The Importance of Questioning Skills in Therapeutic Communication

Therapeutic communication implies the face-to-face interaction between a nurse practitioner and a patient with the ultimate goal of enhancing the patient’s physical and emotional wellbeing. According to Martin and Chanda (2016), nurses should use therapeutic communication to facilitate an interpersonal relationship with the patient. Also, Hall, Leach, Brosnan, and Collins (2017) found that through establishing a therapeutic relationship based on communication, nurses develop an essential element of the nursing practice enabling them to serve and fully understand patients. Therapeutic communication and relationship can only emerge after a nurse establishes a close connection with a patient during the health assessment, patient interview process, or general care practice. This paper aims at expounding on the importance of communication as a primary element in establishing a relationship between a practitioner and a patient. Thus, it focuses on therapeutic communication literature and also the aspects of communication such as active listening, questioning, and body language.

Active Listening

According to Srivastava (2013), listening is hearing what one is saying. Srivastava (2013) expounds on active listening as a dynamic process involving listening, processing, and interpreting the message and words spoken by someone. Active listening enables nurse practitioners to understand and interpret the message provided by the patients during the practice (Arnold, & Boggs, 2015). Communication can be ineffective due to external and internal distractions. External communication distractions include ringing telephones, sounds from automatic reminders, and flickering computer screens. One can avoid such distractions by choosing a place or time free from detractions for the communication with the patient during interview (Kurtz, Draper, & Silverman, 2016). Internal distractions may include mental disturbance during the practice, problems in interpreting the patient’s message, and cultural barriers (Srivastava, 2013). A practitioner can prevent internal distractions during communication by allowing more time for interaction with the client. Other mistakes that may emerge in active listening include trying to outline the talk, faking attention, avoiding difficult content, and lagging behind in conversation.

a) An Example of Mistakes while showing Active Listening Skills

Interviewer: Hello, I would like us to have a short discussion for the assessment of your healing progress after the operation. (Phone rings). As I said, I would like us to discuss your healing progress.

Patient: Hi, thank you. I have been experiencing relatively positive progress with my body recovering well after the XXXX operation.

Interviewer: I have realised a significant change in your body that has taken place within a short time. (Checks at the flickering computer screen and gets back to the process shortly). I am going to ask you a few questions to determine your progress.

Patient: (Strains to listen due to increased noise from outside the room). Well, I will appreciate your help.

Interviewer: This interview will help us to recommend more treatment to you while also assisting you in knowing the stage of your healing. (Checks phone again).

Patient: (Remains silent waiting for the practitioner to get back from engaging the phone)

Details: Video was taken from a health care assessment session at 2:35 pm.

b) Analysis of the Active Listening Example

During the active listening session above, several aspects depict poor communication skills. Firstly, the practitioner allows internal and external distractions to affect communication with the patient. According to Srivastava (2013), allowing distractions during conversation affects the patient’s confidence and trust in the relationship developed during communication while also impeding the interview process. Secondly, the practitioner did not allow the patient to engage actively in expressing their healing progress. For an effective interview process, the patient should take maximum time to define, explain, and talk about their experience while the practitioner listens (Arnold, & Boggs, 2015). Lastly, the interviewer allowed the devices such as computer and phone to take away the concentration from the patient.

Questioning Skills

Questioning is a process of involving the patient using questions and allowing them to answer in an appropriate time. According to Moore, Rivera, Bravo‐Soto, Olivares, and Lawrie (2018), a practitioner should deploy adaptive and direct questioning that involve posing questions to the patient from the general to specific ones. It is also important to use open and close-ended questions that provide a patient with options on the answers to give (Srivastava, 2013).  Throughout questioning, the practitioner may offer sample answers for the patient to use for the close-ended questions such as ‘yes,’ ‘no,’ ‘great,’ and ‘less’ (Hiller, Guillemin, & Delany, 2015). For the open-ended questions, the interviewer should allow the patient enough time to think and give the appropriate answer (Srivastava, 2013). In this case, the interviewer may assist in interpreting the question. The questioning process also includes the use of nonverbal communication cues such as eye contact, posture, and facial expression. By maintaining concentration, an interviewer shows interest in listening to the patient. The interviewer should avoid piling numerous questions to the patient at a time.

a) An Example of Mistakes while showing Questioning Skills

Interviewer: Have you been experiencing any pain in the recent days after your operation?

Patient: Yes, I have been experiencing a lot of pain in various parts of my body like chest, abdomen, and the back. However, the pain has gradually reduced lately making it possible for me to sleep well. Do you want to know the specific parts that have been more painful to me?

Interviewer: Yes, how about your chest? Is the pain sharp, stabbing, or what? Does it last for a long time or it comes occasionally?

Patient: The chest has more pain than my abdomen or the back. The pain is a bit stabbing, and it lasts for a few minutes during the day but longer during the night.

Interviewer: (Taking a look at the computer and phone) I noticed that you can now walk with ease. Are you still adhering to your medication well? What are some of the medicine doses that you have already completed?

