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UNIVERSIDAD de MANILA

One Mehan Gardens, Ermita, Philippines

THERAPEUTIC COMMUNICATION TECHNIQUE

TECHNIQUE DESCRIPTION EXAMPLES


Accepting pauses or silence that may Sitting quietly (or walking with the
Using Silence extend for several seconds or minutes client) and waiting attentively until the
without interjecting any verbal client is able to put thoughts and
response feelings into words
Using statements or questions that (a). Can you tell me how it is for you?
Providing General Leads encourage the client to verbalize, (b). Perhaps you would like to talk about…
choose a topic of conversation, and (c). Would it help to discuss your feelings?
facilitate continued verbalization Where would you like to begin?
And then what?
Making statement that are specific Rate your pain on scale 0 - 10 (specific
Being Specific and Tentative rather than general, and tentative statement)
rather than absolute Are you in pain? (general statement)
You seem unconcerned about your
diabetes (tentative statement)
You don’t care about you
Asking broad question that lead or I’d like to hear more about that
invite the client to explore (elaborate, Tell me about…
Using Open-ended Question clarify, describe, compare or illustrate) How have you been feeling lately?
thoughts or feelings. Open-ended What brought you to the hospital?
questions the topic to be discussed and What is your opinion?
invite answer that is longer than one or
two words
Providing appropriate forms of touch to Putting an arm on client’s shoulder
reinforce caring feelings. Because Placing your hands over the client’s
Using Touch tactile contacts vary considerably hand
among individuals, families, and
cultures, the nurse must be sensitive to
the differences in attitude and practices
of client and self.
Actively listening to the client’s Client: I couldn’t manage to eat dinner
message and then repeating those last night not even the dessert
thoughts and/or feelings in similar Nurse: You have difficulty eating last
Restating or Paraphrasing words. This conveys that the nurse has night
listened and understood the client’s Client: Yes, I was very upset after my
basic message and also offers clients a family left
clearer idea of what they have said Nurse: You were upset when your
family left
Client: I have trouble talking to
strangers
Nurse: You find it difficult talking to
people you do not know
Seeking Clarification A method of making the client’s broad I’m puzzled
over all meaning of the message more I’m not sure I understand that, would
understandable. It is used when you please say that again
paraphrasing is difficult or when the I meant this, rather than that
communication is rambling or garbled. I’m sorry that wasn’t very clear. Let
To clarify the message, the nurse can me try to explain another way
restate the basic message or confess
confusion and ask the client to repeat
or restate the message. Nurses can also
clarify their own message with
statements
Seeking Consensual Validation A method similar to clarifying that Client: My husband never give me any
verifies the meaning of specific words present.
rather than the overall meaning of a Nurse: You mean he has never given
message you a present for your birthday or
Christmas?
Client: Well, not never. He does get
me something for my birthday and
Christmas but he never thinks of giving
anything at any given time.
Suggesting one’s presence, interest, or I’ll stay with you until your daughter
Offering Self wish to understand the client without arrives.
making any demands or attaching We can sit here quietly for a while; we
conditions that the client must comply don ‘t need to talk unless you would
with to receive the nurse’s attention like to
I’ll help you to dress or go home if you
like
Giving Information Providing in a simple and direct Your surgery is scheduled for 11 AM
manner, specific factual information the tomorrow.
client may or may not request. When You will feel a pulling sensation when
information is not known, the nurse the tube is removed from your
state this and indicates who has it or abdomen.
when the nurse obtain it.
Acknowledging Giving recognition, in a non-judgmental You trimmed your beard and
way, of a change in behavior, an effort mustache and wash your hair
the client has made, or a contribution I notice you keep squinting your eyes.
to a communication. Are you having difficulty seeing?
Acknowledgement may be with or You walked twice as far as today with
without understanding, verbal or your walker
nonverbal.
Clarifying Time and Sequence Helping the client clarify an event, Client: I vomited this morning
situation, or happening in relationship Nurse: Was that after breakfast?
to time Client: I feel that I have been asleep
for weeks
Nurse: You had your operation
Monday, and today is Tuesday
Presenting Reality Helping the client to differentiate the That telephone ring came from the
real from the unreal program in television
I see shadows from the windows
coverings
Your magazine is here in the drawer. It
has not stolen

Helping the client expand on and Client: My wife says she will look after
develop a topic of importance. It is me, but I don’t think she can,what
Focusing important for the nurse to wait until the with the children to take care of, and
client finishes stating the main concerns they’re always after about something,
before attempting to focus. The focus clothes, homework, what’s for dinner
may be an idea or a feeling; however, last night.
the nurse often emphasizes a feeling to Nurse: Sounds like you are worried
help the client recognize an emotion about how well she can manage.
disguised behind words.

