COMMUNICATION

C.N.A 1ST YEAR

FON
By;
Nursing Faculty ; Perveena Shaheen
B.Sc. ,Diploma In G. Nursing ( NEBP )
Professional Post RN Nursing (UHS )
 THERAPEUTIC COMMUNICATION

Therapeutic communication is the use of communication for the purpose of

creating a beneficial outcome for the client.
Therapeutic communication:
• Is purposeful and goal-directed
• Has well-defined boundaries
• Is client-focused
• Is nonjudgmental
• Uses well-planned, selected techniques
CONTINUE,,
Ruesch (1961), who originated the
term therapeutic communication,
stated that the purpose is to
improve the client’s ability to
function.
 Principles of Therapeutic Interaction
Regardless of the type of interaction, principles and guidelines of
therapeutic communication are used to direct the nurse when relating with
clients. A discussion of basic principles for guiding therapeutic
communication follows.
• Plan to interview at an appropriate time.
The time frame within which an interaction occurs influences the outcome.
For example, it is unwise to plan to talk with a client during visiting hours,
during change of shift, or when the client is distracted by environmental
stimuli (e.g., the homebound client is watching a favorite television show).
In such situations , the nurse may be rushed or the client may be
preoccupied.
• Ensure privacy.
Clients are entitled to confidentiality. It is both a legal
mandate and an ethical obligation that nurses respect
the client’s confidence; this includes spoken words
and medical records. No one wants to discuss private
matters when or where other people are listening.
Privacy can be arranged by screening the client’s bed,
closing the door to the room, or finding a quiet
secluded place in which to talk.
• Establish guidelines for the therapeutic interaction.

During the initial contact with the client, the nurse should
share certain information such as the nurse’s name and
affiliation, purpose of the interaction, the expected length of
the contact with the client, and the assurance of
confidentiality. The client needs to have this basic
information, and it serves as an introduction to the
development of the therapeutic nurse-client relationship.
• Provide for comfort during the interaction.

Discomfort can be distracting. Pain interferes with a

person’s ability to concentrate; thus, communication
becomes impaired. See the Nursing Checklist, which
provides guidelines for promoting a client’s comfort
in order to improve communication.
• Accept the client exactly as is.

Being judgmental blocks communication. Nurses

who put aside personal prejudices , curiosities ,
feelings, and values are more receptive to the feelings
and behaviors of the client, regardless of content
stated by the client. Nonjudgmental nurses are less
encumbered by their own personal needs.
• Encourage spontaneity.

•The nurse gathers more data when the

client is talking freely. Also, the client
experiences relief and freedom from
worries by talking without inhibition.
• Focus on the leads and cues presented by
the client
. Asking questions just for the sake of talking or for the
satisfaction of one’s own curiosity does not contribute to
effective interviewing. Therapeutic interaction involves
discussing the client’s problems, needs, or concerns.
Therefore, allow the client to initiate the topic to be
discussed; then, use techniques to focus on that topic.
Pay attention to the verbal, paraverbal, and nonverbal
cues and signals of the client, and focus on them when
they occur.
• Encourage the expression of
feelings.
Simply allowing the client to talk is not interviewing.
Therapeutic interaction occurs when the client is
permitted to voice feelings about troublesome events
or interpersonal situations. Doing so requires the nurse
to identify those areas that are emotionally charged
and to focus on them.
• Be aware of one’s own feelings during the
interaction.
The nurse’s feelings influence the interaction. For example,
the nurse who becomes anxious may change the subject or
make comments that finalize the session. The nurse must
make a conscious effort to prevent personal feelings from
getting in the way of the client’s progress. Identifying one’s
own feelings and behavior and recognizing the way they
affect the client lead to better communications.
• Therapeutic Communication Techniques
Offering self •
• Nurse is available, physically and emotionally
• Indicates nurse’s willingness and intent to help
• Nurse’s presence is reassuring; may prompt client to
continue
• Indicates nurse’s attention and interest
• Broad openings
• Encourage client to choose topic for discussion
• Demonstrate respect for client’s thoughts
• Emphasize importance of client’s needs
 • Silence
• Gives client time to reflect
• Encourages client to express self
• Indicates interest in what client has to say
• Increases nurse’s understanding of client’s
message
• Helps to structure and pace the interaction
• Conveys respect and acceptance
Open-ended comments

• Unfinished sentences that prompt client to

continue
• Questions that require more than a one-word
answer
• Allow client to decide what content is relevant
 • Reflection
• Focuses on content of client’s message and feelings
• Repeating client’s words in order to prompt further
expression
• Lets client know the nurse is actively listening
• Communicates nurse’s interest
• Restating

• Repeating or paraphrasing client’s main idea

• Indicates nurse is listening to client
• Encourages further dialogue
• Gives client an opportunity to explain or elaborate
• Exploring
• Attempts to develop in more detail a specific
area of concern to client
• Identifies patterns or themes
•Recognition
• Nurse points out observed cues to client
• Clarifying
• Makes the meaning of client’s message clear
• Prevents nurse from making assumptions
about client’s message
• Nontherapeutic communication
• Nontherapeutic communication is a type of
communication that can make a patient feel
uncomfortable, increase stress, or worsen their
well-being.
• Nontherapeutic communication
techniques
• Reassuring
• Comments that indicate to the client that concerns or fears are unwarranted
• Agreeing
• Comments that indicate that the nurse's views are those of the client
• Approving
• Comments that indicate that the client's views, actions, needs, or wishes
are "good" rather than "bad“
• Defending
• Comments that are aimed at protecting the nurse, someone else, or
something from verbal attack
• Using closed questions
Questions or comments that can be answered by the client with one word
• Using stereotyped comments
"Pat" answers or clichés that indicate that the client's concerns are unimportant
or insignificant
• Changing focus
Switching to a topic that is more comfortable to discuss
• Judging
Comments or actions by the nurse that indicate pleasure or displeasure with what
the client says
• Blaming
Accusing the client of misconduct; undermining the client's need to be loved and
accepted.
• Belittling the client's feelings
• Indicating to the client that feelings expressed are unwarranted or
unimportant
• Advising
• Giving the client opinion or direction about solving a problem
• Rejecting
• Indicating to the client that certain topics are not open to discussion
• Disapproving
• Indicating displeasure about comments or behaviors or placing a
value on them
• Probing
• Pressuring the client to discuss something before he or she is ready