2.2 Basic Concepts of Communication

Communication Standard of Professional Performance

The Standard of Professional Performance for Communication established by the American Nurses Association (ANA) is defined as, “The registered nurse communicates effectively in all areas of professional practice.”^[1] See the following box for the competencies associated with the Communication standard.

Nurse-Client Relationship

Establishment of the therapeutic nurse-client relationship is vital in nursing care. Nurses engage in compassionate, supportive, professional relationships with their clients as part of the “art of nursing.”^[2] This is especially true in psychiatric care, where the therapeutic relationship is considered to be the foundation of client care and healing.^[3] The nurse-client relationship establishes trust and rapport with a specific purpose; it facilitates therapeutic communication and engages the client in decision-making regarding their plan of care.

Therapeutic nurse-client relationships vary in depth, length, and focus, and are influenced based on the care setting. Brief therapeutic encounters might last only a few minutes and focus on the client’s immediate needs, safety, current feelings, or behaviors. For example, in the emergency department setting, a nurse may therapeutically communicate with a client in crisis who recently experienced a situational trauma. During longer periods of time, such as inpatient care, nurses work with clients in setting short-term goals and outcomes that are documented in the nursing care plan and evaluated regularly. In long-term care settings, such as residential facilities, the therapeutic nurse-client relationship may last several months and include frequent interactions focusing on behavior modification.

Phases of Development of a Therapeutic Relationship

The nurse-client relationship goes through three phases. A well-known nurse theorist named Hildegard Peplau described these three phases as orientation, working, and termination.^[4]

Orientation Phase

During the brief orientation phase, clients may realize they need assistance as they adjust to their current status. Simultaneously, nurses introduce themselves and begin to obtain essential information about clients as individuals with unique needs, values, beliefs, and priorities. During this brief phase, trust is established, and rapport begins to develop between the client and the nurse. Nurses ensure privacy when talking with the client and providing care and respect the client’s values, beliefs, and personal boundaries.

A common framework used for introductions during client care is AIDET, a mnemonic for Acknowledge, Introduce, Duration, Explanation, and Thank You.

• Acknowledge: Greet the client by the name documented in their medical record. Make eye contact, smile, and acknowledge any family or friends in the room. Ask the client their preferred way of being addressed. For example, knock gently and enter the room calmly. Approach with a non-threatening demeanor and open body language. “Hello, Alex. I see you’ve just arrived—welcome. I know being here might feel overwhelming at first, but I’m really glad you’re here. May I ask how you’d like to be addressed and what pronouns you use?”
• Introduce: Introduce yourself by your name and role. Build trust by being transparent and personable. For example, “My name is Jordan, and I’m the registered nurse assigned to support you today. My role is to help make sure you feel safe, listened to, and supported throughout your stay.”
• Duration: Estimate a timeline for how long it will take to complete the task you are doing. Provide structure without adding pressure, acknowledging the client’s emotional state. For example, “Right now, I’d like to spend about 15–20 minutes getting to know you a little better and going over a few admission questions. We’ll talk about how you’re feeling, your goals for being here, and how we can support you best.”
• Explanation: Explain step by step what to expect next and answer questions. Be clear and gentle, inviting collaboration. For example, “We’ll talk in a private space so you can share as much or as little as you’re comfortable with. I’ll ask about what brought you in, what’s been going on recently, and your support system. You’re welcome to take breaks or let me know if anything feels too much.”
• Thank You: At the end of the encounter, thank the client and ask if anything is needed before you leave. Affirm the client’s effort and courage in showing up. In an acute or long-term care setting, ensure the call light is within reach and the client knows how to use it. If family members are present, thank them for being there to support the client as appropriate. For example, ““Thank you for sharing your time with me today—it takes real strength to take this step. Before I go, is there anything I can get for you? I’ll make sure you know how to reach me if you need anything.”

Working Phase

The majority of a nurse’s time with a client is spent in the working phase of the therapeutic relationship. This is where trust deepens, and meaningful progress toward health and well-being begins. During this phase, nurses use active listening to understand the client’s needs, values, and goals, starting with open-ended questions to explore the reason for seeking care. Assessment findings are used to develop or refine the nursing plan of care and to guide client education that is tailored to the individual. For example, after using the AIDET framework to greet and orient a new client like Alex, a nurse might say: “Alex, thank you again for sharing some of your story with me earlier. I know being here is a big step. Based on what you’ve told me so far, I’d like to talk through a few ideas together that could help you feel supported during your stay.”

If a care plan has already been initiated, the nurse uses this phase to implement targeted interventions aimed at both short-term relief and long-term outcomes. As the relationship strengthens, clients begin to see nurses as educators, counselors, and trusted care providers—not just clinical staff. In Alex’s case, the nurse might continue: “Can you tell me more about what led you to seek care today and what you’re hoping will be different by the time you leave? Your voice really matters here—we’ll create a plan together that feels realistic and helpful for you.”

This collaborative approach is essential. Nurses use therapeutic communication techniques—such as reflection, clarification, silence, and motivational interviewing—to help clients become more aware of their thoughts, emotions, and options. Through nonjudgmental feedback, the nurse supports the client in exploring and clarifying their goals, strengths, and coping strategies.^[5] For example, the nurse might gently reflect: “It sounds like you’ve been trying to manage everything on your own, and it’s been exhausting. It’s okay to need help—being here is a brave step.” In these moments, the nurse not only delivers clinical care but also fosters emotional healing and client empowerment. The working phase is where healing conversations and actions come together, providing a foundation for meaningful change and lasting outcomes.

Termination Phase

The termination phase marks the conclusion of the therapeutic nurse-client relationship. It typically occurs at the end of a shift, during a transfer, or at discharge from care. When the working phase has been effective, the client’s goals have been addressed collaboratively through the efforts of the client, nurse, and interprofessional team. This final phase provides an opportunity for reflection, reinforcement, and closure—essential for empowering the client to move forward independently with confidence.

In Alex’s case, after several days of support and progress, the nurse prepares to end the therapeutic relationship at the end of the shift and as Alex nears discharge. The nurse approaches the conversation with sensitivity and structure. “Alex, I want to take a few minutes to talk with you before I end my shift. It’s been a privilege working with you this week, and I want to thank you for the trust you’ve placed in me.”

Because clients may sometimes attempt to return to the working phase to delay separation, the nurse remains aware and gently holds space for any emotions that arise. “I know transitions can bring up a lot of feelings. It’s normal to feel a mix of relief, nervousness, or even sadness. Would it be helpful to talk through any of that together before I go?”

The nurse encourages Alex to reflect on progress and reinforces the client’s strengths. “You’ve worked incredibly hard to identify what matters most to you, and you’ve been honest and brave every step of the way. Remember when we first talked and you weren’t sure if you even belonged here? Now look at how far you’ve come—recognizing your needs, setting goals, and planning next steps.”

Together, they review discharge goals and available community supports. “Before you leave, we’ve set up a follow-up appointment with the outpatient team for next Tuesday. I’ve also included a few community support groups you might want to explore. These resources are here to walk with you as you continue building on the work you started here.”

The nurse concludes the relationship with warmth, professionalism, and closure. “Alex, thank you again for allowing me to be part of your care. I truly believe in your ability to keep moving forward. If you ever need support again, know that it’s okay to reach out.”

This approach to the termination phase helps ensure that the client leaves with a clear sense of accomplishment, continuity of care, and confidence in their ability to self-advocate and engage support systems. It also models a healthy ending to a professional relationship—an important skill for both clients and nurses.