Leadership: Therapeutic Communication
The nurse is providing care to a client who is diagnosed with hypertension. Which response by the nurse is an appropriate example of informational confrontation with the client? A) "I noticed you rubbing your head and your eyes. Are you hurting? Let's take your blood pressure." B) "I heard raised voices when I was coming down the hall to your room. Are you upset?" C) "It is 3 p.m. and time to take your blood pressure before I give you your medication." D) "Is the blood pressure medication making your head hurt?"
Answer: A Explanation: A) An informational confrontation describes the visible behavior of another individual, whereas an interpretive confirmation expresses thoughts and feelings about behavior and draws inferences. Of the options provided, only the one that begins with "I noticed you rubbing your head and your eyes" is an example of an informational confrontation.
The nurse is providing care for a client who is newly diagnosed with chronic obstructive pulmonary disease (COPD). In this scenario, which action by the nurse would be considered an example of therapeutic communication? A) The nurse asks appropriate questions about the client's medical history. B) The nurse closes the conversation with an anecdote about breathing. C) The nurse plans to tell the client about a COPD support group. D) The nurse bonds with the client by describing her own experiences living with COPD.
Answer: A Explanation: A) Attentive or "mindful" listening is a therapeutic communication technique that involves listening and absorbing the content and feeling of what an individual is conveying, without selectivity. This technique requires paying attention to the client's total message, both verbal and nonverbal, and noting whether these communications are congruent. During attentive listening, the nurse focuses not on the nurse's own needs but rather on the client's needs. By asking appropriate questions about the client's medical history and carefully noting the client's responses, the nurse is engaging in attentive listening and thus in therapeutic communication.
The nurse completes a teaching session on wound care for a client who will require dressing changes after discharge. The nurse then evaluates the effectiveness of the teaching session and determines that more education is required. Which statement by the nurse is appropriate in this situation? A) "Let me clarify again some of the steps that are required during wound care." B) "You didn't pay attention, did you?" C) "Here, let me do it for you." D) "I don't think you understood me correctly the first time."
Answer: A Explanation: A) Responding with some clarifications indicates that the client understood some of the teaching and preserves the client's dignity and trust in the nurse. Saying that the client did not understand the information is belittling. Beginning a negative phrase with "you" is assigning blame, which impedes the therapeutic relationship. Telling the client that the nurse can take care of the task defeats the goal of feedback; the nurse would want to instill self-confidence in the client, and this type of action will hurt that goal.
The nurse is providing care to a client who is newly diagnosed with human immunodeficiency virus (HIV). Which statements by the nurse could inhibit the development of therapeutic communication with this client? Select all that apply. A) "I am so happy today! I just found out that I got accepted into nurse practitioner school!" B) "Well, I guess your lifestyle finally caught up to you." C) "One of my cousins has AIDS. It is hard to watch him die." D) "Tell me your feelings about the diagnosis." E) "Would you like to talk about the new medications you've been prescribed?"
Answer: A, B, C Explanation: A) Various obstacles to attentive listening can inhibit the development of therapeutic communication. Being concerned with oneself, assuming, and identifying are all common obstacles to attentive listening. In contrast, using open-ended questions and providing general leads-in are actions that enhance therapeutic communication.
A nurse is caring for a client with cancer who is struggling with chronic pain. The nurse tells the client, "It is normal to feel frustrated about the discomfort." Which skill associated with the working phase of the nurse-client relationship does the nurse's statement best reflect? A) Confronting B) Respect C) Concreteness D) Genuineness
Answer: B Explanation: A) Respect is correct because the nurse is validating the client's feelings. This situation is not an example of genuineness because the nurse is giving information versus making a personal statement. Rather than being confrontational by pointing out discrepancies between thoughts, feelings, and actions that inhibit the client's self-understanding or exploration of specific areas, the nurse is being supportive by respecting the client's feelings. Concreteness involves assisting the client by giving specific examples rather than speaking in generalities.
