Chapter 10: Communication and the Clinical Interview Flashcards
You have been working closely with a patient for the past month. Today, he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?
a. Stating that a new psychiatrist is a fresh start and offering false reassurance that “it will go well” minimizes the feelings and experience of the patient, closing off therapeutic communication.
b. Making observations such as the fact that the patient states he is looking forward to the meeting, while also pointing out the discrepancy (“but you appear anxious”), raises the patient’s awareness of the hidden aspects of his or her communication and brings feelings to the surface, a helpful result for the therapeutic process. The nurse has communicated the observation in an open question that is nonthreatening, which is also highly therapeutic.
c. While making the observation (“I notice that you frowned . . .” ) does encourage the patient to reflect on his feelings, naming the feeling for the patient (“Don’t you feel well?”) minimizes the patient’s experience and does not support communication.
d. Providing an interpretation without obtaining the patient’s perspective is not effective communication. Asking a “why” question—especially about a nurse’s impression rather than a patient’s statement—conveys criticism, which is nontherapeutic.
b. Making observations such as the fact that the patient states he is looking forward to the meeting, while also pointing out the discrepancy (“but you appear anxious”), raises the patient’s awareness of the hidden aspects of his or her communication and brings feelings to the surface, a helpful result for the therapeutic process. The nurse has communicated the observation in an open question that is nonthreatening, which is also highly therapeutic.
Which behaviour is consistent with therapeutic communication?
a. Offering opinions does not convey support but, rather, assumes the nurse knows best and the patient can’t think for him- or herself. This action inhibits problem solving and fosters dependency.
b. Summarizing a patient’s comments reflects his or her words back to aid in reflection and also allows any miscommunication to be clarified promptly, which is consistent with therapeutic communication.
c. Interrupting silence is not therapeutic in that it forces a pace on the interview that is not set by the patient. As well, many valuable thoughts surface in periods of silence.
d. Providing approval imparts power on the part of the nurse and discourages self-exploration and reflection on the part of the patient, which is not therapeutic. Offering approval also fosters dependence in the therapeutic relationship.
b. Summarizing a patient’s comments reflects his or her words back to aid in reflection and also allows any miscommunication to be clarified promptly, which is consistent with therapeutic communication.
Which statement about nonverbal behaviour is accurate?
a. A calm expression does not always reflect the internal experience. Interpreting nonverbal messages must be more carefully measured. Often, people have greater conscious awareness of their verbal messages than of their nonverbal behaviours.
b. Touch is often miscommunicated and is highly culturally interpreted; further, it is not a mode of communication appropriate in the therapeutic nurse–patient relationship.
c. Cultural and individual differences often dictate the meanings of nonverbal messages, so therapeutic communication requires that these messages and cues be carefully checked and understood.
d. Nonverbal gaze or eye contact is not always a reliable measure of the patient’s degree of attentiveness and engagement since cultural norms or practices may contribute to differences in meaning.
c. Cultural and individual differences often dictate the meanings of nonverbal messages, so therapeutic communication requires that these messages and cues be carefully checked and understood.
A nurse stops in to interview a patient on a medical unit and finds the patient lying supine in her bed with the head elevated at ten degrees. Which initial response would most enhance the chances of achieving a therapeutic interaction?
a. Rushing an interaction and maintaining a power differential through the placement of nurse and patient in the room is not therapeutic.
b. While seeking permission for interventions (such as raising the elevation of the head of the bed) promotes therapeutic communication, invading the personal space of the patient by sitting on the bed is not therapeutic and is counter to the boundaries of the nurse–patient relationship.
c. Seeking permission for interventions (such as raising the elevation of the head of the bed) promotes therapeutic communication, and creating an even level for the nurse and patient to interact promotes more open communication and supports the sense of a shared power within the interaction.
d. Creating an atmosphere of informality is appropriate to a more social relationship or visit but does not set the tone of therapeutic communication desired in this setting.
c. Seeking permission for interventions (such as raising the elevation of the head of the bed) promotes therapeutic communication, and creating an even level for the nurse and patient to interact promotes more open communication and supports the sense of a shared power within the interaction.
A patient with schizophrenia approaches staff arriving for day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?
a. Dismissing the patient’s experience and interpretation of reality minimizes the magnitude of the experience and is not therapeutic.
b. Suggesting the impossibility of a person entering the patient’s room provides false reassurance and does not respond to the immediate concern of the patient, and so is counter-therapeutic.
c. Providing an observation (“You seem very upset”) allows the patient to confirm or clarify your observation, and inviting the patient to elaborate encourages expression of feelings, experiences and contexts, which is a therapeutic communication practice.
d. While acknowledging the patient’s feeling of fear provides a validation of the experience, rapidly suggesting a solution (that the patient will be checked on) inhibits problem solving and communication. Further, the suggestion “You’ll be safe” provides false reassurance and minimizes the patient’s problem.
c. Providing an observation (“You seem very upset”) allows the patient to confirm or clarify your observation, and inviting the patient to elaborate encourages expression of feelings, experiences and contexts, which is a therapeutic communication practice.
