Chapter 9: Communication and the Clinical Interview

Question 1

The communication process

Answer 1

Stimulus (reason for the communication) for information, comfort, or advice 
Sender- initiates contact 
Message- sent or expressed 
Variety of media (how it is sent)- hearing, visual, touch, smell 
Feedback received 
Interaction between sender and receiver 
Creating meaning in the relationship 
Roles switch

Question 2

Factors that affect communication

Answer 2

Personal factors
Environmental factors (physical, societal, presence of others, expectations of others)
Relationship factors

Question 3

All words a person speaks.
Communicates beliefs and values, perceptions and meaning.
Can convey interest and understanding, insult and judgement, clear or conflicting messages, honest or distorted feelings.

Answer 3

Verbal communication.
Clarify what the word you are saying means.
Look for mixed messages.

Question 4

Tone of voice. Emphasis on certain words. Physical appearance. Facial expressions. Body posture. Amount of eye contact. Hand gestures. Paralanguage (pitch, tone, loudness, expressively placed gestures).
Behaviors displayed by the individual to express thoughts or feelings.

Answer 4

Nonverbal communication.
Interpretation depends on culture, class, age, sex…
How the message is verbalized can be more important than how it is said
If verbal message is not reinforced or is contradicted, this is called a double or mixed message

Question 5

Tools for enhancing communication

Answer 5

Using silence (making oneself available)
Active listening
Listening with empathy
Accepting lets person know they have been heard and understood- does not mean agreement and is not judgmental. do not convey understanding if you do not.
Offer general leads that encourage client to continue.
Encourage comparison between similarities and difference between ideals, situations, and relationships.

Question 6

Clarifying techniques

Answer 6

Paraphrasing
Restating- lets them know whether an expressed statement has been understood or not. repeat what they said back to them in their own words.
Reflecting- answering a question with a question
Exploring- delve further into an idea or relationship
Projective questions
Presumption questions

Question 7

Encourage pts to share information about experiences, perceptions, or responses to a situation. Not intrusive and do not put the pt on the defensive. They help to elicit information, especially in the beginning of an interview or when a pt is guarded or resistant to answering questions.
The degree to which the verbalization produces spontaneous and verbal responses. The degree to which the verbalization does not limit the person’s verbal set. The degree to which the verbalization opens up a moderately resistant pt.

Answer 7

Open-ended questions.

Question 8

When used sparingly, can give you more specific and needed information. Most useful during an initial assessment or intake interview or to ascertain results. Care needs to be exercised with this technique. Frequent use during time spent with pts can close an interview down rapidly.

Answer 8

Close-ended questions.

Question 9

Non-therapeutic communication techniques

Answer 9

Excessive questioning (esp. closed-ended questions. puts you as role of interrogator). 
Giving approval or disapproval (implies a nurse has right to pass judgement. usually involves a value judgement).
Giving advice (difference between giving advice and teaching! "This is how you can come to your own decision")
Asking "why" questions (requesting an explanation. asking why implies that the pt must defend their feelings and behavior. instead ask them how they are feeling and what is happening)

Question 10

Cultural considerations

Answer 10

Communication style.
Eye contact.
Touch.
Cultural filters- form of bias or prejudice

Question 11

Observing the pt’s nonverbal behaviors. Understanding and reflecting on the pt’s verbal message. Understand the pt in the context of the social setting of the pt’s life. Detecting “false notes.” Providing feedback about himself or herself of which the pt may not be aware

Answer 11

Active listening

Question 12

SOLER

Answer 12

Sit squarely facing the pt 
Observe in an open posture 
Lean forward toward the pt 
Establish eye contact 
Relax

Question 13

Preparing for the Interview

Answer 13

Pace- pt sets in
Setting
Seating- avoid physical barriers. door should be accessible to both.
Introductions: tell pt who you are, school name, purpose of the meeting, how long, when it will end. ask what they want to be called. confidentiality.
Initiating the interview (open-ended questions)
Don’t argue, don’t minimize, don’t compare
Don’t give false reassurance
Don’t interpret or speculate on dynamic
Don’t probe
Don’t join in on personal attacks
Don’t sell the pt on treatment
Speak briefly
Say nothing when you don’t know what to say
When in doubt, focus on feelings
If paranoid, don’t focus on the delusion, focus on the feeling
Keep focus on pt, note any of their nonverbal cues
Apologize if you say something wrong to the pt

Question 14

Foundation of the interview

Answer 14

Eye contact- more contact when pt speaks, less when nurse speaks
Body language: kinesics- body movement, postures. proxemics- significance of physical distance between the two people.
Vocal quality- loudness, rate, pitch, fluency. can be a sign of a mood disorder.
Verbal tracking- giving neutral feedback in the form of restating what the pt said

Question 15

Communication and interviewing are acquired skills. ____ _____ fosters professional growth and helps minimize the development of non therapeutic nurse-pt relationships.

Answer 15

Clinical supervision

Question 16

Written record of a segment of the nurse-pt session that reflects as closely as possible the verbal and nonverbal behaviors of both pt and nurse. Useful tool for identifying communication patterns. What you said, how you looked. what they said, how they looked. what was really going on in the convo. how you interacted and HOW YOU CAN IMPROVE.

Answer 16

Process recording

Question 17

The preferred seating arrangement for a nurse-client interview is with

a) the nurse behind a desk and the client in a chair in front of the desk.
b) the nurse and client sitting at a 90-degree angle to each other.
c) the client sitting in a chair and the nurse standing a few feet away.
d) the nurse and client sitting facing each other.

Answer 17

b) the nurse and client sitting at a 90-degree angle to each other.
This arrangement allows the nurse to observe the client but places no barriers between the principals. The two are at the same height, so neither is in an inferior position. Face-to-face seating is a more confrontational arrangement and therefore more anxiety producing.

Question 18

When discussing her husband, a client 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?”

a) Focusing
b) Restating
c) Reflection
d) Clarification

Answer 18

d) Clarification

Question 19

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?

a) The mental image of a word may not be the same for both nurse and client.
b) One statement may simultaneously convey conflicting messages.
c) Many of the client’s remarks are no more than social phrases.
d) Content of messages may be contradicted by process.

Answer 19

d) 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 client’s feelings than the verbal message.