Chapter 14 – Nontherapeutic Communication – What to Avoid

There are many types of nontherapeutic communication techniques including False Reassurances, Overloading, and Judging. These can be harmful, as they suggest that the nurse knows best. Instead, therapeutic communication techniques should focus on asking good questions, guiding, and listening to the patient’s needs.

False Reassurances

There are many nontherapeutic communication techniques, but one technique is particularly harmful. False Reassurances are statements that the nurse makes without being able to verify them. An example is a nurse’s statement to an inmate about an HIV test: “Don’t worry, it will be fine.” While the nurse is trying to be helpful, this false reassurance actually devalues the client’s experience. Instead of reassurance, the nurse may try to assess the client by making observations and verbalizing what they have observed. The nurse may also try to encourage the patient to recognize certain behaviors and make comparisons with the nurse’s perceptions.

When a patient asks for help, the nurse may ask what they think should be done. Reflection is a positive therapeutic communication technique, which helps the patient take responsibility for their own healthcare decisions and teaches them that their opinions are important. The nurse must remember that patients are the center of their own care and should be given enough time to ask questions and perform tasks. False Reassurances undermine the importance of therapeutic communication.

Another example of a false reassurance is the nurse’s assurance that the patient will get better. The nurse may feel better by reassurance, but this does not guarantee the patient’s success. False reassurances also block expression and make the client feel uncomfortable. For this reason, the nurse must be careful and never use false reassurances in nontherapeutic communication techniques.

Judging

There are a few common communication mistakes that can lead to poor patient-provider relationships: judgement and approval. Avoid using the words “you should” or “don’t.” When giving advice or addressing a personal issue, avoid starting the conversation with “you should.” Changing the subject is a common communication mistake, but it actually blocks the flow of communication and can discourage the patient from sharing in the future.

Stereotyping

One of the worst things nurses can do is engage in stereotyping. It impedes effective communication and inhibits the nurturing of interpersonal relationships with patients. Effective communication is crucial for nursing, and all nurses should aim to become proficient in therapeutic engagement.

Instead use reflection: When a patient is having a difficult time talking about their symptoms, they may turn to their caregiver for advice. In this case, reflection can be a positive therapeutic communication technique. The healthcare professional can ask the patient what he or she believes should be done and encourages autonomy. In addition, reflection is a method of expressing gratitude for the patient’s trust and support.

Overloading

Overloading a patient is an example of a nontherapeutic communication technique. The patient may ask a nurse for advice regarding a problem or concern, or they may simply want to talk about a problem they are having. Reframing the patient’s perspective on the situation can promote autonomy and encourage them to take responsibility for their health. This technique can be helpful in addressing many aspects of a patient’s care.

When a patient tells a story or makes an important decision about the condition, a nurse can acknowledge that statement and rephrase it as a question. The patient’s statement is then a prompt for patient education. This technique requires the nurse to listen carefully and determine if their impression matches the statement. Then, the nurse can ask the question based on their impression. Once the patient has rephrased it, the nurse can then use it to make the patient more comfortable about talking about their problem.

When therapeutic communication techniques fail, barriers exist. The patient is unable to understand or follow an effective care plan, or the nurse is not able to develop a trusting nurse-patient relationship. Both problems can affect patient outcomes, so it is important to be aware of any barriers and try to solve them before they become overwhelming. However, it’s important to remember that communication is a two-way street and should be handled with respect, even if the patient can’t speak out.

Incongruence

In therapeutic communication, there is an incongruence between what the client says and what he or she knows. Congruence between client and therapist is important, as therapists are personally invested in the therapeutic relationship and may draw on their own experiences to foster the relationship. A therapist’s unconditional positive regard facilitates increased self-regard in the client and increased awareness of distorted self-worth.

Invalidation

While many well-intentioned individuals may claim to be validators, their actions can be detrimental to the other person. Invalidation is the opposite of acceptance and nurture, and it can create a negative emotional impact on the other person. Often, invalidating messages are used to make someone feel crazy or unreal. Here are some ways invalidating messages can affect a relationship:

Reflection is a technique that is positive in therapeutic communication. It involves asking a patient what they think should be done in a specific situation. Invalid questions are often those that are irrelevant to the patient’s medical history. A nurse should never ask a question just to satisfy her own curiosity. The patient needs to feel empowered to make decisions about their healthcare, and reflection is a great way to do this.

It is important to understand how nontherapeutic communication techniques can negatively impact the patient. Nontherapeutic communication techniques can impede patient expression, impair the nurse-client relationship, and negatively affect nursing interventions.

The patient interview is an essential component of nursing assessment. During this time, the nurse must learn all the information she needs to get a complete patient history through proper therapeutic communication so the patient trusts the nurse and the nurse can gather all the data they need to do their job well.