Local theories and models of nursing intervention “Technological Competency as Caring in Nursing: A Model

for Practice”
Rozzano Locsin

 is a Professor of Nursing at Tokushima University  Dr. Locsin’s middle range nursing theory [2] is an
(Japan) interesting discussion of the correlation between
 a Professor Emeritus of Florida Atlantic University hands-on patient care and the use of technology.
(United States)  Technology is defined as anything that makes things
 and a Visiting Professor at universities in Thailand, efficient – from basic diagnostic technologies to
Uganda, and the Philippines. therapeutic practices familiar to all nurses.
 authored a book entitled Technological Competency as  Specifically, he discusses the importance of
Caring in Nursing: A Model for Practice, edited and co- understanding the need for knowing “high-tech”
authored three more books, including one entitled A instruments e.g. monitors, implants, and devices that
Contemporary Nursing Practice: The (Un)Bearable are a part of patient care as these will provide
Weight of Knowing in Nursing. opportunities for the nurse to know the patient fully as
 Born-1954 Philippines person.
 Nationality - Filipino/American
 Occupation
Technological competency as caring
o Theoretical Nursing: Nursing Theory, Nursing
Philosophy Professor of Nursing at Tokushima  Technological competency as caring in nursing informs
University (Japan) nursing as a critical process of knowing persons’
o Professor Emeritus of Florida Atlantic University wholeness. Dr. Locsin’s theory book explores, clarifies,
(United States) and advances the conception of technological
o Visiting Professor – St. Paul University competency as caring in nursing. His theory is essential
Philippines, (Philippines); Silliman University to modeling a practice of nursing from the perspective
(Philippines); Prince of Songkla University of caring. It is a practical illumination of excellent
(Thailand); Mbarara University of Science and nursing in a technological world.
Technology (Uganda)
o Locsin’s Technological Nursing As caring Model
 Known for - The middle-range theory, “Technological
Competency as Caring in Nursing  Background:

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  The theory of Technological Competency as Agravante’s The Transformative Leadership Theory
Caring in Nursing (TCCN) was developed by
Locsin (2005)  The Casagra Transformational Leadership Model
 to guide the expression of "technological  is suitable for nursing educators, particularly those
competency as caring in nursing" among who are administrators in the educational setting
practicing nurse (Magallanes, 2009).
 What do these recipients of care (patients) express as  It has a psycho-spiritual model which can be utilized as
caring? a formula for faculty and administrators to become
 Locsin (2005) has described nursing as better teachers and servant leaders.
"technological competency as caring in nursing“
 that is focused on :
 the proficient practice of nurses using The model is a three fold transformation leadership
technologies to know persons more fully as concept
caring, while affirming that being
technologically competent is being caring. 1. Servant Leader Spirituality.
 The general theory of Nursing as Caring by
Boykin and Schoenhofer (2001) is the basis of 2. Self Mastery expressed in a vibrant concept.
Locsin's theory.
 Locsin's conceptual model, Technological Competency 3. Special expertise level in the nursing field one is
as Caring in Nursing engaged in.
 In Locsin's (2005) model,
 These elements rolled into one make-up the
 the concepts of technology and caring within
personality of the modern professional nurse who
the framework of competency exemplify the
will challenge the demands of these crucial times in
realities of purposefully advancing technologies
society today.
in health care.
 The CASAGRA Transformative Leadership Theory is
 Locsin (2005) stated, "Competency with
classified as a Practice Theory basing on the
technology is the skilled demonstration with
characteristics of a Practice Theory stated by
intentional, deliberate, authentic activi- ties by
McEwen (2007), which are the following:
experienced RNs who practice in environments
requiring technological expertise.
1. Complexity / Abstractness, Scope - Focuses on a
narrow view of reality, simple and straightforward;

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 2. Generalizability /Specificity - Linked to a special 2. are complex is a structure in the personality of the
populations an identified field practice; caregiver that is significantly related to the leadership
3. Characteristic of Scope – Single, concrete concept that behavior.
is operationalized; 3. The CASAGRA servant-leadership formula is an
4. Characteristic of Proposition – Propositions defined; effective modality in enhancing the nursing faculty’s
5. Testability – Goals or outcomes defined and testable; servant-leadership behavior.
6. Source of Development – Derived from practice or 4. Vitality of Care Complex of the nursing faculty is
deduced from middle range theory or grand theory. directly related to leadership behavior. 

