Therapeutic Communication (Nursing)

by Christy Hennessey (Davidson), DNP, RNC-OB

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    00:00 Welcome back everyone. We are continuing our conversation about communication. Have you ever been in a situation with the patient that you really want to get your point across or you really want to understand what they're feeling or saying? Therapeutic communication is a great technique to help with that. Therapeutic communication is defined as the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient. Now there are some common challenges to therapeutic communication. The first one is level of development in age. So for example, think about babies. Babies only have emotional cues, they can only cry to get their point across. They don't understand words that you speak to them, but they do understand intonation how you say it or even physical touch when you're holding them and caressing them. Likewise, toddlers or young children, they only have limited vocabulary so for them you actually have to use very simplistic language to get your point across to them. Also, level of consciousness.

    01:03 Some people that have altered levels of consciousness may either be able to only send a message or only receive a message or they may be in a situation where they can't do either. For those particular patients, you might consider other forms of communication such as a soft touch to make sure that they know that you are there or if they are able to maybe use pictures to show what you need and maybe they can indicate what they desire from that. Also consider the emotional state and level of stress. When someone is anxious or fearful, they're not really in a state where they can listen to what you say. So as the nurse is important to kind of get to those fears maybe make them feel a little bit better so that when you start the communication process, they're receptive. Clearly, the language spoken could be an obvious barrier. If they're from another country, they may not speak the same language so an interpreter is very helpful. Also, if you have a client who is hard of hearing, sometimes to have someone who can do sign language is very helpful as well. In addition to challenges, there are also barriers to therapeutic communication. First, the nature of the relationship. If a patient or client sees you in a position of authority, they may not feel comfortable opening up. So one technique that you might want to try is when you're communicating with your client is to actually sit at eye level, speak with them as a peer or someone who is on their level. That can help open up the communication and enable trust between you both. Also, individual beliefs do play a part in how they either hear or receive your message so it's important to get to to know your patients and what their individual beliefs are. Culture plays a big part. In some cultures for example, direct eye contact or even touch may not be perceived the same as it is in other cultures. So it's important to know the difference. Also, certain medical treatments may inhibit therapeutic communication. For example if you have a patient who might have a sedative and they are sleepy, they may not be able to understand what you're saying or they might be intubated and may not be able to communicate at all. Now there are some important considerations. You do want to respect the client's personal values and beliefs, their culture awareness and their cultural influences on health. Also, allowing time to communicate with the client. This is so very important. We are busy everyday but it is critical that you carve out the space that you go and you take the time to actually sit and communicate with your client anytime you're doing teaching or any other interaction with them so that they feel hurt and that you understand what they have to say. Now there are some therapeutic techniques such as active listening. Active listening is different than just hearing. Hearing is just hearing what they say, but rather active listening means that you are listening what they say and you're comprehending it and you're understanding their point of view. Second is silence. This is a great technique when used appropriately. Silence benefits both parties because it gives you an opportunity to really process what they're saying and for your client it gives them an opportunity to maybe even think further about what they said and to continue the conversation if they have additional thoughts. Focusing. Sometimes when you're communicating with a client, they might get off topic just a little bit. So for example if you're doing discharge education with the client and they start talking about their family and their friends or their children that they love, a great way to refocus them maybe to say something along the lines of "I know you love your family and that you are so excited for them to come pick you up today to go home, so let's get back to your discharge instructions and talk about the medications you'll be taking at home." And then there's open-ended questions. Open-ended questions do not require the use of a yes or no, rather they give the client the opportunity to expand on what they're saying and to give you further thoughts about what you are talking about. Now, that is not to say that yes or no questions are not appropriate in certain situations. For example, if you have a client with an altered level of consciousness or maybe they're intubated and they simply can't answer an open-ended question, the yes or no answer is actually appropriate in that situation. Then there's clarification.

    05:13 Clarification gives you the opportunity to hear what they're saying to repeat it back to them or gives you an opportunity if maybe you have a question about something they're saying you don't quite understand. Clarification gives you the opportunity to actually understand what they're talking about. And then you have exploring. Exploring gives you the chance to go a little deeper into a specific topic if they've opened up on a certain aspect of their care and you want to know a little bit more about how that might be impacting their overall wellness. That's a great opportunity to dive a little deeper into that. And then there's summarizing. Summarizing is a great technique especially when you're doing education with the patient. Because summarizing after you finished your entire conversation, it actually just hits the highlights so that they understand the main point of what you talked about. So here's a great example. Beth is a registered nurse providing discharge instructions to George who was previously admitted with high blood glucose. Now Beth states during our discussion today we've discussed the roles of diabetic medications, exercise, diet, and other factors as they interact with each other and how these interactions impact on the successful management of diabetes. What type of therapeutic communication is Beth using with George? Is it active listening, silence, focusing, open-ended questions, clarification, exploring, or summarizing? So if you selected summarizing you are correct. In this instance, Beth summarized the education that she provided to George. This is a great example especially in discharge planning where you take all of the main points of your conversation and you present it to your client in an understandable fashion so that they can take away the most important things that you talked about. So remember, the therapeutic nurse-client relationship with the client begins with the establishment of trust. Now this trust is initiated within this relationship with honesty, openness, caring, compassion, and respect. So what do we learn today? We learned that effective nurse-patient communication is the cornerstone of nursing care and treatment irrespective of any other healthcare setting. The term therapeutic communication is mainly used in the field of nursing; however, it's not restricted to nursing only. Rather all healthcare professionals, family, and friends that the patient play a vital role in implementing the strategies of communication in a therapeutic manner.

    07:44 The therapeutic nurse-patient relationship gives confidence to patients and that's an important aspect to his or her care. The ideal therapeutic communication between a patient and nurse acts as a catalyst in gratification of patient's physical, emotional, and spiritual needs. And finally, effective verbal and nonverbal communication forms the basis of the nurse-patient interaction and fosters therapeutic communication that enables patients to achieve wellness in a better manner. I hope you've enjoyed this video on therapeutic communication. Thank you so much for watching.

    About the Lecture

    The lecture Therapeutic Communication (Nursing) by Christy Hennessey (Davidson), DNP, RNC-OB is from the course Leadership and Management (Nursing).

    Included Quiz Questions

    1. Therapeutic
    2. Restorative
    3. Compassionate
    4. Constructive
    1. Age and level of development
    2. Willingness to engage
    3. Capacity for empathy
    4. Verbal and nonverbal acuity
    1. Therapeutic communication
    2. Empathetic communication
    3. Compassionate communication
    4. Assertive communication
    1. Clarification
    2. Open-ended questions
    3. Summarizing
    4. Active listening

    Author of lecture Therapeutic Communication (Nursing)

     Christy Hennessey (Davidson), DNP, RNC-OB

    Christy Hennessey (Davidson), DNP, RNC-OB

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