6 THERAPEUTICCOMMUNICATION 125
- Facilitate the client’s expression of thoughts
and feelings. - Guide the client to develop new skills in
problem-solving. - Promote the client’s evaluation of solutions.
Beginning Therapeutic
Communication
Often the nurse will be able to plan the time and set-
ting for therapeutic communication such as having
an in-depth, one-on-one interaction with an assigned
client. The nurse has time to think about where to
meet and what to say and will have a general idea of
the topic such as finding out what the client sees as his
or her major concern or following up on interaction
from a previous encounter. At times, however, a client
may approach the nurse saying, “Can I talk to you
right now?” Or the nurse may see a client sitting
alone, crying, and decide to approach the client for an
interaction. In these situations, the nurse may know
that he or she will be trying to find out what is hap-
pening with the client at that moment in time.
When meeting the client for the first time, intro-
ducing oneself and establishing a contract for the re-
lationship is an appropriate start for therapeutic
communication. The nurse can ask the client how he
or she prefers to be addressed. A contractfor the re-
lationship includes outlining the care the nurse will
give, the times the nurse will be with the client, and
acceptance of these conditions by the client.
Nurse: “Hello, Mr. Kirk. My name is Joan, and
I’ll be your nurse today. I’m here from 7 am to 3:30 pm.
Right now I have a few minutes, and I see you are
dressed and ready for the day. I would like to spend
some time talking with you if this is convenient.”(giv-
ing recognition and introducing self, setting
limits of contract)
After making the introduction and establishing
the contract, the nurse can engage in small talk to
break the ice and help to get acquainted with the
client if they have not met before. Then the nurse can
use a broad opening question to guide the client to-
ward identifying the major topic of concern. Broad
opening questions are helpful to begin the therapeu-
tic communication session because they allow the
client to focus on what he or she considers important.
The following is a good example of how to begin the
therapeutic communication:
Nurse: “Hello, Mrs. Nagy. My name is Donna,
and I am your nurse today and tomorrow from 7 am
to 3 pm. What do you like to be called?”(introducing
self, establishing limits of relationship)
Client: “Hi, Donna. You can call me Peggy.”
Nurse: “The rain today has been a welcome relief
from the heat of the past few days.”
Client: “Really? It’s hard to tell what it’s doing
outside. Still seems hot in here to me.”
Nurse: “It does get stuffy here sometimes. So tell
me, how are you doing today?”(broad opening)NONDIRECTIVE ROLE
When beginning therapeutic interaction with a client,
it is often the client (not the nurse) who identifies the
problem he or she wants to discuss. The nurse uses ac-
tive listening skills to identify the topic of concern. The
client identifies the goal, and information-gathering
about this topic focuses on the client. The nurse acts as
a guide in this conversation. The therapeutic commu-
nication centers on achieving the goal within the time
limits of the conversation.
The following are examples of client-centered
goals:- Client will discuss her concerns about her
16-year-old daughter who is having trouble
in school. - Client will describe difficulty she has with
side effects of her medication. - Client will share his distress about son’s
drug abuse. - Client will identify the greatest concerns he
has about being a single parent.
The nurse is assuming a nondirective rolein
this type of therapeutic communication, using broad
openings and open-ended questions to collect infor-
mation and help the client to identify and discuss the
topic of concern. The client does most of the talking.
The nurse guides the client through the interaction,
facilitating the client’s expression of feelings and iden-
tification of issues. The following is an example of the
nurse’s nondirective role:
Client: “I’m so upset about my family.”
Nurse: “You’re so upset?”(reflecting)
Client: “Yes, I am. I can’t sleep. My appetite is
poor. I just don’t know what to do.”
Nurse: “Go on.”(using a general lead)
Client: “Well, my husband works long hours and
is very tired when he gets home. He barely sees the
children before their bedtime.”
Nurse: “I see.”(accepting)
Client: “I’m busy trying to fix dinner, trying to
keep an eye on the children, but I also want to talk to
my husband.”
Nurse: “How do feel when all this is happening?”
(encouraging expression)
Client: “Like I’m torn in several directions at once.
Nothing seems to go right, and I can’t straighten
everything out.”
Nurse: “It sounds like you’re feeling overwhelmed.”
(translating into feelings)
Client: “Yes, I am. I can’t do everything at once
all by myself. I think we have to make some changes.”