Purpose three-Fold Transformative Leader Concept

• Nursing education is faced with a new concern that is 1. The Servant-Leadership Spirituality 

globalization of nursing services for the international
market. Therefore a need to develop globalization of • consists of a spiritual exercise  the determination of the
care with focus on developing caring nurses. vitality of the care complex in the personality of an
individual and finally a seminar workshop on
• The formation of new nursing leaders is urgently transformative teaching.
needed; leaders with new vision who will venture
new traits and who have gone through new formation • The servant-leader formula prescription includes a
in order to serve the society as professional nurse. spiritual retreat that goes through the process of:

• Nurses need competent leaders with a dream of what  awareness, contemplation,

nursing can be whose basic stand is caring and  story telling,
service who are competent in nursing, assertive  reflection, and finally commitment to become
of their own rights with the help profession. servant-leaders in the footsteps of Jesus
2. The Self-Mastery consists of a vibrant care complex
Main Propositions possessed to a certain degree by all who have been
through formal studies in a care giving profession such
1. CASAGRA Transformative Leadership is a psycho- as nursing.
spiritual model: was an effective means for faculty to
become better teachers and servant- leaders. 3. The Special-Expertise level is shown in a creative,
caring, critical, contemplative and collegial teaching of

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 the nurse faculty who is directly involved with the  Transformative teaching is the guide that desired for
formation of the nursing. the modern educative process designed to form the
millennium professional nurse.
Meaning and Paradigm  expertise is the practice of caring and proactive in face
of challenges for the profession go hand-in-hand.
Meaning of The Theory
Education and practice bring this about
 the effect of the CASAGRA Leadership model using the Divinagracia’s composure model
servant leader model on the leadership behavior of the
nursing faculty, the care complex in the personality of  Dr. Carmelita A. Divinagracia,
the nursing faculty is highly correlated to their  a Master of Nursing in 1975, and a doctoral degree
leadership behavior. he care complex is necessary holder in 2001, has been lauded for developing the art
given as a stimulant in the performance of the and competency of teaching nursing.
leadership activities. The leadership behavior of the  Her love for nursing and her dedication to carve out
faculty after going to the servant leadership formula learning tools for nursing students, has been a
was significantly higher in the two-post test periods commendable and rare field of discipline.
than during the pre-test. It improved the leadership  As a teacher, a perfect thesis adviser.
behavior of the nursing faculty in both groups.   She has teamed up with the Commission on Higher
Education for the drafting of a higher standard of
Paradigm
competency in nursing schools in the Philippines.
 According to care complex of Agravante, caring
personality rests on the possession of a care complex
with in a person as an energy source of caring.
 The framework explains and predicts the continuous
formation of nursing leadership behavior in nursing
faculty that will eventually affect their teaching
function.
 Servant-leadership formula runs parallel to the generic
elements of the transformative-leadership model.

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 SISTER LETTY G. KUAN “ RETIREMENT AND ROLE  She also had Bioethics formal training at Institute of
Religion, Ethics and Law at Baylor College of Medicine
DISCONTINUITIES “ in Houston, Texas.

 Born on November 19, 1936 in Katipunan-Dipolog,  She is a recipient of the Metrobank Foundation
Zamboanga del Norte “Outstanding Teacher’s Award” in 1995 and an “Award
of Continuing Integrity and Excellence in Service” in
 Master degree in Nursing and Guidance and 2004. (ACIES)
Counseling.
 Her religious community is the Notre Dame de Vie
 She also holds a Doctoral degree in Education. founded in France in 1932.

 Has a vast contribution to the University of the  She authored several books giving her insights in the
Philippines College of Nursing Faculty and Academic areas of Gerontology, Care of Older Persons and
achievements. Bioethics and Essence of Caring.

