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Therapeutic Communication Strategies (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:01 When we're thinking about therapeutic communication, we are focused on our patient.

    00:07 We are taking the flashlight and spotlighting it on our patient's recovery.

    00:12 So in order to develop therapeutic communication, the first thing we need to do is establish respect and trust.

    00:22 I've always found that the best way to receive respect from someone is to show respect.

    00:30 Authenticity and honesty helps to build trust.

    00:35 Therapeutic communication will utilize some strategies that help us to increase that level of trust and also allow the person to have a felt sense of being heard.

    00:53 What do I mean by that? Very frequently, when we talk to someone and they're speaking, you almost are waiting for them to stop so you can tell them the next thing on your mind.

    01:07 Or perhaps, they remind you of something and you interrupt them.

    01:12 When you do that, it robs that person of the sense of being heard.

    01:20 Most importantly, it's so, so important to remember that a therapeutic relationship is not a social one.

    01:30 Your patients are not your friends. They're not your buddies.

    01:35 They're not someone you're going to tell about Friday nights social events to.

    01:39 You're not going to share your Instagram, you're not going to tell them what you saw in TikTok.

    01:45 You're not going to give them any of your internet or social network attachments.

    01:50 It's very important to remember that patients are patients for a finite period of time in the hospital, and if you work in an environment in a medical center as I do, not far from my home, I bump into patients I've seen in the hospital all the time.

    02:10 I might be at Costco or BHA's. I might be in a department store and I will see somebody who I knew in the hospital, they may come over to me or they may pretend they don't know me, that therapeutic relationship belongs as a therapeutic relationship. It is not a social one.

    02:30 They don't need to know about my personal life. You are professional.

    02:34 Your purpose to work with this client or a patient is to help this patient towards recovery it has nothing to do with you.

    02:44 It has to do with the patient. It has that flashlight.

    02:47 If you can keep that idea in your head, the flashlight, the spotlight is always on the patient.

    02:55 Professionalism includes the use of strategies that support therapeutic communication which has the patient as the most important sender of messages.

    03:07 We are there to receive their message.

    03:12 Therapeutic communication focus on us supporting them in their recovery.

    03:20 Let's talk about some strategies of therapeutic communication.

    03:26 What do you think might be an excellent strategy for therapeutic communication? If you said silence, you're correct.

    03:39 Silence is an incredible strategy.

    03:43 Sometimes, a patient might say, "I don't really feel like talking." Then you can just say, "Do you mind if I sit down?" And sit and be silent.

    03:56 After a period of time, that patient might look at you and say, "So what's going on with you?" And then you can respond.

    04:05 Restating is another really good strategy.

    04:10 It takes some skill though and I'd suggest that if you're going to try restating, work on this at home with your family first.

    04:20 Because it means that you're going to repeat exactly what the person said last.

    04:25 So if someone says to yo, "You know, I haven't felt so well this day." You'll say, "You didn't feel well today?" And then believe it or not, they will continue on and say, "No, I didn't." And you know why? And then you can continue to listen.

    04:45 Another one is focusing.

    04:47 Focusing your communication on the patient, not bringing it on yourself.

    04:54 So being able to say, "So what I heard you say was you weren't feeling so well today, can you tell me more about that?" If the patient says, "Well, what about you? How do you feel today?" You're allowed to refocus back into the patient and say.

    05:15 "You know, I would prefer to think about how you felt, if you don't mind.

    05:23 How did you feel today?" You want to explore.

    05:29 Oftentimes, you'll get a sentence that gives you an opening into something else.

    05:35 For example, if the patient says, "While I was eating breakfast this morning, the coffee tasted like - like what the coffee I used to have when I was a child." At which time you can say, "Wow." Restate.

    05:52 "The coffee tasted like when you were a little child?" Focus in. "Oh, so the coffee reminded you of something when you were a child." And then explore, "So how did that make you feel?" If the person is saying to you, "It made me feel great," and you see that they're crying.

    06:15 "It made me felt fine, it made me feel great. I had a great childhood." You're allowed to voice some doubt, but base it in reality.

    06:26 "So I see that you're crying and you're telling me that you had a great childhood.

    06:32 I'm wondering why would you be crying if you had these memories of a great childhood?" When you are asking questions, if you've noticed, most of the questions I've asked cannot be answered with a yes or no, those are close-ended questions.

    06:53 You want to ask questions that start with when, why, how, tell me, these are open-ended questions that allow the patient to have to answer with more than one or two words.

    07:10 And when they tell you something, even if you are voicing doubt, you have to be accepting.

    07:17 Accept what they are telling you.

