Chapter 20 - Communicating & Therapeutic Relationships

A client says to the nurse, "I feel so sick and weak, I don't think I'll ever be able to go home." Which response by the nurse is therapeutic? - "Let's get you up and walking more; that will help." - "It sounds like you are frustrated. What do you mean by 'sick and weak'?" - "What can I do to help you feel better?" - "I'm sure you are frustrated; you must miss being home."

- "It sounds like you are frustrated. What do you mean by 'sick and weak'?"

A client tells the nurse, "My injury is hurting a lot. I don't think it will ever get better." Which responses by the nurse are therapeutic? Select all that apply. - "Is your pain severe? I'll get you something." - "Tell me about your pain." - "Let's see if I can help. When did the pain begin?" - "I'm sure you are frustrated; how would you describe your pain?" - "It's difficult having pain all of the time. Your incision will heal; it just takes time."

- "Tell me about your pain." - "I'm sure you are frustrated; how would you describe your pain?" - "It's difficult having pain all of the time. Your incision will heal; it just takes time."

A client admitted in hypertensive crisis informs the nurse that he stopped taking his blood pressure medication 2 weeks ago. Which is the nurse's best response? - "Tell me more about your experience with your high blood pressure medication." - "Why did you stop taking your high blood pressure medication?" - "It's very important to take your blood pressure medication." - "Did you talk to your healthcare provider about stopping it?"

- "Why did you stop taking your high blood pressure medication?"

A client comes to the emergency department with severe shortness of breath and difficulty breathing. He is restless and anxious. Which response made by the nurse offers reassurance and builds trust? Select all that apply. - "I'll give you some medication to help with your breathing." - "Would you like your family to stay here with you as I step out?" - "Please try not to think about the breathing." - "This must be a frightening situation for you." - "Tell me more about what you are doing when your breathing is most difficult."

- "Would you like your family to stay here with you as I step out?" - "This must be a frightening situation for you." - "Tell me more about what you are doing when your breathing is most difficult."

Client: "I'm so terrified about this diagnosis. I'm afraid I'll never see my children grow up." Nurse, while checking the IV pump: "Oh? How old are your children?"Which technique would improve the therapeutic communication?

Active Listening - The nurse in this situation is distracted by the equipment and failing to stay focused on the needs of the client. The therapeutic response would have been to stop looking at the equipment, pull up a chair to the bedside, and ask, "Tell me more about what frightens you."

Client: "I don't want another IV; you can just forget about that!"Nurse: "It's needed for your antibiotics, but if you don't want it, that's fine."Which technique would improve the therapeutic communication?

Assertiveness - The IV is important to the care of the client. Although clients are able to refuse care, the nurse needs to be assertive and explain why the IV has been ordered. Often, once the explanation is given, the client will consent.

Nurse (while standing at the door with arms crossed, looking at the family and not the client): "We've made arrangements to transfer you to hospice care."The client thinks, "That nurse doesn't care about me."Which technique would improve the therapeutic communication?

Body Language and Sharing Observations - Much of the communication between the client and nurse is nonverbal. When using inconsistent body language, the wrong message can be sent. In this case, the nurse should have come in, pulled up a chair, and spoken with both the client and the family, answering questions and clarifying the information being communicated.

Client: "You told me you would speak to my doctor about getting my pain medication increased. Were you able to do that?"Nurse: "Oh, I decided we could wait until the doctor makes his rounds this evening and ask then."Which technique would improve the therapeutic communication?

Establishing Trust - To establish trust the nurse must be respectful, greet the client by name, listen actively, respond honestly, and be open and consistent in the care. This includes doing what you told the client you would do.

Client: "My stomach hurts."Nurse: "I'll get you some pain medicine."Which technique would improve the therapeutic communication?

Exploring Issues - When a client expresses a symptom, the nurse must explore further to see whether something more severe is happening. In this case, the nurse should have completed a pain assessment.

Client: "My neighbor just called and my dog died" (crying loudly).Nurse: "Tell me about your dog" (touching the client's shoulder).Which technique would improve the therapeutic communication?

Using Silence - Loss is difficult for everyone. The nurse may not know what to say to help (and often there is nothing that can be said). Using silence would allow the client to grieve, feeling supported with the touch of the shoulder. Allow the client to speak when he or she is ready.

Which statements about communication are correct? Select all that apply. - Group communication is a form of public speaking. - Communication consists of sender, receiver, message, feedback, encoding, decoding, and channel. - Interpersonal communication occurs between two or more people. - Content is the subject matter being communicated. - Nonverbal communication is the message sent with body language.

- Communication consists of sender, receiver, message, feedback, encoding, decoding, and channel. - Interpersonal communication occurs between two or more people. - Content is the subject matter being communicated. - Nonverbal communication is the message sent with body language.

A nurse observes an interaction between a client and another healthcare team member. Which observations demonstrate active listening by the team member? Select all that apply. - Recognizing nonverbal cues by the client - Eliminating intrusions and distractions in the room - Using all the senses to interpret verbal messages - Seeking clarification of unclear ideas - Limiting the use of direct eye contact

- Recognizing nonverbal cues by the client - Eliminating intrusions and distractions in the room - Using all the senses to interpret verbal messages - Seeking clarification of unclear ideas

The nurse enters the room of a client who just received devastating news. He is visibly upset and crying. As the nurse approaches the client, which communication techniques would be best? Select all that apply. - Remain silent until the client speaks - Use humor to lighten the situation - Sit on the edge of the bed - Gently touch his hand or back - Use a look of concern

- Remain silent until the client speaks - Sit on the edge of the bed - Gently touch his hand or back - Use a look of concern

An older adult client begins crying after being informed of her terminal illness. Which intervention by the nurse is best? - Sit quietly with the client while she composes her thoughts. - Inform the client that a chaplain is available if she would like to speak to one. - Tell the client there are always options and suggest she not give up hope. - Remind the client that she has lived a long and happy life.

- Sit quietly with the client while she composes her thoughts.

Which nonverbal behavior best enhances communication? - Keeping a neutral facial expression - Maintaining a distance of 6 to 8 inches - Sitting down to speak with the patient - Asking open-ended questions

- Sitting down to speak with the patient

The nurse comes into a client's room and says in a loud voice, "We need to get you up and moving today!" Which communication style is being used? - Pacing - Intonation - Clarity and brevity - Timing and relevance

Intonation

Client: "I don't want to learn about my new medications right now."Nurse: "All right." (Documents that the patient refused, and reports this in handoff report.)Which technique would improve the therapeutic communication?

Restating, Clarifying, and Validating Messages - It is important for the nurse to seek clarification when care is refused, as the refusal may stem from exhaustion or pain. A better response would be to say, "It is important that you understand these medications and how to safely take them. Tell me why you don't want to learn about them."

Client: "You told me so much about my diabetes, I'm not sure I'll remember it."Nurse: "Don't worry, we'll give you everything in writing."Which technique would improve the therapeutic communication?

Summarizing the Conversation - The client is interested in learning but was given too much information at one time. The nurse should summarize the conversation and create a teaching plan that allows for smaller amounts of information to be provided in each session.