Therapeutic Communication
Comprehensive Nursing Notes
Introduction to Therapeutic Communication
Therapeutic communication is a purposeful, interpersonal, information-transmitting process that leads to client understanding and participation. It involves goal-directed exchanges between healthcare providers and patients to facilitate healing, promote wellness, and improve patient outcomes.
Unlike social communication, therapeutic communication is purposeful, patient-centered, and focused on addressing the patient’s needs. It establishes trust, demonstrates empathy, and encourages patient autonomy within a professional relationship.
Key Functions of Therapeutic Communication
- Establishing a trusting nurse-patient relationship
- Gathering essential assessment data about the patient’s condition
- Providing emotional support and validating patient experiences
- Facilitating patient expression of thoughts, feelings, and concerns
- Empowering patients to participate in healthcare decisions
- Providing patient education and health promotion
Types of Therapeutic Communication
Verbal Communication
Spoken words and language used to convey messages and exchange information with patients.
Key Elements:
- Clear, concise language
- Appropriate tone and pace
- Open-ended questioning
- Validation statements
- Avoidance of medical jargon
Non-Verbal Communication
Transmission of messages without words through body language, gestures, facial expressions, and physical appearance.
Key Elements:
- Eye contact and facial expressions
- Body posture and gestures
- Proxemics (use of space)
- Touch (therapeutic touch)
- Silence (as communication)
Active Listening
Fully concentrating on what the patient is saying, understanding their message, and providing feedback that demonstrates comprehension.
Key Elements:
- Full attention to speaker
- Paraphrasing and summarizing
- Asking clarifying questions
- Providing verbal and non-verbal feedback
- Avoiding interruptions
Written Communication
Documentation and written exchanges that support patient care and education.
Key Elements:
- Clear, accurate documentation
- Patient education materials
- Care plans and instructions
- Appropriate literacy level
- Visual aids and diagrams
SOLER Technique for Non-Verbal Communication
A powerful mnemonic to enhance your non-verbal communication with patients
Sit Squarely
Face the patient squarely to show engagement and interest
Open Posture
Maintain open posture, avoid crossing arms to appear approachable
Lean Forward
Lean slightly toward the patient to show interest in what they’re saying
Eye Contact
Maintain appropriate eye contact to establish connection
Relaxed
Stay relaxed and comfortable to create a calm environment
Phases of Therapeutic Relationship
The nurse-client relationship develops through three distinct phases, each with unique characteristics and goals:
Orientation Phase
- Initial meeting and introduction
- Clarification of roles and expectations
- Establishing trust and rapport
- Initial assessment of patient needs
- Setting boundaries and guidelines
- Beginning to develop the plan of care
Working Phase
- Active problem identification
- Implementing the plan of care
- Exploring feelings and thoughts
- Teaching and learning
- Promoting health behavior changes
- Ongoing assessment and intervention
Termination Phase
- Summarizing achievements
- Evaluating outcomes
- Processing feelings about ending the relationship
- Discussing follow-up plans
- Providing referrals as needed
- Formal closure of the relationship
Therapeutic Communication Techniques
Effective therapeutic communication relies on specific techniques that facilitate understanding, trust, and healing:
Active Listening
Fully focusing on what the patient is saying while providing verbal and non-verbal feedback.
Example: Maintaining eye contact, nodding, and occasionally saying “I understand” or “I hear you” while the patient explains their concerns.
Using Silence
Purposefully remaining quiet to give patients time to gather their thoughts or express difficult emotions.
Example: After asking a significant question, allowing the patient time to reflect and respond without interruption.
Open-Ended Questions
Questions that cannot be answered with a simple “yes” or “no” and encourage detailed responses.
Example: “How have you been managing your medication routine?” instead of “Are you taking your medications?”
Clarification
Asking patients to explain or elaborate on something they’ve said to ensure understanding.
Example: “I’m not sure I understand what you mean by feeling ‘out of control.’ Could you explain that a bit more?”
Paraphrasing
Restating what the patient has said in your own words to verify understanding.
Example: “So what you’re saying is that you’ve been having trouble sleeping since starting the new medication.”
Reflection
Mirroring the patient’s feelings or content to encourage further exploration.
Example: “You seem frustrated about the slow progress in your recovery.”
Focusing
Directing or redirecting the conversation to important aspects that require attention.
Example: “You mentioned earlier that you’ve been experiencing dizziness. Could we talk more about that?”
