9 Effective Communication
Laura K. Garner-Jones
Chapter 9 Overview
- Review communication essentials
- Understand and apply therapeutic communication and techniques to nursing practice
- Evaluate non-therapeutic communication and its impact on the patient
Introduction
Communicating honestly, genuinely, and authentically is a powerful approach. It opens the door to creating meaningful connections with others. The importance of effective communication in nursing cannot be overstated. For example, without a patient disclosing symptoms such as chest pain, it would be difficult for the nurse to interpret the problem and determine the appropriate course of care. The quality of nursing care depends heavily on the accuracy and completeness of the information gathered, making strong relational and communication skills essential. When information is missing or incomplete, nurses are limited in their ability to provide safe, effective, and holistic care. Patients may withhold important details if they sense disinterest or insincerity, or if they fear judgment, misunderstanding, or ridicule. These missed opportunities for open dialogue can significantly affect assessment accuracy, care planning, and health outcomes.
Effective communication is a two-way dialogue in which both individuals actively speak and listen, exchange information, ask clarifying questions, and express opinions, ensuring that both parties fully understand what their counterpart is saying (Boykins, [year]). It requires empathy, attentiveness, and respect, qualities that foster trust and cooperation between patients and providers. Research has consistently shown that effective communication is crucial in delivering patient care and promoting recovery (Crawford et al., 2017; Madula et al., 2018; Schopf et al., 2017). In fact, Joolaee et al. (2010) found that patients often value good communication from nurses even more than the physical aspects of their care.
This chapter examines the principles of effective communication in nursing, focusing on therapeutic strategies that promote nurse–patient relationships and non-therapeutic patterns that can erode trust. By developing these skills, nurses can ensure that every interaction contributes to compassionate, person-centered, and high-quality care.
Patient Communication
Nurses’ communication skills and strategies should focus on educating, supporting, and empowering patients to manage their healthcare needs effectively (Arnold & Boggs, 2019). Effective nurse–patient communication enhances patients’ understanding of their health conditions and treatment options, enabling them to become active, informed participants in their own care. In many ways, communication in nursing mirrors the profession itself; it is both an art and a science. The science lies in understanding communication, evidence-based strategies, and applying structured frameworks to guide dialogue. The art, however, is reflected in how the message is expressed. A nurse’s tone of voice, body language, sense of humor, empathy, calmness, and overall demeanor are very individual and can shape how messages are received and interpreted (Arnold & Boggs, 2019). These subtle interpersonal dynamics can either foster trust and openness or create distance and discomfort.
Successful nurse–patient interactions also require a person-centered approach, in which the patient’s preferences, beliefs, and values are acknowledged and incorporated into care planning. Being able to “read the room” and adapt communication accordingly is an essential professional skill. Nurses must be attentive to patients’ verbal and nonverbal cues, such as their comfort with physical space, receptiveness to humor, or attitudes toward touch, to ensure that communication remains respectful and supportive. Establishing a positive first impression is equally important, as it sets the tone for future interactions and can significantly influence the therapeutic relationship and overall outcomes.
When communication is effective, the impact extends far beyond the exchange of information. According to Arnold and Boggs (2019), the benefits of effective communication include:
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- Increased patient satisfaction
- Early identification of changes in health status
- Improved understanding of patient needs and health conditions
- Enhanced patient outcomes
Ultimately, mastering communication enables nurses to not only deliver information but also connect, comfort, and empower, transforming each interaction into an opportunity for healing and trust.
Communication Essentials for Nurses
Establishing Rapport
Expectations
Managing expectations can eliminate emotional reactions. An expectation is the belief that something will happen. Once emotional reactions are managed, expectations are managed in return. Healthcare providers who manage expectations are better able to care for patients. For example, a patient may have the expectation that they will feel better immediately postoperatively from knee replacement surgery, only to find that they are in pain from the surgery. The nurse should help the patient manage their expectations for the postoperative period, thereby helping to manage the emotional reactions the patient might have.
Self-Awareness
Having self-awareness means being able to recognize and understand one’s own emotions that arise in communication encounters. Healthcare providers should attempt to have self-awareness when caring for patients. Healthcare providers can encounter circumstances in which their nonverbal communication may show their thoughts that may not always be positive. For instance, a patient with a large, necrotic wound and a foul odor will likely be embarrassed about the wound and appreciate healthcare providers who can care for them without betraying their emotions through facial expressions, such as holding their breath or making a facial expression of disgust.
