COMMUNICATION – is the means by which people make their needs known.
It is
the way they obtain understanding, reinforcement, and assistance from others.
Without communication, effective functioning in society is impossible.
Communication is divided into two categories:
a. social – it is superficial and meets the needs of both parties; the goal
is enjoyment
b. therapeutic – the goal is to develop or maintain a healthy personality
and this is done by relieving stress and assisting the patient in
developing better coping mechanisms. It is effective and purposeful.
INTERPRETING COMMUNICATION
Valid interpretations of communications are dependent upon:
a. the nurse ability to listen to communication and observe as well what
goes on during interactions with other persons.
b. The nurse ability to make appropriate responses which aid in
extending, exploring and validating interpretations
c. The nurses degree of self awareness
d. The nurses sensitivity to the feelings expressed as well underlying
needs and the various ways in which needs are communicated.
GOALS OF THERAPEUTIC COMMUNICATIONS
1. to obtain useful information
2. to show caring
3. to help patient understand himself
4. to relieve stress
5. to provide information
6. to teach problem solving skills
7. to encourage acceptance of responsibility
8. to encourage activities of daily living
DEVELOPING THERAPEUTIC NURSE
The foundation of all therapeutic interactions is ACCEPTANCE. Acceptance
implies that the nurse treats the clients as important individuals who have
inherent worth not as diagnostic entity or set of psychiatric symptoms. The nurse
implies that she is accepting the client by calling him by name and by recognizing
that he has the same basic personal rights. The nurse encourages the client to
express feelings to her, realizing that in this way, he is able to relieve emotional
tensions.
Other behaviors that are equally important are:
NON-JUDGMENTAL is used in conjunction with the word attitude. A
non-judgmental attitude is neither condemning nor approving. Through tone of
voice or manner, the nurse conveys to client a helpful attitude towards a recognized
behavior, either good or bad, right or wrong .
CONSISTENCY – is another important characteristic of therapeutic interactions.
The consistent nurse maintains the basic attitude towards the client so that he
derives security from being able to predict her behavior. Consistency helps lessen
the client’s anxiety by simplifying decision making and by avoiding uncertainties.
THERAPUETIC COMMUNICATION TECHNIQUES
1. Giving Recognition – showing positive regard to patient
Ex. “ GOOD EVENING Mr. X, I noticed you have comb your hair today.”
2. Silence – being able to sit in silence with a person can connote
acceptance and understanding of patients needs. Dangers: the nurse may
wrongly give the impression that there is lack of interest; may discourage
verbalization.
3. Accepting – indicates the nurse is listening and understanding what
the patient says. A way to encourage the patient to speak.
Ex. “YES” or nodding head, moving closer to the patient and leaning
forward.
4. Offering self – communication support to a patient who is unable to
communicate; conveys message that the nurse thinks the patient is
worthwhile and she accepts him as he is
Ex. “I will sit with you a while”
“I will stay here with you”
“I am interested in your comfort”
5. Broad Openings – use to encourage patient to talk
Ex. “Is there something bothering you?”
“Is there something you’d like to talk about?”
“What are you thinking about?”
6. Open ended Leads – encourage patient to talk
Ex. “Go on . . . . .”
“Then what happened…..”
“Tell me more… talk about that….”
7. Placing the event in sequence – helps patient arrange his ideas in a
logical manner
Ex. “What seemed to lead up to…“
“Was this before or after.”
“ When did this happen…”
8. Validations – an attempt to verify the nurses perception of the verbal
and non Verbal messages
Ex. “You appear tense…”
“I notice that you are swinging your leg…”
“I see that you are tapping you feet”
“I notice that you are wetting you lips”
9. Recall and description of details – verifies perceptions; ascertains
behavior of patient.
Ex. “Is it something like…”
“Tell me more…”
“Please describe the experience…”
“What did you say then…”
10. Reflecting- aids in helping patient to focus on the communication
topic
Ex. P – “I can’t sleep, I stayed awake all night”
N – “You have difficulty sleeping”
11. Focusing – has a prompting and encouraging effect and focuses on
the communication topic.
Ex. “This point seems more looking at closely”
12. Exploring – ascertains the meaning of the patient’s behavior.
Ex. “Let’s talk more about it…”
“Would you describe it more clearly…”
13. Giving information – provides information and keeps patient
oriented.
Ex. “my name is...”
“Visiting hours is..”
“I’m taking you to the…”
14. Presenting or focusing on reality by expressing doubts on unreal
perceptions – strives to focus on reality and encourages patient to give up
fantasies.