 She is now a Professor Emeritus, a title awarded only  Concepts of illness and health care intervention in an
to a few who met the strict criteria. urban community.
by Kuan, Letty Gurdiel; [Quezon City]: 1975.
 She has two Masters Degrees, M.A in Nursing and M.S  Understanding the Filipino elderly :a text book for
in Education, Major in Guidance and Counseling, nurses and related health professional
culminating in Doctor of Education (Guidance and by Kuan, Letty G.; Dipolog City: Jesus G. Kuan
Counseling). Foundation, 1993.
 Essence of Caring
 Has a Clinical Fellowship and Specialization in by Letty G. Kuan,
Neuropsychology in University of Paris, France National Teacher Training Center for the Health
(Salpetriere hospital). Professions, University of the
Philippines Manila, Learning Resources Unit, 1993
 Neurogerontology in Watertown, New York (Good
Samaritan Hospital ) and Syracuse University, New  Pag-aaruga Sa Mga Taong May Edad Na.
York. by Kuan, Letty G.; Quezon City: UP-KAT, 1998

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  Bioethics in Nursing  Physiological Age- is the endurance of cells and tissues
by Kuan, Letty G.; Manila: Educational Pub. House, to withstand the wear-and-tear phenomenon of the
2006 human body. some individuals are gifted with the
strong genetic affinity to stay young for a long time
RETIREMENT AND ROLE DISCONTINUITIES period.

CONCEPTUAL MODEL (as studied and researched by the  Role – Refers to the set of shared expectations focused
author) upon a particular position. These may include beliefs
about what goals or values the position incumbent is
to pursue and the norms that will govern his behavior.

BACKGROUND  It is also the set shared expectations from the retirees

socialization experiences and the values internalized
 Retirement – is an inevitable change in one’s life. It is while preparing for the position as well as the
evident in the increasing statistics of aging population adaptations to the expectations socially defined for the
accompanied by related disabilities and increased position itself.
dependence.
 For every social role there is complementary set of
 this developmental stage, even at later part of life, roles in the social structure among which interaction
must be considered desirable and satisfying through constantly occurs.
the determination of factors that will help the person
enjoy his remaining years of life.  Change of Life - is the period between near retirement
and post-retirement years. In medico-physiological
 It is of primary importance to prepare early in life by terms, this equates with the climacteric period of
cultivating other role of options at age 50-60 in order adjustment and re- adjustment to another tempo of
to have a rewarding retirement period even amidst the life.
presence of role discontinuities experienced by this
age group.  Retiree – is an individual who has left the position
occupied for the past years of productive life because
BASIC ASSUMPTIONS AND CONCEPTS he/she has reached the prescribed retirement age or
has completed the required years of service.

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  Role Discontinuity - is the interruption in the line of FINDINGS AND RECOMMENDATIONS
status enjoyed or performed. The interruption may be
brought about by an accident, emergency, and change 1. Health status dictates the capacities and the type of
of position or retirement. role one takes both for the present and for the future.

 Coping Approaches- Refer to the interventions or - It fits for the everyone to maintain and
measures applied to solve a problematic situation or promote health at all ages because only proper
state in order to restore or maintain equilibrium and care of the mind and body is needed to
normal functioning. maintain health in old age.

DETERMINANTS OF POSITIVE PERCEPTIONS IN RETIREMENT 2. Family constellation is a positive index regarding

AND POSITIVE REACTIONS TOWARD ROLE DISCONTINUITIES: retirement positively and also in reacting to role
discontinuities.
1. Health Status - refer to physiological and mental state
of the respondents, classified as either sickly or - In the Philippines, the family undoubtedly
healthy. stands as the security or trusting bank where all
2. Income – (economic level) refers to the financial members, young and old can always run and
affluence of the respondent which can be classified as get help.
poor, moderate, or rich.
3. Work Status (according to Webster’s dictionary)- status - When one retires, the shock of the role
of an individual according to his/her work. discontinuities is softened because the family
not only cushions the impact, but also offers
4. Family Constellation – Means the type of family gainful substitutes, as in providing monetary
composition described either close knit or extended support, absorbing emotional strains that often
family where three or more generations of family times with discontinuities and other forms of
members live under one roof; or distanced family, surrogating.
whose members live in separate dwelling units; or
nuclear type of family where only husband, wife and 3. Income has a high correlation with both the perception
children live together. of retirement and reactions towards role
discontinuities.
5. Self-Preparation (according to Webster’s dictionary) - it
is preparing of self to the possible outcomes in life.