Social Awareness
Social awareness is an understanding of the strong emotions one might encounter as part of their experiences and how they can empathize with others. For instance, a nurse who witnessed a fetal demise during delivery may develop intense emotions of sadness with subsequent deliveries. Being socially aware of the perspective of a parent who is experiencing fetal demise gives the healthcare provider a new perspective to understand the behavior of others who have experienced fetal demise.
Healthcare providers who have emotionally charged experiences should engage in self-care to manage intense emotions, allowing them to continue serving patients effectively (Fessell & Goleman, 2020). Healthcare providers who are depleted and lack self-awareness or the ability to manage their emotions will be unable to provide effective care to patients. During the COVID-19 pandemic, nurses experienced deeply emotional experiences caring for many patients who died; patients who included coworkers, friends, and families. Nurses needed to participate in self-care to prevent burnout.
Therapeutic Communication
Effective communication occurs when nurses establish trusting, therapeutic relationships with their patients (Arnold & Boggs, 2019). When nurses communicate in a therapeutic way, they are interacting for the purpose of learning about the patient’s values, preferences, culture, interests, health needs, and developmental level (Rosenberg & Gallo-Silver, 2011).
Therapeutic communication is a common form of communication used in healthcare. It is defined as “The purposeful, interpersonal information-transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills, which leads to client understanding and participation” (Abdolrahimi et al., 2017). Therapeutic communication is at the foundation of the nurse-patient relationship. It is different than the conversations you have with friends, peers, family, and colleagues. It is intended to develop an effective interpersonal relationship that supports the client’s well-being and ensures holistic, person-centered, quality care. The word “therapeutic” is related to the word “therapy,” which is defined as having a restorative and healing effect on the mind and body, as well as doing no harm. It is essential to consider how you communicate and its impact on the client.
Therapeutic communication techniques have been used by nurses for many years. The roots of this approach date back to Florence Nightingale, who emphasized the importance of establishing trusting relationships with clients and believed in the therapeutic healing that resulted from nurses’ presence with them (Karimi & Masoudi, 2015). Since then, several professional nursing associations have highlighted therapeutic communication as one of the most vital elements in nursing. Therapeutic communication is a learned skill, just like inserting a intravenous catheter. Acquiring therapeutic communication skills requires a concerted effort. Ongoing practice, self-reflection, and refinement of communication skills will enable nurses to adapt to various situations and continually enhance patient safety.
An Example of Therapeutic Communication
Ms. Z. is a nursing student who enjoys interacting with clients. When she visits clients’ rooms, she greets them and introduces herself and her role in a calm and professional tone. She kindly asks clients about their problems and notices their reactions. She does her best to encourage problem-solving and answer questions. Clients perceive that she wants to help them. She treats clients professionally by respecting boundaries and listening to them in a nonjudgmental manner. She addresses communication barriers and respects clients’ cultural beliefs. She assesses clients’ health literacy and ensures they understand her messages and educational materials. As a result, clients trust her and feel as if she cares about them, so they feel comfortable sharing their health care needs with her (Abdolrahimi et al., 2017).
Therapeutic Communication Strategies and Techniques
Therapeutic communication strategies and techniques are specific methods used to provide patients with support and information while focusing on their concerns. These techniques encourage patients to explore their feelings, solve problems, and develop coping responses to medical conditions and life events. There are various therapeutic communication techniques in health care. Nurses should be well-versed in these various techniques and apply the appropriate techniques (based on the situation) in every patient communication encounter.
Here are some key therapeutic communication strategies (Table 9.1) that nurses can use to promote patient safety and improve outcomes. By incorporating these strategies into their practice, nurses can contribute to a safer healthcare environment and enhance patient outcomes. Ongoing reflection and refinement of communication skills will enable nurses to adapt to various situations and continually enhance patient safety.
