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Therapeutic Communication Technique

TECHNIQUE DESCRIPTION EXAMPLES
Using Silence Accepting pauses or silence that may Sitting quietly (or walking
extend for several seconds or minutes with the client) and waiting
without interjecting any verbal response attentively until the client is
able to put thoughts and
feelings into words
Providing Using statements or questions that( a) Can you tell me how is it for
General leads encourage the client to verbalize, (b) you Perhaps you would
choose a topic of conversation, and (c) like to talk about Would it
facilitate continued verbalization help to discuss your
feelings?Where would you
like to begin?And then
what?
Being specific Making statements that are specific rather Rate your pain on scale 0-
and tentative than general, and tentative rather than 10 (specific statement)
absolute Are you in pain? (general
statement)
You seem unconcerned
about your diabetes
(tentative statement)
You dont care about you
diabetes and you never will
(absolute statement)
Using open- Asking broad question that lead or invite Id like to hear more about
ended the client to explore (elaborate, clarify, that
question describe, compare, or illustrate) thoughts Tell me about
or feelings. Open ended questions specify How have you been feeling
only the topic to be lately? What brought you to
the hospital?
What is your opinion?
Discussed and invite answer that is longer You said you were
than one or two words. frightened yesterday. How
do feel now?
Using touch Providing appropriate forms of touch to Putting an arm on clients
reinforce caring feelings. Because tactile shoulder. Placing your
contacts vary considerably among hands over the clients
individuals, families, and cultures, the hand
nurse must be sensitive to the differences
in attitude and practices of client and self.
Restating or Actively listening for the clients basic Client: I couldnt manage to
paraphrasing message and then repeating then eat any dinner last night not
repeating those thoughts and/or feelings even the dessert
in similar words. This conveys that the Nurse: you have difficulty of
nurse has listened and understood the eating yesterday
clients basic message and also offers Client: Yes, I was very
clients a clearer idea of what they have upset after my family left.
said. Client: I have trouble
talking to strangers.
Nurse: You find it difficult
talking to people you do not
know?
Seeking A method of making the clients broad Im puzzled
clarification over all meaning of the message more Im not sure I understand
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understandable. It is used when par that Would you please say

phrasing is difficult or when the that again?
communication is rambling or garbled. To Would you tell me more?
clarify the message, the nurse can restate
the basic message or confess confusion I meant this rather than that
and ask the client to repeat or restate the Im sorry that wasnt very
message. Nurses can also clarify their clear. Let me try to explain
own message with statements. another way
Perception A method similar to clarifying that verifies Client: My husband never
checking or the meaning of specific words rather than gives me any present
seeking the overall meaning of a message. Nurse: You mean he has
consensual never given you a present
validation for your birthday or
Christmas?
Client: Well not never. He
does get me something for
my birthday and Christmas
but he never thinks of
giving anything at any other
time.

Offering self Suggesting ones presence, interest, or Ill stay with you until your
wish to understand the client without daughter arrives.
making any demands or attaching We can sit here quietly for
conditions that the client must comply with a while; we dont need to
to receive the nurses attention. talk unless you would like
to
Ill help you to dress o go
home if you like.
Giving Providing in a simple and direct manner, Your surgery is scheduled
Information specific factual information the client may for 11 AM tomorrow.
or may not request. When information is You will feel a pulling
not known, the nurse state this and sensation when the tube is
indicates who has it or when the nurse will removed from your
obtain it abdomen.
Acknowledgin Giving recognition, in a non judgmental You trimmed your beard
g way, of a change in behavior, an effort the and mustache and washed
client has made, or a contribution to a your hair.
communication. Acknowledgement may I notice you keep squinting
be with or without understanding, verbal your eyes. Are you having
or non verbal. difficulty seeing?
You walked twice as far
today with your walker.
Clarifying time Helping the client clarify an event, Client: I vomited this
and sequence situation, or happening in relationship to morning
time. Nurse: Was that after
breakfast?
Client: I feel that I have
been asleep for weeks.
Nurse: You had your
operation Monday, and
today is Tuesday.

