AH116 CHAP 4

When the health care professional changes the subject or shifts to new topics

, the direction of the conversation will be controlled by the professional rather than allowing clients to discuss freely what they choose. Shifting the trust of the helping interview toward the health care professional's perceptions also blocks the exchange.

Giving help feels:

-Important -Useful -Powerful -Gratified -Happy

Needing help feels:

-Unimportant or inadequate -Useless or depressed -Powerless -Frightened or embarrassed -Sad or angry

Open-ended questions

are most helpful for therapeutic communication, as they encourage clients to identify more of the problem. They do not put words into clients' mouths; rather, they allow them to express their own thoughts and feelings. Open-ended questions usually begin with how, what, or could. They are an invitation for clients to express more detail. Examples of open-ended questions are as follows: "Could your new job be responsible for a change in your eating habits?" "What foods seem to trigger the need for antacids?" "What did the doctor tell you about this medication?"

Reassuring clichés

are often given automatically, and consist of patterned responses; trite expressions; or empty, meaningless phrases that express false assumptions about how a client feels. Examples of reassuring clichés are as follows: "Everything will be all right." "Keep your chin up. Hang in there." "Just do it!"

Closed questions

are useful in collecting information during the client history, and are most common at the beginning of the verbal exchange. They do not require the individual being asked the question to enlarge upon the answer. The questions usually begin with do, is, or are, and are answered with a simple yes, no, or a brief phrase. Examples of closed questions are as follows: "Are you experiencing pain now?" "Does it hurt when you raise your arm?" "Can you feel the lump when you are lying down?"

Indirect statements

call for a response from the client, but do not make the client feel like he or she is being questioned. They do, however, encourage verbalization and express interest in the client from the health care professional. Examples of indirect statements are as follows: "I'd like to hear about your new therapy program." "Tell me what worries you most about this problem and how it affects your daily life." "Let's discuss what makes it so difficult for you to quit smoking."

ridicule or shame a client will

close communication immediately. Most often, this ridicule or shame is in the form of nonverbal rather than verbal communication. Health care professionals have been taught not to ridicule or shame, but these behaviors often show in actions rather than words. To laugh at a client's description of an ailment or misunderstanding of basic body functions is a common example of ridicule.

Reflecting

focuses on the emotional aspect of the client's expression. It involves listening to the verbal message as well as considering the nonverbal cues being sent. Facial expression and tone of voice will provide insight regarding the meaning of the message and its congruency.

Sincerity

involves those attributes already identified, as well as creating an atmosphere that is free from hypocrisy. The sincere health care professional is forthright, candid, and truthful.

Helping interview

is a conversation between a health care professional and a person in need and is a common tool of communication in any health care setting.

Sharing observations

is a way to acknowledge the client's feelings. This responding skill communicates to clients that their feelings are understood and accepted. It encourages verbalization by providing a safe, nonthreatening environment.

Genuineness

is being real and honest with others. The health care professional must be able to communicate honestly with others while being careful not to judge or condemn.

Empathy

is the ability to accept another's private world as if it were your own. It is fair and sensitive; it is an awareness of others' situations and what they are experiencing.

Sympathy

is to respond to the emotional state of others and to acknowledge the feelings expressed by clients. Sympathy states, "I am available to you."

Clarifying

is used when the health care professional is not certain of the meaning of the message communicated. Such statements as "I'm not sure I understand what you mean" or "Do you mean . . .?" are examples of clarification. Words or nonverbal cues used during an exchange may hold different meanings for others, so clarifying is important.

"There is no way the doctor will discharge you today." When the health care professional defends something or someone the client has criticized or contradicts a client's statement,

it implies the client has no right to express his or her feelings, concerns, or impressions.

The professional being in control

often intimidates clients

During the helping interview, it is beneficial to stay away from the use of

questions that begin with why. When questions begin with why, clients often become defensive or feel they are being accused.

Paraphrasing

simply restates in the professional's own words what the client said. Its focus is more on the cognitive aspects of the message than on the feelings. Paraphrasing allows the client to hear what was just said and to verify the accuracy of the professional's listening ability.

Asking clients to explain their reasons for feelings, behaviors, or thoughts requires

them to analyze and explain these experiences. Questions that ask why are intimidating. Examples include "Why do you think you are feeling this way?" and "Why did you do that?" Often clients may not understand the reasons for the discomfort to begin with. health care professionals should ask clients to describe their feelings rather than explain them.

Giving advice may occur

when health care professionals act from a subconscious desire to have all the answers, or feel the need to control the client's thoughts or actions. This usually occurs when the health care professional is doing more talking than listening. When clients are told what they should do, opinions and solutions are imposed on them.

When a client comes with a concern or a complaint, responding negatively

will close the communication process immediately. The client feels what the client feels. Even if the professional knows that what is being described is impossible, clients are still the only ones who know their own body and feelings.

Observations

will focus on both the client's physical and emotional state. The statement "You seem a little anxious" conveys concern and interest in knowing more, and comes from the health care professional's observation of the client.

10 preparations to be made by the health care professional before the interview takes place

•Personal appearance and grooming •Medical clinic appearance •Meeting, greeting client •Privacy of client •Conversing with client •Risk and trust•Warmth and caring •Genuineness •Sympathy and empathy •Sincerity

Levels of Need

•Problem - has a solution•Predicament - no easy solution •Crisis - large predicament; short term •Panic - state of fear •Shock - numbed or dazed condition

With today's changes in health care, which of the following is important?

Empower the client to actively participate in his or her health care

clichés

Patterned responses; trite expressions; empty, meaningless phrases

Three components of the helping interview are

1.the orientation of the professional and the client to each other, 2.the identification of the client's problem, and 3.the resolution of the client's problem.

Which statement describes an indirect statement?

Calls for a client response without the client feeling questioned.

When conducting the helping interview, what is best for the health care professional to do?

Have the client not disrobe during the interview orientation.

What are the three components of the helping interview?

Orientation of each other, identifying the problem, and resolution of problem

Some of the most common roadblocks to therapeutic communication are:

Reassuring clichés Requiring explanations Defending Moralizing/lecturing Giving advice/approval Belittling/contradicting/criticizing Changing subject/shifting Shaming/threatening/ridiculing

The orientation phase of the helping interview should find the health care professional using which of the following skills?

Showing warmth, being genuine, establishing trust, and expressing sympathy/empathy and sincerity

Warmth

Warmth may be defined as an attitude expressing caring and concern. It is primarily communicated through facial expressions, such as a caring look or a smile, which cross all cultural differences. Often, the question "How can I help you today?" or a comment such as "I see you're here for a physical exam" is appropriate at this point.