Mental Health - Chapter 9 - Therapeutic Communication
During a clinical interview the patient falls silent after disclosing that she was sexually abused as a child. The nurse should 1 Allow the patient to break the silence 2 Reach out and gently touch the patient's arm 3 Reassure the patient that the abuse was not her fault 4 Quickly break the silence and encourage the patient to continue
1 Allow the patient to break the silence Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts.
During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? 1 Content of messages may be contradicted by process. 2 Many of the patient's remarks are no more than social phrases. 3 One statement may simultaneously convey conflicting messages. 4 The mental image of a word may not be the same for both nurse and patient.
1 Content of messages may be contradicted by process. Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the patient's feelings than the verbal message.
Which clarification technique should a nurse apply to learn more about the ideas and experiences of the patients? 1 Exploring 2 Restating 3 Reflecting 4 Paraphrasing
1 Exploring Exploring is a clarification technique of better understanding the ideas and experiences of a patient. The nurse encourages the patient to express his or her ideas clearly and in detail. Reflecting is a clarification technique by which the nurse encourages the patient to acknowledge his or her feelings and perceptions. In this technique, the nurse states the patient's emotions and seeks clarification. Restating is a clarification technique in which the nurse restates the statements made by the patient. The nurse uses this technique to convey that the nurse has effectively heard the patient's statements. In paraphrasing, the nurse states a few words from the statements made by the patients. It is helpful for clearly discussing the patient's queries.
A patient with dissociative identity disorder tells the nurse, "Unknowingly I committed theft in my house." The nurse asks the patient, "If you were given a chance to go back and change your action, would you?" Which category of question did the nurse ask? 1 Projective question 2 Open-ended question 3 Closed-ended question 4 Presupposition question
1 Projective question Projective questions help the patient to articulate and explore his or her thoughts and feelings. Closed-ended questions are usually used in initial assessment. They constrict the communication between the patient and nurse. Open-ended questions are used to encourage the patient to share information. Presupposition questions are also known as miracle questions. They help in identifying the patient's goals.
The nurse would make the assessment that not using touch would probably be in the best interest of which patient? 1 A deeply depressed patient 2 A Chinese American patient 3 A tearful patient reporting pain 4 A recent immigrant from Russia
2 A Chinese American patient Chinese Americans may not like to be touched by strangers.
When determining the appropriateness of touching a psychiatric patient, the nurse should 1 Touch the elderly but avoid touching the young 2 Check the facility's policy on the acceptability of touch 3 Follow his or her instincts concerning touching individual patients 4 Perceive touch as a gesture of warmth and friendship that fosters a relationship
2 Check the facility's policy on the acceptability of touch Students are urged to check the policy manual of their facilities, because some facilities have a no-touch policy, particularly with adolescents and children who may have experienced inappropriate touch and would not know how to interpret the touch of the health care worker.
The content and direction of the clinical interview is determined by the 1 Nurse 2 Patient 3 Health care team 4 Health care provider
2 Patient The patient always takes the lead and determines the content and direction of the clinical interview, although the nurse may discourage social conversation or intrusive personal questioning.
A Hispanic patient avoids eye contact when interacting with the nurse. What does the nurse infer from the patient's behavior? 1 The patient is depressed. 2 The patient has respect for the nurse. 3 The patient is trying to hide emotions. 4 The patient is confident and enthusiastic.
2 The patient has respect for the nurse. The nurse should consider the cultural norms of the patient while caring for and interacting with him. It helps the nurse to maintain effective therapeutic relations and to interpret the feelings of the patient. Hispanic patients may avoid maintaining eye contact with nurses and primary health care providers because of respect. The patient is not depressed and is not trying to hide emotions; the patient avoids maintaining eye contact because of his or her culture. Avoiding eye contact does not indicate that the patient is confident and enthusiastic.
When discussing her husband, a patient shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" 1 Focusing 2 Restating 3 Reflection 4 Clarification
4 Clarification Clarification verifies the nurse's interpretation of the patient's message.
A nurse should perceive an intense, highly emotional communication style as culturally appropriate for a patient who is 1 Asian American 2 British American 3 African American 4 Hispanic American
4 Hispanic American Highly emotional verbal communication accompanied by dramatic body language when describing emotional problems is a style associated with persons of Hispanic culture. French and Italian Americans also demonstrate animated facial expressions and expressive hand gestures during communication.
What is the value of an open-ended question when considering communication between nurse and patient? Select all that apply. 1 Facilitates the questioning of a guarded patient. 2 Encourages patients to share experiences and perceptions. 3 Excellent tool to use when initiating an admission assessment. 4 Tends to be viewed as nonintrusive communication by the patients. 5 Allows patients with poor communication skills to use one-word answers.
