Therapeutic Communication Techniques

Active Listening & Non-verbal Communication

• Active listening involves eye contact, nodding, paraphrasing, and summarizing to show full attention to the patient.
• Non-verbal communication includes body posture, facial expressions, gestures, and touch used for comfort.

Asking Questions

• Open-ended questions should be used, to avoid simple "yes/no" answers.
• Framing questions neutrally focuses on the patient’s experiences and thoughts without judgment.

Therapeutic vs. Non-Therapeutic Techniques

• Therapeutic communication involves active listening, empathy, validating feelings, offering silence, and therapeutic touch.
• Non-therapeutic communication includes giving advice, judging, interrupting, using medical jargon, or changing the subject.

Motivational Interviewing (MI)

• MI establishes a trusting relationship.
• MI narrows down to specific areas of concern.
• MI elicits the patient’s motivation for change.
• MI involves collaboratively creating a change plan.
• MI actively listens to and reflects the patient's feelings.

SBAR and CUS Protocols

• SBAR includes situation, background, assessment, and recommendation.
• Situation briefly describes the current situation.
• Background provides relevant context.
• Assessment shares an assessment of the situation.
• Recommendation proposes a course of action.
• CUS states concern, discomfort, and safety issues.

Patient Care Documentation

• Proper documentation ensures continuity of care, legal protection, and accuracy in medical records.
• Documentation allows care team members to understand the patient's history, treatments, and progress.
• Documentation must include assessments, interventions, patient responses, medications, consent, education, and discharge planning.
• Documentation must not include personal opinions, derogatory remarks, or unverified information.

Correcting Errors

• Errors in written documentation should be corrected by drawing a single line through the error.
• Write “error” with the date, and add your initials.
• Never use white-out or erase.

Patient Education

• Tailor education based on the patient's learning style, physical or developmental limitations, timing, and methods.
• Assess readiness and adapt the approach considering cognitive, physical, or emotional barriers.

Medication Administration: Bodily Processes

• Absorption is the movement of a drug from the administration site to the bloodstream.
• Absorption varies by route (oral, IV, etc.).
• Distribution is the transport of a drug via the bloodstream to tissues and organs.
• Metabolism is the conversion of the drug into a form that can be eliminated, mainly by the liver.
• Excretion is the elimination of the drug from the body, primarily through the kidneys.

Medication Effects

• Therapeutic effects are the desired, beneficial effects of a medication.
• Adverse effects are unintended, harmful reactions to a drug.
• Side effects are minor, often expected effects of a drug.
• Toxic effects are harmful effects due to excessive dosing or accumulation.
• Idiosyncratic effects are unusual, unpredictable reactions unique to an individual.

Routes of Administration

• Parenteral routes bypass the gastrointestinal tract, including IV, IM, subcutaneous, inhaled, and topical.
• Enteral routes are delivered through the GI tract, such as PO and feeding tubes.

Administering Medications

• Ensure proper swallowing for oral medications and avoid crushing unless allowed.
• Apply topical medications thinly to intact skin to avoid cross-contamination.
• For nasal medications, have the patient sit up and administer drops/spray while they breathe in.
• For eye medications, administer in the lower conjunctival sac, avoiding touching the eye.
• Warm ear drops to body temperature and pull the ear back to administer.
• Use gloves and position the patient appropriately for vaginal medications.
• Position the patient in the left Sims position for rectal medications, inserting the suppository beyond the sphincter.
• Rescue meds (fast-acting bronchodilators) are for immediate relief of symptoms.
• Maintenance meds are used regularly to prevent symptoms (long-acting).

Parenteral Administration Details

• Use a calibrated syringe to draw the correct dose of insulin or medication in mLs.
• Use a filter needle for glass vials.
• Rotate injection sites, check blood sugar levels, and confirm the correct type and dose for insulin.
• Subcutaneous injection sites are the abdomen, upper arm, and thigh at a 45-90 degree angle.
• Intramuscular injection sites are the deltoid, ventrogluteal, and vastus lateralis at a 90-degree angle.
• Use aseptic techniques, label syringes if preparing multiple doses, and avoid needlestick injuries.

Medication Measurement

• Always use a leading zero (e.g., 0.5 mg) to prevent dosage errors.
• Avoid trailing zeros (e.g., write 1 mg instead of 1.0 mg) to avoid confusion.
• Dosing must be weight-based, double-check calculations, and use pediatric-specific formulations/tools for children.

Medication Safety

• The six rights of medication administration: right patient, right medication, right dose, right route, right time, and right documentation.
• Metabolism slows with age, increasing sensitivity to drugs, so adjust dosages and monitor for side effects.

Nutrition

• Protein provides 4 calories per gram.
• Carbohydrates provide 4 calories per gram.
• Fat provides 9 calories per gram.
• Normal BMI is 18.5-24.9.
• Underweight is less than 18.5.
• Overweight is 25-29.9.
• Obese is 30 and above.
• Enteral feeding delivers nutrition through a tube directly into the stomach or intestines.
• Parenteral feeding delivers nutrition intravenously, bypassing the digestive system.
• Central line TPN can cause infection, thrombosis, hyperglycemia, and electrolyte imbalance.
• Peripheral line TPN can cause phlebitis, shorter-term use due to lower calorie concentration.
• Consult a speech therapist for swallow studies for dysphagia.
• Risks of dysphagia include aspiration, pneumonia, and choking.
• NPO means the patient cannot take any food or drink orally.
• Encourage fluids, fiber intake, and mobility for constipation..
• Nutrition-related nursing diagnoses include "Imbalanced Nutrition" and "Risk for Aspiration."
• Confirm initial tube placement with X-ray.
• Check gastric residual volume, assess abdominal distension, and check pH of aspirate for ongoing tube feeding checks.
• Stop feeding, assess, and consider removing the feed for nausea/abdominal.
• Vitamin K can reduce the effectiveness of Coumadin (warfarin), which requires you to monitor intake and adjust medication.
• Ileostomy produces liquid, frequent stool.
• Sigmoid colostomy produces formed stool.
• Stomas should appear beefy red, moist, and without active bleeding or purulent drainage.
• Bedpans are for patients who are immobile.
• Bedside commodes are for those with mobility.
• Limit time on a bedpan to avoid pressure ulcers.
• Enteral feeding stool may be loose, monitor to prevent dehydration/electrolyte imbalance.
• Clean/dry skin immediately to manage loose stools and use barrier creams to prevent breakdown.

Explore verbal and non-verbal therapeutic communication techniques. Includes active listening, asking open-ended questions, and motivational interviewing. Learn to avoid non-therapeutic communication and create healthy conversations.