Open Resources for Nursing (Open RN) Show
Therapeutic communication is a type of professional communication used by nurses with patients and defined as, “The purposeful, interpersonal information-transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills, which leads to patient understanding and participation.”[1] Therapeutic communication techniques used by nurses have roots going back to Florence Nightingale, who insisted on the importance of building trusting relationships with patients and believed in the therapeutic healing that resulted from nurses’ presence with patients.[2] Since then, several professional nursing associations have highlighted therapeutic communication as one of the most vital elements in nursing. Read an example of a nursing student effectively using therapeutic communication with patients in the following box. An Example of Nursing Student Using Therapeutic Communication Ms. Z. is a nursing student who enjoys interacting with patients. When she goes to patients’ rooms, she greets them and introduces herself and her role in a calm tone. She kindly asks patients about their problems and notices their reactions. She does her best to solve their problems and answer their questions. Patients perceive that she wants to help them. She treats patients professionally by respecting boundaries and listening to them in a nonjudgmental manner. She addresses communication barriers and respects patients’ cultural beliefs. She notices patients’ health literacy and ensures they understand her messages and patient education. As a result, patients trust her and feel as if she cares about them, so they feel comfortable sharing their health care needs with her.[3],[4] Active Listening and Attending BehaviorsListening is obviously an important part of communication. There are three main types of listening: competitive, passive, and active. Competitive listening happens when we are focused on sharing our own point of view instead of listening to someone else. Passive listening occurs when we are not interested in listening to the other person and we assume we understand what the person is communicating correctly without verifying. During , we are communicating verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with the speaker. For example, an active listening technique is to restate what the person said and then verify our understanding is correct. This feedback process is the main difference between passive listening and active listening.[5] TouchTouch is a powerful way to professionally communicate caring and empathy if done respectfully while being aware of the patient’s cultural beliefs. Nurses commonly use professional touch when assessing, expressing concern, or comforting patients. For example, simply holding a patient’s hand during a painful procedure can be very effective in providing comfort. See Figure 2.7[6] for an image of a nurse using touch as a therapeutic technique when caring for a patient. Figure 2.7 Using Touch as Therapeutic CommunicationTherapeutic Techniquesare specific methods used to provide patients with support and information while focusing on their concerns. Nurses assist patients to set goals and select strategies for their plan of care based on their needs, values, skills, and abilities. It is important to recognize the autonomy of the patient to make their own decisions, maintain a nonjudgmental attitude, and avoid interrupting. Depending on the developmental stage and educational needs of the patient, appropriate terminology should be used to promote patient understanding and rapport. When using , nurses often ask open-ended statements and questions, repeat information, or use silence to prompt patients to work through problems on their own.[7] Table 2.3a describes a variety of therapeutic communication techniques.[8] Table 2.3a Therapeutic Communication Techniques
In addition to the therapeutic techniques listed in Table 2.3a, nurses and nursing students should genuinely communicate with empathy. Communicating honestly, genuinely, and authentically is powerful. It opens the door to creating true connections with others.[9] Communicating with empathy has also been described as providing “unconditional positive regard.” Research has demonstrated that when health care teams communicate with empathy, there is improved patient healing, reduced symptoms of depression, and decreased medical errors.[10] Nurses and nursing students must be aware of potential barriers to communication. In addition to considering common communication barriers discussed in the previous section, there are several to avoid. These responses often block the patient’s communication of their feelings or ideas. See Table 2.3b for a description of nontherapeutic responses.[11] Table 2.3b Nontherapeutic Responses
Strategies for Effective CommunicationIn addition to using therapeutic communication techniques, avoiding nontherapeutic responses, and overcoming common barriers to communication, there are additional strategies for promoting effective communication when providing patient-centered care. Specific questions to ask patients are as follows:
Listen closely for feedback from patients. Feedback provides an opportunity to improve patient understanding, improve the patient-care experience, and provide high-quality care. Other suggestions for effective communication with hospitalized patients include the following:
Adapting Your CommunicationWhen communicating with patients and family members, take note of your audience and adapt your message based on their characteristics such as age, developmental level, cognitive abilities, and any communication disorders. For patients with language differences, it is vital to provide trained medical interpreters when important information is communicated. Adapting communication according to the patient’s age and developmental level includes the following strategies:
Strategies for Communicating with Patients with Impaired Hearing and Vision Impaired Hearing
Impaired Vision
Patients with communication disorders require additional strategies to ensure effective communication. For example, aphasia is a communication disorder that results from damage to portions of the brain that are responsible for language. usually occurs suddenly, often following a stroke or head injury, and impairs the patient’s expression and understanding of language. is caused by injuries to multiple language-processing areas of the brain, including those known as Wernicke’s and Broca’s areas. These brain areas are particularly important for understanding spoken language, accessing vocabulary, using grammar, and producing words and sentences. Individuals with global aphasia may be unable to say even a few words or may repeat the same words or phrases over and over again. They may have trouble understanding even simple words and sentences.[17] The most common type of aphasia is . People with Broca’s aphasia often understand speech and know what they want to say, but frequently speak in short phrases that are produced with great effort. For example, they may intend to say, “I would like to go to the bathroom,” but instead the words, “Bathroom, Go,” are expressed. They are often aware of their difficulties and can become easily frustrated. See the hyperlink in the box below for evidence-based strategies to enhance communication with a person with impaired speech.[18] Strategies to Improve Communication with Patients with Impaired Speech
Maintaining Patient ConfidentialityWhen communicating with patients, their friends, their family members, and other members of the health care team, it is vital for the nurse to maintain patient confidentiality. The provides standards for ensuring privacy of patient information that are enforceable by law. Nurses must always be aware of where and with whom they share patient information. For example, information related to patient care should not be discussed in public areas, paper charts must be kept in secure areas, computers must be logged off when walked away from, and patient information should only be shared with those directly involved in patient care. For more information about patient confidentiality, see the “Legal Considerations & Ethics” section in the “Scope of Practice” chapter. How do you communicate with a patient with aphasia?You can encourage the person with aphasia to use other ways to communicate, such as:. Pointing.. Hand gestures.. Drawings.. Writing out what they want to say.. Signing out what they want to say.. Which of the following nursing actions would be most helpful in promoting communication for the patient?The nurse should ask the client to "show me" and should encourage the use of gestures to assist in getting the message across with minimal frustration and exhaustion for the client.
How do you care for someone with an aphasia?Top Tips for supporting someone with Aphasia. Keeping your language clear and simple. ... . Giving the person time to speak and formulate thoughts – give the person time to take in what you say and to respond.. Using short phrases and sentences to communicate.. Reduce background noise/distractions.. What can you do for aphasia?Tips to facilitate success. Continue to treat the aphasic patient as the mature adult that he or she is.. Reduce background noise (radio, other conversations, etc.).. Reduce visual distractions (TV, movement).. Be sure you have the person's attention prior to speaking.. Keep messages short and simple.. |