Flashcards in Chapter 11: Communication and the Clinical Interview Deck (24)
A patient says to the nurse, “I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which response should the nurse use to clarify the patient’s comment?
a. “It sounds as though you were uncomfortable with the content of your dream.”
b. “I understand what you’re saying. Bad dreams leave me feeling tired, too.”
c. “So you feel as though you did not get enough quality sleep last night?”
d. “Can you give me an example of what you mean by ‘stoned’?”
The technique of clarification is therapeutic and helps the nurse examine the meaning of the patient’s statement. Asking for a definition of “stoned” directly asks for clarification. Restating that the patient is uncomfortable with the dream’s content is parroting, a nontherapeutic technique. The other responses fail to clarify the meaning of the patient’s comment.
A patient diagnosed with schizophrenia tells the nurse, “The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say.” Which response by the nurse would be most therapeutic?
a. “Let’s talk about something other than the CIA.”
b. “It sounds like you’re concerned about your privacy.”
c. “The CIA is prohibited from operating in health care facilities.”
d. “You have lost touch with reality, which is a symptom of your illness.”
It is important not to challenge the patient’s beliefs, even if they are unrealistic. Challenging undermines the patient’s trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patient’s message conveys. The correct response uses the therapeutic technique of reflection. The other comments are nontherapeutic. Asking to talk about something other than the concern at hand is changing the subject. Saying that the CIA is prohibited from operating in health care facilities gives false reassurance. Stating that the patient has lost touch with reality is truthful, but uncompassionate.
The patient says, “My marriage is just great. My spouse and I always agree.” The nurse observes the patient’s foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient’s communication is which of the following?
Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patient’s verbal message that all was well in the relationship was modified by the nonverbal behaviours denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.
A nurse interacts with a newly hospitalized patient. Select the nurse’s comment that applies the communication technique of “offering self.”
a. “I’ve also had traumatic life experiences. Maybe it would help if I told you about them.”
b. “Why do you think you had so much difficulty adjusting to this change in your life?”
c. “I hope you will feel better after getting accustomed to how this unit operates.”
d. “I’d like to sit with you for a while to help you get comfortable talking to me.”
“Offering self” is a technique that should be used in the orientation phase of the nurse–patient relationship. Sitting with the patient, an example of “offering self,” helps to build trust and convey that the nurse cares about the patient. Two incorrect responses are ineffective and nontherapeutic. The other incorrect response is therapeutic but is an example of “offering hope.”
Which technique will best communicate to a patient that the nurse is interested in listening?
a. Restating a feeling or thought the patient has expressed
b. Asking a direct question, such as “Did you feel angry?”
c. Making a judgement about the patient’s problem
d. Saying, “I understand what you’re saying.”
Restating allows the patient to validate the nurse’s understanding of what has been communicated. Restating is an active listening technique. Judgements should be suspended in a nurse–patient relationship. Closed-ended questions such as “Did you feel angry?” ask for specific information rather than showing understanding. When the nurse simply states that he or she understands the patient’s words, the patient has no way of measuring the understanding.
A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?
a. “What are the common elements here?”
b. “Tell me again about your experiences.”
c. “Am I correct in understanding that . . .”
d. “Tell me everything from the beginning.”
Asking, “Am I correct in understanding that . . .” permits clarification to ensure that both the nurse and patient share mutual understanding of the communication. Asking about common elements encourages comparison rather than clarification. The remaining responses are questions that suggest the nurse was not listening.
A patient tells the nurse, “I don’t think I’ll ever get out of here.” Select the nurse’s most therapeutic response.
a. “Don’t talk that way. Of course you will leave here!”
b. “Keep up the good work, and you certainly will.”
c. “You don’t think you’re making progress?”
d. “Everyone feels that way sometimes.”
By asking if the patient does not believe that progress has been made, the nurse is reflecting by putting into words what the patient is hinting at. By making communication more explicit, issues are easier to identify and resolve. The remaining options are nontherapeutic techniques. Telling the patient not to “talk that way” is disapproving. Saying that “everyone feels that way sometimes” minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.
Documentation in a patient’s chart shows, “Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, ‘I enjoy spending time with you.’” Which analysis is most accurate?
a. The patient is giving positive feedback about the nurse’s communication techniques.
b. The nurse is viewing the patient’s behaviour through a cultural filter.
c. The patient’s verbal and nonverbal messages are incongruent.
d. The patient is demonstrating psychotic behaviours.