1 Facilitates the questioning of a guarded patient. 2 Encourages patients to share experiences and perceptions. 3 Excellent tool to use when initiating an admission assessment. 4 Tends to be viewed as nonintrusive communication by the patients Open-ended questions encourage patients to share information about experiences, perceptions, or responses to a situation. Because open-ended questions are not intrusive and do not put the patient on the defensive, they help the clinician elicit information, especially in the beginning of an interview or when a patient is guarded or resistant to answering questions. They are particularly useful when establishing rapport with a person, especially those who are guarded. One-word answers result from closed-ended questioning.
Which statement is true regarding nonverbal communication? Select all that apply. 1 Nonverbal communication is said to be sending the person's real message. 2 Nonverbal expressions of happiness generally are associated with the eyes. 3 A person's culture has an influence on his or her use of nonverbal communication. 4 Tone of voice and facial expression are components of nonverbal communication. 5 Physical appearance, eye contact, hand gestures, and fidgeting are examples of nonverbal behavior.
1 Nonverbal communication is said to be sending the person's real message. 3 A person's culture has an influence on his or her use of nonverbal communication. 4 Tone of voice and facial expression are components of nonverbal communication. 5 Physical appearance, eye contact, hand gestures, and fidgeting are examples of nonverbal behavior. It is the person's nonverbal behaviors that may be sending the "real" message through the tone or pitch of the voice. It is important to keep in mind that culture influences the pitch and the tone a person uses. Other common examples of nonverbal communication are physical appearance, body posture, eye contact, hand gestures, sighs, fidgeting, and yawning. Facial expression is extremely important in terms of nonverbal communication; the eyes (sadness) and the mouth (happiness) seem to hold the biggest clues into how people are feeling through emotional decoding.
During a therapeutic encounter the nurse remarks to a patient, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? 1 Reflecting and exploring 2 Clarifying and suggesting collaboration 3 Presenting reality and encouraging planning 4 Giving information and encouraging evaluation
1 Reflecting and exploring Reflecting conveys the nurse's observations of the patient when a sensitive issue is being discussed. Exploring seeks to examine a certain idea more fully.
A patient who has to undergo coronary artery bypass surgery says, "Since childhood I have been afraid of being operated on, and today I'm about to undergo a major surgery." The nurse replies, "You are afraid of being operated on?" Which method of effective communication did the nurse follow? 1 Exploring 2 Restating 3 Reflecting 4 Paraphrasing
2 Restating The nurse used the technique of restating by using the same key words the patient used. This technique helps to explore significant subjects more thoroughly. Exploring is used to examine the patient's ideas and experience by asking questions. Reflecting is used to better understand the patient by asking questions or making statements that reflect the patient's feelings about an issue. With paraphrasing, the content remains the same but different words are used by the nurse. It is used to make sure the perceptions made by the nurse are appropriate.
The nurse admitting a patient to the hospital asks, "Do you feel like harming yourself?" What type of questioning is the nurse using? 1 Miracle 2 Projective 3 Open-ended 4 Closed-ended
4 Closed-ended The nurse is using closed-ended questioning, which is used when specific information is needed and is most useful during an initial assessment. Miracle questioning is a goal-setting technique that helps patients see what the future would look like if a particular problem were to vanish. Projective questioning assists patients with articulation, exploration, and identification of thoughts and feelings. Open-ended questioning encourages a patient to share information about experiences, perceptions, or responses to a situation.
The patient says, "I was going to go to group therapy, but I will just sit here like I usually do because no one likes me." Based on the patient's statement, what therapeutic communication technique will be most effective for the nurse to use? 1 Restating 2 Summarizing 3 Projective questioning 4 Encouraging evaluation
4 Encouraging evaluation The most effective therapeutic communication technique for the nurse to use is encouraging evaluation. This assists the patient in considering other people and events from the perspective of the patient's own set of values to explore how a patient feels about a situation. Restating is a clarifying technique that helps the nurse understand what the patient is saying. This technique should be used sparingly because patients may interpret frequent and indiscriminate use of restating as inattention or disinterest. Summarizing brings together important points of discussion to enhance understanding. A discussion must occur prior to summarizing. Projective questioning is a type of questioning used to help people articulate, explore, and identify thoughts and feelings. The questions usually start with "what if" and are used to facilitate a patient's thinking about problems differently and to identify priorities.
Which statement determines that the nurse understands the issues surrounding the use of therapeutic touch? Select all that apply. 1 "Would it be a comfort to you if I held your hand during this procedure?" 2 "Does this facility have a "no touch" policy when caring for sexually abused patients?" 3 "As nurses we understand that not all members of a culture share similar feelings about being touched." 4 "It is my understanding that as a culture, Hispanics are usually comfortable with appropriate touch." 5 "Personal touch generally brings about similar feelings as does therapeutic touch among most patients."
