4.5: Techniques of therapeutic communication I: Active Listening, Sharing Observations, Validation, and Using Touch

The history of therapeutic communication can be traced back to Florence Nightingale, who emphasized the importance of developing trusting relationships with patients. She taught that the presence of nurses with patients results in therapeutic healing.

Therapeutic communication is not the same as social interaction. Social interaction has no goal or purpose and consists of casual information sharing, whereas therapeutic communication has a plan or purpose for the conversation. Therapeutic communication includes active listening, sharing observations, validation, and using touch.

Active listening involves paying particular attention to what a patient says verbally and nonverbally, such as through words, gestures, facial expressions, and other body language signs. One model that can be used is the SURETY Model. SURETY is a mnemonic for establishing good nonverbal communication with clients. SURETY stands for the following:

• • S: Sitting and squarely facing the client
• • U: Uncross legs and arms
• • R: Maintaining a relaxed posture
• • E: Maintaining good eye contact
• • T: Touch
• • Y: Your intuition.

In sharing observations, nurses observe by remembering how the other person appears, sounds, or acts. Stating observations often helps a patient communicate without requiring extensive questioning, focusing, or clarification. This method can start a conversation with a reserved or quiet patient. Making observations, such as "You appear different today...," "You look exhausted...," or "I notice you haven't eaten anything," is a compassionate and safer technique. For example, saying, "You look a mess!" or something that could make a patient feel angry or embarrassed.

Nurses use the validation technique to identify and accept patients' thoughts, feelings, and needs. When the caregiver addresses the concerns of the patients and their families, they feel supported and respected. Seeking clarification regarding patient concerns enables a nurse to express empathy and interest in the patient's thoughts, feelings, and perceptions.

Using touch is one of the most potent and personal forms of communication. It expresses concern or caring to establish a connection and promote healing. Touch conveys many messages, such as affection, emotional support, encouragement, tenderness, and personal attention. Comfort touch, such as holding a hand, is essential for vulnerable patients experiencing severe illness with accompanying physical and emotional losses. Nurses must be aware of a patient's nonverbal cues and ask before engaging in touch communication because some patients may be sensitive to physical closeness and uncomfortable with touch.

Nurses engage with patients using the following therapeutic communication techniques.

The first technique is active listening which involves paying close attention to what a patient says verbally and nonverbally.

For instance, to make a patient feel heard, a nurse should lean forward, turn to face them, establish eye contact, nod their head, and smile when appropriate.

Then, nurses share observations of the patient's appearance, sounds, or behavior which helps to draw attention to the potential problem.

For instance, the nurse notices that the patient is looking exhausted and asks the patient if he had any trouble sleeping last night.

Next, the nurse uses the validation technique to recognize and accept the patient's thoughts, emotions, and needs.

A nurse, for example, validates a newly diagnosed stroke patient by saying, "I understand that you are concerned about your condition because you will not be able to perform your daily activities as before."

Lastly, the professional touch establishes a connection and promotes healing by expressing concern or care.

For example, holding a patient's hand during a painful procedure will comfort the patient.