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What Is Therapeutic Communication?

Therapeutic communication is a structured, intentional approach to interactions between nurses and patients that facilitates expression, understanding, and problem-solving. It emphasizes empathy, respect, and collaboration to help patients cope, make informed decisions, and engage in their care.

Goals

• Establish trust and rapport
• Assess needs, concerns, and values accurately
• Promote emotional support and coping
• Clarify information and correct misconceptions
• Enhance safety, autonomy, and shared decision-making
• Improve adherence, satisfaction, and health outcomes

Core Principles

• Empathy and unconditional positive regard
• Respect, dignity, and cultural humility
• Genuineness and congruence (words match actions)
• Patient-centeredness and collaboration
• Therapeutic boundaries and professional role clarity
• Privacy and confidentiality
• Trauma-informed care (safety, trust, choice, collaboration, empowerment)

Verbal Therapeutic Techniques

• Open-ended questions: Invites sharing (e.g., "Can you tell me more about how this is affecting you?")
• Active listening: Attentive silence, minimal encouragers ("Go on…"), and observing nonverbal cues
• Restating and paraphrasing: "So you’re saying…"
• Reflection of feelings: "It sounds like you’re feeling frustrated."
• Clarification: "When you say dizzy, do you mean lightheaded or the room is spinning?"
• Summarizing: Pulls key points together to check understanding
• Focusing: "Let’s look at one concern at a time."
• Exploring: "What led up to that?"
• Offering self: "I can sit with you for a while."
• Giving broad openings: "Where would you like to begin?"
• Placing events in sequence: "What happened first?"
• Encouraging description of perceptions: Useful for sensory changes or anxiety
• Presenting reality and voicing doubt: Grounding without arguing (e.g., "I don’t see anyone else in the room.")
• Seeking consensual validation: "Does this match what you meant?"
• Therapeutic use of silence: Allows processing and expression

Nonverbal Skills

• Use SOLER: Sit squarely, Open posture, Lean in, Eye contact (culturally appropriate), Relax
• Calm tone, measured pace, and appropriate volume
• Respect personal space; use touch only with consent and clinical appropriateness
• Attend to facial expressions, posture, and congruence with spoken words

Nontherapeutic Responses to Avoid

• "Why" questions that feel judgmental
• Giving advice or opinions ("You should…")
• False reassurance ("Everything will be fine.")
• Minimizing or dismissing feelings ("It’s not that bad.")
• Changing the subject or interrupting
• Probing for curiosity
• Approval/disapproval, moralizing, or arguing
• Defensiveness or countering
• Leading, multiple, or jargon-filled questions
• Sympathy that shifts focus from the patient to the nurse

Phases of the Nurse–Patient Relationship

• Preinteraction: Review information, self-reflect, plan
• Orientation: Introduce self, establish roles, set goals, build trust
• Working: Explore issues, teach, implement interventions, support coping and change
• Termination: Summarize progress, plan follow-up, provide closure and resources

Using the Nursing Process

• Assessment: Identify communication preferences and barriers (hearing/vision loss, aphasia, language, cognition, pain, anxiety, literacy, culture)
• Nursing diagnoses: Impaired verbal communication, anxiety, ineffective coping, decisional conflict, powerlessness, social isolation
• Planning: Set SMART goals; plan strategies (e.g., interpreter, quiet environment, written materials)
• Implementation: Apply therapeutic techniques; reinforce strengths; involve family as appropriate
• Evaluation: Check understanding (teach-back), reassess distress, revise plan

Adapting to Populations and Settings

• Children/adolescents: Use simple language, play or drawing, involve caregivers while honoring privacy
• Older adults: Allow extra time, reduce noise/glare, verify devices (glasses, hearing aids), speak slowly; avoid elderspeak
• Aphasia or cognitive impairment: Short sentences, one-step instructions, yes/no options, visual aids; consult speech-language pathology
• Language barriers: Use qualified medical interpreters (not family), speak to the patient, pause for interpreting, provide translated materials
• Serious illness/end-of-life: Prioritize presence, silence, reflection, and validation; assess values and goals of care
• Mental health and crises: Maintain safety, set clear limits, de-escalate, and use grounding and reality orientation as needed

Safety, Ethics, and Professional Boundaries

• Confidentiality and privacy; follow laws and policies
• Informed consent and shared decision-making
• Duty to warn/protect when there is imminent risk
• Maintain therapeutic boundaries; avoid dual relationships and gifts
• Document objectively; include patient quotes and observed behaviors

De-escalation Essentials

• Early signs: escalating voice, pacing, clenched fists, refusal, agitation
• Approach: Calm tone, nonthreatening posture, maintain safe distance, reduce stimuli
• Communication: Simple, clear choices; acknowledge feelings; set respectful limits
• Teamwork: Call for help early; use least restrictive interventions

Documentation Tips

• Record verbatim patient statements in quotes
• Separate objective observations from interpretations
• Note techniques used and patient response
• Use teach-back outcomes to confirm understanding

Sample Therapeutic Phrases

• "Tell me more about what concerns you most today."
• "It sounds like this has been overwhelming."
• "What has helped you cope in the past?"
• "Let’s look at the options together."
• "What questions do you have about your plan?"
• "I will stay with you while we sort this out."
• "Let me make sure I understood: you’re worried about…"
• "On a scale of 0–10, how confident do you feel about…?"

Common Pitfalls and Exam Tips

• Choose patient-centered, open-ended, feeling-focused responses
• Avoid advice, reassurance, and "why" questions
• Prioritize safety and least-restrictive strategies
• Match verbal and nonverbal communication; address barriers proactively

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