therapeutic communication and giving hope?

Whispera, MSN, RN · Jul 31, 2015

Therapeutic communication is intended to help the person come to his own conclusions, to sort things out for himself, and it's therapeutic because you help him work through all of this. If you are encouraging positive thinking...what if the person truly see no positives? Then you aren't empathic; you aren't thinking as if you're in his shoes.

Keep in mind, it is not at all about what you think. It's what the patient thinks and feels that matters. You aren't doing therapy. You are listening.

OnlinePersona, LPN · Jul 31, 2015

Therapeutic communication is intended to help the person come to his own conclusions, to sort things out for himself, and it's therapeutic because you help him work through all of this. If you are encouraging positive thinking...what if the person truly see no positives? Then you aren't empathic; you aren't thinking as if you're in his shoes.
Keep in mind, it is not at all about what you think. It's what the patient thinks and feels that matters. You aren't doing therapy. You are listening.

Good point you just made about not doing therapy but to listen.

Just confuses me when nurses are supposed to be all these things from educator to a model of strength... not sure how to convey strength to a patient without sorta kinda giving a little advice.

toomuchbaloney · Jul 31, 2015

Good point you just made about not doing therapy but to listen.
Just confuses me when nurses are supposed to be all these things from educator to a model of strength... not sure how to convey strength to a patient without sorta kinda giving a little advice.

What do you mean by "convey strength"?

It is perfectly normal and acceptable for humans to experience sadness, confusion, anger, frustration, etc when they are confronted with diagnosis and prognosis that are difficult. It is abnormal to get bad health news and to see only positives in it.

Even Jesus wept and grieved.

Listen

Be present "in the moment" with your patient

Do not judge

Farawyn · Jul 31, 2015

What do you mean by "convey strength"?
It is perfectly normal and acceptable for humans to experience sadness, confusion, anger, frustration, etc when they are confronted with diagnosis and prognosis that are difficult. It is abnormal to get bad health news and to see only positives in it.
Even Jesus wept and grieved.
Listen
Be present "in the moment" with your patient
Do not judge

I agree, and 20 plus years in this is still one of my biggest challenges.

Whispera, MSN, RN · Aug 1, 2015

Put yourself in the other person's shoes. How do you feel if something terrible is going on in your life and another person says something like, "think positive" and things will get better"? Condescended-to? Minimized?

When it comes to other advice, the other person has probably thought of most options you might suggest anyway. What matters is the person working toward his own solutions, IF there are any.

amoLucia · Aug 1, 2015

"To encourage the pt to think positively" may be perceived that you DE-VALUE OR MINIMIZEhis/her feelings as unimportant, unrealistic, silly, false etc. and not offering any support or positivity. That may just cause the pt to further spiral down.

Acknowledgement of the pt's feelings as important/real TO THE PT is step 1 when communicating.

JustBeachyNurse, LPN · Aug 1, 2015

Pushing a patient to think positive when grieving or angry over a test result or new diagnosis is demeaning. Hopelessness may be appropriate when given a diagnosis without a cure whether stage 4 cancer or chronic asthma or diabetes. Patients don't need a peppy cheerleader.

If you came to me and told me to think positive or look on the bright side when I received a difficult new diagnosis you would be asked to leave the room. A patient does not need to be told their feelings are invalid or wrong. They do not need your positive thinking projected on them. It's okay to be upset, angry or even hopeless when receiving news. You need to listen and accept their feelings.

Sometimes there is no hope to be had. A friend of mine was told her cancer was out of remission and there were lesions in the brain. There was no hope, no treatment that was going to make it better, slow the progress, or cure. There were few treatments that would be palliative. Being the person she was she started writing her obituary and eulogy while she was still coherent and conscious enough to do so. Two weeks later she was delirious and barely conscious. A week after that she died. Her family had strict orders to hand her obituary to the funeral director and he would simply add the date of her death and funeral arrangements. I've never seen so many people laugh so hard at a funeral when her self-written eulogy was read by her children. We had a piece of her post mortem before her brain was riddled with & overtaken by cancer cells. It was her final gift to fuel her memories. A gift we would not have had if someone told her to not give up hope when she was given her prognosis. Fortunately her hospice nursing team encouraged her choice to accept that there was no hope and validated her thoughts and feelings.