Patient: Yes, I am still attached to my medication strictly. I am yet to complete any dosage for now.

Details: Video was taken from a health care assessment session at 3:15 pm.

b) Analysis of the Questioning Skills Example

In the above questioning session, the interviewer misses on some crucial skills that should be available for effective interview between a practitioner and a patient. Firstly, the interviewer poses many questions to the patient at one time. According to Srivastava (2013), giving a patient numerous questions at a time affect the quality of their answers. Secondly, the interviewer fails to provide answers to close-ended questions. By asking whether the patient has been experiencing pain, the interviewer does not offer options on the parts of the body that the patient should expect pain until later on when the patient provides an answer. Providing suggestions and multiple choice answers guide patients by avoiding unnecessary struggles in answering questions (MacLean, Kelly, Geddes, & Della, 2017). Lastly, the interviewer shifts concentration and attention to devices such as computer and phone during the session. The interruption limits the effectiveness of communication by reducing the attachment through body language and even focus on the provided answers.

Body Language

According to Srivastava (2013), body language involves the sending and receiving of messages from a patient without relying on the use of words. Body language is as interactive as the spoken words utilised during communication. Body language involves the use of gestures, eye contact, body posture, facial expressions, and the overall body appearance. In some cases, the perception of the body language by the patient may depend on various factors such as cultural background and personal assumptions or preferences (Srivastava, 2013). Thus, a practitioner may take the initiative to realize the culture of a patient for effective communication and interaction. Where there is a limited opportunity to learn the culture, a practitioner should deploy professional approach based on care and communication skills to keep the patient at ease (Kurtz, Draper, & Silverman, 2016). During the interview session, the practitioner should avoid various mistakes that are common in using the body language for communication. Some of the errors include avoidance of eye contact, poor use of, wrong facial expression showing inappropriate feelings, expression of negative feelings, and showing restlessness during the interview.

a) An Example of Mistakes while showing Questioning Skills

Interviewer: (Prepares for the interview session). (Sits down beside the patient and the medical devices in the room, avoids eye contact with the patient, sits with arms akimbo while showing restlessness and hurriedness, and also indicates the unwillingness to listen through operating the devices)

Patient: (Waits for the practitioner to get settled for the assessment to begin)

Details: Video was taken from a health care assessment session at 4:01 pm.

b) Analysis of the Questioning Skills Example

The above scenario involves a couple of mistakes in the interviewer’s body language. Firstly, the interviewer fails to give full attention to the patient through operating devices and showing restlessness. Secondly, the interviewer takes an awkward sitting position while also avoiding eye contact and unwilling to listen. Most of these mistakes limit the patient’s confidence in the communication while affecting the quality of answers provided.

Conclusion

Therapeutic communication is an essential element in interacting with and understanding the needs of a patient. Through the process of communication and interaction, a practitioner should create a supportive environment that builds on the patient’s trust and confidence. Proper communication is possible where a practitioner possesses and adequately deploys the communication skills such as active listening, questioning skills, and body language. However, the presence of mistakes and errors in the process affects communication by limiting confidence, trust, and feelings of ease among the patients. Most of the common errors include the failure to give full attention and concentration, poor body language associated with avoiding eye contact and unwillingness to listen, and also lack of supportive guidance in the questioning period. To prevent such scenarios, a practitioner should prepare for the communication sessions through allowing enough time, looking for an appropriate place for the process, and allowing the patient enough time to participate.

References

Arnold, E. C., & Boggs, K. U. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.

Hall, H., Brosnan, C., Frawley, J., Wardle, J., Collins, M., & Leach, M. (2018). Nurses’ communication regarding patients’ use of complementary and alternative medicine. Collegian, 25(3), 285-291.

Hall, H., Leach, M., Brosnan, C., & Collins, M. (2017). Nurses’ attitudes towards complementary therapies: A systematic review and meta-synthesis. International journal of nursing studies, 69, 47-56.

Hiller, A., Guillemin, M., & Delany, C. (2015). Exploring healthcare communication models in private physiotherapy practice. Patient education and counseling, 98(10), 1222-1228.

Kurtz, S., Draper, J., & Silverman, J. (2016). Skills for communicating with patients. CRC Press.

MacLean, S., Kelly, M., Geddes, F., & Della, P. (2017). Use of simulated patients to develop communication skills in nursing education: an integrative review. Nurse education today, 48, 90-98.

Martin, C. T., & Chanda, N. (2016). Mental health clinical simulation: therapeutic communication. Clinical Simulation in Nursing, 12(6), 209-214.

Martin, C. T., & Chanda, N. (2016). Mental health clinical simulation: therapeutic communication. Clinical Simulation in Nursing, 12(6), 209-214.

Moore, P. M., Rivera, S., Bravo‐Soto, G. A., Olivares, C., & Lawrie, T. A. (2018). Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database of Systematic Reviews, (7).

Srivastava, S. B. (2013). The patient interview. Fundamental Skills for Patient Care in Pharmacy Practice, 1.