Table 9.1 Therapeutic Communication Techniques
| Therapeutic Technique | Description |
|---|---|
| Acceptance | Sometimes it is important to acknowledge a patient’s message and affirm that they’ve been heard. Acceptance isn’t necessarily the same thing as agreement; it can be enough to simply make eye contact and say, “Yes, I hear what you are saying.” Patients who feel their nurses are listening to them and taking them seriously are more likely to be receptive to care. |
| Active Listening |
Practice active listening to fully understand patients’ concerns, preferences, and needs. Nurses can offer general leads, such as “What happened next,” which gives patients the courage to continue the discussion. Nurses need to offer their full attention during nurse-patient communication, without making any judgments or assumptions. Ineffective body language during these interactions can impede message transmission, such as looking at the clock or watch, responding to a text message, or beginning to walk away from the patient. The listener must be both physically attentive and mentally focused on the spoken message, while visibly displaying a relaxed and open-minded body language (Chichirez & Purcărea, 2018). You can demonstrate that you are an active listener by maintaining eye contact and adopting an open posture. You can also use facilitation strategies that demonstrate active listening and encourage the client to elaborate, such as nodding and responding with phrases like “uh-huh” and “tell me more.” Active listening can also be demonstrated by paraphrasing what the client says, which shows that you are listening and encourages them to elaborate. |
| Address Differences | Recognize, respect, and address various differences in communication styles based on social identities. Tailor your communication approach to meet the needs of different patient populations. |
| Advocacy | Advocate for patients by ensuring their rights, preferences, and safety concerns are communicated to the healthcare team. Speak up if you observe any potential safety issues or errors. |
| Clarify | Nurses should clarify the communication received from patients. Often, patients use confusing and ambiguous language when describing health issues. Nurses should ask questions to help clarify the communication so that both parties can better understand the issues. Saying something such as “I’m not sure I understand. Can you explain it to me?” helps nurses ensure they understand what’s actually being said and can help clients process their ideas more thoroughly. |
| Clear & Concise Communication | Use clear and simple language to convey information to patients and their families. Avoid using medical jargon and explain complex concepts in a clear and understandable way for patients. |
| Clear Handoff Communication | When handing off patient care to another nurse or healthcare provider, communicate important information accurately and comprehensively. Use standardized handoff tools (SBAR) and protocols to minimize the risk of miscommunication. |
| Collaboration | When patients and caregivers are included in the care process and invited to share their information and opinions, communication improves because misunderstandings and misconceptions are minimized, and education is enhanced (Kwame & Petrucka, 2021). |
| Comparisons | Clients often draw upon previous experiences to deal with current problems. By encouraging them to make comparisons to situations they have previously coped with, nurses can help clients discover solutions to their problems. For example, the following exchange demonstrates encouraging comparisons. Nurse: “It must have been difficult when you went through a divorce. How did you cope with that?” Client: “I walked my dog outside a lot.” Nurse: “It sounds like walking your dog outside helps you cope with stress and feel better?” |
| Conflict Resolution | Develop skills in resolving conflicts and disagreements with patients and families in a professional manner. Address conflicts promptly to maintain a positive and therapeutic care environment. |
| Empathy | Demonstrating empathy involves understanding the emotions and experiences of others and responding with sensitivity. Research has demonstrated that when healthcare teams communicate with empathy, there is improved client healing and a decrease in medical errors (Morrison, 2019).It is important to imagine what another person is experiencing. You need to be curious and demonstrate interest by responding to what the client is saying (e.g., “Tell me more. How do you feel about it?”). Don’t get caught up in following your interview guide – it’s important to let the client’s narrative shape the interview. When a client is talking about a difficult experience, you may say something such as, “That must be very difficult.” |
| Focusing | Sometimes during a conversation, patients may mention something particularly important. When this happens, nurses can focus on their statement, prompting patients to discuss it further. For example, the following exchange demonstrates focusing. Client: “I am nervous about going home.” Nurse: “You’re feeling anxious about going home. Tell me more about that. |
| Hope | Because hospitals can be stressful places for clients, sharing hope that they can persevere through their current situation can help promote coping. However, nurses must avoid giving false reassurance. For example, telling a client who was recently diagnosed with a serious medical condition, “You’ll be fine,” is false reassurance and not therapeutic. On the other hand, stating, “I remember you shared with me how well you have coped with difficult situations in the past,” is an appropriate therapeutic use of offering hope. |
