Therapeutic Communication, SBAR, and Interdisciplinary Handoff — Practical Nursing (LPN)

Objective. Students will conduct a therapeutic patient interview, deliver a complete SBAR handoff report, and demonstrate active listening and de-escalation techniques during a standardized simulated patient interaction.

Why Therapeutic Communication Matters in Practical Nursing

As an LPN, you spend more direct bedside time with patients than almost any other member of the care team. How you speak, listen, and respond shapes whether patients feel safe enough to share accurate information — and accurate information drives safe care. Therapeutic communication is not simply being polite; it is a deliberate set of skills that promotes trust, reduces anxiety, and improves clinical outcomes.

Core Therapeutic Communication Techniques

Open-ended questions invite the patient to describe their experience in their own words. Begin with words like tell me, describe, or what. For example: "Tell me what brought you in today" gathers richer data than "Is your pain a ten out of ten?"

Therapeutic silence allows the patient time to gather thoughts. Resist the urge to fill every pause. A calm nod or brief "I'm listening" signals that you are present without interrupting the patient's train of thought.

Empathetic responses acknowledge feelings without judgment. Saying "That sounds very frightening" validates the patient's experience and builds rapport. Avoid minimizing language such as "At least you're here now" or "It could be worse."

Active listening means giving full attention: maintain comfortable eye contact, face the patient, avoid looking at your phone or chart, and paraphrase what you heard — "So if I understand correctly, the pain started two days ago and comes and goes?" Paraphrasing also catches misunderstandings early.

Avoid leading questions. A leading question contains the expected answer: "The pain is in your chest, right?" This can cause patients to agree rather than correct you, introducing error into the history.

De-escalation Techniques

Anxious or agitated patients need calm, predictable responses. Key de-escalation principles:

Lower your own voice. A soft, even tone is disarming.
Acknowledge the emotion first before providing information. "I can see you're upset. I want to help."
Offer choices where possible to restore a sense of control: "Would you prefer I come back in five minutes, or would you like to talk now?"
Maintain safe positioning. Stay near the door if a patient's behavior is unpredictable, and follow your facility's protocols for escalating to security if safety is threatened. Patient safety and staff safety are equally important.
Never argue or match the patient's agitation. Escalating your own tone worsens the situation.

SBAR: Structured Clinical Communication

SBAR stands for Situation, Background, Assessment, Recommendation. It is a widely adopted framework in healthcare settings that organizes spoken handoff reports so the receiving clinician gets complete information in a predictable order, reducing communication errors at transitions of care.

S — Situation: State who you are, who the patient is, and what is happening right now. Be brief and specific. "This is Nurse Chen calling about Mr. Rivera in Room 204. He is reporting 8/10 chest tightness that started 20 minutes ago."

B — Background: Provide relevant clinical context: admitting diagnosis, significant history, current medications, allergies, and recent vital signs. Include only information relevant to the current situation.

A — Assessment: Share your clinical judgment about what is happening. As an LPN, your assessment focuses on observable changes from baseline: "His blood pressure has dropped 20 points from this morning's reading and he appears diaphoretic." You are not diagnosing — you are communicating what you observe and measure.

R — Recommendation: State clearly what you believe needs to happen or what you are asking for. "I'm requesting an immediate evaluation and asking whether I should administer oxygen per the prn order." If you are handing off to an oncoming nurse rather than escalating an emergency, the recommendation may be a specific action you need them to follow up on.

The LPN Role in Interdisciplinary Handoffs and Team Huddles

In an interdisciplinary team (physicians, RNs, social workers, therapists, dietitians), the LPN's role is to report accurate observations, flag safety concerns, and carry out delegated orders within scope of practice. Practical nurses do not independently develop or change the plan of care — that falls within the RN or provider role.

Being part of the team means:

Concise reporting: Stick to objective findings and your assigned patients. Avoid speculation beyond your scope.
Appropriate deference: When the physician or RN makes a clinical decision, acknowledge and clarify your assignment. Ask questions to ensure you understand orders correctly.
Assertive safety communication: If you observe a potential safety issue — a wrong medication, a patient who is deteriorating — you have both the professional and ethical obligation to speak up clearly, even to a senior colleague. Use structured language: "I have a safety concern I need to raise" to signal urgency without alarm.

Safety Reminders for This Lesson

Inaccurate handoffs are a leading cause of preventable patient harm. Every component of SBAR must be present.
Confidentiality applies in simulation: treat scenario information as you would real protected health information.
De-escalation is first-line; always follow facility policy for escalating aggressive behavior — never put yourself or others at risk.
Scope of practice: report what you observe; defer diagnosis and plan-of-care changes to the appropriate provider.

Key terms10

Therapeutic communicationA deliberate, skill-based approach to interacting with patients that builds trust, gathers accurate information, and supports emotional safety; includes open-ended questioning, empathetic responses, and active listening.

Open-ended questionA question that cannot be answered with a simple yes or no and that invites the patient to describe their experience in their own words, yielding richer clinical data.

Active listeningA communication behavior involving full attentiveness, comfortable eye contact, nonverbal affirmation, and paraphrasing to confirm understanding of what the patient has said.

SBARA structured handoff framework standing for Situation, Background, Assessment, and Recommendation; used to organize verbal or written clinical communication at transitions of care.

De-escalationTechniques used to reduce a patient's agitation or anxiety, including lowering one's voice, acknowledging emotions, and offering choices; the goal is to restore calm without confrontation.

Handoff reportThe transfer of responsibility for a patient's care from one provider or shift to another, accompanied by a structured verbal or written summary of the patient's current status.

Interdisciplinary teamA group of healthcare professionals from different disciplines — such as nursing, medicine, social work, and therapy — who collaborate to coordinate a patient's plan of care.

Therapeutic silenceA deliberate pause in conversation that gives the patient time and space to think, feel, and speak without interruption; a valuable tool for encouraging disclosure.

Scope of practiceThe legally and professionally defined boundaries of what a licensed practical nurse is permitted to assess, perform, and report, as determined by state Nurse Practice Acts.

Empathetic responseA statement that acknowledges and validates a patient's feelings without judgment, helping to build rapport and reduce anxiety during clinical interactions.

In class: Role-play a patient admission interview with a peer acting as an anxious patient; student demonstrates open-ended questioning, therapeutic silence, and empathetic responses while gathering chief complaint and history. · Receive a written patient scenario and deliver a complete four-component SBAR verbal handoff to the instructor (acting as the receiving nurse), incorporating vital signs, current medications, and pending orders. · Participate in a simulated interdisciplinary team huddle (student plays LPN role); practice concise reporting, appropriate deference on medical decisions, and assertive communication when patient safety is at stake.
Materials: SBAR reference card, standardized patient scenario cards, communication skills rubric, role-play evaluation form, de-escalation techniques handout
Check: Communication rubric scored by instructor and one peer observer; therapeutic interview must include at least five open-ended questions and no leading questions; SBAR handoff scored pass/fail requiring all four components; overall rubric score 80% or higher.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.