1 "Would it be a comfort to you if I held your hand during this procedure?" 2 "Does this facility have a "no touch" policy when caring for sexually abused patients?" 3 "As nurses we understand that not all members of a culture share similar feelings about being touched." 4 "It is my understanding that as a culture, Hispanics are usually comfortable with appropriate touch." The therapeutic use of touch is a basic aspect of the nurse-patient relationship and generally is considered a gesture of warmth and friendship; however, the degree to which a patient is comfortable with the use of touch often is determined culturally. People from some cultures, such as Hispanic, are accustomed to frequent physical contact. However, personal touch within the context of an interview may be perceived as an invasion of privacy or experienced as patronizing, intrusive, aggressive, or sexually inviting in other cultures. Even among people from similar cultures, the use of touch has different interpretations and rules regarding gender and class. Some facilities have a "no touch" policy, particularly with adolescents and children who have experienced inappropriate touch and may not know how to interpret therapeutic touch from the health care worker. Touch is not responded to similarly by all individuals.
How can a nurse use active listening to support a patient who demonstrates poor problem-solving skills? Select all that apply. 1 Giving the patient appropriate feedback to attempts at problem solving. 2 Providing the patient with an opportunity to practice problem-solving skills. 3 Affording the patient a chance to "think out loud" while articulating problems. 4 Making suggestions regarding how the patient possibly can solve problems. 5 Presenting undivided attention enhances a patient's self-esteem regarding problem-solving abilities.
1 Giving the patient appropriate feedback to attempts at problem solving. 2 Providing the patient with an opportunity to practice problem-solving skills. 3 Affording the patient a chance to "think out loud" while articulating problems 5 Presenting undivided attention enhances a patient's self-esteem regarding problem-solving abilities. Active listening helps strengthen the patient's ability to solve problems. By giving the patient undivided attention, the nurse communicates that the patient is not alone. This kind of intervention enhances self-esteem and encourages the patient to direct energy toward finding ways to deal with problems. Serving as a sounding board, the nurse listens as the patient tests thoughts by voicing them aloud. This form of interpersonal interaction often enables the patient to clarify thinking, link ideas, and tentatively decide what should be done and how best to do it. These skills are not encouraged by the nurse who provides solutions.
Which intervention demonstrates that the nurse understands the therapeutic value of silence? Select all that apply. 1 Helping the patient refocus by saying," You started to tell me what you wanted for lunch." 2 Recognizing that the conversation of a patient being treated for schizophrenia may be affected by prescribed medications. 3 Self-reflecting on one's personal level of comfort regarding periods of conversational silence. 4 Providing the cognitively impaired patient more time to formulate and express thoughts. 5 Interjecting therapeutic silence when talking with children and teenagers because they like to direct conversations.
1 Helping the patient refocus by saying," You started to tell me what you wanted for lunch." 2 Recognizing that the conversation of a patient being treated for schizophrenia may be affected by prescribed medications. 3 Self-reflecting on one's personal level of comfort regarding periods of conversational silence. 4 Providing the cognitively impaired patient more time to formulate and express thoughts. 5 It is crucial to recognize that some psychiatric disorders, such as major depression and schizophrenia, and medications may cause an overall slowing of thought processes. Patience and gentle prompting can help patients gather their thoughts. Conversely, silence is not always therapeutic. Although a less-talkative nurse may be comfortable with silence, this mode of communication may make the patient feel like a fountain of information to be drained dry. Additionally, children and adolescents in particular tend to feel uncomfortable with silence.
Which statement about a process recording is true? Select all that apply. 1 It offers the nurse an opportunity to review clinical interactions exactly as they happened. 2 Both verbal interactions and nonverbal behavior are documented in the process recording. 3 It allows for themes that occurred during the interaction to be identified more easily. 4 The focus of the process recording is the patient's reaction to the interaction that occurred. 5 It helps improve the communication skills of the nurse by providing an opportunity to identify alternative responses.
1 It offers the nurse an opportunity to review clinical interactions exactly as they happened. 2 Both verbal interactions and nonverbal behavior are documented in the process recording. 3 It allows for themes that occurred during the interaction to be identified more easily. 5 It helps improve the communication skills of the nurse by providing an opportunity to identify alternative responses. The best way to increase communication and interviewing skills is to review clinical interactions exactly as they occur. This process offers the opportunity to identify themes and patterns in both the nurse's and the patient's communications. Process recordings are written records of a segment of the nurse-patient session that reflect as closely as possible the verbal and nonverbal behaviors of both patient and nurse. They are a useful tool for students and new clinicians to reflect on the interview, examine the process, and consider more appropriate responses, thereby improving communication skills.