4.6: Techniques of Therapeutic Communication II: Focusing, Paraphrasing, and Summarizing

Focusing involves centering a conversation on a message's critical elements or concepts. Focusing is valuable if the talk is vague or patients begin to repeat themselves. Sometimes, when patients are asked about their symptoms, they may go off-topic and try to tell their entire life story. Respectfully, the nurse should bring the conversation back into focus.

This therapeutic technique can also be used when a patient brings up pertinent information during a health-related conversation. The nurse can shift the conversation to focus on the pertinent information that the patient provides. Consider a scenario in which a patient casually mentions they are suffering from knee pain. Then, the nurse might find it helpful to concentrate on this question: "How intense is the pain you are experiencing? Rate it from 1 to 10.

Paraphrasing is briefly restating another's message using one's own words. Through paraphrasing, nurses provide feedback informing patients they are actively involved in the search for understanding. Accurate paraphrasing requires practice. If the meaning of a message is changed or distorted through paraphrasing, communication becomes ineffective. For example, a patient says, "I've been overweight all my life and never had any problems. I can't understand why I need to be on a diet." An effective paraphrase of this statement would be: "You're not convinced that you need to make different food choices because you seem to have stayed healthy."

Summarizing is a highly effective therapeutic communication technique that draws attention to the main issues discussed, and the consensus reached at the end of the conversation. A nurse manager working with a disgruntled employee might summarize their interaction: "You've told me why you do not like this job and how unhappy you've been. You agreed to try a few of the solutions we've come up with, and you will let me know if these ideas improve your job satisfaction. We've also thought of some other potential solutions you can consider.”

Here are additional therapeutic communication techniques to improve communication between patients and nurses.

First, it is important that a nurse focuses on the specific details of the conversation and centers it on the key problems.

For example, a nurse educating a patient about insulin self-administration brings back the focus by saying, "Since we have spoken about the diabetic diet, we can now practice insulin self-administration."

Next, a nurse can paraphrase the patient's words to avoid misinterpretation.

For example, if the patient says, "My mind keeps diverting," the nurse can paraphrase:" Do you mean you have difficulty concentrating?".

Next, summarizing helps to analyze and highlight essential communication details, providing a sense of clarification and closure to the patient.

For example, a nurse can summarize diabetes management to a patient by saying, "During our session, we discussed your prescribed diabetic medications, exercise, and diet. Can you briefly review the steps with me?".

Besides these, a nurse may also use techniques like sharing hope, confrontation, empathy, clarifying, and silence to achieve desired outcomes.