Therapeutic Communication Techniques Flashcards
Accepting
Indicates that the person has been understood. An accepting statement does not necessarily indicate agreement but is nonjudgmental. (Nurse should not imply understanding when he/she does not understand.)
Ex. “Yes.” “Uh-huh.” “I follow what you say.”
Giving Recognition
Indicates awareness of change and personal efforts. Does not imply good or bad, right or wrong.
Ex. “Good morning, Mr. James.” “You’ve combed your hair today.” “I see you’ve eaten your whole lunch.”
Offering Self
Offers presence, interest, and a desire to understand. Is not offered to get the person to talk or behave in a specific way.
Ex. “I would like to spend time with you.” “I’ll stay here and sit with you awhile.”
Offering General Leads
Allows the other person to take direction in the discussion. Indicates that the nurse is interested in what comes next.
Ex. “Go on.” “And then?” “Tell me about it.”
Giving Broad Openings
Clarifies that the lead is to be taken by the patient. However, the nurse discourages pleasantries and small talk.
Ex. “Where would you like to begin?” “What are you thinking about?” “What would you like to discuss?”
Placing the events in time or sequence
Puts events and actions in better perspective. Notes cause-and-effect relationships and identifies patterns of interpersonal difficulties.
Ex. “What happened before?” “When did this happen?”
Making Observations
Calls attention to the person’s behavior (e.g., trembling, nail biting, restless mannerisms). Encourages patient to notice the behavior and describe thoughts and feelings for mutual understanding. Helpful with mute and withdrawn people.
Ex. “You appear tense.” “I notice you’re biting your lips.” “You appear nervous whenever John enters the room.”
Encouraging description of perception
Increases the nurse’s understanding of the patient’s perceptions. Talking about feelings and difficulties can lessen the need to act them out inappropriately.
Ex. “What do these voices seem to be saying?” “What is happening now?” “Tell me when you feel anxious.”
Encouraging Comparison
Brings out recurring themes in experiences or interpersonal relationships. Helps the person clarify similarities and differences.
Ex. “Has this ever happened before?” “Is this how you felt when…?” “Was it something like…?”
Restating
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.
Ex. Patient: “I can’t sleep. I stay awake all night.” Nurse: “You have difficulty sleeping?”
Reflecting
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.
Ex. Patient: “What should I do about my husband’s affair?” Nurse: “What do you think you should do?”
Focusing
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 anxiety, the nurse should not persist until the anxiety lessens.
Ex. “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.’”
Exploring
Examines certain ideas, experiences, or relationships more fully. If the patient chooses not to elaborate by answering no, the nurse does not prove or pry. In such a case, the nurse respects the patient’s wishes.
Ex. “Tell me more about that.” “Would you describe it more fully?”
Giving Information
Makes facts the person needs available. 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.
Ex. “My purpose for being here is…” “This medication is for…” “The test will determine…”
Seeking Clarification
Helps patients clarify their own thoughts and maximize mutual understanding between nurse and patient.
Ex. “ 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.”
Presenting Reality
Indicates what is real. The nurse does not argue or try to convince the patient, just describes personal perceptions or facts in the situation.
Ex. “That was Dr. Todd, not a man from the mafia.” “That was the sound of a car backfiring.” “Your mother is not here, I am a nurse.”
Voicing Doubt
Undermines the patient’s beliefs by not reinforcing the exaggerated or false perceptions.
Ex. “Isn’t that unusual?” “Really?” “That’s hard to believe.”
Seeking Consensual Validation
Clarifies that both the nurse and patient share mutual understanding of communications. Helps the patient become clearer about what he or she is thinking.
Ex. “Tell me whether my understanding agrees with yours.”
Verbalizing the Implied
Puts into concrete terms what the patient implies, making the patient’s communication more explicit.
Ex. Patient: “I can’t talk to you or anyone else. It’s a waste of time.” Nurse: “Do you feel that no one understands?”
Encouraging Evaluation
Aids the patient in considering people and events from the perspective of the patient’s own set of values.
Ex. “How do you feel about…?” “What did it mean to you when he said he couldn’t stay?”
Attempting to translate into feelings
Responds to the feelings expressed, not just the content. Often termed decoding.
Ex. Patient: “I am dead inside.” Nurse: “Are you saying that you feel lifeless? Does life seem meaningless to you?”
Suggesting Collaboration
Emphasizes working with the patient, not doing things for the patient. Encourages the view that change is possible through collaboration.
Ex. “Perhaps you and I can discover what produces your anxiety.” “Perhaps by working together, we can come up with some ideas that might improve your communications with your spouse.”
Summarizing
Brings together important points of 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.
Ex. “Have I got this straight?” “You said that…” “During the past hour, you and I have discussed…”
Encouraging Formulation of a Plan of Action
Allows the patient to identify alternative actions for interpersonal situations the patient finds disturbing (e.g., when anger or anxiety is provoked).
Ex. “What could you do to let anger out harmlessly?” “The next time this comes up, what might you do to handle it?”
