Chapter 6 Terms

Question 1

_________ is the study of distance zones between people during communication.

Answer 1

Proxemics

Question 2

Intimate zone

Answer 2

(0–18 in between people): This amount of space is comfortable for parents with young children, people who mutually desire personal contact, or people whispering. Invasion of this intimate zone by anyone else is threatening and produces anxiety.

Question 3

Personal zone

Answer 3

(18–36 in): This distance is comfortable between family and friends who are talking.

Question 4

Social zone

Answer 4

(4–12 ft): This distance is acceptable for communication in social, work, and business settings.

Question 5

Public zone (12–25 ft): This is an acceptable distance between a speaker and an audience, small groups, and other informal functions

Answer 5

(12–25 ft): This is an acceptable distance between a speaker and an audience, small groups, and other informal functions

Question 6

The therapeutic communication interaction is most comfortable when the nurse and client are _______ apart.

Answer 6

3 to 6 ft

Question 7

_______ questions are clear, direct, and easy to understand. They elicit more accurate responses and avoid the need to go back and rephrase unclear questions, which interrupts the flow of a therapeutic interaction.

Answer 7

Concrete

Question 8

________ messages are unclear patterns of words that often contain figures of speech that are difficult to interpret.

Answer 8

Abstract

Question 9

Therapeutic Communication Technique

indicating reception

Answer 9

Accepting—indicating reception

An accepting response indicates the nurse has heard and followed the train of thought. It does not indicate agreement but is nonjudgmental. Facial expression, tone of voice, and so forth also must convey acceptance or the words lose their meaning.

Question 10

Therapeutic Communication Technique

allowing the client to take the initiative in introducing the topic

Answer 10

Broad openings—allowing the client to take the initiative in introducing the topic

Broad openings make it explicit that the client has the lead in the interaction. For the client who is hesitant about talking, broad openings may stimulate him or her to take the initiative.

Question 11

Therapeutic Communication Technique

searching for mutual understanding, for accord in the meaning of the words

Answer 11

Consensual validation—searching for mutual understanding, for accord in the meaning of the words

For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both or all participants. Sometimes, words, phrases, or slang terms have different meanings to different people and can be easily misunderstood.

Question 12

Therapeutic Communication Technique

asking that similarities and differences be noted

Answer 12

Encouraging comparison—asking that similarities and differences be noted

Comparing ideas, experiences, or relationships brings out many recurring themes. The client benefits from making these comparisons because he or she might recall past coping strategies that were effective or remember that he or she has survived a similar situation.

Question 13

Therapeutic Communication Technique

asking the client to verbalize what he or she perceives

Answer 13

Encouraging description of perceptions—asking the client to verbalize what he or she perceives

To understand the client, the nurse must see things from his or her perspective. Encouraging the client to fully describe ideas may relieve the tension the client is feeling, and he or she might be less likely to take action on ideas that are harmful or frightening.

Question 14

Therapeutic Communication Technique

asking the client to appraise the quality of his or her experiences

Answer 14

Encouraging expression—asking the client to appraise the quality of his or her experiences

The nurse asks the client to consider people and events in light of his or her own values. Doing so encourages the client to make his or her own appraisal rather than to accept the opinion of others.

Question 15

Therapeutic Communication Technique

delving further into a subject or an idea

Answer 15

Exploring—delving further into a subject or an idea

When clients deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes.

Question 16

Therapeutic Communication Technique

concentrating on a single point

Answer 16

Focusing—concentrating on a single point

The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It is also a useful technique when a client jumps from one topic to another.

Question 17

Therapeutic Communication Technique

asking the client to consider kinds of behavior likely to be appropriate in future situations

Answer 17

Formulating a plan of action—asking the client to consider kinds of behavior likely to be appropriate in future situations

It may be helpful for the client to plan in advance what he or she might do in future similar situations. Making definite plans increases the likelihood that the client will cope more effectively in a similar situation.

Question 18

Therapeutic Communication Technique

giving encouragement to continue

Answer 18

General leads—giving encouragement to continue

General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. They also encourage the client to continue if he or she is hesitant or uncomfortable about the topic.

Question 19

Therapeutic Communication Technique

making available the facts that the client needs

Answer 19

Giving information—making available the facts that the client needs

Informing the client of facts increases his or her knowledge about a topic or lets the client know what to expect. The nurse is functioning as a resource person. Giving information also builds trust with the client.

Question 20

Therapeutic Communication Technique

acknowledging, indicating awareness

Answer 20

Giving recognition—acknowledging, indicating awareness

Greeting the client by name, indicating awareness of change, or noting efforts the client has made all show that the nurse recognizes the client as a person, as an individual. Such recognition does not carry the notion of value, that is, of being “good” or “bad.”

