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Boost therapeutic relationships

Boctor, Lisa MSN, RN

doi: 10.1097/01.NME.0000438411.53496.93
Department: Ask an Expert

Clinical Instructor of Nursing • University of Alabama • Huntsville, Ala.

The author has disclosed that she has no financial relationships related to this article.



A: Communication is an integral part of nursing. Be on guard against nontherapeutic communication techniques, which can hinder your relationship with your patient and decrease trust between you. They can even keep you from learning critical information.

Stay on your toes by comparing these examples of nontherapeutic communication and therapeutic alternatives.

  • Passing judgment. When you give approval or disapproval, patients can feel like you're judging them.
    • Example: “You did the right thing when you ended that relationship.”
    • Alternative: “It sounds like ending your relationship was difficult for you.”
  • Changing the subject. When you're uncomfortable, sometimes you might switch the topic of conversation. But doing so keeps patients from expressing their feelings. Consider what to say when a patient shares his or her fears about a procedure because a relative had a bad outcome.
    • Example: “That's so sad that your cousin died during surgery. Tell me, what are your plans after you leave?”
    • Alternative: “Tell me about your concerns.”
  • Giving false reassurance. When your patient is seriously ill and you want to offer hope, you may be tempted to give false reassurance. Resist the urge. To maintain your credibility, don't brush off your patient's concerns.
    • Example: “I'm sure your cancer will go into remission.”
    • Alternative: “We'll do everything we can to help you. Would you like to discuss anything?”
  • Asking for an explanation. When assessing a patient, avoid questions beginning with the word why. Such questions put the patient on the defensive.
    • Example: “Why did you stop taking your medication?”
    • Alternative: “Tell me about your experience with this medication and any problems you had as a result.”
  • Being defensive. When a patient criticizes you or another staff member or healthcare provider, it's easy to become defensive. Instead, try to listen uncritically and follow up as needed.
    • Example: “Dr. Smith would never give you bad advice.”
    • Alternative: “I'll discuss your concerns with Dr. Smith. Let me know if you still have concerns after you see him.”
  • Arguing. Sometimes a patient's perception of reality isn't correct. When you're presenting facts, don't become argumentative.
    • Example: “I know you don't have insomnia. I have to wake you up every time I come into the room.”
    • Alternative: “Let's discuss your sleep habits. I've noticed that you sometimes fall asleep during the day.”
  • Belittling. When patients open up about being sad or afraid, we may unintentionally try to assure them that they have nothing to worry about. Or, we may compare their situation with one that's worse. Both are belittling.
    • Example: “Having your gallbladder removed is a routine surgery. You have nothing to worry about.”
    • Alternative: “I see that you're worried. Let's talk about your concerns.”

Now that you've reviewed these examples, think about how you can boost your communication skills by forging a new and improved therapeutic relationship with your patient.

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