Textbook of Medical-Surgical Nursing 3e

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Chapter 2   Thoughtful practice

Table 2-1  Therapeutic Communication Techniques Technique Definition

Therapeutic value

Listening

Active process of receiving information and examining one’s reactions to the ­messages received. Periods of no verbal communication among participants for therapeutic reasons.

Nonverbally communicates nurse’s interest in patient.

Silence

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.

Restating

Repeating to the patient what the nurse believes is the main thought or idea expressed.

Reflection

Directing back to the patient his or her feelings, ideas, questions, or content.

Clarification

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.

Focusing

Broad openings

Humour

Discharge of energy through the comic enjoyment of the imperfect.

Informing

Providing information.

Sharing perceptions

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.

Theme identification

Suggesting

Increases the patient’s perceived options or choices.

Adapted from Stuart, G.W. (2012). Principles and practice of psychiatric nursing (10th ed.). St Louis: Mosby Inc.

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