| Humor | Lightening the mood with humor can help nurses establish rapport and promote a positive state of mind. However, the client should not be given the impression that their situation is not serious or that the nurse is minimizing their feelings or concerns. Humor must be tailored to the client’s sense of humor, or clients may take offense. |
| Information & Education | Nurses are responsible for educating and informing patients and families. Provide patients with information about their condition(s), medication, and treatment plans.Patient education should be ongoing, with nurses using every encounter as an opportunity to educate. Ensure patients understand the information you provide by using techniques like ‘Teach back.’ Patients should also understand their role in maintaining their health and safety. |
| Offering self | Patients in any setting can experience loneliness, fear, and stress. A nurse who offers themselves by sitting with the patient or spending time talking with them is offering themselves. When nurses are present with their patients, it shows patients they value them and are willing to give them time and attention. Offering to simply sit with patients for a few minutes is a powerful way to create a caring connection. Some patients report a mood boost after spending one-on-one time with a nurse. |
| Open Communication | Encourage patients to express their thoughts, concerns, and questions. Foster an environment where patients feel comfortable sharing information about their health and any changes in their condition. |
| Paraphrasing | Paraphrasing rephrases the patient’s words and key ideas to clarify their message and encourage additional communication. For example, if a patient states, “I’ve been way too busy today,” the nurse can therapeutically respond by stating, “Participating in physical and occupational therapy today has kept you busy.” |
| Permission Statements | Use permission statements to initiate conversations that may be difficult to discuss. Permission statements are a combination of statements and questions that suggest to the client that an experience or feeling is expected or normal.One example of a permission statement is: “Often, children your age experience changes in their bodies that they have questions about.” Another example is: “Patients who have experienced your type of surgery often have questions about sex. Do you have any questions for me?” Another example is: “Many people your age begin to experience problems with urinary incontinence. Have you had any issues?” |
| Questioning: Relevant & open-ended | Nurses should ask relevant questions about the healthcare issue to gather information before helping the patient make a decision about their care. It is important not to overwhelm the patient with questions.Additionally, using open-ended questions or statements can enhance the flow of communication. Statements like “Tell me about your concerns” can be a good way to allow clients an opportunity to discuss what is on their minds. |
| Recognition | Recognition acknowledges a patient’s behavior and highlights it without giving an overt compliment. A compliment can sometimes be perceived as condescending, especially when it concerns routine tasks.An example of a nurse giving recognition would be saying something such as, “I noticed you took all of your medications today.” This statement draws attention to the positive action and encourages it. |
| Reflection | Patients often ask nurses for advice on how to address specific problems. Nurses can ask patients what they think they should do, which encourages them to take responsibility for their own actions and helps them develop solutions independently.For example, the following exchange demonstrates reflecting. Client: “Do you think I should do this new treatment or not?” Nurse: “What do you think are the pros and cons of the new treatment plan? |
| Restating | Restating uses different word choices for the same content stated by the patient to encourage elaboration. For example, if a patient states, “The nurses hate me here,” the nurse can respond therapeutically, “You feel as though the nurses dislike you?” |
| Share feelings | Patients should be encouraged to share their feelings. Because patients are often frustrated with healthcare, nurses can create safe spaces where patients feel comfortable sharing their feelings. |
| Share observations | Nurses should share their observations about the patient while providing care. Observations about a patient’s appearance, demeanor, or behavior can help draw attention to areas that may indicate a problem.For example, stating an observation that a patient looks tired may prompt them to explain why they haven’t been getting much sleep lately, or making an observation that they haven’t been eating much may lead to the discovery of a new symptom. |
| Silence | At times, it’s useful not to speak at all. Deliberate silence can provide both nurses and patients with an opportunity to reflect on and process what comes next in the conversation. It may give patients the time and space they need to broach a new topic and allow quiet time for self-reflection. Nurses should respectfully let the patient break the silence.Sometimes silence can be uncomfortable, and professionals want to fill the void with words. It is better to show interest and understanding, and give the patient time to think about how they want to express themselves. If the patient seems to be feeling awkward about taking too much time to think, you can say, “It’s ok. Take your time.” |
