Therapeutic Communication Cheat Sheet

Table of Contents: 1. Therapeutic Relationships 4. Cultural Considerations 2. Therapeutic Communication 5. NCLEX Practice Questions 3. Nontherapeutic Communication Therapeutic Communication 1. Therapeutic Relationships y Time-limited relationships between nurse and client that serve a specific purpose (e.g., developing communication or healthy coping skills)
Discuss the timeline for termination of the nurseclient relationship at the first client meeting (“I will be your nurse until 7 p.m. tonight.”). y Focus on the client’s needs, not the nurse’s needs. y Uses therapeutic communication to build rapport, gain trust, and gather relevant information 2. Therapeutic Communication TABLE 1. THERAPEUTIC COMMUNICATION THEMES y Non-judgmental observations: Neutral, factual statements that demonstrate active listening to: y Let the client know you’ve heard what was said. y Validate the client’s emotions by: y Invite clients to share information in their own words by: Restating Client: “I have been up all night.” Nurse: “You didn’t sleep last night?” Reflecting Client: “What should I do about this situation?” Nurse: “What do you think you should do?” Seeking clarification “I am not sure I understand what you mean.” Giving broad openings “Where do you want to start?” Open-ended questions “Tell me more Offering general leads about ___.” Encouraging description “What makes you feel that way?” Exploring “Could you describe ___?” Silence Sitting in silence Non-judgmental Accepting communication Making observations “Yes. I understand.” “You seem nervous.” Mental Health y Exploring: “I’d like to hear more about your concerns.” y Encouraging description: “Tell me about how you are feeling now.” Example Active listening
Therapeutic communication uses non-judgmental observations and/or open-ended questions (TABLE 1). y Making observations: “That must have been very difficult.” y Restating: “This has been a very stressful time for you.” y Open-ended questions: Cannot be answered with “yes” or “no” Type  Discuss the timeline for termination of the nurse-client relationship at the first client meeting.  Therapeutic communication uses nonjudgmental observations and/or open-ended questions. © 2024 Bootcamp.com 5 2. Therapeutic Communication (Continued) y Nonverbal communication: Behaviors such as body language or tone of voice y Nonverbal cues often convey a person’s true emotions.
If verbal and nonverbal communication don’t match, further assessment is required. y Mismatched verbal and nonverbal communication (e.g., a tearful client states, “Everything is fine.”) indicates an underlying issue (distress, confusion, dishonesty). 3. Nontherapeutic Communication Conveying Judgment Interrogating Disregarding the client’s experience Type Effect on Client Example Therapeutic Alternative Making value judgments May feel unsupported, guilty, angry “Why are you still working when your child has cancer?” “I see you are still working. Is this a problem?” Approving May want to please the health care provider “I think that was the right choice.” “What happened that made you make that decision?” Disapproving May be defensive “I disagree with that choice.” “How did you come to that choice?” Excessive questioning May feel confused and overwhelmed “What did you eat?” “Was it good?” “Did you get enough?” “Tell me about your eating habits.” Asking “why” questions May feel criticized “Why did you think it was “Tell me what made you a good idea to quit?” quit.” Giving advice Assumes client can’t make decisions and the nurse knows best “You need to immediately “What do you think you leave your abusive want to do?” husband.” Minimizing feelings Lacks empathy “I know how you feel.” “This must be very difficult for you.” Falsely reassuring Minimizes the client’s feelings “Don’t worry about that.” “What specific concerns do you have?” Changing the subject May feel invalidated Client: “I keep gaining weight.” Nurse: “Did you change your diet as we discussed?” Client: “I keep gaining weight.” Nurse: “You sound frustrated, what has your diet been like?” Mental Health TABLE 2. NONTHERAPEUTIC COMMUNICATION  If verbal and nonverbal communication don’t match, further assessment is required. © 2024 Bootcamp.com 52 3. Nontherapeutic Communication (Continued) y Avoid conveying judgment, interrogating the client, or disregarding the client’s experience. y Damages the therapeutic relationship and impairs communication
Conveying judgment: Makes the client feel shamed and defensive y Example: Expressing approval or disapproval (“I think you are wrong to smoke when your child has asthma.”)
Interrogating: Makes the client feel shamed and defensive y Example: Asking “why?” questions (“Why did you stop taking your medications?”)