15. Focusing on Feelings – encourages patient to be aware of and
describe personal feelings
Ex. P – “Worms are in my head”
N – “That must be a frightening feeling, what did you feel at that
time”
16. Clarifying- is useful when you are confused about client’s thought or
feelings
Ex. “Could you explain more about that to me?”
“ I’m having some difficulty. Could you help me understand?”
17. Verbalizing – verifies the nurse’s perception of the patient’s message
on the affective domain.
Ex. P- “I cant talk to you or to anyone else. It is a waste of time”z
N – “Is it your feeling that no one understands?”
18. Suggesting – communicates support to the patient and the nurse’s
genuine interest in the patient
Ex. “Perhaps you and I can discover what produces your anxiety.”
19. Summarizing indicates that the nurse has understood the patients
message.
Ex. “Have I got this straight?”
“You said that…”
“During the past hours you and I have discussed…”
20. Encouraging / formulation of a plan of action - encourages
the patient to think independently
Ex. “Next time this comes up, what might you do to handle it?”
21. Encouraging client to consider alternatives – giving patient a
chance to choose what to say or do next
Ex. “What else could you say..”
“Instead of hitting him what would you do next…”
22. Encouraging client to appraise or evaluate the experience or
outcome.
Ex. “How did it turn out…”
“What was it like…”
“How will this help later…”
Suggested Activities:
1. With a group, take turns communicating with the nonverbal cues. See
how many messages the group can correctly identify.
2. Practice reflective responses with classmates.
3. In conversations with casual friends and acquaintances, listen for
phrases which block communication.
NON – THERAPEUTIC COMMUNICATIONS
Changing the subject – tangential response – moves away from problems or
focuses on incidental, superficial content
P – “I hate you…”
N - “Would you like to take your shower now…”
Suggested response – “You hate me, tell me about this…”
“You hate me, what does this hate means to you…”
Moralizing - saying with approval or disapproval that the person’s behavior is
GOOD or BAD, right or wrong, arguing with stated belief of person, directly
opposing the person
Ex. P – “I have nothing to live…”
N – “You certainly do have a lot more…
“That’s good. It is wrong to shoot yourself…”
Agreeing with clients autistic inventions
P – “The eggs are flying…”
N – “Eggs I see, you go on…”
Suggested response – use clarifying response first. “I don’t understand” and
then depending on client responses, either accepting, acknowledging, focusing on
reality or focusing on feelings.
Agreeing with clients negative view of SELF –
P – “I have made a mess of my life…”
N – “Yes you have.”
Suggested response – use clarifying response about “Mess of my life…” “Give
me an example of a time where you messed your life…”
Complimenting, flattering
P - “I have made a mess of my life…”
N - “How could you?You are such an attractive intelligent, generous person.”
Suggested response – same as agreeing with clients negative view of self.
Giving Opinions and advices concerning client’s life situation
Ex. In my opinion or I think you should or why not?
Suggested response –
A. Encourage the client to consider alternatives
“What else do you think you could try…”
B. Encourage the client to appraise and evaluate himself or erself.
“What else do you like for…”
Seeking agreement from clients with nurse’s personal opinion
“I think…” Don’t you…Isn’t it right…”
Suggested Response:
A. It is best to keep personal opinion to yourself and only to give information
what would aid the clients orientation to reality.
B. If you give opinion as a model of orienting to reality, ask client to state his or
her opinion. “My opinion is this, what is yours…”
Probing and or/offering premature solutions and interpretations, jumping
or making conclusions
P – “I can’t find a job”.
N – “You could go to an employment agency.”
P – “I’d rather not talk about it.”
N – “What are you consciously doing when you say that… What do you really
mean.?”
P – “I don’t want to live alone.”
N – “Are you afraid of starting to drink again?”
Questioning on different topics without waiting for a reply
P – Remains Silent
N – What makes you so silent? Are you angry? Would you like to be alone?
Suggested response – choose one of the above and wait for a response before
asking the next question
Ignoring client’s question or comments
P – “Am I crazy, nurse?”
N – Walking away as if he did not hear anything.
Suggested response – “I cant understand what makes you bring up this matter at
this time…” or “Tell me what makes you bring this up at this time…”
Ignoring question or comments usually implies that the nurse is uncomfortable. It
is important not to run away from client.
Closing off expressions with questions that can be answered by yes or no.
P – “I will never get better.”
N – “Is something making you feel that way…”
Suggested response – “What makes you feel that way” open ended questions that
starts with What, Whom, When and Where etc.