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 - Since income is one of the factors that secure - This does not only account professionalism or
the outlook of individual, efforts must be expertise but also benevolent work as in
exerted to save and spend money wisely while charitable actions with the colleagues.
still actively earning in order to have some
reserved when one grows old. - Self-preparation is investing not in monetary
benefits but in something that gives them and
- It also implies that retirement pensions should dignity; enhance their feelings of self-worth and
be adjusted to meet the demands of the happiness.
elderly.
6. To cope with the changes brought by retirement, one
- This should be done in order to have a more must cultivate interest in recreational activities to
relevant and realistic pension and benefits channel feelings of depression or isolation and facing
adjustment. realities through confrontation with some issues.

4. Work status goes hand and hand with economic 7. To perceive retirement positively, it requires early
security that generates decent compensation. socialization of the various roles we take in life.

- For the retired, it implies that retirement - The best place to start is at home extending to
should not be conceptualized as a period of no schools, neighborhoods, The community and
work because capabilities to function get society in general.
sharpened and refined as they practice it on a
regular basis. - in retirement, their fellow retirees are their
own best advocates. To facilitate this, barriers
- Work enhances the aspects of self-esteem and to full participation in the areas where
contributes to the feeling of wellness even and important decisions are rich should be
old age. eliminated in order to give recognition and
appreciation of the knowledge, wisdom,
5. Self-preparation which are said to be both therapeutic experience and values which are the social
and recreational in essence pays its worth in old age. assets that make the retired age and the
custodians’ folk wisdom.

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 8. Government agency to construct holistic pre-  PREPARE ME (Holistic Nursing Interventions) are the
retirement preparation program which will take care of nursing interventions provided to address the multi-
the retiree’s finances, psychological, emotional, and dimensional problems of cancer patients that can be
social needs. given in any setting where patients choose to be
confined. This program emphasizes a holistic approach
9. Retirement should be recognized as the fulfillment of to nursing care. PREPARE ME has the following
every individual’ s birthright and must be lived components:
meaningfully.  Presence – being with another person during the
times of need. This includes therapeutic
communication, active listening, and touch. 
 Reminisce Therapy – recall of past experiences,
feelings and thoughts to facilitate adaptation to
present circumstances. 
Carmencita M. Abaquin  Prayer
 Carmencita M. Abaquin is a nurse with Master’s  Relaxation-Breathing – techniques to encourage and
Degree in Nursing obtained from the University of the elicit relaxation for the purpose of decreasing
Philippines College of Nursing.  undesirable signs and symptoms such as pain, muscle
 An expert in Medical Surgical Nursing with subspecialty tension, and anxiety.
in Oncologic Nursing, which made her known both  Meditation – encourages an elicit form of relaxation
here and abroad.  for the purpose of altering patient’s level of awareness
 She had served the University of the Philippines by focusing on an image or thought to facilitate inner
College of Nursing, as faculty and held the position as sight which helps establish connection and relationship
Secretary of the College of Nursing.  with God. It may be done through the use of music and
 Her latest appointment as Chairman of the Board of other relaxation techniques. 
Nursing speaks of her competence and integrity in the  Values Clarification – assisting another individual to
field she has chosen. clarify his own values about health and illness in order
to facilitate effective decision making skills. Through
“PREPARE ME” Interventions and the Quality of Life Advance this, the patient develops an open mind that will
Progressive Cancer Patients. facilitate acceptance of disease state or may help
deepen or enhance values. The process of values
Basic Assumptions and Concepts: clarification helps one become internally consistent by

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 achieving closer between what we do and what we
feel.

HEALTH AS A MULTIFACTORIAL PHENOMENON

FACTORS AFFECTING HEALTH

A. POLITICAL
 Involves one's leadership how/she rules,
manages and other people in decision making.
1. Safety
- the condition of being free from harm, injury or loss
of authority or power
2. Oppression
- unjust or cruel exercise of authority or power
3. Political will
- determination to pursue something which is for the
interest of the
majority.
4. Empowerment
- the ability of a person to do something
- creating the circumstances where people can use