    07:19 "I hear that you say that you had a very good childhood and I see that you're crying; and I'm wondering, do you want to tell me more about that?" The person starts talking a little bit more and says, "Well, these tears are actually tears of joy because it makes me remember that my mother was so good to me." And then you say, "Oh, I see. Your mother was really good to you and now the tears I'm seeing is because you're remembering a good time." So you see how I'm using restating and focusing, refocusing, voicing doubt, and also accepting what I'm hearing.

    08:03 I'm also recognising that this person is a telling me a story.

    08:09 I'm recognizing what they're saying.

    08:11 I'm recognizing it as being their ideas, and that's really important.

    08:18 It's oftentimes hard for us to simply sit back and recognize what a person is saying and then to be able to offer self. And what does that look like? "So, I'm hearing you say that these are good memories, that these are tears of joy.

    08:39 I'm seeing that there is sadness and happiness that's mixed, and I want you to know that I'm sorry, that you had to have any sadness as a child.

    08:52 And I'm hoping that if you have any thoughts that you want to share, you understand, I'm here to listen." And that is offering self. Offering self does not mean, "Here's my email address, here's my cellphone.

    09:08 If you need me, give me a call." That would be breaking the boundary of a therapeutic communication and sliding into something that is a wee bit more personal.

    09:20 We want to keep this professional.

    09:22 Offering self is being able to say, "I want you to know that I'm here for you." And then reflect. Reflect on what the patient is saying, reflect also on yourself.

    09:36 If you are finding yourself in any communication with the patient, waiting for them to stop so you can tell them about something that happened to you, slow it down, reflect on yourself and then refocus yourself on the patient, and then reflect on what they are telling you.

    09:59 It's important to make sure that you are understanding what is being said to you, so you need to seek clarification.

    10:08 For example, that one thing I was saying before about the patient who says.

    10:14 "Well, I'm crying because I am happy it has happy memories as well as sad ones," you're allowed to clarify and ask, "Wow, happy and sad feelings, memories at the same time.

    10:30 Can you explain that a little bit more?" Seeking clarification allows the person who's speaking to explain what they're saying and make sure that what you are getting is what they are saying.

    10:48 This is that idea of the messenger, the message, and the receiver.

    10:53 If however, you're working with a patient who is not living in reality, who is delusional or who has hallucinations; if they are saying to you, "I am the queen of England." You are allowed to voice doubt.

    11:14 You are allowed to say to them, "You know, I don't believe that you are the queen of England, because you're here talking to me and your name is Brenda Marshall and you live in America," and you can present some reality, some facts and voice your doubt.

    11:38 How you voice it is very important. Tone, delivery - you do it with kindness.

    11:48 After you have spent a bit of time with someone, after you have gained a lot of knowledge about this person, it's always good to slow it down and summarize what you've heard.

    12:02 "Mr. Jay, it's been really wonderful talking to you.

    12:06 I just hope that you don't mind if I just summarize for a moment.

    12:09 When we were talking about breakfast, you explained to me that the coffee reminded you of your childhood.

    12:16 And when you did that some tears came up.

    12:21 Those tears were tears of happiness because they reminded you of your mother who was so good to you when you were a child. Am I getting that right?" That what the patient has the opportunity to correct you if you have said something that is wrong.

    12:42 And never, never feel as though a person is going to correct you because they don't like you or because they're picking on you.

    12:51 It's their stories that we're interested in and so when we listen to them, we want to hear their story, and if they say, "No, no, that's not correct.? Usually, what I'll say is, "Wow, I got that wrong. I'm so sorry. Can you help me get it right?" When you are doing that you are improving the relationship that you're having with that person.

    13:13 You're giving them an opportunity to tell you their story.


    About the Lecture

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


    Included Quiz Questions

    1. The goal is to facilitate recovery.
    2. It focuses on the nurse.
    3. It is interchangeable with a social relationship.
    4. It is strengthened by the nurse sharing personal information.
    1. Silence
    2. Voicing doubt
    3. Probing
    4. Offering self
    5. Accepting
    1. Focusing
    2. Silence
    3. Restating
    4. Exploring
    1. “How did that make you feel?
    2. “Did that make you feel sad?”
    3. “Are you crying because of what you told me?”
    4. “Do you always tear up when you talk about this?”
    1. Offering self
    2. Silence
    3. Focusing
    4. Restating
    1. Seeking clarification
    2. Restating
    3. Recognizing
    4. Focusing
    1. Voicing doubt
    2. Restating
    3. Focusing
    4. Exploring

    Author of lecture Therapeutic Communication Strategies (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN


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