I recently observed a Nursing Sick Call encounter and when it was completed, I asked the nurse a few questions about the patient’s complaint and discussed her use of the nursing protocols and the patient education she provided. I noted that she did an excellent job using therapeutic communication with the patient, and it was clear, as a result, that the patient left the encounter feeling heard. She shared that she did not know the term “Therapeutic Communication,” but that was the way she interacted with all her patients.
What is Therapeutic Communication?
Therapeutic communication is defined as the face-to-face process of interaction that focuses on advancing the physical and emotional well-being of a patient. Nurses use therapeutic communication techniques to ascertain patient problems, determine the correct course of action, and provide patient education and patient support, while maintaining objectivity and professional distance. This is especially important in our clinical setting. I must admit that when I went to school, I remembered it being used in conjunction with mental health nursing, but clearly it is important in all areas of nursing practice.
Techniques in Therapeutic Communication
There are a variety of techniques that may be used to engage in therapeutic communication with a patient, including the use of open-ended questions; acknowledgment and acceptance; using silence; asking for clarification; active listening; reflecting and summarizing. Not all techniques will be used in every encounter, but mastery and appropriate use of these will allow the correctional nurse to demonstrate professional nursing practice and caring for their patients.
When open-ended or broad questions are used, the patient is given the opportunity to direct the flow of the conversation and decide what is most important to them to discuss. An example question is, “What brings you to the clinic today?”
Acknowledgement and acceptance is not the same as agreement. Rather, it is the acknowledgement to the patient that he/she/they have been heard. An example response is saying, “Yes, I get what you are saying.”
Equally important is using silence. Often giving no response at all allows both you and the patient time to think about what was said or what they might want to say.
When Correctional Nurses ask for clarification during an encounter, it ensures that the nurse understands what the patient is trying to explain, and it may also allow the patient to have more clarity in their thinking, as they must rephrase their thoughts. Asking the patient to explain or stating that you don’t quite understand what they mean are examples of clarification.
Active listening is vitally important to all communication, but especially in a therapeutic intervention, when the goal is to have an open, honest, and effective conversation with the patient. It involves giving verbal and non-verbal cues to the speaker to show that you are engaged in the conversation. An example of a non-verbal active listening cue is nodding your head in agreement with something that is said. An example of a verbal active listening cue is asking “What happened after that?”
Reflecting is a technique used most often when the patient asks the Correctional Nurse to solve a problem or tell him/her/them what to do. It involves rephrasing the request/question back to the patient. For example, if the patient asks the Correctional Nurse what to do about a situation in the housing unit that is occurring, the Correctional Nurse should ask the patient what they think they should do and process the response together. This helps the patient take ownership of any decision that is made and will help him/her/them in the future when decisions need to be made.
Summarizing is also a very important technique that all Correctional Nurses should use when communicating with their patients. By restating what they heard the patient say, the Correctional Nurse verifies that he/she/they was listening, and that the patient was understood. This can be done throughout the conversation, or it can be done at the end, but it should include validation by the patient that the summary and the Correctional Nurse’s understanding of the conversation is the same as his/hers/theirs. If not, then the patient will have the opportunity to clarify the misunderstanding. A question to ask at the end of the summary is, “Am I understanding this correctly?”
Therapeutic communication is an important skill for correctional nurses and practicing the techniques does improve expertise. If you are using it already – great, continue to practice and hone your skill; if you are not, pick one or two techniques and use them in all your interactions where appropriate until you become proficient, then chose another to incorporate into your repertoire of therapeutic communication skills. Before you know it, you will be a master of all!
How do you feel about using therapeutic communication in your Correctional Nursing practice? Any pearls of wisdom for your colleagues?
Share your experiences in the comments section of this post.