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 their faculties and
abilities at the maximum level in the pursuit of
common goals
B. CULTURAL
 relating to the representation of non-physical
traits, such as values, beliefs, attitudes and
customs shared by a group of people and
passed from the generation to the next.
1. Practices
- a customary action usually done to maintain or
promote health like use
of anting-anting and lucky charms.
2. Beliefs
- a state or habit of mind wherein a group of people The communication Process
place into something
or a person.  Communication
C. HEREDITY
 is simply the act of transferring information
 the genetic transmission of traits from parents
from one place, person or group to another.
to offspring; genetically 
 Is the exchange of thoughts, feelings and other
determined.
information.
D. ENVIRONMENT
 Every communication involves :
 the sum of all the conditions and elements that
 one sender,
make up the surroundings
 a message and
and influence the development of the
 a recipient
individuals.
 Nurses endeavour to understand and meet the many
E. SOCIO-ECONOMIC
needs of a diverse client population.
 refers to the production activities, distribution
 To do so, nurses must establish therapeutic
of and consumption of goods
relationships with their clients and the quality of those
of an individual.
relationships is directly related to the quality of
communication between nurse and client.

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 1. Components of the communication process out the ways to make the message easy for the
receiver.
a. Sender c. Channel
 the person who initiates the  Is the medium through which
communication process  the sender transmits the message.
 The sender should know the techniques of d. Receiver
initiating an effective communication  Interprets the message
process.  who receives the message.
 These techniques include both verbal and  is either an individual or the whole audience,
non-verbal. and the receiver can communicate either
 Good writing and speaking skills, make easy verbally or non-verbally.
and understandable arguments, good eye  The best way of receiving message is to make
contact, command of grammar, sharing an excellent eye contact, listen carefully and
exact information are some of the sitting up straight.
techniques to be followed for an effective  focus on the message do not involve in any
communication. other activity else while receiving a message
 The sender should be aware of his receiver verbally.
to make changes in the message, if it is not  Give positive response while listening to the
readable for the receiver. message in the form of nodding your head to
b. Message show that you are getting the sender.
 most crucial component of communication. e. Feedback
 different ways in which messages can be sent  is the response of the receiver.
and they can be presentation, written  The receiver has to give his response either by
documents or an advertisement. asking questions or by making comments.
 The message transfer from the sender to  Feedback helps the sender to know that how
receiver. his message has been interpreted.
 The message is what is perceived by the  Remember feedback might be positive and
receiver. negative and even feedback is also the part
 Therefore, the sender should not only create business communication process.
and send forward the message, but also find
Components of the communication process

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 Modes of communication

a. Verbal messages

b. Non verbal messages

a. Facial expressions

b. Posture

c. Gestures

2. Factors influencing Communication d. Touch

a) Perception : individual’s subjective sense of the
world around him. e. Physical appearance
b) Cultural context : Communication varies
significantly from culture to culture. Nonverbal messages
c) Space and distance :defines how close the
1. Facial Expressions
individual should be when communicating,
d) Time : time spend with the persons you are  The face is the ultimate conveyor of nonverbal
trying to communicate. messages
 It gives clues that betray feelings and reactions not
3. Levels of communication expressed in words
a. Intrapersonal level: also known as “self talk”(thoughts,  It support, contradict, or disguise the verbal message.
feelings, information that circulate inside one’s own  Nurses attuned to changes in client’s facial expressions
mind may be aware of emotional reactions and needs
b. Interpersonal level: occurs between two individuals  that a client might be hesitant to express verbally ,
either face-to-face encounter, over the telephone or
leading to better client care.
social media.
c. Group communication level: three or more individuals .
2. Posture
d. Interdisciplinary Communication : communication
 Interpreting posture
between health team or to other agencies.

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  May indicate anxiety, relaxation, positive or
negative self-image.
 Standing tall: indicates self confidence 4. Therapeutic communication
 Slumping : depressed, tired or bored
 Using communication for the purpose of creating a
 Leaning forward : interest
beneficial outcome for the client.
 Leaning backward : rejection, lack of
 Is the hallmark of nurse-client relationship
engagement
 Hand Movements Principles of therapeutic Communication
3. Gestures
 Such as:  Patient focus of interaction
 Shrugging shoulders  Attitude sets the tone
 Waving hands  Use self-disclosure cautiously and for a purpose
 Tapping the feet  Avoid social relationships
 Shaking the head  Maintain patient confidentiality
 Crossed arms : shows nurse has interest in  Assess level of understanding
what client has to say.  Implement intervention from a theoretical basis.
 Repeated looking at the watch :nurse does not
have time to spend time with the client. The elements of therapeutic Communication
4. Touch
 Can be used to soothe , comfort and establish
rapport and a therapeutic bond between nurse
and client .
 Touching a patients hand when delivering bad
news or during a painful procedure.
5. Physical appearance
 Client’s environment,
 Clothing
 Jewelry
 Can convey important messages
 Uniforms : demonstrate professionalism,
2. Trust
inspire confidence, superiority.

