Therapeutic Communication in Correctional Nursing
In correctional nursing practice, professionalism includes knowing and adhering to the boundaries of the nurse-patient relationship, which are defined by the correctional environment and the need for safety. Correctional nurses convey caring for their patients through their communication, rather than through the physical or personal contact that our nursing colleagues practicing in noncorrectional settings might use. Effective communication is so important to correctional nursing that it is included as a standard in The Correctional Nurse: Scope and Standards of Practice, third edition (2020) published by the American Nurses Association. Standard Nine includes, in part, that the correctional nurse uses “communication styles and methods that demonstrate caring, respect, deep listening, authenticity, and trust.” Thus, the correctional nurse must be knowledgeable about, and skilled at, therapeutic communication.
Therapeutic communication is defined as the face-to-face process of interaction that focuses on advancing the physical and emotional well-being of a patient. Nurses use therapeutic communication techniques to provide education and support to patients, while maintaining objectivity and professional distance. There are a variety of techniques that may be used to engage in therapeutic communication with a patient, including the use of open-ended questions, acknowledgment and acceptance, using silence, asking for clarification, active listening, reflecting, and summarizing.
When open-ended or broad questions are used, the patient is given the opportunity to direct the flow of the conversation and decide what is most important to them to discuss. An example question is, “What would you like to discuss today?”
Acknowledgement and acceptance is not the same as agreement. Rather, it is the acknowledgement to the patient that he/she/they have been heard. An example response is saying, “Yes, I get what you are saying.”
Equally important is using silence. Often giving no response at all gives both you and the patient time to think about what was said or to give the patient the “break” needed to switch topics. When using silence, the patient should be the one to restart the conversation.
When correctional nurses ask for clarification during a therapeutic intervention, it ensures that the nurse understands what the patient is trying to convey, and it may also give the patient more clarity in their thinking, as they must rephrase their thoughts. Asking the patient to elaborate or stating that you don’t quite understand what they mean are examples of clarification.
Active listening is vitally important to all communication, but especially in a therapeutic intervention, when the goal is to have an open, honest, effective conversation with the patient. Active listening involves giving verbal and nonverbal cues to the speaker to show that you are engaged in the conversation. An example of a nonverbal active listening cue is nodding your head in agreement with something that is said. An example of a verbal cue is asking, “What happened after that?”
Reflecting is a technique used most often when the patient asks the correctional nurse to solve a problem or tell him/her/them what to do. It involves rephrasing the request/question back to the patient. For example, if the patient asks the nurse what to do about a situation in the housing unit, the nurse should ask the patient what they think they should do, and then process the response together. This helps the patient take ownership of any decision that is made, and will help him/her/them in the future when decisions need to be made.
Summarizing is also a very important technique that all correctional nurses should use when communicating with their patients. By restating what they heard the patient say, the nurse verifies that he/she/they were listening and that the patient was understood. This can be done throughout the conversation, or it can be done at the end, but it should include validation by the patient that the summary and the nurse’s understanding of the conversation is the same as his/hers/theirs. If not, then the patient needs an opportunity to clarify the misunderstanding. A question to ask at the end of the summary is, “Am I understanding this correctly?”
This is not an exhaustive list of techniques that can be used in therapeutic communication but mastering these will allow correctional nurses to engage in effective therapeutic communication with their patients, thereby demonstrating professional nursing practice and caring for their patients.
Author Lori Roscoe, DNP, PhD, APRN, CCHP-RN, is the Accredited Provider Program Director for NCCHC, co-chair of the NCCHC Nursing Education Subcommittee, and a member of NCCHC’s Multi-Disciplinary Education Committee. Through her companies, The Correctional Nurse LLC and Correctional HealthCare Consultants LLC, Dr. Roscoe provides accredited continuing education specialized for correctional nurses and maintains CorrectionalNurse.Net, a blog about correctional nursing practice, and offers professional consulting services in correctional healthcare operations, staff training and legal matters.