Therapeutic Communication Flashcards
Agreeing with and opposing the client’s ideas implies that the nurse has the right to judge, agreeing prevents the client from changing his/her view, disagreeing provokes defensiveness.
Ex. “That’s right. I agree”
“That’s bad. I disagree”
Agree/disagreeing (non-therapeutic)
Implies criticism, often puts the patient on the defensive.
Ex. “Why did you stop taking your medications?”
Asking “Why” questions (Non-therapeutic)
Minimizing problems and discomfort conveys a lack of empathy and understanding. Saying “perk up” and “snap out of it” causes the client to feel insignificant and unimportant.
Ex. Client: “I have nothing to live for. I wish I were dead”
Nurse: “Everybody gets down in the dumps. I feel that way sometimes”
Better: “You must be very upset. Tell me what you are feeling right now”
Belittling (non-therapeutic)
Demanding proof from client tends to strengthen and expand his/her misinterpretation of reality.
Ex. “How can you possibly be Jesus?”
“Show me your million dollars.”
Challenging (NT)
Introducing an unrelated topic blocks communication.
Ex. Client: “I want to die.”
Nurse; “Did you have visitors today?”
Changing the subject (NT)
Attempting to protect someone or something from verbal attack. Implies that the client does not have a right to express ideas, opinions, or feelings.
Ex. Client: “My daughter is hateful to me”
Nurse: “She must be awful to live with”
Criticism of others (NT)
Results in pt no knowing what questions to answer.
Ex. How’s your appetite? Are you losing weight? Are you eating enough?
Excessive questioning (NT)
Attributing the source of thoughts, feeling, and behavior to outside influences encourages the client to project blame for his/her thoughts and behaviors upon others rather than accepting the responsibility personally.
Ex. “What makes you say that?”
:What made you do that?”
“What made you so angry?”
Better to say: “You became angry when your brother insulted your wife?”
Indicating the existence of an external source of power (NT)
Rushes the client and disregards input. Nurse misses what the client is trying to convey.
EX. “I think this is what you really mean. “
Interpreting or analyzing prematurely (NT)
Demonstrates a lack of acceptance of the client’s differences and provides a barrier to further disclosures.
Ex. “You are thinking about divorce when you have 3 children?”
Making value judgments (NT)
Cuts off communication. The nurse is trying to make the patient feel better, but is not addressing the problem.
Ex. Everyone feels that way at times; it’s not a big deal. “
Minimizing the problem. (NT)
Shows the patient that the nurse is not interested, is too busy to talk or is preoccupied with personal issues.
Ex. “I’m sorry, what did I say?”
“Could you start again, I was listening to another client”
Not Listening (NT)
Discourages independent thinking.
Ex. “I think you should”
Offering advice (NT)
Devalues the client’s feelings, shows lack of understanding, and discourages the expressions of feelings.
Ex “Don’t worry about anything. Everything is going to work out.”
Offering false reassurance (NT)
Making stereotyped comments, cliches’ and trite expressions are meaningless and encourage superficial responses from clients.
Ex. “It’s for your own good. Keep your chin up!”
Offering superficial comments (NT)
Pushing for answers to issues the client does not wish to discuss, causes the client to feel used, places client on defensive. Ex. "What did you tell your wife?" "What did you discuss in therapy?" "Why do you do this?" "Why do you feel this way?"
Probing (NT)
Not allowing the client to express thoughts and feelings, blocks communication.
Ex “I don’t want to hear about that again”
Rejecting NT
Encourages the client to invent reasons, give partial answers and expand delusional system. Intimidating and causes defensiveness.
Client:”I’m so nervous.”
Nurse:”Why are you so nervous?”
Better to say: “Describe what happened just before you started feeling nervous.”
Requesting an explanation (NT)
Focus is taken away from the client, who is seeking help.
Ex. “That may have happened to you last year, but I’ve been through that twice already this month…”
Self-focusing (NT)
Refusing to admit a problem exists closes off an avenue of discussion and avoids helping the client from exploring areas of difficulty.
Ex. Client:I”m nothing
Nurse: “Everybody is something”
Better to say: Your feeling like no one care about you right now.”
Using denial
Responding to a figurative comment as a statement of fact.
Client: I am dead.
Nurse: Then why is your heart still beating?
Better to say: Are you saying you feel lifeless?
Giving literal responses NT
Verbal and nonverbal skills that conveys to the patient that the nurse is paying attention. Conveys regard and interest.
Ex. “In an open position, eye contact, “Go, on, I am listening. “
Nurse “Yes” Eye contact, nodding.
Active Listening/Accepting (TC)
Asking clients to decide on the type of change needed.
Nurse: “What do yo think needs to change?”
“What do you want to do differently?”
Assisting in goal setting (TC)
Responds to the feeling expressed, not just the content.
EX. Client; “I am dead inside”
Nurse: “Are you saying you feel lifeless?”
Attempting to translate into feelings (TC)
Recognizing and acknowledging the client’s feelings without losing objectivity.
Ex. Nurse: “I can hear how much this has hurt you.
Empathizing TC
Asking for similarities and differences among feelings, behaviors, and events.
ex. Nurse”How does this compare to the last time?” “What is different about your feelings today?”
Encouraging comparison (TC)
Asking the clients to make a choice among options.
Nurse:”What would work best for you?”
Encouraging decisions (TC)
Asking for client’s view of the importance of something.
Nurse:” What does all this mean to you? How serious is this for you? How important is it to change this behavior?
Encouraging evaluation TC
Asking for clients view of his/her situation, often used with clients experiencing hallucinations.
ex. Nurse; “Can you tell me what is happening now?”
Encouraging descriptions of perceptions TC
Asking for step-by-step actions that will be needed.
Nurse: “What exactly will it take to carry out your plan? what else do you need to do?
Encouraging plan formulation. TC
Helps the client see that new thoughts and actions can be accomplished after discharge
ex. Nurse: “How can a relapse prevention plan assist you after you leave the hospital? “
Encouraging post hospital transition TC
Asking client to evaluate his/her actions and outcomes. Determining progress. Encourages clients to look at their behavior and the outcomes it produces.
Nurse:”How well did it work when you tried ____?”
Client:” I am getting better.”
Nurse: “In what ways do you feel better? How well did it work when you tried…..?
Evaluating actions TC
Obtaining all pertinent data on a particular subject or feeling to move beyond superficial.
Client; “I don’t feel well today. “
Nurse: ‘ What seems to be the matter? “
Exploring
Pursuing a topic until its meaning or importance is clear.
Client; “Women always get put down. It’s as if we don’t count at all.”
Nurse: “Tell me how you feel as a woman”
Focusing TC
