Which communication technique involves giving encouragement to the client enabling continuance of the conversation?

ABDE
Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing Asking why is often interpreted as being accusatory by the patient and should also be avoided. Providing advice or giving approval or disapproval are barriers to communication.

Nội dung chính

• What are three therapeutic communication techniques the nurse would use?
• Which nursing statement is a good example of the therapeutic communication technique of focusing *?
• What are the different therapeutic communication technique and their example?
• Which nursing response is an example of the nontherapeutic communication technique of requesting an explanation?

B
Rationale:
1. The communication must be intrapersonal, interpersonal, group, or societal in nature. Therapeutic communication theory believes communication occurs in four different settings: intrapersonal, interpersonal, group, and societal.
2. The communication needs to be efficient, appropriate, flexible, and include feedback. The formal criteria for successful communication are efficiency, appropriateness, flexibility, and feedback.
3. Nonverbal communication is consistent with verbal communication. Nonverbal communication can contradict the verbal message.
4. The individuals communicating with each other must share a similar perception of the conversation. Perception is highly personal and internal.

ANS: A
Nurturing critical thinking skills is done in part by turning errors into learning opportunities. If the nurse presents an in-service on the cause and prevention of the type of error committed, not only will the nurse learn something but many others nurses on the unit will learn from it to. This is the best example of developing critical thinking skills. This option would allow the nurse to learn from the mistake, which is a method of developing critical thinking skills, but the paper would benefit only the nurse, so this option is not the best choice. Letting the nurse work with more experienced nurses might be a good option in a very limited setting, for example, if the nurse is relatively new and the manager discovers a deficiency in the nurse's orientation or training on giving medications in that system. Otherwise, this option would not really be beneficial. Sending the nurse to refresher courses might be a solution, but it is directed at the nurse's learning, not critical thinking. The nurse might feel resentful at having to attend such classes, but even if they were helpful, only this one nurse is learning. Going to generic classes also does not address the specific reason this error occurred, and thus might be irrelevant. Critical thinking and learning can be enhanced by a presentation to the staff on the causes of the error.

Answer: 3 6 4 2 1 5
3. During the preinteraction stage of the communication process, the nurse gathers information about the patient. This stage occurs before meeting the patient.
6. During the orientation stage of the communication process, the nurse introduces himself or herself to the patient and begins to establish a rapport with the patient.
4. During the orientation stage of the communication process, the nurse and patient exchange information, clarify roles, and identify goals and objectives of the interaction.
2. During the working stage of the communication process, the nurse and patient work toward meeting the patient's needs. The nurse may function as a caregiver, counselor, teacher, resource person, etc.
1. During the working stage of the communication process, the nurse provides feedback about the patient's performance.
5. During the termination stage of the communication process, the nurse summarizes what has been accomplished, reinforces past learning, arranges for available resources, and concludes the interpersonal relationship.

"I'll sit with you for awhile."

Offering oneself

"I think you should leave him."

Giving Advice

"Everything will be just fine."

False Reassurance

"Tell me whether my understanding agrees with yours."

Validation

"I'm not sure that I understand your last comment."

Clarification

"Why do you feel that way."

Requesting an explanation

"During the last hour we have discussed."

Summarizing

Gives clients time to organize thoughts

Silence

"You appear upset about something"

Making an observation

"Go on"

Offering a general lead

Client: "My wife spends all my money."

Nurse: "This causes you to feel angry."

Reflection (of feelings)

Client: "I can't sleep. I stay awake all night."

Nurse: "You have difficulty sleeping."

Restatement (paraphrase)

"My name is......"

"Visiting hours are......."

Giving information

Good Morning, Mr. S. I noticed you combed your hair.

Giving Recognition

Keep your chin up.

Cliche'/Stereotype

"This point seems worth looking at more closely"

Focusing

What are your feelings in regards to?

Encouraging Evaluation

"That's good!!!!"

Giving Approval

"I don't want to hear about it."

