Nontherapeutic Communication (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:00 Let's take a moment since shutting someone down is terribly non-therapeutic.

    00:08 It is the moment when if you feel, I have to make this person hurry up, that's the moment that you have to step back and step away.

    00:17 What are some other non-therapeutic techniques, one in particularly, that we just spoke about? It starts with an A and ends with a G. There's a V-I-S in the middle.

    00:31 Yes, advising. We do not give advice.

    00:36 What about approving and disapproving? What if a person, as you're speaking to them says to you, "You know, I always wanted to stop drinking." The therapeutic response would be, "Oh, you always wanted to stop drinking, hmm?" Not, "Oh, that is so good. I am so proud of you, what a great idea.

    01:04 You always wanted to stop drinking, that's great." Approving what someone says is not therapeutic.

    01:13 Again, it will make that person want to please you.

    01:18 They will start telling you what they think you want to hear.

    01:22 It will take the spotlight off of their recovery and make them want you to like them.

    01:30 The same goes for disapproving.

    01:34 "So you always wanted to stop drinking, did you?" "Well, no, that's why I'm in detox now." "Uh, it's terrible that you couldn't stop.

    01:45 I mean, it's a good thing you are starting now, but boy, oh, boy." That disapproving actually will start reinforcing that that person has done something wrong.

    01:57 That it will reinforce their negative self-image.

    02:01 So, approving and disapproving, and advising are very non-therapeutic techniques.

    02:10 If there is a patient and the patient is not giving you the answers that you are looking for, and you continually ask that patient, what do you think might happen? Think about yourself.

    02:26 Think about people around you.

    02:28 If you are studying for an exam and someone says, "Did you read chapter 12?" And you say, "Well, not yet." "What do you mean not yet? Why didn't you do it?" "Well, I didn't have time." "Why didn't you have time? You don't think that this is your priority? Don't you think you should be reading?" "Well, I didn't have time." "Well, what else are you doing?" What will happen is that starts increasing agitation and you are moving towards having some aggressive behaviors coming out.

    02:58 So avoid persistent questioning.

    03:02 There's another non-therapeutic skill that quite often, every single one of us, at some point in our professional life engages in, and that is assuming.

    03:16 Assuming that you know this patient so well, that you know what they need.

    03:21 Or assuming that you know what they're going to say.

    03:25 Assuming anything immediately closes the door to learning.

    03:32 One of the things that I often like to say is knowing stops learning.

    03:39 It is the antithesis to learning.

    03:43 If I think I know something, I'm closed off to learning more about it.

    03:48 Assuming comes right before that, "I think I know what you're going to say." We never know what another person is going to say.

    03:58 The moment that we are able to actually grow as professionals and help reassure our patients is when we are listening to them; as though their story was so unique that we had never, ever heard before.

    04:15 We want to make sure that we respect that individualistic person in front of us.

    04:22 Understanding, that their struggle, their experience is something that belongs to them and them alone.

    04:31 It's not because they're woman that they feel this way.

    04:35 "Oh, yeah, all women do that. Oh, yeah.

    04:38 He's not doing that, that's - men are so difficult." Avoid making stereotypical comments because those stereotypical comments, although, you may be saying them very innocently, might be taken very poorly by the person you are speaking to.

    05:00 If a person tells you that it's so hard for them, that they've tried to quit smoking and they can't quit, and the reason they can't quit is because no matter what they've done in the past it hasn't work, and they know it won't work in the future and it'd just waste their time. You don't want to support those denials of success that that patient is telling you.

    05:33 You want to be able to explore rather than support the denials.

    05:41 "So I hear you say that you wasted time in the effort to stop smoking.

    05:47 So what I think I'm hearing is that you're choosing the future that may have lung cancer over the present which is a really hard struggle." And then let them talk. Let them clarify.

    06:03 "No, that's not what I'm saying." Do not deny what they are telling you.

    06:09 "I loved my mother. I didn't mean to hit her it was a mistake." Don't deny their reality.

    06:17 "I hear you say that you loved your mother and that it was a mistake to hit her.

    06:23 So how does that feel to know that you hit her?" If they tell you, "It feels terrible, it feels awful because I love her." Don't interpret that. Don't - you can, you can say," I hear you say it feels terrible because you love her." Do not interpret what that person has said.

    06:47 Interpreting would sound more like this.

    06:49 "Wow, you love your mother and then you hit her and you feel so bad because inside you really wanted to hug her and you weren't able to hug her and once that hand went up, you just lost control of it and it landed on her chin instead of holding her." That's interpreting what they're saying.

    07:09 You are now changing their experience and changing reality and supporting a reality that may or may not exist.

    07:21 One thing for novice psychiatric nurses that we often see, is a patient will bring up something that they are not comfortable with.

    07:32 If it is violence, if it is sexual abuse, often times we are uncomfortable with what we are hearing.

    07:42 If you are uncomfortable to a point where you feel that you cannot follow the patient's story anymore, rather than changing topics, recognize that this is too uncomfortable for you.

    07:57 Perhaps it's bringing up something in yourself and you cannot be therapeutic, and allow the person the right have someone who can listen to the story and listen to that story therapeutically.

    About the Lecture

    The lecture Nontherapeutic Communication (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Therapeutic Communication in Psychiatric Nursing.

    Included Quiz Questions

    1. “Oh, you want to stop using cocaine?”
    2. “Good for you! I knew you’d come around!”
    3. “Are you sure? The last time you tried, it didn’t work.”
    4. “You'll need to stop talking to all your old friends.”
    1. Persistent questioning
    2. Giving advice
    3. Approving and disproving
    4. Restating
    5. Voicing doubt
    1. “What I’m hearing is that you put in the effort but didn't get the results you wanted?”
    2. “I understand. There are so many weight loss treatments that are scams.”
    3. “That’s very frustrating. Have you considered gastric bypass surgery?”
    4. “I’m proud of you for trying. A little progress is better than no progress.”
    1. “Why would you do that? You must take it exactly as prescribed.”
    2. "When was the last time you took your metformin?"
    3. "You shouldn't have done that without talking to the doctor first."
    4. "I assume you thought you didn't need the medication anymore?"
    5. "Is there a family member or someone that can remind you to take it?"
    1. Ask the charge nurse to reassign the client to another nurse.
    2. Ask the client not to mention their past trauma.
    3. Change the subject when the client begins talking about their trauma.
    4. Recommend the client discuss their issues during group therapy.

    Author of lecture Nontherapeutic Communication (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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