| Summarizing | It is often useful to summarize what patients have said. This demonstrates to patients that you were listening and allows you to verify information. Ending a summary with a phrase such as “Does that sound correct?” gives patients explicit permission to make corrections if they’re necessary.For example, the following exchange demonstrates summarizing. Patient: “I don’t like to take my medications because they make me feel tired and I gain a lot of weight.” Nurse: “You haven’t been taking your medications this month because of the side effects of fatigue and weight gain. Is that correct?” |
| Team Collaboration | Collaborate with other healthcare team members through effective interprofessional communication. Share important patient information with colleagues to ensure that patients’ needs are met, continuity of care is maintained, and errors are prevented. |
| Technology | Utilize communication technologies, such as electronic health records (EHRs), to document and share patient information securely with other healthcare providers. An example would be sending messages to obtain referrals for patients to meet their needs. |
| Touch | The therapeutic use of touch is a powerful way to professionally communicate care and empathy, provided it is done respectfully and with awareness of the client’s cultural beliefs. Nurses commonly use professional touch when assessing, expressing concern, or comforting clients. A nurse’s touch may be the only positive or healing touch the patient receives. Simply holding a client’s hand during a painful procedure can be highly effective in providing comfort and uplifting spirits.However, nurses must be aware that therapeutic touch may not be appropriate in all situations. Some patients find touch to be unsettling, so the nurse should ask the patient’s permission before engaging. It is essential to respect personal boundaries and avoid touch if the client is not receptive. For example, some patients may view touch by a member of the opposite sex as inappropriate, or the patient may have previously experienced trauma that causes touch to be uncomfortable or trigger negative emotions. |
| Validation | Sometimes it is important to acknowledge a client’s message and affirm that they’ve been heard. Acceptance isn’t necessarily the same thing as agreement; it can be enough to simply make eye contact and say, “Yes, I hear what you are saying.” Clients who feel their nurses are listening to them and taking them seriously are more likely to be receptive to care. |
Watch this video about Active Listening
Non-Therapeutic Communication
Unfortunately, nontherapeutic communication can also occur between patients and healthcare professionals, including nurses. Nontherapeutic communication can be defined as negative expressions, attitudes, and actions that make a patient feel uneasy. Both the patient and the nurse are subjected to many influences that can muddle communication.
Nurses must be aware of potential barriers to communication. In addition to considering common communication barriers discussed in Chapter 8, there are several nontherapeutic or communication blocks/barriers to avoid. These responses often hinder the patient’s ability to communicate their feelings or ideas. Nurses should strive to avoid nontherapeutic communication and, if it occurs, revise the communication to be therapeutic. See Table 9.2 for a description of nontherapeutic responses (Burke, 2021; Ernstmeyer & Christman, 2022).
Nontherapeutic communication can lead to miscommunication between the nurse and patient, as well as among healthcare providers. In addition, nontherapeutic communication often hinders the patient’s ability to express their feelings or ideas, ultimately impacting the care they receive (Amoah et al., 2019; Ernstmeyer & Christman, 2022). Nontherapeutic communications are listed in Table 3.2.
Table 9.2 – Non-Therapeutic Communication Techniques
| Techniques | Description | Examples |
|---|---|---|
| Arguing | Arguing with patients must be avoided at all costs. Arguing or challenging a patient implies that the nurse thinks the patient is lying or misinformed, which can damage the nurse-patient relationship. Arguing often prevents patients from trusting the nurse.A skillful nurse can provide information or present reality in a way that avoids argument. For example, it is not therapeutic to state, “How can you say you didn’t sleep a wink when I heard you snoring all night long!” A more therapeutic response would be, “You don’t feel rested this morning? Let’s talk about ways to improve your rest.” | The nurse argues with the patient about their diet, and the patient raises their voice; the nurse does too. |
| Attacking | Verbal attacking is meant to criticize, dominate, or manipulate the patient. Attacking a patient will likely cause the patient to shut down and stop communicating or elicit an anger defense. Nurses must avoid verbally attacking patients. If the patient perceives that the nurse has attacked them, the nurse should apologize and attempt to reestablish therapeutic communication. | The nurse tells the patient, “You came in here drunk and started hitting people.” |