Using clichés or stereotyped expressions
P – “The doctor took away my weekend pass.”
N – “The doctor is only doing what is best for you. Doctor knows best.”(comment
also example of moralizing)
Suggested response – “Tell me what happened when the doctor took away your
pass…”
Overloading – giving too much information at one time
N –“Hello, I’m Ms. Santos, I’m your nurse. I will be here tomorrow and I will be off
next day. Miss dela Cruz will assign you to another nurse. This unit has 5 RN’s,
three nursing aids and students from different schools who will be taking care of
you at the same time.”
Suggested response – “Hello, I’m Ms. Santos, your nurse today.” Keep initial
orienting information simple and brief.
Understanding - not giving enough information so that meaning is not clear
P – “What are the visiting hours?”
N –“They are flexible and liberal.”
Suggested response – “They are flexible and liberal, from 10AM to 12 noon and
from 6pm to 8pm. “ Use specific terms and give specific information.
Saying NO without saying NO
P – “Can we go for a walk soon?”
N – “We will see, perhaps, maybe later…”
Suggested response – “I will check the schedule in the nursing office and let you
know within an hour” Vague ambiguous responses can be seen as “putting the
client off “.It is best to be clear, specific and direct.
Using double bind communications – sending conflicting messages that do not
have “mutual fit” or are incongruent
N- continuing to stay and talk with the client. “It is time for you to rest…”
Suggested response – “It is time for you to rest and for me to leave.” (Proceeding
to leave…).
Protecting – defending someone else while talking with client, implying client has
no right to personal opinions and feelings.
P – “This hospital is no good. No one cares here.”
N – “This is an excellent hospital. All the staff was chosen for their warmth and
concern with people.”
Suggested response – Focus on feeling tone of clarifying information.
Asking WHY questions implies that the person has immediate conscious
awareness of the reasons for his/ or her feelings and behaviors.
“Why don’t you…” Why do you feel that way…”
“Why did you…”
Suggested response – Ask clarifying questions like “how” “what”...Etc.
Coercion – using the interaction between people to force someone to do your will
with the implication that if they don’t do it for your sake, you won’t love them or
stay with them.
P – “I refuse to talk to him.”
N – “Do it for my sake before it is too late.”
Suggested response - “Something keeps you waiting to talk with him”
Focusing on negative feelings, thoughts, actions
P – “I can’t sleep, I can’t eat, I can’t do anything.”
N – “How long have you not been sleeping, eating or thinking well?”
Suggested response – “What do you do..”
Rejecting – rejecting clients behavior or ideas
P – “Lets talk about incest.”
N – “Incest is a bad thing to talk about. I don’t want to.”
Suggested response – “What do you want to say about incest”
Accusing, belittling –
P – “I’ve had to wait five minutes for you to change my dressing.”
N – “Don’t be so demanding. Don’t you see that I have several people who need
me?”
Suggested response – “It must have been hard to wait for me to come when you
wanted it to be right away”.
Evading a Response – by asking a question in return.
P – “I want to know your opinion, nurse. Am I crazy?”
N – “Do you think you are crazy?
Suggested response – “I don’t know. What do you mean by crazy?
Circumstantialities – communicating in such a way that the main point is only
reached after many side comments, details and additions.
P – “Will you go out on a date with me?”
N –“I work every evening. On my day off I usually go out of town. I have a steady
boyfriend. Besides that, I am a nurse and you are a client. Thank you for asking
me but no, I will not date you.”
Making assumptions without checking them out –
P – (Standing in the kitchen by the sink, peeling onions, with tears in her eyes).
N – “What makes you sad? “
Suggested response – use simple acknowledgement and acceptance initially, such
as “I notice you have tears in your eyes.”
Giving false reassurance –
P –“ I’m scared.”
N – “Don’t worry everything will be all right. There’s nothing to be afraid of.”
Suggested response – “I’d like to hear about what you’re afraid of, so that together
we can see what can be done to help you”.
Open the way for clarification and exploration and offer yourself as a helping
person- not someone with magic answers.
HELPFUL HINTS IN PSYCHIATRIC NURSING
1. Giving negative commands to 1. Tell them directly what is
negativistic patients. expected if they are unable to
cooperate, assist them in doing
so.
2. Prying into the patients 2. Listen to whatever he has to tell
Personal problems you but without emotionally
committing yourself. Report
significant material to the
physician.