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  The client’s belief that the nurse will behave and client have the same understanding of a
predictably and competently while respecting problem or issue.
the client’s needs. a. Behaviors of the nurse Verbal comments
a. Behaviors of the Nurse  “ So you are saying that…”
 Ensure confidentiality  “ let me be sure I understand what you are
 Be consistent saying.”
 Do exactly what you say will do for the client  “ tell me what you understand about what I
 Arrive on time just said.”
 End the session on time b. Outcomes
 Return when you say you will  Clarifies communicating
 Be consistently friendly and honest  Helps client to feel accepted, respected and
b. Outcomes understood.
 Sets up the foundation for therapeutic relationship
 Makes client feel comfortable with the nurse rather 5. Caring
than guarded or afraid.  The level of emotional involvement between
the nurse and the client
3. Honesty a. Behaviors of the nurse Nonverbal actions
 The ability to be truthful, frank, and sincere  Seeking the client out each day
a. Behaviors of the nurse  Spending quality time with the client
 Provide realistic reassurance  Paying attention to the client’s needs
 Avoid false reassurance  Using tactile messages : a pat on the back, to show
 Accept yourself support
b. Outcomes b. Outcomes
 Promotes trust  Makes client feel accepted
 Enable nurse to gain personal insight  Shows nurse’s willingness to help

4. Validation 6. Active Listening

 Hearing and interpreting language, noticing
 Listening to the client and responding nonverbal communication in identifying
congruently in order to be sure that the nurse feelings
a. Behaviors of the nurse

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  Taking time to listen 1. active listening,
 Giving undivided attention
 Making eye contact 2. silence,
 Responding to verbal and nonverbal leads
3. the offering of self,
 Analyzing and validating conversation
 Suspending judgement 4. focusing,
b. Outcomes
 Promotes understanding of the client 5. using open ended questions,
 Allows client to express self more freely
 Helps client gain a better understanding of the 6. clarification,
problem
 Promotes problem solving by the client 7. exploring,
 Enhances client’s self esteem
8. paraphrasing,
Barriers to Therapeutic communication
9. reflecting,
1. Language : individual differences in the use of words
10. restating,
2. Culture : cultural difference in communication
11. providing leads,
transcend spoken language.
12. summarizing,
3. Gender : Differ in communication styles

4. Health status : patient who is in pain or preoccupied 13. . acknowledgment,

may have difficulty communicating effectively.

5. Developmental level : client’s individual development

level can represent difficulty in communication

6. Communication blocks : inappropriate social

interactions during therapeutic interactions

Techniques of therapeutic communication

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 nurses and patients an opportunity
to think through and process what
comes next in the conversation. It
may give patients the time and
space they need to broach a new
topic. Nurses should always let
patients break the silence.
 Sitting quietly , waiting attentively
until client is able to put thoughts
and feelings into words.

The communication process 3. Accepting

 Sometimes it’s necessary to
acknowledge what patients say and
1. Providing general leads
affirm that they’ve been heard.
 Using statements or questions that Acceptance isn’t necessarily the
encourage the client to verbalize, same thing as agreement; it can be
choose a topic of conversation . enough to simply make eye contact
Facilitate continuous verbalization. and say “Yes, I understand.” Patients
 “ Perhaps you would like to talk who feel their nurses are listening to
about it .” them and taking them seriously are
 “Would it help to discuss about your more likely to be receptive to care.
feelings.” 4. . Giving Recognition
 “Where would you like to begin?”  Recognition acknowledges a
2. . Using Silence patient’s behavior and highlights it
 Accepting pauses and periods when without giving an overt compliment.
no one talks that may extend for A compliment can sometimes be
several seconds to minutes without taken as condescending, especially
interjecting any verbal response . when it concerns a routine task like
Using Silence making the bed. However, saying
 At times, it’s useful to not speak at something like “I noticed you took
all. Deliberate silence can give both