A nurse educator is teaching a group of students about therapeutic touch. In which situation is it appropriate to use therapeutic touch as a means of communication? A) When a client's family member is making inappropriate comments to the nurse B) When an upset spouse is alone and the client has just expired C) When speaking to a client with a history of physical abuse D) When a young male client asks a young student nurse for a hug
Answer: B Explanation: A) Therapeutic touch may be an appropriate means for communication when providing nursing care. However, nurses must use therapeutic touch with caution and intention. People from different cultures may view the use of touch differently. Similarly, clients with a history of physical or sexual abuse and/or certain mental illnesses may misinterpret the use of touch. Furthermore, touch is not appropriate when a client's family member is making inappropriate comments to the nurse or when a client asks a student nurse for a hug. Thus, of the options listed, the only one in which therapeutic touch is appropriate is the situation involving the grieving spouse.
The nurse is caring for an older adult client in a long-term care facility. Which behavior by the nurse conveys physical attending when communicating with this client? A) Facilitating and taking action when needed B) Maintaining a proper social distance when speaking with the client C) Leaning toward the client during conversation D) Being concrete about actions that need to be taken during client care
Answer: C Explanation: A) The nurse best conveys physical attending by leaning toward the client, which communicates involvement. Facilitating and taking action and maintaining social distance do not convey physical attending. Being concrete is a method of communicating information to the client, not a method of conveying physical attending.
What is the first phase in the therapeutic nurse-client relationship? A) Introductory phase B) Working phase C) Preinteraction phase D) Anticipatory phase
Answer: C Explanation: A) The therapeutic nurse-client relationship can be described in terms of four sequential phases: the preinteraction phase, introductory phase, working (maintaining) phase, and termination phase. During the preinteraction phase, the nurse plans for the initial face-to-face meeting with the client.
A novice nurse is working with a client who is admitted to a medical-surgical unit. The nurse is establishing a therapeutic relationship with the client by conveying empathy. Which statement by the nurse best exemplifies empathy? A) "I wouldn't be afraid if I were you." B) "You shouldn't have done it that way." C) "You seem to be frightened by the procedure. Tell me how you are feeling." D) "I know just how you feel, because my mother has the same illness."
Answer: C Explanation: A) To be able to empathize with patients, the nurse must be able to understand and acknowledge the ideas that the patient is expressing or that the patient feels are important to the situation. By stating that the client seems frightened and asking the client to describe his or her feelings, the nurse is demonstrating empathy. The nurse should not say he or she knows how the client feels; such a statement will likely be met with disbelief, because one individual never knows how another individual is feeling unless that individual tells them. Telling the client not to be afraid is demeaning; instead, the nurse should ascertain the source of the client's fear and provide appropriate teaching. Saying the client should not have done something is passing judgment and inappropriate.
The nurse is caring for a school-age client who is scheduled to have major heart surgery the next morning. The nurse enters the room to administer a medication and finds the client crying. Which response by the nurse is most therapeutic? A) "Would you like some toys from the playroom?" B) "I'm going to go get the doctor." C) "You shouldn't cry. You are not in pain." D) "It is okay to cry. I know this is scary."
Answer: D Explanation: A) Assertive communication is appropriate in the group setting, but for this client, the nurse should be accepting of the client's feelings of fear. Telling the client not to cry invalidates the client's feelings. Leaving to get the doctor could be seen by the child as abandonment and would signal that the nurse is uncomfortable with the child. Distraction is not appropriate when the client is clearly upset, so the nurse should not ask whether the client wants toys. Instead, the nurse should attempt to seek more information about what the child is feeling.
Which of the following statements by the nurse is an example of the therapeutic communication technique of offering self? A) "Would you like to talk with me about your emotions right now?" B) "I'm not sure I understand. Please tell me more about the situation." C) "I don't know the answer to your question, but I will check with the physician." D) "I'll stay here with you until your family arrives."
Answer: D Explanation: A) Offering self involves suggesting one's presence, interest, or wish to understand the client without making any demands or attaching conditions that the client must comply with to receive the nurse's attention. The nurse's offer to stay with the client until the family arrives is an example of offering self. In comparison, asking whether the client wants to talk about his or her emotions is an example of providing general leads; asking the client to provide more details about a situation is an example of using open-ended questions; and offering to get answers from the physician is an example of giving information.