3. Expressing agreement with 3. & 4. Listen with interest, patient
patient expressing delusions. but do not agree or dispute
Don’t pretend to experience the these false ideas or phrases of
sensations the patient mild doubt, and direct the
experiences through patient’s attention elsewhere.
hallucinations.
4. Arguing or trying to reason
away patient’s delusions or
hallucinations.
5. Allowing the rigid catatonic 5. Change the position to a normal
patient to remain in unnatural or relaxed one to aid his physical
uncomfortable positions. condition and prevent ridicule of
himself.
6. Allowing patient to remain 6. Try to stimulate new interest or
continually idle and withdrawn. re- awaken previous interest in
some activity.
7. Using force 7. Wait if possible, until the patient
is more amenable to the activity
or try to win his cooperation,
friendship and trust.
8. Misleading patient or lying to 8. Deal with the patient honestly at
him in an effort to avoid a all times so that his trust in you
difficult situation. will never be shaken. If unable
to answer a question for ethical
or other reasons, tell him
honestly and tactfully.
9. Discussing something in the 9. Keep in mind that even those
presence of the patient. (Things patients who appear in a deep
which you do not want him to sleep or far withdrawn from
repeat) – even though he may reality, can often hear,
not appear to be alert or understand, and remember all
conscious. that goes on around them.
10. Whispering in the presence of 10. Speak loud enough so that
paranoid patients; don’t use patient can hear clearly that you
many gestures and don’t use are not talking about him; use
complicated equipment. as few gestures as possible to
avoid stimulating the paranoid
patients suspiciousness.
Do use simple apparatus to
prevent the patient from becoming
apprehensive of “Dangerous plots”
and “Instruments of torture.”
11. Allowing your patients mood to 11. Maintain a friendly, neutral
determine your own. mood regardless of the almost
contagious affect of gaiety or
deep depression.
12. Encouraging the manic patient 12. Encourage him to be interested
to participate in competitive in developing sports (in playing
sports and games. games for game sake) skills,
without emphasis on win or
lose. Do encourage more
quieting, less energetic and
stimulating activities for him.
13. Rushing the retarded patient or 13. Encourage him, praise, and
become impatient with his slow give him plenty of time,
response. realizing that physically and
mentally he is incapable of
rapid response.
14. Offering glib reassurance of 14. Offer sincere, thoughtful
flattery. reassurance based only on
facts. Offer genuine praise
whenever and as often as it is
deserved.
15. Bursting suddenly into a 15. Approach him gently and
preoccupied patients dream. unhurriedly.
16. Giving up hope or considering a 16. Remember that psychiatric
patient’s slow progress to be patients do get well and
a sign of futility. progress best when seem
genuinely interested in and
hopeful toward their progress.
17. Holding an impulsive patient by 17. Hold him gently but firmly by
his hand when escorting him. the wrist.
18. Allowing patient to walk out of 18. Keep all your patients in front of
your range of vision when you, walking comfortably
escorting a group of patients. spaced but without wide gaps.
19. Permitting the overconfident 19. Guide him into safe and normal
patient to perform great feast of channels by your own good
power and ability; behave in a judgment, tact, and ingenuity.
manner in which would expose
him to physical danger or
ridicule.
20. Letting the more aggressive 20. Divide group according to their
patient dominate those who are interest, behavior, needs and
more retarded. physical and mental abilities.
21. Being offended by abusive or 21. Remember that if patient was
insulting remarks. able to control his behavior, he
would not be here. His illness
often causes him to misidentify
people. He probably does not
intend his remarks for your
personality, but for someone
who seem to represent in his
imagination.
22. Not talking to the mute and 22. Speak to him often, as though
unresponsive patient. you fully expect him to respond.
23. Being rigid and inflexible in 23. Allow him some flexibility in
dealing with the resistive or routine and deviations, from set
stubborn patient. rules of the game in
accordance with the needs and
abilities of your patient.
24. Attempting to lead a patient off 24. First explain fully where he is
without explanation. going, who authorized it, and
what purpose.
25. Telling your patient to “snap out 25. Remember that he is sick and
of it” or that with a little will is not always able to regulate
power he could overcome his his behavior voluntarily.
illness
26. Giving self-depreciatory 26. Give him activities at which you
remarks on timid patient’s feel he is capable of
activities which are extremely succeeding.
challenging.
27. Giving the preoccupied or 27. Stimulate his interest and
withdrawn patient monotonous thinking so his morbid or
repetitive activities
preoccupations will be
discouraged.
28. Ignoring patient’ physical 28. Report all physical complaints
complaints- no matter how to the physician or nurse.
frequently or unconvincingly These complaints could at one
they are presented. time require important,
immediate medical attention.