Summarizing
Reviewing the main points of a conversation to ensure mutual understanding.
Example: “Let me make sure I understand. You’ve been experiencing headaches in the morning, you’ve noticed they’re worse when you haven’t slept well, and you’re concerned they might be related to your new medication.”
Self-Disclosure
Sharing appropriate personal experiences when beneficial to the therapeutic relationship.
Example: “Many patients find this procedure uncomfortable at first, but most adjust to it over time.”
Offering Information
Providing relevant facts, instructions, or feedback to enhance understanding.
Example: “These side effects are common when starting this medication, but they typically subside within 7-10 days as your body adjusts.”
AIDET Framework for Patient Interactions
A proven framework for effective patient communication
Acknowledge
Greet the patient by name and make eye contact
Introduce
Introduce yourself, your role, and your experience
Duration
Let patients know how long procedures or visits will take
Explanation
Explain procedures and what to expect next
Thank You
Express gratitude for their cooperation and trust
Characteristics & Principles of Therapeutic Communication
Key Characteristics
Patient-Centered
Focuses on the patient’s needs, preferences, values, and experiences rather than the nurse’s agenda.
Goal-Directed
Has specific purposes and outcomes related to the patient’s health and wellbeing.
Dynamic
Adaptive and responsive to changing circumstances and patient needs.
Empathetic
Demonstrates understanding of the patient’s feelings and perspective.
Confidential
Respects and maintains patient privacy and dignity.
Professional
Maintains appropriate boundaries and adheres to ethical standards.
Core Principles
Respect for Autonomy
Honoring patients’ right to make their own healthcare decisions after providing adequate information.
Genuineness
Being authentic and honest in interactions with patients to build trust and rapport.
Empathy
Understanding and acknowledging patients’ feelings and perspectives without judgment.
Confidentiality
Protecting patient information and maintaining privacy to foster trust.
Cultural Sensitivity
Recognizing and respecting cultural differences in communication styles and health beliefs.
Professional Boundaries
Maintaining appropriate limits in the nurse-patient relationship to ensure ethical care.
The 7 Cs of Effective Communication
Use this mnemonic as a checklist for clear and effective therapeutic communication
Clear
Use simple language and avoid jargon
Concise
Keep messages brief and to the point
Concrete
Be specific rather than general
Correct
Ensure accuracy of information
Coherent
Organize information logically
Complete
Include all necessary information
Courteous
Be respectful, friendly, and open
Barriers to Therapeutic Communication
Understanding and addressing barriers is essential for effective therapeutic communication:
Physical Barriers
- Environmental noise – Loud sounds that distract from conversation
- Lack of privacy – Inability to speak confidentially
- Physical discomfort – Pain or discomfort that impedes focus
- Inadequate space – Crowded or inappropriate settings
- Physical barriers – Objects between communicators
Psychological Barriers
- Emotional distress – Anxiety, fear, or anger affecting communication
- Lack of trust – Hesitation to share personal information
- Stereotyping – Preconceived notions about others
- Defense mechanisms – Denial, projection, or rationalization
- Mental health conditions – Depression, anxiety, or thought disorders
Communication Barriers
- Language differences – Different primary languages or dialects
- Medical jargon – Use of technical terms unfamiliar to patients
- Health literacy issues – Limited understanding of health information
- Sensory impairments – Hearing or vision limitations
- Cognitive impairments – Memory issues or intellectual disabilities
Nurse-Related Barriers
- Time constraints – Insufficient time for meaningful interaction
- Work overload – High patient-to-nurse ratios
- Personal biases – Unconscious prejudices affecting care
- Lack of cultural competence – Limited understanding of cultural differences
- Burnout or compassion fatigue – Emotional exhaustion affecting interactions
Non-Therapeutic Communication Techniques to Avoid
CLEAR: Overcoming Communication Barriers
A mnemonic to help address barriers to effective therapeutic communication
Check
Check the environment for physical barriers
Listen
Listen actively for understanding, not just response
Engage
Engage with cultural sensitivity and respect
Adapt
Adapt communication style to patient needs
Reconfirm
Reconfirm understanding through teach-back
Therapeutic vs. Non-Therapeutic Communication Examples
Comparing therapeutic and non-therapeutic approaches helps nurses develop effective communication skills:
| Scenario | Non-Therapeutic Response | Therapeutic Response |
|---|---|---|
| Patient expressing pain | “You’ll be fine. Everyone feels pain after surgery.” | “I can see you’re in pain. Let’s talk about your options for pain management.” |
| Patient refusing medication | “Why won’t you take your medication? You need it to get better.” | “I notice you’re hesitant to take this medication. Could you share your concerns about it?” |
| Patient expressing anxiety about procedure | “Don’t worry about it. It’s a routine procedure with minimal risks.” | “It’s normal to feel anxious before a procedure. What specific concerns do you have about it?” |
| Patient crying | “Please don’t cry. Things could be worse.” | “I see this is difficult for you. It’s okay to express your feelings. I’m here to listen.” |
| Patient asking about diagnosis | “The doctor will explain everything. Don’t worry about it now.” | “What has your doctor told you so far about your diagnosis? I can help clarify information.” |
Detailed Scenario Examples
Scenario 1: Patient Expressing Worry About Test Results
Non-Therapeutic Approach:
Patient: “I’m really worried about my test results. What if they find something serious?”