When a verbal message is not reinforced with nonverbal behaviour, the message is confusing and incongruent. Some clinicians call it a “mixed message.” It is inaccurate to say that the patient is giving positive feedback about the nurse’s communication techniques. The concept of a cultural filter is not relevant to the situation because a cultural filter determines what we will pay attention to and what we will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviours.
While talking with a patient diagnosed with major depression, a nurse notices the patient is unable to maintain eye contact. The patient’s chin lowers to the chest, while the patient looks at the floor. Which aspect of communication has the nurse assessed?
a. Nonverbal communication
b. A message filter
c. A cultural barrier
d. Social skills
Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patient’s social skills or whether a cultural barrier exists.
During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient’s hand. Select the correct analysis of the nurse’s behaviour.
a. It shows empathy and compassion. It will encourage the patient to continue to express feelings.
b. The gesture is premature. The patient’s cultural and individual interpretation of touch is unknown.
c. The patient will perceive the gesture as intrusive and overstepping boundaries.
d. The action is inappropriate. Psychiatric patients should not be touched.
Touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment can be made regarding the way in which the patient will perceive touch. The other options present prematurely drawn conclusions.
During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication.
a. “I notice you keep looking toward the door.”
b. “This is our time together. No one is going to interrupt us.”
c. “It looks as if you are eager to end our discussion for today.”
d. “If you are uncomfortable in this room, we can move someplace else.”
Making observations and encouraging the patient to describe perceptions are useful therapeutic communication techniques for this situation. The other responses are assumptions made by the nurse.
A black patient says to a white nurse, “There’s no sense talking. You wouldn’t understand because you live in a white world.” Which of the following would be the nurse’s best action?
a. Explain, “Yes, I do understand. Everyone goes through the same experiences.”
b. Say, “Please give an example of something you think I wouldn’t understand.”
c. Reassure the patient that nurses interact with people from all cultures.
d. Change the subject to one that is less emotionally disturbing.
Having the patient speak in specifics rather than globally will help the nurse understand the patient’s perspective. This will encourage a description of the patient’s perception that the nurse does not understand the patient. This approach will help the nurse engage the patient. Reassurance and changing the subject are not therapeutic techniques.
An Aboriginal patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patient’s self-esteem, but after 3 weeks, the patient’s eye contact did not improve. What is the most accurate analysis of this scenario?
a. The patient’s eye contact should have been directly addressed by role-playing to increase comfort with eye contact.
b. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient.
c. The patient’s poor eye contact is indicative of anger and hostility that were unaddressed.
d. The nurse should have assessed the patient’s culture before making this diagnosis and plan.
The amount of eye contact a person engages in is often culturally determined. In some cultures, eye contact is considered insolent, whereas in others, eye contact is expected. Aboriginal individuals have traditionally been taught to avoid eye contact with authority figures, including nurses, physicians, and other health care providers; avoidance of direct eye contact is seen as a sign of respect to those in authority, but it could be misinterpreted as a lack of interest or even as a lack of respect.
When a female Aboriginal patient and a female nurse sit together, the patient often holds the nurse’s hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behaviour. Which analysis is most accurate?
a. The patient is accustomed to touch during conversation, as are members of many Aboriginal cultures.
b. The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor.
c. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted.
d. The patient is trying to manipulate the nurse using nonverbal techniques.
The most likely answer is that the patient’s behaviour is culturally influenced. People from some cultures—Aboriginal people, for example—are accustomed to frequent physical contact. Holding an Aboriginal patient’s hand in response to a distressing situation or giving the patient a reassuring pat on the shoulder may be experienced as supportive and thus help facilitate openness. Although the other options are possible, they are less likely.
An Italian Canadian patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patient’s behaviour?
a. The patient has a histrionic personality disorder.
b. The patient believes dramatic body language is sexually appealing.
c. The patient wishes to impress staff with the degree of emotional pain.
d. The patient belongs to a culture in which dramatic body language is the norm.
Members of some cultures tend to use high affect and dramatic body language as they communicate. French and Italian Canadians typically use animated facial expressions and expressive hand gestures during communication, which can be misinterpreted by others.The other options are more remote possibilities.