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 all of your medications” draws patients have to say, acknowledging
attention to the action and that you’re listening and
encourages it without requiring a understanding, and engaging with
compliment. them throughout the conversation.
5. Offering Self Nurses can offer general leads such
 Hospital stays can be lonely, as “What happened next?” to guide
stressful times; when nurses offer the conversation or propel it
their time, it shows they value forward.
patients and that someone is willing 8. Seeking Clarification
to give them time and attention.  Similar to active listening, asking
Offering to stay for lunch, watch a patients for clarification when they
TV show, or simply sit with patients say something confusing or
for a while can help boost their ambiguous is important. Saying
mood. something like “I’m not sure I
6. . Giving Broad Openings understand. Can you explain it to
 Therapeutic communication is often me?” helps nurses ensure they
most effective when patients direct understand what’s actually being
the flow of conversation and decide said and can help patients process
what to talk about. To that end, their ideas more thoroughly.
giving patients a broad opening such 9. Placing the Event in Time or Sequence
as “What’s on your mind today?” or  Asking questions about when certain
“What would you like to talk events occurred in relation to other
about?” can be a good way to allow events can help patients (and
patients an opportunity to discuss nurses) get a clearer sense of the
what’s on their mind. whole picture. It forces patients to
7. Active Listening think about the sequence of events
 By using nonverbal and verbal cues and may prompt them to remember
such as nodding and saying “I see,” something they otherwise wouldn’t.
nurses can encourage patients to 10. Making Observations
continue talking. Active listening  Observations about the appearance,
involves showing interest in what demeanor, or behavior of patients

WAFER D. BSN1-D | NCM100J
 can help draw attention to areas patients that the nurse was listening
that might pose a problem for them. and allows the nurse to document
Observing that they look tired may conversations. Ending a summary
prompt patients to explain why they with a phrase like “Does that sound
haven’t been getting much sleep correct?” gives patients explicit
lately; making an observation that permission to make corrections if
they haven’t been eating much may they’re necessary.
lead to the discovery of a new 14. Reflecting
symptom.  Patients often ask nurses for advice
11. Encouraging Descriptions of Perception about what they should do about
 For patients experiencing sensory particular problems or in specific
issues or hallucinations, it can be situations. Nurses can ask patients
helpful to ask about them in an what they think they should do,
encouraging, non-judgmental way. which encourages patients to be
Phrases like “What do you hear accountable for their own actions
now?” or “What does that look like and helps them come up with
to you?” give patients a prompt to solutions themselves.
explain what they’re perceiving 15. Focusing
without casting their perceptions in  Sometimes during a conversation,
a negative light patients mention something
12. Encouraging Comparisons particularly important. When this
 Often, patients can draw upon happens, nurses can focus on their
experience to deal with current statement, prompting patients to
problems. By encouraging them to discuss it further. Patients don’t
make comparisons, nurses can help always have an objective
patients discover solutions to their perspective on what is relevant to
problems. their case; as impartial observers,
13. Summarizing nurses can more easily pick out the
 It’s frequently useful for nurses to topics to focus on.
summarize what patients have said 16. Confronting
after the fact. This demonstrates to

WAFER D. BSN1-D | NCM100J
  Nurses should only apply this
technique after they have
established trust. It can be vital to
the care of patients to disagree with
them, present them with reality, or
challenge their assumptions.
Confrontation, when used correctly,
can help patients break destructive
routines or understand the state of
their situation.
17. Voicing Doubt
 Voicing doubt can be a gentler way
to call attention to the incorrect or
delusional ideas and perceptions of
patients. By expressing doubt,
nurses can force patients to examine
their assumptions.
18. Offering Hope and Humor
 Because hospitals can be stressful
places for patients, sharing hope
that they can persevere through
their current situation and lightening
the mood with humor can help
nurses establish rapport quickly. This
technique can keep patients in a
more positive state of mind.

WAFER D. BSN1-D | NCM100J