
Public
Electronic
Quick Quiz!
1. Match the levels of communication.
1. Intrapersonal A. One-to-one interaction
between two people

2. Interpersonal B. Occurs within an individual

3. Transpersonal C. Interaction with an audience

4. Small group D. Interaction within a person’s

spiritual domain
5. Public E. Interactions with a small
number of people

7
Quick Quiz!
2. You are invited to attend the weekly unit patient
care conference. The staff discusses patient care
issues. This type of communication is:
A. public.
B. intrapersonal.
C. transpersonal.
D. small group.

8
What do you think is the problem
here?
Elements of the Communication Process

10
 Components
• Referent
Circular
• Sender and receiver
Transactional
• Message
Model
• Channels
• Feedback
• Interpersonal variables
• Environment
 Quick Quiz!
3. Match the basic elements of communication.

1. Referent A. One who encodes and one who decodes the

message
2. Sender and receiver B. The setting for sender-receiver interactions
3. Message C. Message the receiver returns
4. Channels D. Motivates one to communicate with another
5. Feedback E. Means of conveying and receiving messages
6. Interpersonal variables F. Factors that influence communication
7. Environment G. Content of the message
 Verbal communication
• Vocabulary
• Denotative and connotative
meaning
• Pacing

Forms of • Intonation
• Clarity and brevity
Communication • Timing and relevance
 Nonverbal
• Personal appearance

Forms of •
•
Posture and gait
Facial expressions
Communication •
•
Eye contact
Gestures
(Cont.) •
•
Sounds
Territoriality and personal space

Metacommunication
 Nursing actions
within the zones
of personal space
Nursing actions within
the zones of touch
Nurse-Patient Relationship

Caring relationships are the

foundation of clinical nursing
practice.
Therapeutic relationships promote a
psychological climate that facilitates
positive change and growth.
 1. Preinteraction phase: occurs before meeting the patient

2. Orientation phase: when the nurse and the patient

meet and get to know each other
Nurse-Patient
Relationship (Cont.) 3. Working phase: when the nurse and the patient work
together to solve problems and accomplish goals

4. Termination phase: occurs at the end of a relationship

Motivational Interviewing
A technique that holds promise for encouraging
patients to share their thoughts, beliefs, fears,
and concerns with the aim of changing their
behavior.
The interviewing is delivered in a
nonjudgmental, guided communication approach.
 Nurse-family relationships
Nurse-health care team relationships

Nurse-community relationships

Professional Nursing Relationships (Cont.)

 Case Study

Roberto Ruiz is a 44-year-old man of Puerto Rican

descent, suffering from HIV/AIDS. He was near death and
in hospice, but his condition has improved and he is now
home.
Suzanne is a 54-year-old nurse dedicated to hospice and
committed to maximizing quality of life in end-of-life
care.
Quick Quiz!
4. Helping relationships serve as the foundation of clinical nursing practice.
Contracts for a therapeutic helping relationship are formed during the:
A. orientation stage.
B. working stage.
C. termination stage.
D. preinteraction stage.
Elements of Professional Communication
Appearance,
demeanor, and Courtesy
behavior

Use of names Trustworthiness

Autonomy and
Assertiveness
responsibility
 Case Study (Cont.)

As Suzanne works with Roberto, she develops a

helping relationship. Suzanne knows that posing
questions for the patient’s reflection helps her
assess his needs and support his self-care
strategies.
 Through the patient’s eyes
• Gather information, synthesize, apply critical
thinking

Physical and emotional factors

Developmental factors
Nursing Process:
Assessment Sociocultural factors

Gender
 Case Study (Cont.)

Suzanne learns that Roberto wants to travel to New

York to see his extended family.
Even though Roberto is in poor health and the trip will
be difficult, Suzanne expresses her understanding of the
importance of the trip. She understands how important
extended family is in the Puerto Rican culture.
 Nursing Diagnosis
Nursing diagnosis for communication
• Many patients experience difficulty with
communication:
Lacking skills in attending, listening, responding, or
self-expression
Inability to articulate, inappropriate verbalization
Difficulty forming words
Difficulty with comprehension
Planning

Goals and outcomes

• Specific and measurable
Setting of priorities
Teamwork and collaboration
Case Study (Cont.)
During her visit, Roberto tells Suzanne, “I really want to go visit my uncles in New York, but I’m not
sure I’m up for the trip.”
Suzanne is understanding: “It sounds like you miss your family. Let’s talk about your options for
maintaining contact.”
As they talk, Suzanne helps Roberto to identify two methods of communicating with his family in
New York.
Implementation
Therapeutic communication techniques are specific responses that encourage the
expression of feelings and ideas and convey acceptance and respect.
• Active listening means being attentive to what a patient is saying both verbally and
nonverbally.
• Use “SOLER”: Sit facing the patient; observe an open posture, lean toward the patient,
establish and maintain intermittent eye contact; relax

Copyright © 2017, Elsevier Inc. All Rights Reserved.

 Implementation
(Cont.)

Therapeutic communication techniques (Cont.)

• Sharing observations
• Sharing empathy
• Sharing hope
• Sharing humor
• Sharing feelings
• Using touch
• Using silence

Copyright © 2017, Elsevier Inc. All Rights Reserved.

 Therapeutic communication
techniques (Cont.)
• Providing information
• Clarifying
• Focusing
• Paraphrasing
• Validation
• Asking relevant questions
Implementation (Cont.) • Summarizing
• Self-disclosure
• Confrontation
Implementation (Cont.)
Nontherapeutic communication techniques
• Asking personal questions
• Giving personal opinions
• Changing the subject
• Automatic responses
• False reassurance
• Sympathy
Implementation (Cont.)
Nontherapeutic communication
techniques (Cont.)
• Asking for explanations
• Approval or disapproval
• Defensive responses
• Passive or aggressive responses
• Arguing
Barriers of communication and methods of overcoming the
barriers
Barriers of communication and methods of overcoming the
barriers
 Barriers of
communication
Adapting Communication Techniques
Patients who cannot speak clearly
Cognitive impairment
Hearing impairment
Visual impairment
Unresponsive
Patients who do not speak English (or your language)
 Communicating
with patients
who have special
needs
 Communicating
with patients who
have special needs
 Communicating
with patients
who have special
needs
 Communicating
with patients who
have special needs
 5. While admitting a patient, during the initial
interview, a family member tells you, “My
mom really means that she does not
Quick Quiz! understand her medical diagnosis.” The
communication form used by the family
member is:
A. focusing.
B. clarifying.
C. summarizing.
D. paraphrasing.
 Through the patient’s eyes
Patient outcomes
• Nurses and patients need to determine
whether the plan of care has been successful.
Evaluation • Nursing interventions are evaluated to
determine which strategies or interventions
were effective.
• If expected outcomes are not met, the plan of
care needs to be modified.