Nurse: “Don’t worry so much. Most people’s tests come back fine. Worrying won’t change the results anyway.”
This response dismisses the patient’s legitimate concerns and offers false reassurance.
Therapeutic Approach:
Patient: “I’m really worried about my test results. What if they find something serious?”
Nurse: “It’s understandable to feel worried while waiting for test results. Many patients feel this way. Can you tell me more about your specific concerns?”
This response validates the patient’s feelings, normalizes their experience, and encourages further discussion.
Scenario 2: Patient with Cultural Dietary Restrictions
Non-Therapeutic Approach:
Patient: “I can’t eat this food. It’s against my religious beliefs.”
Nurse: “You really should eat something. Hospital food is designed to help you recover. Just try a little bit.”
This response disregards the patient’s cultural and religious values and pressures them to violate their beliefs.
Therapeutic Approach:
Patient: “I can’t eat this food. It’s against my religious beliefs.”
Nurse: “Thank you for letting me know. I want to make sure you receive food that respects your religious practices. Could you tell me more about your dietary restrictions so I can request appropriate meals for you?”
This response respects the patient’s values, shows cultural sensitivity, and offers a practical solution.
Scenario 3: Patient Experiencing Side Effects
Non-Therapeutic Approach:
Patient: “I think I’m having side effects from the new medication. I’ve been feeling dizzy.”
Nurse: “Why did you wait so long to tell someone? You should have reported this immediately. These could be serious symptoms.”
This response uses blaming language and creates guilt, potentially discouraging the patient from reporting future concerns.
Therapeutic Approach:
Patient: “I think I’m having side effects from the new medication. I’ve been feeling dizzy.”
Nurse: “Thank you for telling me about the dizziness. This is important information. Can you describe when it started and how it feels? I’ll document this and discuss it with your healthcare provider.”
This response validates the patient’s report, gathers specific information, and outlines clear next steps.
Summary & Key Takeaways
Core Concepts
- Therapeutic communication is purposeful, patient-centered, and goal-directed
- The nurse-patient relationship develops through orientation, working, and termination phases
- Effective communication techniques facilitate healing and improve patient outcomes
- Verbal and non-verbal communication both play critical roles
- Cultural sensitivity is essential for therapeutic communication
Best Practices
- Use active listening and provide your full attention
- Ask open-ended questions to encourage expression
- Provide information at an appropriate level of understanding
- Validate patient feelings and concerns
- Maintain professional boundaries while showing empathy
- Be aware of and address communication barriers
Clinical Application
Therapeutic communication is not just a theoretical concept but a practical skill that nurses must develop and refine throughout their careers. Each patient interaction provides an opportunity to practice and improve these essential skills.
Remember that becoming proficient in therapeutic communication takes time and practice. Seek feedback from colleagues, mentors, and patients to continue developing this core nursing competency. Regularly reflect on your communication interactions to identify strengths and areas for improvement.
References
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
- Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electronic Physician, 9(8), 4968-4977.
- Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (2018). Peplau’s Theory of Interpersonal Relations: An alternate factor structure for patient experience data? Nursing Science Quarterly, 30(2), 160-167.
- Stickley, T. (2011). From SOLER to SURETY for effective non-verbal communication. Nurse Education in Practice, 11(6), 395-398.
- Droppa, M., & Lee, H. (2014). Motivational interviewing: A journey to improve health. Nursing, 44(3), 40-46.
- Ross, C. A., & Goldner, E. M. (2009). Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: A review of the literature. Journal of Psychiatric and Mental Health Nursing, 16(6), 558-567.