Rejecting

"What has brought you into the hospital?"

open-ended question

"Mmmmm?"

cue to continue

"It is understandable that you feel anxious- you seem to be going through a lot of stress all at once"

statement & restatement

"It can be difficult asking for help- you did the right thing coming here"

feedback

"are you feeling any different since you first came here?"

closed-ended question

"What are you thinking about?"

open-ended question

"You're concerned about how you're going to adjust to the changes that you're going through"

restatement

"Why don't we start by focusing on you?"

focus

"It is important to look after yourself so that you can be present for your family"

confrontation & feedback

"It is hard. You care a lot about your family"

validation & restatement

"It is that likely to happen right now?"

reality

"When we become anxious, we often worry about our future, or feel regret or guilt about the past..."

education

A nurse gathers data about the patient and the setting

Pre-Interaction

A nurse engages in activities that boost self-awareness

Pre-Interaction

A nurse chooses a time and place for the interaction

Pre-Interaction

This phase occurs before a nurse and patient meet

Pre-Interaction

Communication strategies allow for the development of rapport

Orientation

A nurse clarifies the purpose of the relationship

Orientation

A nurse assesses the patient's needs

Orientation

This phase occurs when a nurse and patient first meet

Orientation

Goals for the relationship are established

Orientation

The problems or nursing diagnoses are well defined

Working

This phase begins when the patient engages in a care plan

Working

A nurse challenges the patient's resistant behaviours

Working

The care plan is implemented

Working

Alternative solutions are planned

Working

A nurse summarizes the progress a patient has made

Termination

Goals for the relationship are met

Termination

The patient is referred to another health professional

Termination

A nurse assesses the patient's understanding of the relationship

Termination

This phase occurs when the relationship is coming to a close

Termination

Self-awareness

Conscious knowledge of one's true self

Self-esteem

A measure of one's overall sense of self-worth

Self-concept

Mental image one has of one's self

Emotional intelligence

the ability to perceive, express, understand, and regulate emotions

Verbal communication vs. Vocal Communication

Spoken written words vs TONE of voice

Circular transactional communication process

shows the situational contextual inputs, channels of communication, interpersonal contextual concepts, and factors affecting the sender and receiver

Components of the Circular transaction communication process

-Sender
-Receiver
-Message
-Environmental factors
-Interpersonal factors

five foundational components of a nurse-patient relationship

-Power
-Trust
-Empathy
-Respect
-Professional Intimacy

Social communication

reciprocity
self-disclosure
often no purpose or goal
could be about any topic
no definite end point
no definite rules
entered into by choice

SOLER technique

-S: sit facing the patient (or slightly to the patient's side)
-O: open posture
-L: lean in
-E: eye contact occasionally
-R: relax

Therapeutic communication

-[limited self-disclosure
-goal-oriented
-empathetic
-health-focused
-time-limited
-rules for conduct
-culturally appropriate language
-boundaries

Communication techniques that hinder understanding

- Sharing approval/disapproval - Sympathy
- False reassurance - Sharing personal opinions
- Asking for explanations
- Subject changes
- Defensiveness

Communication techniques that help understanding

- Paraphrasing
- Silence
- Summarizing
- Clarifying
- Reflection

Did you sleep well last night?

Closed-ended question

Are you in any pain?

Closed-ended question

Pt barriers to understanding

- Cognitive- demensia, stroke
- Sensory deficit
- privacy
- They don't like us
- Personal beliefs
- Time
- Confused with medical jargon
- Pain
- Personal emotions
- Crowded environment
- Strong smells
- Fatigued

Clarifying

- Asking for a re-phrase
- Use it to avoid assumptiom, clarify jargon, when delivering important info
- Cant use it when breaking confidentiality

Paraphrasing

- Putting into words the ideas or feelings you have perceived from the message
- Helps with language barriers
- Not appropriate When the patient already clearly understands

Touch

- When someone needs therapeutic touch
- Used when the patient initiates they want to be touched appropriately

Silence

Used when someone is going through grief, for inner reflection

A nurse challenges resistant behaviors

working

A nurse encourages a patient to continue their activities

termination

A nurse recognizes their personal biases and understands their gaps in knowledge

pre-interaction

Which therapeutic communication technique is being used in this nurse-client interaction?
Client: "When I get angry, I get into a fistfight with my wife or I take it out on the kids."
Nurse: "I notice that you are smiling as you talk about this physical violence."

A. Encouraging comparison
B. Exploring
C. Formulating a plan of action
D. Making observations

ANS: D
The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.

Which therapeutic communication technique is being used in this nurse-client interaction?
Client: "My father spanked me often."
Nurse: "Your father was a harsh disciplinarian."

A. Restatement
B. Offering general leads
C. Focusing
D. Accepting

ANS: A
The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood.

Which therapeutic communication technique is being used in this nurse-client interaction?
Client: "When I am anxious, the only thing that calms me down is alcohol."
Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?"