| Automatic response | Automatic responses are ready-made sayings or statements that are used without considering the patient as an individual. Nurses should avoid making these types of statements when communicating with patients, as they can be interpreted as generalizations or stereotypes. Phrases like “I am sorry for your loss” seem automatic. Patients who receive automatic responses from the nurse may refrain from communicating at all. | The nurse tells the patient several times in the day that they will be right back, but each time, the nurse does not return to the room unless the patient specifically calls them. |
| Changing the subject | When a nurse changes the subject while a patient is talking, the patient perceives that their communication is not important. Sometimes nurses rush patients through a communication encounter and can change the subject to meet the nurse’s goals for the encounter. The patient may see this as a form of disrespect or a way to silence them. The nurse needs to recognize factors influencing their own communication and allow the patient to speak uninterrupted to establish a positive nurse-patient relationship.Changing the subject when someone is trying to communicate with you demonstrates a lack of empathy and blocks further communication. It implies you don’t care about what they are sharing. For example, stating, “Let’s not talk about your insurance problems; it’s time for your walk now,” is not a therapeutic approach. A more therapeutic response would be, “After your walk, let’s talk some more about what’s going on with your insurance company.” | The patient tells the nurse about their chest pain, and the nurse asks, “What kind of insurance do you have?” |
| Defensive responses | Nurses should refrain from being defensive in all communication with patients. Patients sometimes express criticism about their health care, and nurses should not respond defensively. Nurses need to actively listen to the criticism, as there is often a deeper meaning that the patient is attempting to convey.When patients or family members express criticism, nurses should listen to what they are saying. Listening does not imply agreement. To discover reasons for the client’s anger or dissatisfaction, the nurse should listen without criticism, avoid being defensive or accusatory, and attempt to defuse anger.
For example, if the client states, “Everyone here is lying to me,” it is not therapeutic to state, “No one here would intentionally lie to you.” Instead, a more therapeutic response would be, “You believe people have been dishonest with you. Tell me more about what happened.” (After obtaining additional information, the nurse may elect to follow the chain of command at the agency and report the client’s concerns for follow-up.) |
The nurse states, “I didn’t do anything,” when the patient states that the nurse took their belongings. |
| False reassurance | Part of being honest involves avoiding false reassurance. False reassurance is when you assure or comfort the client about something that is not based on fact. Giving false reassurance that everything will be all right may do more harm than good. The nurse should allow the patient to voice their fears and concerns and then offer hope without devaluing the patient’s feelings.When a patient is seriously ill or distressed, the nurse may be tempted to offer hope with statements such as “You’ll be fine,” or “Don’t worry; everything will be alright.” These comments tend to discourage the patient from further expressing their feelings. Additionally, these comments may not present reality. If a client is terminally ill, telling them, “You’ll be fine in no time,” is not realistic and provides false reassurance. The client may perceive these statements as a minimization of their situation and associated feelings. A more therapeutic response would be, “It must be difficult not to know what the surgeon will find. What can I do to help?” | The nurse tells the patient that the medication they are given for nausea during chemotherapy will make all the nausea go away, and the patient will feel much better in a few minutes. |
| Generalizations and stereotypes | Generalizations and stereotypes can compromise nurse-client relationships by perpetuating preconceived assumptions about clients that may or may not be accurate. For example, it is not therapeutic to state the stereotype, “Older adults are always confused.” A more therapeutic response is to focus on the family’s concern and ask, “Tell me more about your concerns about your father’s confusion.” | The nurse indicates that everyone undergoing chemotherapy experiences a certain set of emotions and that the patient should not worry about it. This fails to recognize the patient’s unique experience and discourages further sharing. |
| Giving advice or opinions | Nurses should not give advice when communicating with patients. Patients often ask for the nurse’s opinion, and the nurse should strive to communicate therapeutically by providing factual information without sharing personal experiences or offering advice. Giving advice can prevent the patient from developing their own healthcare goals. In addition, giving personal opinions takes away the client’s decision-making power. Effective problem-solving must be accomplished by the client and not the nurse. For example, stating, “If I were you, I’d put your father in a nursing home,” is not therapeutic. Instead, it is more therapeutic to say, “Let’s talk about what options are available to your father.” | The nurse states, “You know, if it were me, I would not go to that healthcare provider.” |