29. Giving information to visitors or 29. Refer questions to the
discussing a patient’s problem physician and protect patient’s
or behavior outside the hospital. confidence.
30. Overlooking your friends and 30. Help the public to understand
neighbors misconceptions, the importance of mental
prejudices and superstitious hygiene, early treatment, and to
regarding mental health. develop wholesome attitudes
towards the mentally ill.
31. Devoting your entire attention to 31. Include as many activities as
only the most responsive or possible, dividing attention to
social ones. the best therapeutic advantage
and giving the retarded and
withdrawn patient sufficient
attention to draw him out of his
dream world.
32. Offering medical or physical 32. Encourage the patient’s
advice. confidence in his physician.
33. Talking to the patient in a 33. Speak to the patient naturally
condescending manner in and as a friend might on the
response to his dull or childish level which you would if he
behavior. were well.
34. Treating the patient as though 34. Treat the patient as you would
he were unfeeling, unaware or like to be treated if you were in
sensitive. his situation.
35. Selecting activities for the 35. Select activities in accordance,
patient according to his with the various manifestations
diagnosis alone. of the behavior of the patient as
an individual.
The first step towards the establishment of a Therapeutic Nurse-Patient
Relationship is self-awareness. A nurse can successfully facilitate the client’s
awareness of his feelings only when she has awareness of her own. The following
questions are your guide in going through the process.
1. What are your beliefs about mental illness?
2. How do you feel toward mentally ill individuals?
3. You, as a Person
A. What are your capabilities/strength/abilities?
What do you do with those good qualities of yours?
B. What are your weaknesses? How do you deal with them?
C. What do you perceive yourself to be ten years from now?
D. What are your fears/worries/concerns in your present life?
E. What experiences or events in the past do you consider as
Significantly affecting your personality?
F. Who are the significant persons in your life? Why
G. What do you consider to be the most important in your life?
H. What coping mechanisms do you use in managing the stress in your life?
4. You, as a psychiatric Student Nurse
A. What do you consider to be your Psychiatric Nursing capabilities?
B.What aspect/s of Psychiatric Nursing do you feel inadequate in?
C. What qualities must you possess in order to be therapeutic in your relationship
with your client?
5. You, as perceived by others confront other people (your classmate, friends,
relatives, instructor, etc.) and ask them to comment on the different aspects of
your personality specified below?
a. Physical Appearance
b. Communicative Ability
_c. Behavior
_d. Interpersonal relationships
e. Behavior
f. Interpersonal relationships
_6. Self
On this page, write your beliefs and feelings which you intentionally and consciously
conceal from others for fear that you will be criticized if they were known. Being
aware that these suppressed feelings will affect your behavior as a nurse, you are
encouraged to reveal them to others to seek validation or clarification. If, at this
point, you are ready to open up, write them on this page. If you will have some
inhibitions, postpone this activity until such time when you are ready to disclose
them.
II. NURSE – PATIENT RELATIONSHIP
Definition of Communication
Definition: The Communication is a two-way process wherein the message in the form of ideas,
thoughts, feelings, opinions is transmitted between two or more persons with the intent of creating
a shared understanding.
Simply, an act of conveying intended information and understanding from one person to another is called
as communication. The term communication is derived from the Latin word “Communis” which means to
share. Effective communication is when the message conveyed by the sender is understood by the
receiver in exactly the same way as it was intended.
Communication is divided into two categories:
1. social – it is superficial and meets the needs of both parties; the goal is enjoyment
2. therapeutic – the goal is to develop or maintain a healthy personality and this is done by relieving
stress and assisting the patient in developing better coping mechanisms. It is effective and purposeful.
COMMUNICATION PROCESS
The communication is a dynamic process that begins with the conceptualizing of ideas by the sender who then transmits the message
through a channel to the receiver, who in turn gives the feedback in the form of some message or signal within the given time frame. Thus,
there are Seven major elements of communication process:
1. Sender: The sender or the communicator is the person who initiates the conversation and has conceptualized the idea that he intends t o
convey it to others.
2. Encoding: The sender begins with the encoding process wherein he uses certain words or non-verbal methods such as symbols, signs,
body gestures, etc. to translate the information into a message. The sender’s knowledge, skills, perception, background, competencies,
etc. has a great impact on the success of the message.
3. Message: Once the encoding is finished, the sender gets the message that he intends to convey. The message can be written, oral,
symbolic or non-verbal such as body gestures, silence, sighs, sounds, etc. or any other signal that triggers the response of a receiver.