A. Reflecting
B. Making observations
C. Formulating a plan of action
D. Giving recognition

ANS: C
The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client's poor coping choice, may serve to prevent anger or anxiety from escalating.

The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a "general lead"?

A. "Do you know why you are here?"
B. "Are you feeling depressed or anxious?"
C. "Yes, I see. Go on."
D. "Can you chronologically order the events that led to your admission?"

ANS: C
The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information.

A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique?

A. The therapeutic technique of "giving advice"
B. The therapeutic technique of "defending"
C. The nontherapeutic technique of "presenting reality"
D. The nontherapeutic technique of "giving false reassurance"

ANS: D
The nurse's statement, "Things will look better tomorrow after a good night's sleep." is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings.

A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening?

A. "What occurred prior to the rape, and when did you go to the emergency department?"
B. "What would you like to talk about?"
C. "I notice you seem uncomfortable discussing this."
D. "How can we help you feel safe during your stay here?"

ANS: B
The nurse's statement, "What would you like to talk about?" is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction.

A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations?

A. "You appear to be talking to someone I do not see."
B. "Please describe what you are seeing."
C. "Why do you continually look in the corner of this room?"
D. "If you hum a tune, the voices may not be so distracting."

ANS: A
The nurse is making an observation when stating, "You appear to be talking to someone I do not see." Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions.

A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening?

A. S
B. O
C. L
D. E
E. R

ANS: B
The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the "O" in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback?

A. "Why did you use the client's name on your clinical worksheet?"
B. "You were very careless to refer to your client by name on your clinical worksheet."
C. "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name."
D. "It is disappointing that after being told, you're still using client names on your worksheet."

ANS: C
The instructor's statement, "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name." is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual.

After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, "I'm so proud of you for being assertive. You are so good!" Which communication technique has the leader employed?

A. The nontherapeutic technique of giving approval
B. The nontherapeutic technique of interpreting
C. The therapeutic technique of presenting reality
D. The therapeutic technique of making observations

ANS: A
The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client.

What is the purpose of a nurse providing appropriate feedback?

A. To give the client good advice
B. To advise the client on appropriate behaviors
C. To evaluate the client's behavior
D. To give the client critical information

ANS: D
The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.

A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst?

A. "Why do you continue to alienate your peers by your angry outbursts?"
B. "You accomplish nothing when you lose your temper like that."
C. "Showing your anger in that manner is very childish and insensitive."
D. "During group, you raised your voice, yelled at a peer, left, and slammed the door."

ANS: D
The nurse is providing appropriate feedback when stating, "During group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice.

A client diagnosed with dependant personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate?

A. "It would be best to do that in order to increase independence."
B. "Why would you want to leave a secure home?"
C. "Let's discuss and explore all of your options."
D. "I'm afraid you would feel very guilty leaving your parents."

ANS: C
The most appropriate response by the nurse is, "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action.

When interviewing a client, which nonverbal behavior should a nurse employ?

A. Maintaining indirect eye contact with the client
B. Providing space by leaning back away from the client
C. Sitting squarely, facing the client
D. Maintaining open posture with arms and legs crossed

ANS: C
When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response?

A. "The smoke was too thick. You couldn't have gone back in."
B. "You're feeling guilty because you weren't able to save your children."
C. "Focus on the fact that you could have lost all four of your children."
D. "It's best if you try not to think about what happened. Try to move on."

ANS: B
The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted.

A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation?

A. "Everyone diagnosed with OCD needs to control their ritualistic behaviors."
B. "It is important for you to discontinue these ritualistic behaviors."
C. "Why are you asking for help if you won't participate in unit therapy?"
D. "Let's figure out a way for you to attend unit activities and still wash your hands."

ANS: D
The most appropriate statement by the nurse is, "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client's anxiety.

Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process?

A. "We've discussed past coping skills. Let's see if these coping skills can be effective now."
B. "Please tell me in your own words what brought you to the hospital."
C. "This new approach worked for you. Keep it up."
D. "I notice that you seem to be responding to voices that I do not hear."

ANS: A
This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level.

A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic?

A. "It's quite common for clients to feel that way after a lengthy hospitalization."
B. "Why don't you talk to your mother? You may find out she doesn't feel that way."
C. "Your mother seems like an understanding person. I'll help you approach her."
D. "You feel that your mother does not want you to come back home?"

