Therapeutic Communication - a Technique for Patients' Well-being Support

Therapeutic communication is a technique used to support the well-being of patients, emotionally, and physically (NCCHC, 2011). This communication allows us as nurses to not only support our patients but to keep them informed (NCCHC, 2011). It is important to use therapeutic communication with our patients to establish patient-nurse relationships. A way we are able to direct our patients is through motivational interviewing. There are situations where we need to use this technique to help our patients resolve ambivalence. Motivational interviewing consists of five principals. The five principals include, the expression of empathy, the ability to develop discrepancy between the patient’s current situation and thoughts and the goal we want the client to reach, avoidance of arguments and confrontations with the patient, rolling with resistance, and supporting the patient’s self-efficacy (Wells & Jones, 2018).

An article called “Primary Healthcare Nurses’ Experiences with Motivational Interviewing in Health Promotion Practice”, studied the effectiveness of motivational interviewing compared to the conventional methods (Brobeck, Bergh, Odencrants & Hildingh, 2011). The study focused on nurses who were using motivational interview questions to ask patients about their lifestyle. The twenty nurses used in the study were all trained for motivational interviewing. The main lifestyle situations these nurses worked with were patients who had issues with their weight, they had alcohol consumption issues, or they were smokers (Brobeck, Bergh, Odencrants & Hildingh, 2011).The nurses who were chosen for this study had stated that motivational interviewing is demanding (Brobeck, Bergh, Odencrants & Hildingh, 2011). Not only did it take time to become trained for this skill, it also took time to find opportunities to practice and master the skill (Brobeck, Bergh, Odencrants & Hildingh, 2011).

While interviewing it was important to have a real desire to motivationally interview the patients because the nurses needed to be patient with the interviewing process. It was also important for the nurses to keep in mind that they are lifestyle changes that aren’t going to happen quickly, they can take some time to accomplish. A big topic the nurses addressed about motivational interviewing was experience. It is important to have confidence and the ability to motivate patients in order to be successful with motivational interviewing (Brobeck, Bergh, Odencrants & Hildingh, 2011). Overall, the nurses found it takes a combination of experience, training, respect and understanding, time, and interest to have successful motivational interviewing (Brobeck, Bergh, Odencrants & Hildingh, 2011). It is important to remember that changes take time, so will motivational interviewing. The study did find it to be useful and enriching (Brobeck, Bergh, Odencrants & Hildingh, 2011), but it seems to be more beneficial when the nurse is able to put a great amount of time and effort into it. The study found all experiences were positive and motivational interviewing was used as a guidance for nurse-patient relationships (Brobeck, Bergh, Odencrants & Hildingh, 2011).

Working in the healthcare setting I think every single day with every single patient there is an opportunity to use motivational interviewing. Whether is it lifestyle changes that need to be addressed, hygiene, or maybe compliance with medications, there are always opportunities. From a personal experience, I was caring as a nursing assistance for an elderly patient in the hospital. She was typically up independently, but due to back pain this was limiting her abilities. She wasn’t admitted into the hospital for back pain, but it was impacting her abilities while she was there. The nurse would come into the room and ask her if she wanted her Tylenol for her back pain, but the patient would say no. I knew if my patient was able to ease some of her pain, she would be able to ambulate safer and feel better. Throughout the day I informally used motivational interviewing. I say informally, because until now I didn’t know what motivational interviewing was, but I knew I needed to let my patient make the choice and I knew a relationship needed to be formed before this could happen. I began by engaging the patient by asking about the pain and then asking why they weren’t open to taking Tylenol to reduce the pain. My patient believed in waiting things out, waiting for the pain to pass instead of putting any medications into the body. I was able to gain my patients trust because I listened and understood how putting medications into your body can be frightening. From there, the patient decided if the pain hadn’t gone away by the next time we got up to ambulate she would consider taking the medication. For the time being we used alternative methods to see if they would decrease the pain, and they didn’t.

Eventually, we were up ambulating again and my patient asked if she could have Tylenol for the pain. My patient was able to make the decision herself, and she made a decision she felt comfortable with. She was able to do this because she felt comfortable with me. Of course, I was not able to pass the medication or get it for the patient, but it was a joint effort throughout the day between the nurse, patient, and I. It took time throughout the day to get to this point with this patient, but if the nurse and I weren’t as supportive and patient we may have never gotten to this point and our patient might have still been in pain. Once my patient realized they were feeling relief, she was satisfied with her decision. Sometimes motivational interviewing can be used for smaller things like getting a patient to allow a bed bath because they have been refusing for days, or helping a patient who needs lifestyle changes that are going to potentially take a while to occur. I think the most important thing to remember with motivational interviewing is, it takes time.