Question 21

Therapeutic Communication Technique

verbalizing what the nurse perceives

Answer 21

Making observations—verbalizing what the nurse perceives

Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk.

Question 22

Therapeutic Communication Technique

making oneself available

Answer 22

Offering self—making oneself available

The nurse can offer his or her presence, interest, and desire to understand. It is important that this offer is unconditional; that is, the client does not have to respond verbally to get the nurse’s attention.

Question 23

Therapeutic Communication Technique

clarifying the relationship of events in time

Answer 23

Placing event in time or sequence—clarifying the relationship of events in time

Putting events in proper sequence helps both the nurse and the client to see them in perspective. The client may gain insight into cause-and-effect behavior and consequences or the client may be able to see that perhaps some things are not related. The nurse may gain information about recurrent patterns or themes in the client’s behavior or relationships.

Question 24

Therapeutic Communication Technique

offering for consideration that which is real

Answer 24

Presenting reality—offering for consideration that which is real

When it is obvious that the client is misinterpreting reality, the nurse can indicate what is real. The nurse does this by calmly and quietly expressing his or her perceptions or the facts, not by way of arguing with the client or belittling his or her experience. The intent is to indicate an alternative line of thought for the client to consider, not to “convince” the client that he or she is wrong.

Question 25

Therapeutic Communication Technique directing client actions, thoughts, and feelings back to client

Answer 25

Reflecting—directing client actions, thoughts, and feelings back to client Reflection encourages the client to recognize and accept his or her own feelings. The nurse indicates that the client’s point of view has value and that the client has the right to have opinions, make decisions, and think independently.

Question 26

Therapeutic Communication Technique repeating the main idea expressed

Answer 26

Restating—repeating the main idea expressed The nurse repeats what the client has said in approximately or nearly the same words the client has used. This restatement lets the client know that he or she communicated the idea effectively. This encourages the client to continue. Or if the client has been misunderstood, he or she can clarify his or her thoughts.

Question 27

Therapeutic Communication Technique seeking to make clear that which is not meaningful or that which is vague

Answer 27

Seeking information—seeking to make clear that which is not meaningful or that which is vague The nurse should seek clarification throughout interactions with clients. Doing so can help the nurse to avoid making assumptions that understanding has occurred when it has not. It helps the client articulate thoughts, feelings, and ideas more clearly.

Question 28

Therapeutic Communication Technique absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking

Answer 28

Silence—absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking Silence often encourages the client to verbalize, provided that it is interested and expectant. Silence gives the client time to organize thoughts, direct the topic of interaction, or focus on issues that are most important. Much nonverbal behavior takes place during silence, and the nurse needs to be aware of the client and his or her own nonverbal behavior.

Question 29

Therapeutic Communication Technique offering to share, to strive, and to work with the client for his or her benefit

Answer 29

Suggesting collaboration—offering to share, to strive, and to work with the client for his or her benefit The nurse seeks to offer a relationship in which the client can identify problems in living with others, grow emotionally, and improve the ability to form satisfactory relationships. The nurse offers to do things with, rather than for, the client.

Question 30

Therapeutic Communication Technique organizing and summing up that which has gone before

Answer 30

Summarizing—organizing and summing up that which has gone before Summarization seeks to bring out the important points of the discussion and seeks to increase the awareness and understanding of both participants. It omits the irrelevant and organizes the pertinent aspects of the interaction. It allows both client and nurse to depart with the same ideas and provides a sense of closure at the completion of each discussion.

Question 31

Therapeutic Communication Technique seeking to verbalize client’s feelings that he or she expresses only indirectly

Answer 31

Translating into feelings—seeking to verbalize client’s feelings that he or she expresses only indirectly Often what the client says, when taken literally, seems meaningless or far removed from reality. To understand, the nurse must concentrate on what the client might be feeling to express him or herself this way.

Question 32

Therapeutic Communication Technique voicing what the client has hinted at or suggested

Answer 32

Verbalizing the implied—voicing what the client has hinted at or suggested Putting into words what the client has implied or said indirectly tends to make the discussion less obscure. The nurse should be as direct as possible without being unfeelingly blunt or obtuse. The client may have difficulty communicating directly. The nurse should take care to express only what is fairly obvious; otherwise, the nurse may be jumping to conclusions or interpreting the client’s communication.

Question 33

Therapeutic Communication Technique expressing uncertainty about the reality of the client’s perceptions

Answer 33

Voicing doubt—expressing uncertainty about the reality of the client’s perceptions Another means of responding to distortions of reality is to express doubt. Such expression permits the client to become aware that others do not necessarily perceive events in the same way or draw the same conclusions. This does not mean the client will alter his or her point of view, but at least the nurse will encourage the client to reconsider or reevaluate what has happened. The nurse neither agreed nor disagreed; however, he or she has not let the misperceptions and distortions pass without comment.