Disregarding the client’s experience: Invalidates the client’s emotions by implying there is no reason to worry 4. Cultural Considerations
Collaborate with the health care team to safely incorporate cultural preferences in the care plan. y Example: The treatment team collaborates with a spiritual healer to safely include traditional healing ceremonies in the client’s care plan. y Communication styles are impacted by religion and culture. y Examples: y Use of touch or amount of physical space preferred y Amount of eye contact considered appropriate y Level of emotions expressed Mental Health y Example: Giving false reassurance, or false comfort/hope (“Don’t worry. Everything is going to be okay.”)  Avoid nontherapeutic communication such as asking “why” questions and giving false reassurance.  Collaborate with the health care team to safely incorporate cultural preferences in the care plan. © 2024 Bootcamp.com 53 5. NCLEX Practice Questions 1. 2. 3. 4. “Why are you so worried?” “Don’t worry. Everything will be fine.” “You shouldn’t think about that right now.” “It sounds like you’re feeling anxious. What concerns do you have?” Hint: Look for therapeutic communication strategies such as making observations and asking open-ended questions. A client is upset and reports feeling overwhelmed at work. How should the nurse respond? 1. 2. 3. 4. “Have you tried doing yoga?” “You should quit your job immediately.” “Work is a big source of stress for you.” “I think you were right to tell your coworkers how you feel.” Hint: Look for active listening techniques like restating what the client has said. A client states, “I decided to stop taking my medication.” How should the nurse respond? 1. “Why did you stop taking your medication?” 2. “You need to resume that medication immediately.” 3. “Tell me about the barriers you had to taking this medication.” 4. “Did it make you sick? Could you afford it? Was there a pharmacy issue?” Hint: Look for the non-judgemental openended question. Correct: 4. “It sounds like you’re feeling anxious. What concerns do you have?” begins with a NON-JUDGMENTAL OBSERVATION, which shows the nurse is listening and understands. Use of an OPEN-ENDED QUESTION invites the client to share further, helping the nurse to understand the source of anxiety. Incorrect: 1. “Why are you so worried?” is a why question, which is a form of INTERROGATING. 2. “Don’t worry. Everything will be fine,” gives false reassurance, which is a form of DISREGARDING. 3. “You shouldn’t think about that right now,” CONVEYS JUDGMENT, which is non-therapeutic. Correct: 3. “Work is a big source of stress for you,” retates and reflects the client’s feelings, which demonstrates empathy and ACTIVE LISTENING. Incorrect: 1. “I think you were right to tell your co-workers how you feel,” expresses approval, which CONVEYS JUDGMENT. 2. “Have you tried doing yoga?” changes the subject, which DISREGARDS the client’s feelings. 4. “You should quit your job immediately” gives advice, which DISREGARDS the client’s feelings. Correct: 3. “Tell me about the barriers you had to taking this medication” is a form of an OPEN-ENDED QUESTION and is a non-judgmental invitation for the client to share more. Mental Health A client expresses anxiety about an upcoming procedure. How should the nurse respond? Incorrect: 1. “Why did you stop taking your medication?” is a why question, which is a form of INTERROGATING. 2. “You need to resume that medication immediately” gives advice, which DISREGARDS the client’s feelings. 4. “Did it make you sick? Could you afford it? Was there a pharmacy issue?” demonstrates excessive questioning, which is a form of INTERROGATING. © 2024 Bootcamp.com 54  When should the nurse discuss the timeline for termination of the therapeutic relationship?  In therapeutic communication, observational statements should be non-______, and questions should be ______-ended.  Further assessment is required if there is a mismatch between the client’s _____ and _______ communication.  Avoid nontherapeutic communication such as passing judgment, asking “____” questions, and giving false ________.  To safely incorporate cultural preferences into the care plan, the nurse must _______ with the health care team. Mental Health Answers: 1. At the first meeting 2. nonjudgmental, open 3. verbal, non-verbal 4. why, rassurance 5. collaborate References: Halter, M. J. (2022). Varcarolis’ foundations of psychiatric-mental health nursing: A clinical approach (9th ed.). Elsevier. Videbeck, S. L. (2023). Psychiatric-mental health nursing (9th ed.). Wolters Kluwer. Pollard, C. L. & Jacubek, S. L. (2023). Vacarolis’s Canadian psychiatric mental health nursing: A clinical approach (3rd ed.). Elsevier. © 2024 Bootcamp.com 55