4. Communication Channel: The Sender chooses the medium through which he wants to convey his message to the recipient. It must be
selected carefully in order to make the message effective and correctly interpreted by the recipient. The choice of medium depends on
the interpersonal relationships between the sender and the receiver and also on the urgency of the message being sent. Oral, virtual,
written, sound, gesture, etc. are some of the commonly used communication mediums.
5. Receiver: The receiver is the person for whom the message is intended or targeted. He tries to comprehend it in the best possible
manner such that the communication objective is attained. The degree to which the receiver decodes the message depends on his
knowledge of the subject matter, experience, trust and relationship with the sender.
6. Decoding: Here, the receiver interprets the sender’s message and tries to understand it in the best possible manner. An eff ective
communication occurs only if the receiver understands the message in exactly the same way as it was intended by the sender.
7. Feedback: The Feedback is the final step of the process that ensures the receiver has received the message and interpreted it correctly
as it was intended by the sender. It increases the effectiveness of the communication as it permits the sender to know the efficacy of his
message. The response of the receiver can be verbal or non-verbal.
Note: The Noise shows the barriers in communications. There are chances when the message sent by the sender is not received by the
recipient.
INTERPRETING
COMMUNICATION
Valid interpretations of communications are dependent upon:
1. the nurse ability to listen to communication and observe as well what goes on during interactions with other persons.
2. The nurse ability to make appropriate responses which aid in extending, exploring and validating interpretations
3. The nurses degree of self awareness
4. The nurses sensitivity to the feelings expressed as well underlying needs and the various ways in which needs are communicated.
GOALS OF THERAPEUTIC
COMMUNICATIONS
1. to obtain useful information
2. to show caring
3. to help patient understand himself
4. to relieve stress
5. to provide information
6. to teach problem solving skills
7. to encourage acceptance of responsibility
8. to encourage activities of daily living
DEVELOPING THERAPEUTIC
NURSE
The foundation of all therapeutic interactions is ACCEPTANCE. Acceptance implies that the nurse treats the clients as important individuals
who have inherent worth not as diagnostic entity or set of psychiatric symptoms. The nurse implies that she is accepting the client by calling
him by name and by recognizing that he has the same basic personal rights. The nurse encourages the client to express feelings to her,
realizing that in this way, he is able to relieve emotional tensions.
Other behaviors that are equally important are:
NON-JUDGMENTAL is used in conjunction with the word attitude. A non-judgmental attitude is neither condemning nor approving. Through
tone of voice or manner, the nurse conveys to client a helpful attitude towards a recognized behavior, either good or bad, right or wrong .
CONSISTENCY – is another important characteristic of therapeutic interactions. The consistent nurse maintains the basic attitude towards
the client so that he derives security from being able to predict her behavior. Consistency helps lessen the client’s anxiety by simplifying
decision making and by avoiding uncertainties.
THERAPEUTIC
COMMUNICATION TECHNIQUES
1. Giving Recognition – showing positive regard to patient
Ex. “ GOOD EVENING Mr. X, I noticed you have comb your hair today.”
2. Silence – being able to sit in silence with a person can connote acceptance and understanding of
patients needs. Dangers: the nurse may wrongly give the impression that there is lack of interest;
may discourage verbalization.
3. Accepting – indicates the nurse is listening and understanding what the patient says. A way to
encourage the patient to speak.
Ex. “YES” or nodding head, moving closer to the patient and leaning forward.
4. Offering self – communication support to a patient who is unable to communicate; conveys
message that the nurse thinks the patient is worthwhile and she accepts him as he is
Ex. “I will sit with you a while”
“I will stay here with you”
“I am interested in your comfort”
5. Broad Openings – use to encourage patient to talk
Ex. “Is there something bothering you?”
“Is there something you’d like to talk about?”
“What are you thinking about?”
6. Open ended Leads – encourage patient to talk
Ex. “Go on . . . . .”
“Then what happened…..”
“Tell me more… talk about that….”
7. Placing the event in sequence – helps patient arrange his ideas in a logical manner
Ex. “What seemed to lead up to…“
“Was this before or after.”
