Therapeutic Communication

Dr. Libba McMillan was my favorite teacher in nursing school. A lot of students didn't like her because she didn't always teach the classes with the most "content." She didn't teach us clinical physiology, clinical practice techniques, or even fundamental nursing procedures, but taught us something much more important: therapeutic communication.

I think that therapeutic communication is the difference between a good nurse and a great nurse. Therapeutic communication is the most essential aspect of a patient-health care provider relationship. Without it, the best doctor or nurse is absolutely, well, useless.

Therapeutic communication, in addition to being the most important thing I developed for my nursing career, has been invaluable in relationships with my friends, family, and even strangers.

Here are just a few points on therapeutic communication from my study book for my nursing licensing exam. Actually, these are the only points on therapeutic communication included. It says:

Therapeutic Communication

Nonverbal interaction:

-May be more important than verbal communication

*(I personally think nonverbal interaction can drastically impact the nurse-patient relationship far more than verbal communication).

Verbal communications:

-Promote insight and help client to problem solve

-Must keep client as focus

-Allow clients to make choices

-JUST FACTS!

-Use matter-of-fact approach

A couple points that I remember, and have paraphrased, from Dr. McMillan's class:

• Ask open-ended questions, that is, ones that can't be answered with a yes or no answer.
• Never ask a patient why they did or didn't do something. "Why" questions are judgmental questions. (This is one of the hardest techniques for me to use).
• If you ask a patient, or friend, a question and you really intend to have them give you an answer wait in silence a little while until they answer.
• Don't walk out of the room while asking questions or talking to a client.
• If a patient is upset and cries you don't have to say anything. Your presence is enough. Sometimes it's even okay to cry with them.
• Speak on their level. That doesn't just mean explaining things in layman's terms. Actually bend down to talk to them. If they are sitting in the bed squat or sit nearby in order to talk to them while maintaining eye contact.
• Normalize the client's feelings, symptoms, and understanding. This also helps when interviewing a patient about uncomfortable subjects, e.g. "Many patients who take diuretics experience erectile dysfunction. Is this something you've experienced?"
• Acknowledge and directly address a client's confusion, fear, or other feelings regarding a diagnosis or procedure, e.g. A patient's wife complains that she is so exhausted from caring for her terminally ill husband. Don't say, "Well, you don't have to worry now. We will take care of him." Rather, try something like, "I can imagine you must be really exhausted from caring for your husband. Would you like to talk about it?"
• Finally, listen to your patients. They will tell you what is the matter with them. (Simply listening is one of the best tricks for a fruitful friendship).

Overall, therapeutic communication interests me very much. I wonder how many of these strategies we employ each day without even knowing it.

Do you find yourself ever using these therapeutic communication tools? If not, do any of them seem valuable to you?