Therapeutic Communication in Nursing
Definition: 3Therapeutic
1 communication is a purposeful exchange between2a nurse and2 patient
1 (or family)
using both verbal and nonverbal methods to support patient well-being. In other words, it is a specialized
form of communication aimed at establishing a healing relationship 1 . Its ultimate goal is to help
patients feel understood and to overcome emotional or psychological distress . Therapeutic
communication is professional and patient-centered, focused on the patient’s needs rather than casual
social talk .
Importance and Goals: In nursing, therapeutic communication
5 5 is essential for safe,
5 effective care.
6 5By
encouraging patients to express feelings and questions, nurses build trust and rapport, which leads to
better understanding of needs and priorities 4 . Clear therapeutic dialogue helps clarify patient
concerns, improves decision-making, and even enhances the accuracy of diagnoses . For example, using
empathic listening and open questions can reveal hidden anxieties or misconceptions. When nurses do not
use therapeutic communication, patient outcomes can suffer – studies note that neglecting it can lead to
negative health outcomes and decreased satisfaction 4 . By contrast, effective therapeutic
communication improves patient satisfaction, adherence to treatment, and overall health outcomes .
Key Principles and Characteristics: Core qualities of therapeutic communication include:
• Empathy and Caring: Showing understanding and genuine concern for the patient’s feelings helps
patients feel validated. A nurse who listens attentively and responds warmly conveys that the patient
“feels as if she cares” 7 . Empathy does not mean agreeing with everything, but it means
acknowledging the patient’s experience.
• Active Listening: Giving the 8 patient full attention – through
8 eye contact, head nodding, and lean-in
posture – signals interest. During active listening, nurses restate or paraphrase what the patient says
to confirm understanding . For example, repeating a patient’s words and asking “So you’re feeling
___, is that correct?” shows the nurse is truly listening .
• Respect and Non-judgment: The nurse treats every patient with respect and acceptance. Speaking
calmly, respecting personal boundaries, and withholding blame help patients share sensitive
concerns 7 . Nonjudgmental responses (“Yes, I understand”) encourage openness.
• Trust and Confidentiality: Trust is built by being consistent, honest, and maintaining confidentiality.
Knowing information stays private makes patients more willing to be honest. When a nurse is
reliable and genuine, patients tend to trust and cooperate more.
• Cultural Sensitivity: Nurses respect and adapt to each patient’s cultural background and beliefs.
They avoid assumptions and ask about preferences (for example, how a patient prefers to be
addressed). Cultural competence – like understanding personal space differences – is key to
respectful communication 9 .
1
• Clear, Patient-Centered Approach: Information is given in plain language (avoiding medical jargon)
and focused on the patient’s concerns. The nurse uses gentle tone, simple terms, and confirms
understanding. This patient-focused approach makes communication therapeutic.
Core Techniques: Nurses use specific methods to encourage patient expression and ensure understanding.
Key techniques include:
• Open-Ended Questions: Questions like “What brings you to the hospital today?” or “How are you
coping with this pain?” invite longer responses and give patients control over the topic 10 . These
questions often begin with “how,” “what,” or “tell me about…”.
• Silence: Allowing intentional pauses gives patients time to think and continue speaking. A nurse
might sit quietly and listen without interrupting, which shows patience and often prompts the
patient to share more 11 .
• Paraphrasing/Summarizing: The nurse restates the patient’s statements in her own words to
ensure understanding. For example, “It sounds like you’re worried about your surgery; is that right?”
This verifies information and demonstrates that the nurse is listening 12 .
• Reflecting: The nurse mirrors the patient’s feelings or
concerns to help the patient explore emotions. For
instance, “You sound frustrated because of the
waiting” helps patients clarify their feelings 13 .
Reflection validates the patient’s experience and
encourages deeper discussion.
• Clarification: If a patient’s statement is unclear,
the nurse asks for clarification. Phrases like “Can
you tell me more about that?” or “What do you mean by
___?” help ensure messages are clear and prevent
misunderstandings 13 .
• Acceptance and Recognition: Acknowledging
the patient’s statements (even nonverbally with a nod or
with words like “I see”) confirms the patient’s input.
Recognizing specific actions (e.g., “I noticed you took
your medication on time”) encourages positive behavior
without judgment.
• Offering Information: Providing relevant information
honestly and succinctly is therapeutic. The nurse gives
explanations and answers questions, and then asks if the
patient understands. Using techniques like teach-back (asking the patient to repeat instructions)
ensures understanding 14 12 .
• Professional Touch: When appropriate, gentle touch (like a hand on the shoulder) conveys support
and empathy 15 . For example, holding a patient’s hand during a procedure can reassure and comfort
them 15 . (Of course, nurses always ask permission and respect cultural boundaries before touching.)
