Other Psychosocial Skills

In addition to therapeutic communication, nurses use a variety of other skills to help patients find new ways of coping with illness and the problems it causes. Many of these skills are used without the nurse's even being aware of using them. Perfecting the following techniques can greatly enhance your ability to meet the psychosocial needs of your patients.

Acceptance:Demonstrating an interest in a patient's behavior and feelings communicates to the patient that he or she is valued. You can demonstrate acceptance of the patient by listening to him or her even if you disagree with the ideas being communicated. It is important not to criticize or judge the patient. Acceptance reinforces self-esteem.

Reassurance: Providing support by giving your attention to matters that are important to the patient reinforces emotional security and helps reduce the patient’s anxiety. With less anxiety to deal with, the patient can spend more time on effective problem solving and healing. However, nurses should avoid giving false reassurance. If something unexpected occurs after the nurse has reassured the patient, for instance, that everything will be all right, it can reinforce a sense of distrust in the nurse.

Enhancing self-esteem: Increased self-esteem gives the patient a sense of control and hope. This will help reduce anxiety and give the patient more time for problem solving and healing. Techniques to reinforce positive self-esteem include focusing on patient's positive traits and accomplishments, providing opportunities for the patient to demonstrate skills and abilities successfully, and providing emotional support and reassurance.

Expression of feelings:Providing an environment in which a patient can feel safe and comfortable to express emotions, including sorrow or anger, and to verbalize disagreement, fear, and disappointment is essential for both enhancing a therapeutic relationship and allowing the patient to solve problems.

Role modeling: The nurse can exhibit more socially acceptable ways of performing a certain role or demonstrating a certain behavior. When the patient sees how effective these behaviors are, he or she can more easily understand how to use them and emulate the behaviors. For example, the nurse can communicate assertively with a family member who may be intimidating the patient. When the patient sees how that family member responds to assertive behavior, he or she may adopt that method of interaction. The nurse also provides a role model for adopting a healthy lifestyle by eating healthy foods, exercising, and not smoking.

Role playing: Role playing is acting out other methods of response to a situation. It can be done to increase one's own or another's understanding of the other’s point of view or to practice appropriate responses, such as assertiveness. This is done with a supportive person playing the part of someone you want to communicate with in a new way.

Stress management: Accepting stress as a fact of life and managing it using specific, tested techniques can reduce feelings of anxiety. The techniques are meant to promote a feeling of calm and a sense of control over the situation. Common stress management techniques include physical interventions such as taking deep breaths, exercising, and avoiding caffeine and psychological interventions such as counting to 10, avoiding additional stressors, maintaining a positive attitude, and seeking out emotional support.

Assertiveness: Assertiveness is the use of behavioral techniques that allow the individual to stand up for his or her rights without infringing on the rights of others. To gain expertise in using assertive behavior, role-playing, and practicing with others is useful. You may try role-playing assertive responses to common situations in a supportive environment, such as asking for a refund or telling a colleague that you are not satisfied with the quality of work performed.

Limit setting: Limit setting is a form of behavior modification rather than a punishment and is used for times when acceptance of the patient's behavior is no longer appropriate. To set limits on behavior, you need to clearly define the desired behaviors and the consequences of not conforming to them. Then you must be prepared to follow through with the stated consequences. If appropriate limits are not set to control the patient's inappropriate behavior, it can escalate and possibly lead to injury and resentment from those who feel manipulated by the patient. Setting limits may be required to ensure patient safety (Manos & Braun, 2006).

De-escalation: De-escalation techniques are also used to reduce anxiety and slow down the emotional response to it, such as aggressive behavior. Useful techniques include removing the patient from volatile situations and using appropriate medication and physical restraints.

Confrontation: At times it is necessary to make direct statements that challenge the patient's behavior or beliefs. Confrontation is a verbal message designed to help the other person recognize inconsistencies or inappropriate behavior. It can assist the patient in gaining insight. However, it can also be so threatening that it could precipitate a crisis situation, so be sure to consult with specialists before using this method.

Empathy: Communicating an understanding of how the client feels indicates that the nurse shares the feelings. Empathy differs from sympathy in that empathy does not indicate sharing of personal feelings.

Silence: Sometimes saying nothing for a few moments can communicate more than words. This can convey support, acceptance, and concern and give the patient time to compose himself or herself.

Relaxation techniques: The nurse can use a variety of techniques, including deep breathing, imagery, and muscle relaxation. See Box 3-2 Relaxation Techniques for more details.