“ When did this happen…”
8. Validations – an attempt to verify the nurses perception of the verbal and non Verbal messages
Ex. “You appear tense…”
“I notice that you are swinging your leg…”
“I see that you are tapping you feet”
“I notice that you are wetting you lips”
9. Recall and description of details – verifies perceptions; ascertains behavior of patient.
Ex. “Is it something like…”
“Tell me more…”
“Please describe the experience…”
“What did you say then…”
10. Reflecting- aids in helping patient to focus on the communication topic
Ex. P – “I can’t sleep, I stayed awake all night”
N – “You have difficulty sleeping”
11. Focusing – has a prompting and encouraging effect and focuses on the communication topic.
Ex. “This point seems more looking at closely”
12. Exploring – ascertains the meaning of the patient’s behavior.
Ex. “Let’s talk more about it…”
“Would you describe it more clearly…”
13. Giving information – provides information and keeps patient oriented.
Ex. “my name is...”
“Visiting hours is..”
“I’m taking you to the…”
14. Presenting or focusing on reality by expressing doubts on unreal perceptions – strives to focus on
reality and encourages patient to give up fantasies.
1. Focusing on Feelings – encourages patient to be aware of and describe personal feelings
Ex. P – “Worms are in my head”
N – “That must be a frightening feeling, what did you feel at that time”
16. Clarifying- is useful when you are confused about client’s thought or feelings
Ex. “Could you explain more about that to me?”
“ I’m having some difficulty. Could you help me understand?”
17. Verbalizing – verifies the nurse’s perception of the patient’s message on the affective domain.
Ex. P- “I cant talk to you or to anyone else. It is a waste of time”z
N – “Is it your feeling that no one understands?”
18. Suggesting – communicates support to the patient and the nurse’s genuine interest in the patient
Ex. “Perhaps you and I can discover what produces your anxiety.”
19. Summarizing indicates that the nurse has understood the patients message.
Ex. “Have I got this straight?”
“You said that…”
“During the past hours you and I have discussed…”
1. Encouraging / formulation of a plan of action - encourages the patient to think independently
Ex. “Next time this comes up, what might you do to handle it?”
1. Encouraging client to consider alternatives – giving patient a chance to choose what to say or do
next
Ex. “What else could you say..”
“Instead of hitting him what would you do next…”
22. Encouraging client to appraise or evaluate the experience or outcome.
Ex. “How did it turn out…”
“What was it like…”
“How will this help later…”
NON – THERAPEUTIC
COMMUNICATIONS
Changing the subject – tangential response – moves away from problems or focuses on incidental,
superficial content
P – “I hate you…”
N - “Would you like to take your shower now…”
Suggested response – “You hate me, tell me about this…”
“You hate me, what does this hate means to you…”
Moralizing - saying with approval or disapproval that the person’s behavior is GOOD or BAD, right or
wrong, arguing with stated belief of person, directly opposing the person
Ex. P – “I have nothing to live…”
N – “You certainly do have a lot more…
“That’s good. It is wrong to shoot yourself…”
Agreeing with clients autistic inventions
P – “The eggs are flying…”
N – “Eggs I see, you go on…”
Suggested response – use clarifying response first. “I don’t understand” and then depending on client
responses, either accepting, acknowledging, focusing on reality or focusing on feelings.
Agreeing with clients negative view of SELF –
P – “I have made a mess of my life…”
N – “Yes you have.”
Suggested response – use clarifying response about “Mess of my life…” “Give me an example of a time
where you messed your life…”
Complimenting, flattering
P - “I have made a mess of my life…”
N - “How could you?You are such an attractive intelligent, generous person.”
Suggested response – same as agreeing with clients negative view of self.
Giving Opinions and advices concerning client’s life situation
Ex. In my opinion or I think you should or why not?
Suggested response –
1. Encourage the client to consider alternatives
“What else do you think you could try…”
1. Encourage the client to appraise and evaluate himself or erself.
“What else do you like for…”
Seeking agreement from clients with nurse’s personal opinion
“I think…” Don’t you…Isn’t it right…”
Suggested Response:
1. It is best to keep personal opinion to yourself and only to give information what would aid the clients
orientation to reality.
2. If you give opinion as a model of orienting to reality, ask client to state his or her opinion. “My opinion
is this, what is yours…”
Probing and or/offering premature solutions and interpretations, jumping or making conclusions
P – “I can’t find a job”.
N – “You could go to an employment agency.”
P – “I’d rather not talk about it.”
N – “What are you consciously doing when you say that… What do you really
mean.?”
P – “I don’t want to live alone.”
N – “Are you afraid of starting to drink again?”
Questioning on different topics without waiting for a reply
P – Remains Silent
N – What makes you so silent? Are you angry? Would you like to be alone?
Suggested response – choose one of the above and wait for a response before asking the next question
Ignoring client’s question or comments
P – “Am I crazy, nurse?”
