06.02 Therapeutic Communication

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In this lesson, we’re going to talk about therapeutic communication.

This is an awesome quote by Carl Rogers, one of the pioneers to psychology. He was a humanist, so most, if not all of his theories hinged on this idea that we are all very unique individuals. The reason I use this quote is because I think that it helps to encourage the idea of therapeutic communication. It says “We think we listen, but very rarely do we listen with real understanding, true empathy. Yet listening, of this very special kind, is one of the most potent forces for change that I know.” Let’s look at how we can use what Rogers said to help out our patients.

When we communicate with our patients, we want to focus on connecting with them. It doesn’t do us any good to try to treat a patient or do procedures if they don’t trust us, or if they feel like a pin-cushion. You have to connect.

We always talk about “building rapport,” so what do I mean? I mean, create a relationship. It’s this two way street where you are privileged to care for a patient, and they trust you to provide that care.

By going in trying to at least gain a better understanding of what your patient is going through, then it changes the way you care for them, which can make all of the difference for that patient and their family.

And here are a couple of ways to do that. Remove biases. When the nurse you get report from says your patient is “grumpy,” ignore it. It puts this idea in your head that is far worse than grumpy.

Be aware of your own values, especially when you find common ground. When you find a common interest, you recognize that you and the patient have something in common - and you can connect with them. And when you connect, it really helps to foster that trust between you.

When we talk about communicating therapeutically with a patient, what do I mean? What tools can you use?

Let’s look at those. First off, you can listen actively. Pull a chair up and sit down next to the patient. Look at them in their eyes and listen really intently. They may not get to have great conversation with people because everyone is so focused on the patient being sick - really listen to them, and only respond when they stop talking. And be silent if you have to - that’s ok. That gives you the opportunity to act instead of react. Because once those words come out, you can’t put them back in.

Also paraphrase, summarize and clarify. By that I mean, take Memaw’s 5 minute long conversation about how she went to the store to pick up groceries and she saw a good sale on pickles and that one nice gentleman she always sees was restocking the fruits and she didn’t see the spilt milk on the ground that caused her to slip, humor Memaw, but then summarize it. So you can say something like “So you went to the store and slipped, is that right?” You’re asking for clarity, summarizing and paraphrasing it. And by asking a question, it gives them the opportunity to let you know if you missed something important to them. So listen carefully, and tell them what you heard.

Also, do this with empathy. Don’t be mundane, engage your patient and show you care for them by feeling what they’re feeling.

Sometimes, you’ll come across patients that just want to vent, and that’s ok. They use it as a way to process grief or disgust, or sometimes that’s just part of who they are. And until you figure out how to navigate that, ask them, “Would you prefer I just listen? Because I’ll be glad to.”

And sometimes they’ll just be ok with that. Other times, they’re asking for advice or reaffirmation. For instance, if they grow frustrated with the multiple times they’re woken up in the middle of the night for bloodwork, they want to hear from someone else that they’re justified in believing what they do. Hell, I’d hate to be woken up, so I’ll surely empathize with them. I’ll reaffirm their beliefs.

This is a tricky area though - be careful not to just give unsolicited advice. “What would you do?” is a great time to tell them what you think. But if not, then go back to using those communication tools we just talked about to help communicate with them.

Knowing when to respond is tricky. Since a majority of communication is nonverbal, you have to pay attention to more than just words.

But do pay attention to words, but also to feelings, to expressions, to tone and volume and inflection. These give you ideas as to how people actually feel. If their tone changes to soft, or sad, pay more attention to their body language and what they’re talking about - it could cue you in on the opportunity to be extra-caring in a time that the patient may need it. It might show you the opportunity to consider any other changes in the patient’s overall behavior. So just don’t listen to words, watch your patient as a whole.

Today, we really focused on the ideas behind communication, professionalism and interpersonal relationships for our therapeutic communication with our patients.
Ok, so let’s recap.

Connect with your patient. There are multiple ways to do this. Remove your bias and start each interaction with a clean slate.

Use the tools of communication. Summarize or paraphrase what your patient said, and if you need a second to find the right words, do so.

Your patient sometimes looks to you to vent about an issue. Just listen. You could make all the difference.

Watch your patient. Communication is also nonverbal, and that can give you the opportunity to embrace what your patient is saying because they did something that tells you how the patient REALLY feels.

That’s it for our lesson on therapeutic communication. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!
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