ANS: D
This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary.

A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block?

A. Requesting an explanation
B. Belittling the client
C. Making stereotyped comments
D. Probing

ANS: C
This is an example of the nontherapeutic communication block of making stereotyped comments. Clichés and trite expressions are meaningless in a therapeutic nurse-client relationship.

Which nursing statement is a good example of the therapeutic communication technique of giving recognition?

A. "You did not attend group today. Can we talk about that?"
B. "I'll sit with you until it is time for your family session."
C. "I notice you are wearing a new dress and you have washed your hair."
D. "I'm happy that you are now taking your medications. They will really help."

ANS: C
This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse's judgment.

A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions?

A. "You seem to be motivated to change your behavior."
B. "How will these changes affect your family relationships?"
C. "Why don't you make a list of the behaviors you need to change."
D. "The team recommends that you make only one behavioral change at a time."

ANS: A
This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly.

The nurse asks a newly admitted client, "What can we do to help you?" What is the purpose of this therapeutic communication technique?

A. To reframe the client's thoughts about mental health treatment
B. To put the client at ease
C. To explore a subject, idea, experience, or relationship
D. To communicate that the nurse is listening to the conversation

ANS: C
This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response?

A. "It's scary to feel put on the spot by a client. Nurses don't always have the answer."
B. "Remember, clients, not nurses, are responsible for their own choices and decisions."
C. "Just keep the client's best interests in mind and do the best that you can."
D. "Set a goal to continue to work on this aspect of your practice."

ANS: B
Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking.

A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication?

A. "Touch carries a different meaning for different individuals."
B. "Touch is often used when deescalating volatile client situations."
C. "Touch is used to convey interest and warmth."
D. "Touch is best combined with empathy when dealing with anxious clients."

ANS: A
Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction.

Which nursing statement is a good example of the therapeutic communication technique of focusing?

A. "Describe one of the best things that happened to you this week."
B. "I'm having a difficult time understanding what you mean."
C. "Your counseling session is in 30 minutes. I'll stay with you until then."
D. "You mentioned your relationship with your father. Let's discuss that further."

ANS: D
This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another.

After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response?

A. "Do you believe that I was the cause of your blood test being canceled?"
B. "I see that you are upset, but I feel uncomfortable when you swear at me."
C. "Have you ever thought about ways to express anger appropriately?"
D. "I'll give you some space. Let me know if you need anything."

ANS: B
This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.

During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns?

A. "Don't worry. Everything will be alright."
B. "You appear uptight."
C. "I notice you have bitten your nails to the quick."
D. "You are jumping to conclusions."

ANS: A
This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client's discomfort, thus a lack of empathy and understanding may be conveyed.

A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response?

A. "How would your family feel if you died?"
B. "You feel worthless now, but that can change with time."
C. "You've been feeling sad and alone for some time now?"
D. "It is great that you have come in for help."

ANS: C
This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted.

Which nursing response is an example of the nontherapeutic communication block of requesting an explanation?

A. "Can you tell me why you said that?"
B. "Keep your chin up. I'll explain the procedure to you."
C. "There is always an explanation for both good and bad behaviors."
D. "Are you not understanding the explanation I provided?"

ANS: A
This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking "why" a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.

A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred?

A. "Does your husband treat you like this very often?"
B. "What do you think is your role in this relationship?"
C. "Why do you think he behaved like that?"
D. "Describe what happened during your time with your husband."

ANS: D
This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations?

A. "My sister has the same diagnosis as you and she also hears voices."
B. "I understand that the voices seem real to you, but I do not hear any voices."
C. "Why not turn up the radio so that the voices are muted."
D. "I wouldn't worry about these voices. The medication will make them disappear."

ANS: B
This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client.

Which nursing statement is a good example of the therapeutic communication technique of offering self?

A. "I think it would be great if you talked about that problem during our next group session."
B. "Would you like me to accompany you to your electroconvulsive therapy treatment?"
C. "I notice that you are offering help to other peers in the milieu."
D. "After discharge, would you like to meet me for lunch to review your outpatient progress?"

ANS: B
This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing client's feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self.

A client slammed a door on the unit several times. The nurse responds, "You seem angry." The client states, "I'm not angry." What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating?

A. Making observations and the defense mechanism of suppression
B. Verbalizing the implied and the defense mechanism of denial
C. Reflection and the defense mechanism of projection
D. Encouraging descriptions of perceptions and the defense mechanism of displacement

ANS: B
This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both.

