Therapeutic Communication Techniques PDF

CHAPTER 10 Communication and the Clinical Interview 181 can become a definite barrier to ­communication. To Exploring. A technique that enables the nurse to avoid overuse of restating, the nurse can ­combine...

CHAPTER 10 Communication and the Clinical Interview 181 can become a definite barrier to ­communication. To Exploring. A technique that enables the nurse to avoid overuse of restating, the nurse can ­combine examine important ideas, experiences, or ­relationships restatements with direct questions that encourage more fully is exploring. For example, if a patient tells descriptions: “What does your life lack?” “What kind you he does not get along well with his wife, you will of meaning is missing?” “Describe a day in your life want to ­further explore this area. Possible ­openers that appears empty to you.” include: “Tell me more about your relationship with your Reflecting. Reflection is a means of assisting people wife.” to better understand their own thoughts and feelings. “Describe your relationship with your wife.” Reflecting may take the form of a question or a sim- “Give me an example of how you and your wife don’t ple statement that conveys the nurse’s observations of get along.” the patient when sensitive issues are being discussed. Asking for an example can greatly clarify a vague or The nurse might then describe briefly to the patient the generic statement made by a patient. apparent meaning of the emotional tone of the patient’s Patient: “No one likes me.” verbal and nonverbal behavior. For example, to reflect Nurse: “Give me an example of one person who a patient’s feelings about his or her life, a good begin- doesn’t like you.” ning might be, “You sound as if you have had many or disappointments.” Patient: “Everything I do is wrong.” Sharing observations with a patient shows accep- Nurse: “Give me an example of one thing you do tance and that the patient has your full attention. that you think is wrong.” When you reflect, you make the patient aware of inner Table 10-2 lists more examples of therapeutic com- feelings and encourage the patient to own them. For munication techniques. example, you may say to a patient, “You look sad.” Perceiving your concern may allow the patient to Asking Questions and Eliciting Patient spontaneously share feelings. The use of a question in Responses response to the patient’s question is another reflective Open-Ended Questions. Many of the examples technique (Arnold & Boggs, 2007). For example: above and in Table 10-2 are open-ended. Open-ended Patient: “Nurse, do you think I really need to be ­questions and comments encourage lengthy responses hospitalized?” and information about experiences, perceptions, or Nurse: “What do you think, Jane?” responses to a situation. For example: Patient: “I don’t know; that’s why I’m asking you.” “What do you perceive as your biggest problem Nurse: “I’ll be willing to share my impression with right now?” you at the end of this first session. However, “Give me an example of some of the stresses you you’ve probably thought about hospitalization are under right now.” and have some feelings about it. I wonder what “Tell me more about your relationship with your they are.” wife?” Text continued on page 184 Table 10-2 Therapeutic Communication Techniques Therapeutic Technique Description Example Using silence Gives the person time to collect thoughts or Encouraging a person to talk by waiting for the think through a point. answers. Accepting Indicates that the person has been “Yes.” ­understood. An accepting statement “Uh-huh.” does not necessarily indicate agreement “I follow what you say.” but is nonjudgmental. (Nurse should not imply understanding when (s)he does not understand.) Giving recognition Indicates awareness of change and personal “Good morning, Mr. James.” efforts. Does not imply good or bad, right or “You’ve combed your hair today.” wrong. “I see you’ve eaten your whole lunch.” Offering self Offers presence, interest, and a desire to “I would like to spend time with you.” understand. Is not offered to get the person “I’ll stay here and sit with you awhile.” to talk or behave in a specific way. Continued 182 Unit 3 Psychosocial Nursing Tools Table 10-2 Therapeutic Communication Techniques—cont’d Therapeutic Technique Description Example Offering general leads Allows the other person to take direction “Go on.” in the discussion. Indicates that the nurse is “And then?” interested in what comes next. “Tell me about it.” Giving broad openings Clarifies that the lead is to be taken by the “Where would you like to begin?” patient. However, the nurse discourages “What are you thinking about?” pleasantries and small talk. “What would you like to discuss?” Placing the events in time Puts events and actions in better p­ erspective. “What happened before?” or sequence Notes cause-and-effect ­relationships “When did this happen?” and identifies patterns of interpersonal difficulties. Making observations Calls attention to the person’s b­ ehavior (e.g., “You appear tense.” trembling, nail biting, restless ­mannerisms). “I notice you’re biting your lips.” Encourages patient to notice the behav- “You appear nervous whenever John enters ior and describe thoughts and feelings for the room.” mutual understanding. Helpful with mute and withdrawn people. Encouraging description of