Types of Therapeutic & Non-Therapeutic Communication Flashcards
Identify what each of these techniques are and provide an example.
Using silence
T- Gives person time to collect thoughts or think through a point.
Ex: encouraging a person to talk by waiting for an answer
Accepting
T- Indicates that the person has been understood.
Does not necessarily mean agreement on the nurses part but is nonjudgmental.
Ex: “Yes.” “Uh-huh.”
Giving recognition
T- 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.”
Offering self
T- 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.”
Offering general leads
T- 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.
T- Clarifies that the lead is to be taken by the patient.
The nurse discourages pleasantries and small talk.
Ex: “Where would you like to begin?” “What are you thinking about?”
Placing the events in time or sequence?
T- 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
T- Calls attention to the person’s behavior (eg. trembling, nail biting, restlessness)
Encourages patient to notice their 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Helpful with mute and withdrawn people.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 lip.”
Encouraging description of perception.
T- 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?”
Encouraging comparison
T- 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…”
Restating
T- 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:
Pt: “I can’t sleep. I stay awake all night.”
N: “You have difficulty sleeping?”
Reflecting
T- Directs questions, feelings, and ideas back to the patient.
Encourages the patient to accept his or her own ideas and feelings
Acknowledges the patients right to have an opinion and make decisions.
Ex:
Pt: “What should I do about my husband’s affair?”
N: “What do you think you should do?”
Focusing
T- Concentrates attention on a single point
It is especially useful when the patient jumps from topic to topic
Ex: “This point you are making about leaving school seems worth looking at more closely.”
Exploring
T- 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
Ex: “Tell me more about that.”
“Would you describe that more?”
Giving information
T- 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, the time, place, and duration of the meeting, etc
EX: “My purpose for being here is…”
“This medication is for…”
Seeking clarification
T- 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?”
Presenting reality
T- 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.”
Voicing doubt
T- Undermines the patients beliefs by not reinforcing the exaggerated or false perceptions.
Ex: “Is that unusual?”
“Really?”
Seeking consensual validation
T- 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
T- Puts into concrete terms what the patient implies, making the patient’s communication more explicit.
Ex:
Pt: “I can’t talk to you or anyone else. It’s a waste of time.”
N: “Do you feel that no one understands?”
Encouraging evaluation
T- 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
T- Responds to the feelings expressed, not just the content.
Often termed decoding.
Ex:
Pt: “I am dead inside.”
N: “Are you saying that you feel lifeless? Does life seem meaningless to you?”
Suggesting collaboration
T- 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”
Summarizing
T- 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…”
Encouraging formulation of a plan of action
T- Allows the patient to identify alternative actions for interpersonal situations the patient finds disturbing (e.g. when anger/anxiety is provoked).
Ex: “What could you do to let anger out harmlessly?”
“What are some other ways you can approach your boss?”
Giving premature advice
N- Assumes the nurse knows best and the patient can’t think for self.
Ex: “Get out of this situation immediately.”
Better:
Encourage problem solving.
Ex: “What were some actions you thought you might take?”
Minimizing feelings
N- Indicates that the nuse is unable to understand or empathize with the patient.
Ex: “Everyone gets down in the dumps.”
Better: Empathize and Explore
Ex: “You must be feeling upset. Would you like to talk about how you are feeling?”
False reassurance
N- Underrates a person’s feelings and belittles their concerns.
Ex: “Everything will be all right.”
Better: Clarifying the patient’s message.
Ex: “What are you concerned might happen?”
Making value judgments.
N - Prevents problem solving. Can make patient feel guilty, angry, misunderstood.
Ex: “How come you still smoke when your wife has lung cancer?”
Better: Making observations.
Ex: “I notice you are still smoking even though your wife has lung cancer. Is this a problem”
Asking “why” questions.
N- Implies criticism
Ex: “Why did you stop taking your medication?”
Better: Asking open-ended questions; Giving broad opening
Ex: “Tell me some of the reasons that led up to your not taking your medications.
Asking excessive questions
N- Patient doesn’t know what question to answer.
Ex: “How’s your appetite? Are you losing weight? Are you eating enough?”
Better: Clarifying
Ex: “Tell me about your eating habits since you’ve been depressed?”
Giving approval, agreeing.
N- Implies the patient is doing the right thing - and that not doing it is wrong.
Ex: “I’m proud of you for applying for a job.”
Better: Making observations, Asking open ended questions, Giving broad openings
Ex: “What factors led to you changing your mind?”
“What led to that decision?”
Disapproving; disagreeing
N- Can make a person defensive.
Ex: “I disagree with that”
Better: Exploring
Ex: “HOw did you arrive at that conclusion?”
Changing the subject
N- May invalidate the patient’s feelings and needs
Ex: Pt: “I’d like to die.”
N: “Did you go to AA like we discussed?”
Better: Validating and Exploring
Pt: “I’d like to die.”
N: “This sounds serious. Have you thought of harming yourself?”