Which of the following individuals are communicating a message? (Select all that apply.)

A. A mother spanking her son for playing with matches
B. A teenage boy isolating himself and playing loud music
C. A biker sporting an eagle tattoo on his biceps
D. A teenage girl writing, "No one understands me"
E. A father checking for new e-mail on a regular basis

ANS: A, B, C, D
The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal.

Self concept

mental image one has of one's self

Self Esteem

: an individual's overall sense of self worth; an emotional appraisal of self-concept

Self-awareness

conscious knowledge of one's own character, feelings, motives, and desires.

Emotional Intelligence

Described as the ability to understand one's own emotions, to show empathy towards others' emotions and to organize one's emotions in a way that enriches his/her life.

verbal communication

communication that uses written or spoken words

Vocal

tone of voice

Non-verbal communication

Unspoken messages sent through eye contact, facial expressions and body language

Therapeutic Communication

A dynamic, interactive, and purposeful form of communication that is entered into by a clinician and a patient for the purpose of achieving identified health-related treatment goals.

therapeutic relationship

Professional alliance in which a clinician and patient join together for a defined period of time in order to achieve health-related treatment goals

Respect

Knowing the client as an individual with valued priorities, needs, and wants

Professional Intimacy

It includes physical activities and psychological, spiritual, and social elements of care.

Empathy

To connect with the patient, have an understanding of what they are going through, and acknowledge their emotional state by listening attentively

Power

the professional position, being able to access private information, ability to advocate for them (patient is vulnerable)

Pre-interaction phase of a therapeutic relationship includes

Obtain information about the client from the chart, significant others or other health team members. Examine one's own feelings, fears, and anxieties about working with a particular client.

Orientation phase of a therapeutic relationship includes

Occurs when nurse and patient first meet; clarify the purpose; assess patient needs; participant observation; communication strategies; define goals

Working phase of a therapeutic relationship includes

Begins when patient engages in care plan; define the problem; develop realistic goals; plan alternative solutions; implement the plan; challenge resistant behaviours

Termination phase of a therapeutic relationship includess

Relationship comes to a close; goals are met or care is transferred; review/summarize; referral; preparation for this phase begins in orientation phase where patient must acknowledge the termination and we asses their emotions, and understanding.

Active listening

dynamic, interactive process that involves hearing and decoding messages and providing feedback to convey understanding

SOLER stands for what

Sit square, Open Posture, Leaning Towards, Eye contact, Relaxed

Paraphrasing

express the meaning using different words, especially to achieve greater clarity

Clarifying

make a statement less confused and more clearly comprehensible

Reflection

seek to understand patient, then offer the idea back to the patient, to confirm the idea has been understood correctly

Sharing Observations

observations, empathy, humour, feelings)-
Observations: comment on observations (high BP) in a way that they can understand (use simple terms)
don't use during an emotional time (pt is crying)-

Sharing Humor

need to build rapport before using, consider age/culture/personality/behavior before using

Silence

don't use when someone is asking a question.
Intentional pause that allows a client to think.
Do use when someone needs time to think about what to say or there's nothing to say

Summarizing

taking together multiple points of a discussion & linking together to focus on one part

Restatement

repeating an idea in a variety of ways

focusing

centering a client's thinking and feelings on the situation causing a problem and assisting the person in choosing the behavior or adjustment to solve the problem.

validation

act of confirming or verifying

confrontation

face to face conflict, only use if you have really good rapport with client

What are three therapeutic communication techniques the nurse would use?

Therapeutic communication techniques such as active listening, silence, focusing, using open ended questions, clarification, exploring, paraphrasing, reflecting, restating, providing leads, summarizing, acknowledgment, and the offering of self, will be described below.

Which nursing statement is a good example of the therapeutic communication technique of focusing *?

“You mentioned your relationship with your father. Let's discuss that further.” This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another.

What are the different therapeutic communication technique and their example?

17 Therapeutic Communication Techniques.

Which nursing response is an example of the nontherapeutic communication technique of requesting an explanation?

D. "Are you not understanding the explanation I provided?" This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events.

Which communication technique involves expressing uncertainty about the reality of the client's perception?

Which therapeutic communication technique is being used in nurse

Which term is used to refer to signals that encourage effective communication?

Which therapeutic communication technique is being utilized when the nurse asked the client is there something you'd like to talk about?