During an interview, a patient attempts to shift the focus from self to the student nurse by asking personal questions. The student nurse should respond by saying:
a. “Why do you keep asking about me?”
b. “Nurses direct the interviews with patients.”
c. “Do not ask questions about my personal life.”
d. “The time we spend together is to discuss your concerns.”
When a patient tries to focus on the student nurse, the student should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses the discussion in a neutral way. Telling patients not to ask about the student nurse’s personal life shows indignation. Saying that student nurses prefer to direct the interview reflects superiority. “Why” questions are probing and nontherapeutic.
Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?
a. A nurse is responsible for breaking silences.
b. Patients withdraw if silences are prolonged.
c. Silence can provide meaningful moments for reflection.
d. Silence helps patients know that what they said was understood.
Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas. A nurse breaking silences is not a principle related to silences. It is inaccurate to say that patients withdraw during long silences or that silence helps patients know that they are understood. Feedback helps patients know they have been understood.
A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies?
a. Giving advice is rarely helpful.
b. Giving advice fosters independence.
c. Giving advice lifts the burden of personal decision making.
d. Giving advice helps the patient develop feelings of personal adequacy.
Giving advice fosters dependence on the nurse and interferes with the patient’s right to make personal decisions. It robs patients of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it contributes to patient feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.
A school-age child tells the school nurse, “Other kids call me mean names and will not sit with me at lunch. Nobody likes me.” Select the nurse’s most therapeutic response.
a. “Just ignore them and they will leave you alone.”
b. “You should make friends with other children.”
c. “Call them names if they do that to you.”
d. “Tell me more about how you feel.”
The correct response uses exploring, a therapeutic technique. The distracters give advice, a nontherapeutic technique.
A patient with acute depression states, “God is punishing me for my past sins.” What is the nurse’s most therapeutic response?
a. “You sound very upset about this.”
b. “God always forgives us for our sins.”
c. “Why do you think you are being punished?”
d. “If you feel this way, you should talk to your minister.”
The nurse reflects the patient’s comment, a therapeutic technique to encourage sharing for perceptions and feelings. The incorrect responses reflect probing, closed-ended comments, and giving advice, all of which are nontherapeutic
A patient cries as the nurse explores the patient’s feelings about the death of a close friend. The patient sobs, “I shouldn’t be crying like this. It happened a long time ago.” Which responses by the nurse facilitate communication? Select all that apply.
a. “Why do you think you are so upset?”
b. “I can see that you feel sad about this situation.”
c. “The loss of a close friend is very painful for you.”
d. “Crying is a way of expressing the hurt you are experiencing.”
e. “Let’s talk about something else because this subject is upsetting you.”
ANS: B, C, D
Reflecting (“I can see that you feel sad”; “This is very painful for you”) and giving information (“Crying is a way of expressing hurt”) are therapeutic techniques. “Why” questions often imply criticism or seem intrusive or judgemental. They are difficult to answer. Changing the subject is a barrier to communication.
During the initial patient interview, which of the following are reasons that the patient may be reluctant to speak? Select all that apply.
a. Feelings of distrust
b. The nurse is a health care provider
c. Feelings of embarrassment
d. Repetitive nature of the situation
ANS: A, C, E
In the initial interview, patients may be reluctant to speak because of the newness of the situation, the fact that the nurse is a stranger, or feelings of distrust, self-consciousness, embarrassment, or shyness. The nurse must recognize and respect individual differences in styles and tempos of responding. It would be the newness of the situation, not the repetitive nature of the situation that may cause a patient to be reluctant to speak. The nurse being a health care provider does not directly cause the patient to be reluctant to speak but rather the fact that the nurse is a stranger.
Which comments by a nurse demonstrate use of therapeutic communication techniques? Select all that apply.
a. “Why do you think these events have happened to you?”
b. “There are people with problems much worse than yours.”
c. “I’m glad you were able to tell me how you felt about your loss.”
d. “I noticed your hands trembling when you told me about your accident.”
e. “You look very nice today. I’m proud you took more time with your appearance.”
ANS: C, D
The correct responses demonstrate use of the therapeutic techniques of making an observation and showing empathy. The incorrect responses demonstrate minimizing feelings, probing, and giving approval, which are nontherapeutic techniques.