Types of Therapeutic Communication: Communication can be verbal or nonverbal, and effective nursing
uses both. Below are key examples of each:
Nonverbal cues – Nurses convey caring and attentiveness through body language. A gentle touch or a
reassuring hand on the shoulder can comfort a patient . 1Eye
5 contact, open posture, and leaning toward the
2
patient (the SOLER technique: Sit squarely, Open posture, Lean forward, Eye contact, Relax 16 ) show the
patient that the nurse is fully engaged. Facial expressions (smiling, concerned look) and tone of voice also
communicate empathy and understanding. Silence and presence (simply being there) can itself be a
powerful nonverbal message of support.
• Verbal: Clear spoken words and tone. Nurses use open-ended questions and simple language so
patients can share openly 10 . They explain procedures and care plans in the patient’s language level,
describe medical information without jargon, and speak in a calm, reassuring voice. Verbal
responses (e.g. “I understand…”, “Tell me more…”) encourage communication.
• Nonverbal: Body language and non-word cues. As above, gestures like nodding and facial
expressions (smiling, attentive look) reinforce that the nurse is listening. Professional touch (hand on
arm), appropriate eye contact, and pauses are nonverbal tools. Even the distance and orientation
(facing the patient) matter. For instance, a nurse sitting at the patient’s level and making eye contact
signals respect and attention 17 .
Common Models (Nursing Theories): Nursing frameworks often highlight therapeutic communication. For
example, Hildegard Peplau’s Interpersonal Relations Theory describes the nurse-patient relationship in phases
(orientation, working, termination) and positions communication as the core of the nursing process 18 19 . In
the orientation phase, the nurse and patient get acquainted and build trust; in the working phase they
address problems; and in termination they end the relationship on a positive note 19 . Other nursing models
(e.g., Joyce Travelbee’s Human-to-Human model) similarly emphasize empathy, caring, and nursepatient
interaction. All these models underscore that a supportive, collaborative relationship (mediated by good
communication) is key to healing.
Barriers to Effective Communication: Several obstacles can interfere with therapeutic communication,
including:
• Medical or Sensory Issues: Patient conditions like pain, fatigue, hearing loss, aphasia, or intubation
can hinder understanding. For example, a patient in severe pain or under sedation may not be able
to communicate clearly 20 21 . An unconscious or very ill patient cannot engage in dialogue.
• Language and Cultural Differences: When the patient and nurse do not share a language9 or
culture, misunderstandings occur. Accents, idioms, and unfamiliar beliefs can be barriers .
Cultural taboos may inhibit questions or touch.
• Emotional/Psychological: Patient anxiety, anger, fear or depression can block communication.
Overly anxious or angry patients may refuse to talk or may be hostile 22 . Similarly, a stressed or
burnt-out nurse (experiencing workload stress or fatigue) may send negative nonverbal messages
(avoiding eye contact, appearing rushed) that discourage patient expression 23 24 .
• Environmental: Noisy, chaotic, or poorly lit settings (busy hallways, alarm beeps, or a lack of privacy)
disrupt communication 25 . Interruptions (eg. constant call lights or colleagues) break the flow of
conversation.
• Jargon and Complexity: Using medical terms or talking too quickly can confuse patients 26 . If the
nurse’s language is too technical, the patient may not follow or may feel intimidated.
• Attitudinal Barriers: Prejudice or judgment from either side hinders openness. For example, if a
patient is rude or hostile, a nurse may become defensive. Conversely, if a nurse shows disinterest or
judgment (even unintentionally by crossing arms or looking at a watch), the patient may shut down
27
7.
3
Strategies to Overcome Barriers: Nurses use many strategies to address these challenges:
• Environmental Control: Ensure privacy and minimize distractions. Speak with the patient in a quiet,
well-lit space with doors closed if possible 25 . Turn off or lower loud equipment and close
unnecessary TV/phones.
• Language Support: Use interpreters, translators, or bilingual staff when needed. Provide written
materials or picture boards in the patient’s preferred language 28 . Speak slowly and use simple
terms.
• Cultural Sensitivity: Learn about and respect the patient’s cultural norms (for example, preferences
about eye contact or touch). Ask culturally appropriate questions rather than making assumptions
9 . Be aware of nonverbal norms (personal space, gestures) and adapt accordingly.
• Active Listening & Feedback: Give patients time to speak, and practice teach-back. After explaining
something, ask the patient to repeat the information in their own words to check understanding 14
12 . Paraphrase and summarize the patient’s statements, and ask confirmatory questions (e.g.
“Does that sound right?”) to ensure clarity 12 14 .
• Avoid Jargon: Translate medical terms into everyday language. If you must use medical names,
follow with a simple explanation. For example, “You have hypertension (high blood pressure)…”
instead of using only the technical term.
• Manage Nurse Stress: Nurses should practice self-awareness. If feeling rushed or upset, take a
deep breath before entering a patient’s room. Using stress-reduction (deep breathing or a brief
break) helps maintain a calm demeanor 24 . When the nurse is relaxed and attentive, communication
flows better.