| Interrogating | Interrogation of a patient is often described as asking “why” questions. When “why” questions are asked, the patient can become defensive or uncomfortable and stop communicating altogether. The nurse should avoid asking “why” questions and rephrase questions to prevent the patient from becoming defensive.For example, instead of asking, “Why are you so upset?” it is more therapeutic to rephrase the statement as, “You seem upset. Tell me more about how you are feeling.” | The nurse asks the patient, “Why did you not take the medication like I instructed you to do?” |
| Judgmental responses | Nurses should not make value judgments about the patients’ healthcare decisions. Making judgments about whether the patient has done something right or wrong implies that the nurse is the only person who has the authority to make those decisions. In a positive nurse-patient relationship, the nurse should not be seen as superior to the patient. | The nurse tells the patient, “You know the reason you have lung cancer is because you smoked for forty years.” |
| Overwhelming questions | You should avoid asking multiple questions at once because this can be confusing for patients. Here is an example: “Tell me about your support system. Your brother seems like he’s a great help, right? Do you have anyone else to support you?” Instead, try it this way to start: “Tell me about your support system?” – then, wait for an answer. You can probe with follow-up questions depending on what the client says. | Ask one question at a time so that the client understands it and so that you are more likely to receive a clear answer. |
| Passive or aggressive responses | Passive or aggressive responses should be avoided, if possible. Passive responses are those that try to avoid conflict or circumvent issues. Aggressive responses are intended to provoke confrontation. When the nurse attempts to avoid conflict or is angry with the patient, they should not disclose this to the patient. Nurses should use assertive communication when they are tempted to use passive or aggressive responses that can damage the nurse-patient relationship. Passive responses serve to avoid conflict or sidestep issues, whereas aggressive communication tends to provoke confrontation. Nurses should use assertive communication.For example, it is not therapeutic to state, “It’s your fault you are feeling ill because you don’t take your medication.” A therapeutic response would be, “Taking your prescribed medications every day can prevent symptoms from returning.” Nurses should use assertive communication as described in Chapter 8: Communication Basics. | The patient soils themselves for the third time in the shift, and the nurse has to change the sacral dressing. The patient apologizes profusely to the nurse, and the nurse responds, “Yeah, yeah, I know.” |
| Showing Approval or Disapproval | Nurses should not impose their own attitudes, values, beliefs, and moral standards on others while in the professional nursing role. Judgmental messages contain terms such as “should,” “shouldn’t,” “ought to,” “good,” “bad,” “right,” or “wrong.” Agreeing or disagreeing sends the subtle message that nurses have the right to make value judgments about the client’s decisions. Approving implies that the behavior being praised is the only acceptable one, and disapproving implies that the client must meet the nurse’s expectations or standards. Instead, the nurse should help the client explore their own values, beliefs, goals, and decisions.For example, it is nontherapeutic to state, “You shouldn’t consider elective surgery; there are too many risks involved.” A more therapeutic response would be, “So you are considering elective surgery. Tell me more about the pros and cons of surgery.” This gives the client a chance to express their ideas or feelings without fear of being judged.
Using this approach involves accepting that clients are generally doing the best they can. Avoid judging or blaming them for their beliefs, behaviours, or conditions. You should avoid questions that begin with “why” as this can imply blame. For example, avoid “Why do you smoke?” You can reframe this inquiry as, “Tell me about the reasons that you smoke.” |
Demonstrate unconditional positive regard, which means accepting and respecting that each client has agency to believe and behave how they want, or feel is best. You don’t have to agree or approve, but your acceptance of their self-determination should not be conditional on its alignment with your beliefs or behaviours.
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Conclusion
Effective communication is the cornerstone of safe, compassionate, and person-centered nursing practice. Throughout this chapter, the importance of building trust, establishing rapport, and maintaining professional boundaries has been emphasized as essential to forming therapeutic relationships. These connections enable nurses not only to gather accurate information and advocate for patients but also to provide comfort and emotional support during times of vulnerability. Developing self-awareness enables nurses to recognize how their own values, biases, and emotional responses influence interactions, ensuring communication remains respectful and patient-focused. It is best to apply therapeutic communication techniques, such as active listening, empathy, and open-ended questioning, to enhance the therapeutic relationship. Additionally, nurses should avoid non-therapeutic behaviors and foster environments of mutual respect and collaboration. Ultimately, effective communication enhances patient outcomes and upholds the integrity of the nursing profession.
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