Therapeutic Communication

The nurse uses advanced therapeutic communication techniques for complex clinical situations: delivering bad news, managing conflict, conducting motivational interviews, navigating cultural communication differences, and maintaining therapeutic relationships with challenging patient populations. Breaking bad news uses the SPIKES protocol: Setting (private, comfortable environment, sit down, make eye contact), Perception (assess what the patient already knows), Invitation (ask how much information the patient wants), Knowledge (share information in clear, simple language, avoid medical jargon), Empathy (respond to emotional reactions with empathy before providing more information), and Strategy/Summary (discuss next steps and plan). Motivational interviewing (MI) is a collaborative communication style for addressing ambivalence about behavior change: express empathy through reflective listening, develop discrepancy between current behavior and personal values/goals, roll with resistance (do not argue or confront), and support self-efficacy. MI uses OARS: Open questions, Affirmations, Reflections, and Summaries. Change talk (patient statements favoring change: desire, ability, reason, need, commitment) should be reinforced; sustain talk (statements against change) should be explored without confrontation. The nurse also navigates difficult conversations about advance directives, goals of care, treatment refusal, and end-of-life decisions, requiring sensitivity...