Directing ideas, feelings, questions, or


content back to client to enable them Client: What can I do?
Reflecting to explore their own ideas and feelings Nurse: What do you think would be
about a situation helpful?
Client: Do you think I should tell my
husband?
Nurse: You seem unsure about telling
your husband
Stating the main points of a discussion During the past half hour we have
to clarify the relevant points discussed. talked about…
Summarizing and Planning This technique is useful at the end of an Tomorrow afternoon, we may explore
interview or to review a health teaching this further
session. It often acts as introduction to In few days I’ll review what you have
future care planning learned about the actions and effects
of your insulin
Tomorrow I will look at your feeling
journal

BARRIERS TO COMMUNICATION/NON-THERAPEUTIC COMMUNICATION

TECHNIQUE DESCRIPTION EXAMPLES


Offering generalized and over Two year old are brats
STEREOTYPING simplified beliefs about group of Women are complainers
people that are based on experiences Men don’t cry
too limited to be valid. These Most people don’t have any pain
responses categorize clients and after this type of surgery
negate their uniqueness as
individuals
Akin to judgmental responses, Client: I don’t think Dr. Kitty is a very
agreeing and disagreeing imply that good doctor. He doesn’t seem
AGREEING AND DISAGREEING the client is either right or wrong and interested in her patients.
the nurse is in the position to judge Nurse: Dr. Kitty is the head of the
this. This responses deter clients surgery and is an excellent surgeon
from thinking trough their position
and may cause a client to become
defensive
Attempting to protect a person or Client: Those night nurses must just
health care services from negative sit around and talk all night. They
comments. These responses prevent didn’t answer my light for even an
BEING DEFENSIVE the client from expressing true hour.
concerns. The nurse is saying, You Nurse: I’ll have you know we literally
have no rights to complain. Defensive run around on nights. You’re not the
responses protect the nurse only client, you know.
admitting weaknesses in the health
care services, including personal
weaknesses.
Giving a response that makes clients Client: I felt nauseated after those
prove their statement or point of red pills.
view. These responses indicates that Nurse: Surely you don’t think I gave
CHALLENGING the nurse is failing to consider the you the wrong pill?
client’s feelings, making the client Client: I feel as if I am dying
feel it necessary to defend a position. Nurse: How can you feel that way
when your pulse is 60?
Client: I believe that my husband
doesn’t love me
Nurse: You can’t say that; Why, he
visits you every day?
Asking for information chiefly out of Client: I was speeding along the
curiosity rather than with the intent street and didn’t see the stop sign.
PROBING to assist the client. These responses Nurse: Why were you speeding?
are considered prying and violate the Client: I don’t ask the doctor when he
client’s privacy. Asking why, is often was here.
probing and places the client in a Nurse: Why don’t you?
defensive position.
Asking the question that makes the Who do you think you are? (forces
TESTING client admit to something. These people to admit their status is only
responses permit the client only that of client)
limited answer and often meet the Do you think I am not busy?
nurse’s need rather than the clients. (forces the client to admit that the
nurse really is busy)

Refusing to discuss certain topic with


the client. These responses often I don’t want to discuss that
REJECTING make client feel that the nurse is Let’s talk about…
rejecting not only their Let’s discuss other areas of interest
communication but also the clients to you rather than the two problems
themselves. you keep mentioning
I can’t talk now. I’m on my way to
coffee break.
Directing the communication into Client: I’m separated from my wife.
areas of self-interest rather than Do you think I should have sexual
considering client’s concern is often a relations with other woman?
CHANGING TOPICS AND SUBJECTS self-protective response to a topic Nurse: I see that you’re 36 and that
that causes anxiety. These responses you like gardening. This sunshine is
imply what the nurse considers good for my roses. I have a beautiful
important will be discussed and the rose garden.
clients should not discuss certain
topics.
Using clichés or comforting You’ll feel better soon.
UNWARRANTED REASSURANCE statements of advice as a means to I’m sure everything will turn out all
reassure the client. These responses right.
block the fears, feelings, and other Don’t worry.
thoughts of the clients.
Giving opinions and approving and That’s good (bad)
PASSING JUDGMENT disapproving responses, moralizing, You shouldn’t do that.
or implying one’s own values. These That’s not good enough.
responses imply that the client must What you did was wrong (right).
think as the nurse thinks, fostering
client dependence
Telling the client what to do. Client: Should I move from my home
GIVING COMMON ADVICE These responses deny the client’s to a nursing home?
right to be an equal partner. Note Nurse: If I were you, I’d to a nursing
that giving expert rather than home, where you’ll get your meals
common advice is therapeutic cooked for you.