• Encourage Questions: Invite the patient to ask questions and clarify doubts. Use phrases like “What
questions do you have?” or “I’m here to help you.” This openness can overcome patient shyness or
fear.
• Therapeutic Touch and Presence: When appropriate, a nurse might place a hand on the patient’s
shoulder or simply sit quietly by the bed. Such gestures can overcome words – the patient feels the
nurse’s support. (Always ask permission and respect any refusal.)
• Role Modeling and Education: Explain the value of communication to both patients and families.
Sometimes family members can help bridge communication gaps. Nurses also learn continuously
(through training or mentors) how to improve their own communication skills.
Clinical Examples (Scenarios): Real-life scenarios illustrate these principles:
• Example 1 (Orientation/Building Trust): A nursing student begins a shift by greeting each patient
by name and explaining her role: “Hello Mr. Smith, I’m Jane, the nurse who will be taking care of you
today.” She sits facing the patient, makes eye contact, and pauses to let him ask questions 7 . By
introducing herself and listening respectfully, she establishes rapport. When Mr. Smith asks about
his treatment plan, she uses clear words and checks for understanding by asking him to repeat it
back. After this first conversation, Mr. Smith feels comfortable sharing other concerns, knowing Jane
is attentive and respectful.
• Example 2 (Active Listening & Empathy): A patient cries after hearing a difficult diagnosis. The
nurse calmly approaches, sits nearby, and remains silent, offering tissues. After a moment, the nurse
gently asks, “How are you feeling right now?” and listens without interrupting. When the patient says
“I’m scared,” the nurse replies, “It sounds like this news has really frightened you.” The nurse’s
4
paraphrasing and sympathetic tone make the patient feel understood. By the end of the
conversation, the patient has shared specific worries and feels a bit comforted by the nurse’s
understanding.
• Example 3 (Cultural Sensitivity): A nurse cares for a patient whose first language is not English.
When the nurse realizes the patient is struggling, she arranges for a translator over the phone. She
also uses simple, friendly language and gestures (for example, demonstrating breathing exercises)
to explain care. The nurse’s patience and use of a translator help the patient understand instructions
and feel respected.
• Example 4 (Pediatric Scenario): A child is anxious about an injection. The pediatric nurse sits at the
child’s level, smiles, and speaks softly. She lets the child hold a toy and explains the procedure using
play (“I’m going to give you a super-strong pretend shot on your arm”). She gives the child control by
saying “You can squeeze my hand if it hurts.” By combining simple words, play, and gentle touch, the
nurse uses therapeutic communication to reassure the child and make the experience less scary.
These examples show how techniques like open questions, silence, empathy, and clear explanations work in
real settings.
Benefits for Patients and Nurses: Therapeutic communication benefits patients by making them feel
heard, valued, and involved in their care. Patients who experience good communication report higher
satisfaction and trust in the healthcare team 6 5 . They are more likely to follow treatment plans (better
adherence) and have improved clinical outcomes – for example, studies link effective communication to
better blood pressure and glucose control 29 5 . When patients’ emotional needs are acknowledged, anxiety
decreases and recovery can improve.
For nurses, using therapeutic communication leads to more effective and rewarding care. A nurse who
communicates well builds a cooperative relationship, so work becomes smoother and conflict is reduced.
Patients are more open and compliant, which in turn makes the nurse’s job easier. Collaborative
communication also extends to the healthcare team: techniques like openness, active listening, and
respectful language are known to improve teamwork and patient safety 30 5 . In short, nurses gain
professional satisfaction from seeing happier patients and from working in a more supportive,
understanding environment.
Sources: These concepts are based on nursing communication textbooks and research 1 7 5 6 ,
which emphasize evidence-based techniques and guidelines for therapeutic nurse–patient interaction. The
cited sources (open nursing textbooks and clinical reviews) provide detailed discussion of these principles in
practice.
1 4 18 2.4 Therapeutic Communication - Fundamentals of Nursing | OpenStax
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2 5 6 Therapeutic Communication - StatPearls - NCBI Bookshelf
29 30 https://www.ncbi.nlm.nih.gov/books/NBK567775/
3 7 Chapter 2 Therapeutic Communication and the Nurse-Client Relationship - Nursing: Mental
8 13 Health and Community Concepts - NCBI Bookshelf
15 16 https://www.ncbi.nlm.nih.gov/books/NBK590036/
17 19
5
27
9 20 24 Chapter 2 Communication - Nursing Fundamentals - NCBI Bookshelf
25 26 28 https://www.ncbi.nlm.nih.gov/books/NBK591817/
10 11 12 17 Therapeutic Communication Techniques - Rivier Academics
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14 The Importance of Effective Communication in Nursing | USAHS https://www.usa.edu/blog/communication-
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21 22 Barriers to nurses’ therapeutic communication practices in a district hospital in Ghana |
23 BMC Nursing | Full Text
https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-023-01191-2