Presenting Helping the client to differentiate the real That telephone ring came
reality from the unreal. from the program in
television.

Focusing Helping the client expand on and develop
a topic of importance. It is important for
the nurse to wait until the client finishes
stating the main concerns before
attempting to focus. The focus may be an
idea or a feeling; however, the nurse often
emphasizes a feeling to help the client
recognize an emotion disguised behind
words.
Reflecting Directing ideas, feelings, questions, or
content back to clients to enable them to
explore their own ideas and feelings about
a situation.
Summarizing Stating the main points of a discussion to
and planning clarify the relevant points discussed. This
technique is useful at the end of an
interview or to review a health teaching
session. It often acts as an introduction to
future care planning.
Barriers to communication
TECHNIQUE DESCRIPTION
Stereotyping Offering generalized and over
simplified beliefs about group of
people that are based on
experiences too limited to be
valid. These responses
categorize clients and negate
their uniqueness as individuals.
Agreeing and disagreeing Akin to judgmental responses,
agreeing and disagreeing imply
that the client is either right or
wrong and that the nurse is in a
position to judge this. These
responses deter clients from
thinking trough their position and
may cause a client to become
defensive.
Being defensive Attempting to protect a person or
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I see shadows from the
windows coverings.
Your magazine is here in
the drawer. It has not been
stolen.
Client: My wife says she
will look after me, but I
dont think she can, what
with the children to take
care of, and theyre always
after about something-
clothes, homework, whats
for dinner that night.
Nurse: Sounds like you are
worried about how well she
can manage.
Client: What can I do?
Nurse: What do think would
be helpful?
Client: Do you think I
should tell my husband?
Nurse: You seem unsure
about telling your husband.
During the past half hour
we have talked about
Tomorrow afternoon we ay
explore this further.
In new days Ill review what
you have learned about the
actions and effects of your
insulin.
Tomorrow I will look at your
feeling journal.
EXAMPLES
Two year olds are brats.
Women are complainers.
Men dont cry.
Most people dont have any pain
after this type of surgery.
Client: I dont think Dr. Broad is
a very good doctor. He doesnt
seem interested in her patients.
Nurse: Dr. Broad is the head of
the department of surgery and is
an excellent surgeon.
Client: Those night nurses must

health care services from
negative comments. These
responses prevent the client
from expressing true concerns.
The nurse is saying, You have
no right to complain. Defensive
responses protect the nurse
admitting weaknesses in the
health care services, including
personal weaknesses.
Challenging Giving a response that makes
clients prove their statement or
point of view. These responses
indicates that the nurse is failing
to consider the clients feelings,
making the client feel it
necessary to defend a position
Probing Asking for information chiefly out
of curiosity rather than with the
intent to assist the client. These
responses are considered prying
and violate the clients privacy.
Asking why is often probing and
places the client in a defensive
position.
Testing Asking the question that makes
the client admit to something.
These responses permit the
client only limited answer and
often meet the nurses need
rather than the clients.
Rejecting Refusing to discuss certain topic
with the client. These responses
often make clients feel that the
nurse is rejecting not only their
communication but also the
clients themselves.
Changing topics and subjects Directing the communication into
areas of self interest rather than
considering clients concerns is
often a self protective response
to a topic that causes anxiety.
These responses imply that
what the nurse considers
important will be discussed and
the clients should not discuss
certain topics.
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just sit around and talk all night.
They didnt answer my light for
even an hour.
Nurses: Ill have you know we
literally run around on nights.
Youre not the only client, you
know.
Client: I felt nauseated after
those red pills.
Nurse: Surely you dont think I
gave you the wrong pill?
Client: I feel as if I am dying
Nurse: How can you feel that
way when your pulse is 60?
Client: I believed my husband
doesnt love me.
Nurse: You cant say that; Why,
he visits you every day?
Client: I was speeding along the
street and didnt see the stop
sign.
Nurse: Why were you
speeding?
Client: I didnt ask the doctor
when he was here.
Nurse: Why didnt you?
Who do you think you are?
(forces people to admit their
status is only that of client)
Do you think I am not busy?
(forces the client to admit that
the nurse really is busy)
I dont want to discuss that. Lets
talk about
Lets discuss other areas of
interest to you rather than the
two problems you keep
mentioning.
I cant talk now. Im on my way
for coffee break.
Client: Im separated from my
wife. Do you think I should have
sexual relations with other
woman?
Nurse: I see that youre 36 and
that you like gardening.
This sunshine is good for my
roses. I have a beautiful rose
garden.
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Unwarranted reassurance Using clichs or comforting Youll feel better soon.