N – Walking away as if he did not hear anything.
Suggested response – “I cant understand what makes you bring up this matter at this time…” or “Tell me
what makes you bring this up at this time…”
Ignoring question or comments usually implies that the nurse is uncomfortable. It is important not to run
away from client.
Closing off expressions with questions that can be answered by yes or no.
P – “I will never get better.”
N – “Is something making you feel that way…”
Suggested response – “What makes you feel that way” open ended questions that starts with What,
Whom, When and Where etc.
Using clichés or stereotyped expressions
P – “The doctor took away my weekend pass.”
N – “The doctor is only doing what is best for you. Doctor knows best.”(comment also example of
moralizing)
Suggested response – “Tell me what happened when the doctor took away your pass…”
Overloading – giving too much information at one time
N –“Hello, I’m Ms. Santos, I’m your nurse. I will be here tomorrow and I will be off next day. Miss dela
Cruz will assign you to another nurse. This unit has 5 RN’s, three nursing aids and students from different
schools who will be taking care of you at the same time.”
Suggested response – “Hello, I’m Ms. Santos, your nurse today.” Keep initial orienting information simple
and brief.
Understanding - not giving enough information so that meaning is not clear
P – “What are the visiting hours?”
N –“They are flexible and liberal.”
Suggested response – “They are flexible and liberal, from 10AM to 12 noon and from 6pm to 8pm. “ Use
specific terms and give specific information.
Saying NO without saying NO
P – “Can we go for a walk soon?”
N – “We will see, perhaps, maybe later…”
Suggested response – “I will check the schedule in the nursing office and let you know within an hour”
Vague ambiguous responses can be seen as “putting the client off “.It is best to be clear, specific and
direct.
Using double bind communications – sending conflicting messages that do not have “mutual fit” or are
incongruent
N- continuing to stay and talk with the client. “It is time for you to rest…”
Suggested response – “It is time for you to rest and for me to leave.” (Proceeding to leave…).
Protecting – defending someone else while talking with client, implying client has no right to personal
opinions and feelings.
P – “This hospital is no good. No one cares here.”
N – “This is an excellent hospital. All the staff was chosen for their warmth and concern with people.”
Suggested response – Focus on feeling tone of clarifying information.
Asking WHY questions implies that the person has immediate conscious awareness of the reasons for
his/ or her feelings and behaviors.
“Why don’t you…” Why do you feel that way…”
“Why did you…”
Suggested response – Ask clarifying questions like “how” “what”...Etc.
Coercion – using the interaction between people to force someone to do your will with the implication that
if they don’t do it for your sake, you won’t love them or stay with them.
P – “I refuse to talk to him.”
N – “Do it for my sake before it is too late.”
Suggested response - “Something keeps you waiting to talk with him”
Focusing on negative feelings, thoughts, actions
P – “I can’t sleep, I can’t eat, I can’t do anything.”
N – “How long have you not been sleeping, eating or thinking well?”
Suggested response – “What do you do..”
Rejecting – rejecting clients behavior or ideas
P – “Lets talk about incest.”
N – “Incest is a bad thing to talk about. I don’t want to.”
Suggested response – “What do you want to say about incest”
Accusing, belittling –
P – “I’ve had to wait five minutes for you to change my dressing.”
N – “Don’t be so demanding. Don’t you see that I have several people who need me?”
Suggested response – “It must have been hard to wait for me to come when you wanted it to be right
away”.
Evading a Response – by asking a question in return.
P – “I want to know your opinion, nurse. Am I crazy?”
N – “Do you think you are crazy?
Suggested response – “I don’t know. What do you mean by crazy?
Circumstantialities – communicating in such a way that the main point is only reached after many side
comments, details and additions.
P – “Will you go out on a date with me?”
N –“I work every evening. On my day off I usually go out of town. I have a steady boyfriend. Besides
that, I am a nurse and you are a client. Thank you for asking me but no, I will not date you.”
Making assumptions without checking them out –
P – (Standing in the kitchen by the sink, peeling onions, with tears in her eyes).
N – “What makes you sad? “
Suggested response – use simple acknowledgement and acceptance initially, such as “I notice you have
tears in your eyes.”
Giving false reassurance –
P –“ I’m scared.”
N – “Don’t worry everything will be all right. There’s nothing to be afraid of.”
Suggested response – “I’d like to hear about what you’re afraid of, so that together we can see what can
be done to help you”.
Open the way for clarification and exploration and offer yourself as a helping person- not someone with
magic answers.