Increases the nurse’s understanding of the “What do these voices seem to be saying?” perception patient’s perceptions. Talking about f­eelings “What is happening now?” and difficulties can lessen the need to act “Tell me when you feel anxious.” them out inappropriately. Encouraging comparison Brings out recurring themes in experiences “Has this ever happened before?” or interpersonal relationships. Helps the per- “Is this how you felt when... ?” son clarify similarities and differences. “Was it something like... ?” Restating Repeats the main idea expressed. Gives Patient: “I can’t sleep. I stay awake all night.” the patient an idea of what has been Nurse: “You have difficulty sleeping?” ­communicated. If the message has been or misunderstood, the patient can clarify it. Patient: “I don’t know... he always has some excuse for not coming over or keeping our appointments.” Nurse: “You think he no longer wants to see you?” Reflecting Directs questions, feelings, and ideas back Patient: “What should I do about my hus- to the patient. Encourages the patient to band’s affair?” accept his or her own ideas and f­eelings. Nurse: “What do you think you should do?” Acknowledges the patient’s right to or have opinions and make ­decisions and Patient: “My brother spends all of my money ­encourages the patient to think of self as a and then has the nerve to ask for more.” capable person. Nurse: “You feel angry when this happens?” Focusing Concentrates attention on a single point. “This point you are making about leav- It is especially useful when the patient ing school seems worth looking at more jumps from topic to topic. If a person is closely.” ­experiencing a severe or panic level of “You’ve mentioned many things. Let’s go back ­anxiety, the nurse should not persist until to your thinking of ‘ending it all.” the anxiety lessens. Exploring Examines certain ideas, experiences, or “Tell me more about that.” ­relationships more fully. If the patient “Would you describe it more fully?” chooses not to elaborate by answering no, “Could you talk about how it was that you the nurse does not probe or pry. In such learned your mom was dying of c­ ancer?” a case, the nurse respects the patient’s wishes.  CHAPTER 10 Communication and the Clinical Interview 183 Table 10-2 Therapeutic Communication Techniques—cont’d Therapeutic Technique Description Example Giving information Makes facts the person needs available. “My purpose for being here is... ” Supplies knowledge from which d ­ ecisions “This medication is for... ” can be made or conclusions drawn. For “The test will determine... ” 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. Seeking clarification Helps patients clarify their own thoughts and “I am not sure I follow you.” maximize mutual understanding between “What would you say is the main point of nurse and patient. 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 “That was Dr. Todd, not a man from the argue or try to convince the patient, just Mafia.” describes personal perceptions or facts in “That was the sound of a car backfiring.” the situation. “Your mother is not here; I am a nurse.” Voicing doubt Undermines the patient’s beliefs by not “Isn’t that unusual?” ­reinforcing the exaggerated or false “Really?” perceptions. “That’s hard to believe.” Seeking consensual Clarifies that both the nurse and patient share “Tell me whether my understanding agrees ­validation mutual understanding of communications. with yours.” Helps the patient become clearer about what he or she is thinking. Verbalizing the implied Puts into concrete terms what the Patient: “I can’t talk to you or anyone else. It’s patient implies, making the patient’s a waste of time.” ­communication more explicit. Nurse: “Do you feel that no one understands?” Encouraging evaluation Aids the patient in considering people and “How do you feel about... ?” events from the perspective of the patient’s “What did it mean to you when he said he own set of values. couldn’t stay?” Attempting to translate into Responds to the feelings expressed, not just Patient: “I am dead inside.” feelings the content. Often termed decoding. Nurse: “Are you saying that you feel lifeless? Does life seem meaningless to you?” Suggesting collaboration Emphasizes working with the patient, not “Perhaps you and I can discover what doing things for the patient. Encourages ­produces your anxiety.” the view that change is possible through “Perhaps by working together, we can come ­collaboration. up with some ideas that might improve your communications with your spouse.” Summarizing Brings together important points of ­discussion “Have I got this straight?” to enhance understanding. Also allows the “You said that... ” opportunity to clarify communications so that “During the past hour, you and I have both nurse and patient leave the ­interview ­discussed... ” with the same ideas in mind. Encouraging formulation of Allows the patient to identify alternative “What could you do to let anger out a plan of action actions for interpersonal situations the harmlessly?” patient finds disturbing (e.g., when anger or “The next time this comes up, what might you anxiety is provoked). do to handle it?” “What are some other ways you can approach your boss?” Adapted from Hays, J. S., & Larson, K. (1963). Interacting with patients. New York: Macmillan. Copyright © 1963 Macmillan Publishing Company.