Therapeutic Communication

Question 1

Gives the person time to collect thoughts or think through a point.
Example: Encourage a person to talk by waiting for the answers.

Answer 1

Using Silence

Question 2

Indicates that a person has been understood. The statement does not necessarily indicate agreement but is nonjudgmental. However, nurses should not imply that they understood when they do not understand.
Examples: “Yes”,
“Uh-huh”,
“I follow what you say”

Answer 2

Accepting

Question 3

Indicates awareness of change and personal efforts. Does not imply good or bad, or right or wrong.
Examples: “Good morning, Mr. James”,
“You’ve combed your hair today”,
“ I notice that you shaved today”

Answer 3

Giving Recognition

Question 4

Offers presence, interest, and a desire to understand. It is not offered to get a person to talk or behave in a specific way.
Examples: “I would like to spend time with you”
“I’ll stay here and sit with you a while”

Answer 4

Offering Self

Question 5

Allows the other person to take direction in the discussion, Indicates that the nurse is interested in what comes next.
Examples: “Go on”,
“And then?”
“Tell me about it”

Answer 5

Offering General Leads

Question 6

Clarifies that the lead is to be taken by the patient. However, the nurse discourages pleasantries and small talk.
Examples: “Where would you like to begin?”,
“What are you thinking about?”,
“What would you like to discuss?”

Answer 6

Giving Broad Openings

Question 7

Puts events and actions in better perspective. Notes cause-and-effect relationships and identifies patterns of interpersonal difficulties.
Examples: “What happened before?”,
“When did this happen?”

Answer 7

Placing the events in time or sequence

Question 8

Calls attention to the person’s behavior (e.g. trembling, nail-biting, restless mannerisms). Encourages the person to notice the behavior to describe thoughts and feelings for mutual understanding. Helpful with mute and withdrawn people.
Example: “You appear nervous whenever John enters the room”

Answer 8

Making Observations

Question 9

Increases the nurse’s understanding of the patient’s perceptions. Talking about feelings and difficulties can lessen the need to act them out inappropriately.
Examples: “What do these voices seem to be saying?”
“What is happening now?”
“Tell me when you feel anxious”

Answer 9

Encouraging Description of Perception

Question 10

Reveals recurring themes in experiences or interpersonal relationships. Helps the person clarify similarities and differences.
Examples: “Has this ever happened before?”
“Is this how you felt when…?”
“Was it something like…?”

Answer 10

Encouraging Comparison

Question 11

Repeats the main idea expressed. Gives the patient an idea of what has been communicated. If the message has been misunderstood, the patient can clarify it.
Examples: Patient: “I can’t sleep. I stay awake all night.”
Nurse: “You have difficulty sleeping?”
Patient: “I don’t know…he always has some excuse for not coming over or keeping appointments.”
Nurse: “You think he no longer wants to see you?”

Answer 11

Restating

Question 12

Directs questions, feelings, and ideas back to the patient. Encourages the patient to accept his or her own ideas and feelings. Acknowledges the patient’s right to have opinions and make decisions and encourages the patient to think of self as a capable person.
Examples: Patient: “What should I do about my husband’s affair?”
Nurse: “What do you think you should do?”
Patient: “My brother spends all of my money and then has the nerve to ask me for more.”
Nurse: “You feel angry when this happens?”

Answer 12

Reflecting

Question 13

Concentrates attention on a single point. It is especially useful when the patient jumps from topic to topic. If a person is experiencing a severe or panic level of anxiety, the nurse should not persist until the anxiety lessens.
Examples: “This point you are making about leaving school seems worth looking at more closely”
“You’ve mentioned many things. Let’s go back to your thinking of ‘ending it all’.”

Answer 13

Focusing

Question 14

Examines certain ideas, experiences, or relationships more fully. If the patient chooses not to elaborate by answering no, the nurse does not probe or pry, In such a case, the nurse respects the patient’s wishes.
Examples: “Tell me more about that.”
“Would you describe it more fully?”
“Could you talk about how it was that you learned your mom was dying of cancer?”

Answer 14

Exploring

Question 15

Makes available facts the person needs. Supplies knowledge from which decisions can be made or conclusions drawn. For example, the patient needs to know the role of the nurse; the purpose of the nurse-patient relationship; and the time, place, and duration of the meetings.
Examples: “My purpose for being here is…”
“This medication is for…”
“The test will determine…”

Answer 15

Giving Information

Question 16

Helps patient clarify their own thought and maximize mutual understanding between nurse and patient.
Examples: “I am not sure I follow you.”
“What would you say is the main point of what you just said?”
“Give an example of a time you thought everyone hated you.”

Answer 16

Seeking Clarification

Question 17

Indicates what is real. The nurse does not argue or try to convince the patient, just describes personal perceptions or facts in the situation.
Examples: “That was Dr. Todd, not a terrorist stalking and trying to harm you.”
“That was the sound of a car backfiring.”
“Your mother is not here; I am a nurse.”

Answer 17

Presenting Reality

Question 18

Undermines the patient’s beliefs by not reinforcing the exaggerated or false perceptions.
Examples: “Isn’t that unusual?”
“Really?”
“That’s hard to believe.”

Answer 18

Voicing Doubt

Question 19

Clarifies that both the nurse and the patient share mutual understanding of communications. Helps the patient become clearer about what he or she is thinking.
Example: “Tell me whether my understanding agrees with yours.”

Answer 19

Seeking Consensual Validation

Question 20

Puts into concrete terms what the patient implies, making the patient’s communication more explicit.
Example: Patient: “I can’t talk to you or anyone else. It’s a waste of time.”
Nurse: “Do you feel that no one understands?”

Answer 20

Verbalizing the Implied

Question 21

Aids the patient in considering people and events from the perspective of the patient’s own set of values.
Examples: “How do you feel about…?”
“What did it mean to you when he said he couldn’t stay?”

Answer 21

Encouraging Evaluation

Question 22

Responds to the feelings expressed, not just the content. Often termed decoding.
Examples: Patient: “ I am dead inside.”
Nurse: “Are you saying that you feel lifeless? Does life seem meaningless to you?”

Answer 22

Attempting to Translate into Feelings

Question 23

Emphasizes working with the patient, not doing things for the patient. Encourages the view that change is possible through collaboration.
Examples: “Perhaps you and I can discover what produces your anxiety.”
“Perhaps by working together we could come up with some ideas that might improve your communication with your spouse.”

Answer 23

Suggesting Collaboration

Question 24

Combines the important points of the discussion to enhance understanding. Also allows the opportunity to clarify communications so that both nurse and patient leave the interview with the same ideas in mind.
Examples: “Have I got this straight?”
“You said that…”
“During the past hour, you and I have discussed…”

Answer 24

Summarizing

Question 25

Allows the patient to identify alternative actions for interpersonal situations the patient finds disturbing (e.g., when anger or anxiety is provoked).
Examples: “What could you do to let anger out harmlessly?”
“The next time this comes up, what might you do to handle it?”
“What are some ways you could approach your boss?”

Answer 25

Encouraging Formulation of a Plan of Action