Chapter 2
Thoughtful practice
31
well as techniques and strategies for assessing behaviours and
role changes are discussed in Chapter 4.
Other components of the database
Additional relevant information should be obtained from the
patient’s family or significant others, from other members of
the health team, and from the patient’s health record or chart.
Depending on the patient’s immediate needs, this information
may have been obtained before the health history and the
physical assessment were conducted. Whatever the sequence
of events, it is important to use all available sources of perti-
nent data to complete the nursing assessment.
Recording the database
After the health history and physical assessment are com-
pleted, the information obtained is recorded in the patient’s
health record that provides a means of communication among
members of the healthcare team.
A variety of systems are used for documenting patient
care, and each healthcare agency selects the system that best
meets its needs. The types of systems available include the
problem-oriented health record system, focus charting, patient
outcome charting, problem intervention evaluation (PIE)
charting, and charting by exception (CBE). In addition, many
healthcare agencies have moved towards computerised doc-
umentation systems; these appear to save time, improve the
monitoring of quality improvement issues, and make it easier
to access patient information.
Diagnosis
The assessment component of the nursing process serves as
the basis for identifying nursing diagnoses and collaborative
problems. Soon after the completion of the health history and
the physical assessment, the nurse organises, analyses, synthe-
sises, and summarises the data collected and determines the
patient’s need for nursing care.
Nursing diagnosis
Nursing, unlike medicine, does not yet have a universally
accepted and used taxonomy, or classification system, of diag-
nostic labels. The NMBA’s National Competency Standards
(2006a) refer to the need for accurate nursing assessment
and the formulation of a plan of care. The plan of care using
nursing diagnoses is an important communication tool provid-
ing a common language that enhances communication among
colleagues, and facilitates the coding of standardised informa-
tion for use in databases. Nursing diagnoses have fostered the
Listening
Silence
Restating
Reflection
Clarification
Focusing
Broad openings
Humour
Informing
Sharing perceptions
Theme identification
Suggesting
Active process of receiving information and examining
one’s reactions to the messages received.
Periods of no verbal communication among participants
for therapeutic reasons.
Repeating to the patient what the nurse believes is the
main thought or idea expressed.
Directing back to the patient his or her feelings, ideas,
questions, or content.
Asking the patient to explain what he or she means
or attempting to verbalise vague ideas or unclear
thoughts of the patient to enhance the nurse’s
understanding.
Questions or statements to help the patient develop or
expand an idea.
Encouraging the patient to select topics for discussion.
Discharge of energy through the comic enjoyment of
the imperfect.
Providing information.
Asking the patient to verify the nurse’s understanding
of what the patient is thinking or feeling.
Underlying issues or problems experienced by the
patient that emerge repeatedly during the course of
the nurse–patient relationship.
Presentation of alternative ideas for the patient’s
consideration relative to problem solving.
Nonverbally communicates nurse’s interest in patient.
Gives patient time to think and gain insights, slows the
pace of the interaction, and encourages the patient
to initiate conversation, while conveying the nurse’s
support, understanding, and acceptance.
Demonstrates that the nurse is listening and validates,
reinforces or calls attention to something important
that has been said.
Validates the nurse’s understanding of what the patient
is saying and signifies empathy, interest and respect for
the patient.
Helps to clarify the patient’s feelings, ideas, and
perceptions and to provide an explicit correlation
between them and the patient’s actions.
Allows the patient to discuss central issues and keeps
communication goal-directed.
Indicates acceptance by the nurse and the value of the
patient’s initiative.
Promotes insight by bringing repressed material to
consciousness, resolving paradoxes, tempering
aggression, and revealing new options; a socially
acceptable form of sublimation.
Helpful in health teaching or patient education about
relevant aspects of patient’s well-being and self-care.
Conveys the nurse’s understanding to the patient and has
the potential to clarify confusing communication.
Allows the nurse to best promote the patient’s exploration
and understanding of important problems.
Increases the patient’s perceived options or choices.
Table 2-1 Therapeutic Communication Techniques
Technique
Definition
Therapeutic value
Adapted from Stuart, G.W. (2012).
Principles and practice of psychiatric nursing
(10th ed.). St Louis: Mosby Inc.