statements of advice as a Im sure everything will turn out
means to reassure the client. all right.
These responses block the Dont worry.
fears, feelings, and other
thoughts of the clients.

Passing judgment Giving opinions and approving Thats good (bad).

Giving common advice
and disapproving responses,
moralizing, or implying ones
own values. These responses
imply that the client must think
as the nurse thinks, fostering
client dependence.
Telling the client what to do.
These responses deny the
Clients right to be an equal
partner. Note that giving
expert rather than
common advice is
therapeutic.
You shouldnt do that.
Thats not good enough.
What you did was wrong (right).
Client: Should I move from my
home to a nursing home?
Nurse: If I were you, Id go to a
nursing home, where youll get
your meals cooked for you.

Levels of Care
Health Promotion
Activities that develop human attitudes and behaviors to maintain or enhance well-being.
Nurses Role in Health Promotion
Model healthy lifestyle behaviors and attitudes
Facilitate client involvement in the assessment, implementation, and evaluation of health goals
Teach clients self-care strategies to enhance fitness, improve nutrition, manage stress, and
enhance relationships.
Assist individuals, families, and communities to increase their levels of health.
Educate clients to be effective health care consumers
Assist clients, families, and communities to develop and choose health-promoting options.
Guide clients development in effective problem solving and decision making
Reinforce clients personal and family health-promoting behaviors
Advocate in the community for changes that promote a healthy environment

Disease Prevention
Activities that protect people from becoming ill because of actual or potential health threats.

The Three Levels of Prevention

Primary prevention health - promoting behaviors or activities that reduce the occurrence of an illness.
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Secondary prevention early diagnosis and treatment of illness (e.g., screening for hypertension).

Tertiary prevention care that prevents further progression of disease.

Health Maintenance

A systematic program or procedure planned to prevent illness, maintain maximum function, and promote
health. It is central to health care, especially to nursing care at all levels (primary, secondary, and tertiary)
and in all patterns (preventive, episodic, acute, chronic, and catastrophic).

Curative
Curative care involves treatment intended to alleviate the symptoms or cure a current medical condition. It
strives to reduce pain, improve function, and help improve the quality of life for patients. Examples of
treatment options include medications, casts and splints for broken bones, dialysis for kidney conditions,
and chemotherapy for cancer. Nurses provide and coordinate curative care for patients in various
environments. They set up plans for the care of patients, carry out medical treatments, observe patients,
and discuss conditions with doctors and other medical staff. They also assist with diagnostic testing and
evaluating results. Nurses perform an important role in instructing patients and families on how to manage
their medical condition and explain home care and follow up treatments.

Rehabilitative

In rehabilitative care, nurses assist patients with temporary and long-term disabilities or chronic illnesses.
They assist in adapting to their conditions, meeting their highest potential, and living more independent
lives. They commonly use holistic approaches to medical treatment to meet all needs of patients. They
work with patients and family members to establish a treatment plan and establish short and long-term
goals. They also prepare patients and caregivers for changes that occur in rehabilitative treatment. Many
rehabilitative nurses join the Association of Rehabilitation Nurses to access continuing education options
and various other resources.