Fundamentals · chapter 2 · Communication
Therapeutic Communication
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
Universal therapeutic use
Therapeutic communication has progressed to include verbal and nonverbal communication, helping patients overcome illnesses of the body and mind. Nurses should use therapeutic communication in all communication encounters with patients (Martin Chanda, 2016).
Conflict and outcomes
If the nurse and other members of the healthcare team do not provide therapeutic communication, the expected outcomes for the patient could be impacted negatively. If there is conflict between the patient and the healthcare team, negative health outcomes could occur.
Technique selection
Knowledge: The nurse must have an understanding of the key therapeutic communication delivery techniques so that they can use the most appropriate approach for the specific patient or designee and are able to evaluate its effectiveness.
Patient expression
Therapeutic communication allows patients to express themselves. There are various therapeutic communication techniques in health care.
Communication techniques
These techniques include providing information; sharing observations, feelings, empathy, hope, and humor; using touch and silence; focusing and clarifying; asking relevant questions; offering self, which is contributing support by being present or spending time with a patient; and active listening.
Open-ended questions
Using all these techniques as the situation warrants helps the nurse provide safe and effective care for the patient. The nurse should recognize that the use of open-ended questions supports therapeutic communication.
Evaluation and feedback
Nurses should be adept at evaluating the effectiveness of therapeutic communication. Communication should go two ways, using the feedback loop, as feedback ensures the therapeutic communication has been effective.
Ineffective communication revision
If the communication has not been effective, the nurse should revise their approach, making sure they are providing effective communication for the patient.
Reflection technique
Nurses who use reflection on the response during therapeutic communication should restate what the patient has said. This allows the patient to hear their own words and encourages them to continue to communicate.
Active listening relationship
Reflection helps the patient understand that the nurse is actively listening to them, further establishing the nurse-patient relationship.
Compare with goals
It is crucial to compare the patient’s response to the desired goal. If they align, it confirms effective therapeutic communication.
Message revision
The nurse needs to revise the message and employ the feedback loop to again check if the intended message has been received.
Nontherapeutic miscommunication
Nontherapeutic communication can lead to miscommunication between the nurse and patient, and among healthcare providers, ultimately affecting the care the patient receives (Amoah et al., 2019).
Nonlistening consequences
Another nontherapeutic communication technique is not listening to the patient or not being actively present when with a patient, like scrolling on a phone during a patient encounter. All these nontherapeutic responses can negatively affect the nurse-patient relationship.
Terms to know
- therapeutic communication
- The most used form of communication in health care is therapeutic communication, a specialized form of communication used by healthcare professionals, such as nurses, doctors, and therapists, to establish a therapeutic or healing relationship with patients (Martin Chanda, 2016).
- offering self
- These techniques include providing information; sharing observations, feelings, empathy, hope, and humor; using touch and silence; focusing and clarifying; asking relevant questions; offering self, which is contributing support by being present or spending time with a patient; and active listening.
- nontherapeutic communication
- Nontherapeutic communication can be defined as negative expressions, attitudes, and actions that make a patient feel uneasy.
- false reassurance
- Nontherapeutic communication techniques include attacking and interrogating patients; changing the subject; giving automatic responses that are not helpful; giving false reassurance, which is comfort that is not based in facts, and advice; providing passive, aggressive, judgmental, or defensive responses; and arguing with the patient.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
A patient tells the nurse, 'I am worried that no one is telling me what is happening.' Which response by the nurse best demonstrates therapeutic communication?
- 'Do not worry; everything will be fine.'
- 'Before we talk about that, what kind of insurance do you have?'
- 'Let me clarify: you feel like no one is talking to you, and that makes you think something bad is happening?'
- 'Why do you think the staff would keep information from you?'
Answer: 'Let me clarify: you feel like no one is talking to you, and that makes you think something bad is happening?'
The correct response uses clarification and encourages the patient to continue communicating. The other responses provide false reassurance, ask a 'why' question that can feel interrogating, or change the subject.
A patient has just received upsetting health news and is quiet, tearful, and slow to respond. Which nursing actions support therapeutic communication? Select all that apply.
- Sit with the patient and spend time talking when the patient is ready.
- Provide factual information while sharing a sense of possibility.
- Tell the patient, 'Everything will be all right.'
- Encourage the patient to describe what they are feeling.
- Allow the patient time to think and process before speaking again.
Answer: Sit with the patient and spend time talking when the patient is ready., Provide factual information while sharing a sense of possibility., Encourage the patient to describe what they are feeling., Allow the patient time to think and process before speaking again.
Therapeutic communication includes using silence, offering self, encouraging sharing of feelings, and sharing hope while keeping information factual. Telling the patient that everything will be all right is false reassurance and may devalue the patient's feelings.
After teaching a patient new care instructions, the nurse asks the patient to repeat the instructions. The patient cannot repeat them accurately. What should the nurse do next?
- Stop teaching until the next shift.
- Revise the message and use the feedback loop again.
- Document that teaching was completed because the information was given.
- Ask only yes-or-no questions to avoid overwhelming the patient.
Answer: Revise the message and use the feedback loop again.
The nurse should revise the message when communication has not been effective and use feedback again to check understanding. Simply giving information or documenting teaching does not confirm the patient understood it.
Which nurse statements are examples of nontherapeutic communication? Select all that apply.
- 'Go on.'
- 'The medication will make all the nausea go away, and you will feel much better in a few minutes.'
- 'I noticed you are crying; would you like to share with me what is making you sad?'
- 'If it were me, I would not go to that healthcare provider.'
- 'Why did you not take the medication like I instructed you to do?'
Answer: 'The medication will make all the nausea go away, and you will feel much better in a few minutes.', 'If it were me, I would not go to that healthcare provider.', 'Why did you not take the medication like I instructed you to do?'
The 'why' question is interrogating, promising that the medication will make all the nausea go away is false reassurance, and 'If it were me…' gives advice. Sharing observations and using brief prompts such as 'Go on' support therapeutic communication and active listening.
A nurse wants to use touch to comfort a patient who has had many treatments and procedures. What is the best nursing action?
- Use touch only after the patient begins joking with the nurse.
- Hold the patient's hand without asking because touch is always healing.
- Ask the patient before using touch.
- Avoid all touch because patients who receive treatments always view touch negatively.
Answer: Ask the patient before using touch.
Touch can be therapeutic, but some patients may find it unsettling or negative, especially when they are receiving many treatments. The nurse should ask before engaging in touch.
A patient says, 'That sounded like you were criticizing me.' Which nurse actions are appropriate to reestablish therapeutic communication? Select all that apply.
- Apologize to the patient.
- Argue with the patient to prove the nurse did not mean it that way.
- Continue the conversation using a defensive response.
- Try to reestablish therapeutic communication.
- Ask, 'Why are you being so defensive?'
Answer: Apologize to the patient., Try to reestablish therapeutic communication.
If the patient perceives that the nurse attacked them, the nurse should apologize and work to reestablish therapeutic communication. Arguing, asking 'why' questions, or responding defensively are nontherapeutic and can damage the nurse-patient relationship.
Where every quote comes from
Section 2.4 Therapeutic Communication of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.