Oceanpacific · Aug 1, 2015

There is a context to everything. I had a pregnant maternal child health patient who I saw for home visits. She was severely mentally ill. One day she told me she had beaten up her kitten for attempting to seduce her rabbit. The kitten was hiding behind the radiator. The rabbit was in the refrigerator (still alive). My patient was whisked away for an involuntary psych stay. I took the rabbit with me, but couldn't catch the kitten.

While my patient was still on the locked psych unit, I got Animal Control to go rescue the kitten. A couple of days later I got a hysterical phone call from my patient still on psych unit. Her "therapeutic team" encouraged her to call me so that she could share how painful it was that she never got to say goodbye to her kitten and that she needed me to know that I had violated her trust.

I told her she had no idea what it was like for me to find her rabbit wedged in between the milk and the fruit juice on the top rack of a refrigerator and that it was an image I would never be able to get out of my mind. As for her grief at not being able to say goodbye to her kitten, I told her I didn't want to discuss it.

Was I being therapeutic in my professional relationship? Was I being professional at all?

I have had to testify in court only once in my career. A year after "the rabbit in the refrigerator" I got a subpoena to testify in family court in a hearing to permanently revoke my former patient's parental rights to her long-suffering infant. I think my meticulous documentation of what happened on that awful day and on some almost as awful days, was the thing that made her lose custody of her baby. The judge and attorneys had lots of questions about those animals.

Sometimes you have to tell a patient something they don't want to hear. Sometimes you as a nurse have to try to live with images and outcomes you will never forget

Farawyn · Aug 1, 2015

Pushing a patient to think positive when grieving or angry over a test result or new diagnosis is demeaning. Hopelessness may be appropriate when given a diagnosis without a cure whether stage 4 cancer or chronic asthma or diabetes. Patients don't need a peppy cheerleader.
If you came to me and told me to think positive or look on the bright side when I received a difficult new diagnosis you would be asked to leave the room. A patient does not need to be told their feelings are invalid or wrong. They do not need your positive thinking projected on them. It's okay to be upset, angry or even hopeless when receiving news. You need to listen and accept their feelings.
Sometimes there is no hope to be had. A friend of mine was told her cancer was out of remission and there were lesions in the brain. There was no hope, no treatment that was going to make it better, slow the progress, or cure. There were few treatments that would be palliative. Being the person she was she started writing her obituary and eulogy while she was still coherent and conscious enough to do so. Two weeks later she was delirious and barely conscious. A week after that she died. Her family had strict orders to hand her obituary to the funeral director and he would simply add the date of her death and funeral arrangements. I've never seen so many people laugh so hard at a funeral when her self-written eulogy was read by her children. We had a piece of her post mortem before her brain was riddled with & overtaken by cancer cells. It was her final gift to fuel her memories. A gift we would not have had if someone told her to not give up hope when she was given her prognosis. Fortunately her hospice nursing team encouraged her choice to accept that there was no hope and validated her thoughts and feelings.

I love this. I'm so sorry for your loss. She sounded like a fun person.

JustBeachyNurse, LPN · Aug 1, 2015

I love this. I'm so sorry for your loss. She sounded like a fun person.

I nearly choked when I saw the printed obituary "Well if you all are reading this I must be dead.." Then described her life in the third person. While a shock at first, I would have expected nothing less. Can you imagine if a nurse pushed false hope on her in her last days of lucidity rather than encouraging her to accept her fate in the best way she knew how?

There is not one absolute answer for every patient. We must remember what works for us may not be right for our patients. Therapeutic listening is not cheerleading, therapeutic talking, it's about empowering the patient not making ourselves feel better