Unit 1 Therapeutic Communication Chapter 9

Question 1

Communication process or Mode of communication

Answer 1

Stimulus – someone has a need to communicate
 Sender – the person sending the message
 Message – information send or expressed
 Channel – auditory, visual, tactile, olfactory or a combination
 Receiver – person receiving the message
 Feedback – validates the accuracy of the sender’s message and is EXTREMELY
IMPORTANT

Question 2

Sender

Answer 2

1. Communicator: Senders and receivers are both considered to be communicators, which makes roles fluid. Communica- tors are interdependent. For example, communication is not occurring if the receiver is not listening.

Question 3

Message

Answer 3

Message: The message is the content and the ideas that are being exchanged. Messages are also relational, which are communicated nonverbally by such elements as tone and body posture.

Question 4

Channel

Answer 4

. Channel: The method by which the communication takes place (e.g., in person or by telepsychiatry).

Question 5

Receiver

Answer 5

The individual recieving the message

Question 6

Feedback

Answer 6

4. Feedback: The messaging takes place with a constant feed- back being given by both parties. Feedback for one is the message for the other.

gives the receiver a way to respond to message and clarify understanding

Question 7

What are the benefits of Therapeutic communication

Answer 7

Benefits include feeling safe and protected, being more satisfied with the care, increased recovery rates, and improved adherence to treatment

Question 8

Can you learn from possibly saying the wrong thing to a psychiatric patient

A. Yes
B. No

Answer 8

A. Yes

Nursing students are often concerned that they may say the wrong thing. Will you say the “wrong thing”? Yes, that may happen.

Making mistakes helps us to find more useful and effective ways of helping individuals reach their goals.

Even if you make mistakes in communication or when you say the “wrong thing,” there is little chance that the comments will do actual harm.

Question 9

What are some factors that affect communication

Answer 9

*Personal Factors
*Environmental Factors
*Relationship factors

Question 10

You are conducting an interview with your patient diagnosed with social anxiety disorder. While asking them a question they cannot hear you due to the loud background noise. What factor is affecting the effectiveness of the dialogue?

A. Environmental
B. Personal
C. Realtional
D. Mileu

Answer 10

A. Environmental

Environmental factors within a healthcare setting that may affect communication include physical factors.
*Background noise,
* lack of privacy, and
*uncomfortable accommodations(lighting temperature, furniture)

are not conducive to a smooth flow of communication.

While units are not as crowded and noisy as they once were, it may still be difficult to carry on a private conversation in the day hall or other common area.

Question 11

You are shadowing a psychiatric. use conducting a Mental Status Exam on a patient with depression. Due, to your previous knowledge of factors that affect comminication , what factor would you suspect to be affected?

A. Environmental
B. Personal
C. Realtional
D. Mileu

Answer 11

B. Personal

Patients may have difficulty communicating due to a psychiatric disorder. For example, depression may result in slow thinking and reduced communication, anxiety can cause lack of concentration, and mania creates an inability to focus for any length of time.

 Cognitive Function &  Education
-Cognitive factors have to be considered when communicat- ing and providing education. Problem-solving ability, knowledge level, and language use are reduced in intellectual development disability, neurocognitive disorders, and psychotic states

 Anxiety- lack of concentration
 Language barrier (professional
interpreter)- reduce flow of communication

Question 12

Communication between friends and colleagues is what type of relationship factor in communication?

A. Symmetrical
B. Unequal

Answer 12

A. Symmetrical

For the purpose of this discussion, relationship factors refer to the level of equality within the relationship. When the two participants are equal, such as friends or colleagues, the rela- tionship is symmetrical. However, when there is a difference in status or power, such as between nurse and patient or teacher and student, the relationship is characterized by inequality. One participant has more control. This is called a comple- mentary relationship. Usually, the inequality decreases as the patient recovers and as the student progresses and graduates. Complementary relationships also exist based on social status, age or developmental differences, gender differences, and edu- cational differences.

Question 13

Communication between Doctor and his patient is what type of relationship factor in communication?

A. Symmetrical
B. Unequal(Complentary)

Answer 13

B. Unequal

However, when there is a difference in status or power, such as between nurse and patient or teacher and student, the relationship is characterized by inequality. One participant has more control. This is called a comple- mentary relationship. Usually, the inequality decreases as the patient recovers and as the student progresses and graduates. Complementary relationships also exist based on social status, age or developmental differences, gender differences, and edu- cational differences.

Question 14

Verbal communications consist of … Select all that apply

A. words spoken
B. Body language
C. Facial expressions
D.eye contact
E. tone of voice

Answer 14

A. words spoken

Verbal communication consists of all the words a person speaks.

Question 15

Non-Verbal communications consist of … Select all that apply

A. words spoken
B. Body language
C. Facial expressions
D.eye contact

Answer 15

B. Body language
C. Facial expressions
D.eye contact

It is said, “It’s not what you say but how you say it.” In other words, it is the nonverbal behaviors that may be defining the real message.

The tone of voice, emphasis on certain words, and the manner in which a person paces speech are examples of nonverbal communication.

Other common examples of non- verbal communication are physical appearance, body posture,eye contact, hand gestures, sighs, fidgeting, and yawning. Table 9.1 identifies examples of nonverbal behaviors.

Question 16

1. Which statement made by the nurse demonstrates the best understanding of nonverbal communication?
   a. “The patient’s verbal and nonverbal communication is
   often different.”
   b. “When my patient responds to my question, I check for
   congruence between verbal and nonverbal communication to help validate the response.”
   c. “If a patient is slumped in the chair, I can be sure he’s
   angry or depressed.”
   d. “It’s easier to interpret verbal communication than to
   interpret nonverbal communication.”

Answer 16

b. “When my patient responds to my question, I check for
congruence between verbal and nonverbal communication to help validate the response.”

Question 17

5. What principle about nurse-patient communication should guide a nurse’s fear about “saying the wrong thing” to a patient?
   a. Patients tend to appreciate a well-meaning person who
   conveys genuine acceptance, respect, and concern for their situation.
   b. The patient is more interested in talking to you than listening to what you have to say and so is not likely to be
   offended.
   c. Considering the patient’s history, there is little chance
   that the comment will do any actual harm.
   d. Most people with a mental illness have by necessity
   developed a high tolerance of forgiveness.

Answer 17

a. Patients tend to appreciate a well-meaning person who
conveys genuine acceptance, respect, and concern for their situation.

Question 18

6. 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 con- tact while reporting this to you. Which of the following
   responses would most likely be therapeutic?
   a. “A new psychiatrist is a chance to start fresh; I’m sure it
   will go well for you.”
   b. “You say you look forward to the meeting, but you
   appear anxious or unhappy.”
   c. “I notice that you frowned and avoided eye contact just
   now. Don’t you feel well?”
   d. “I get the impression you don’t really want to see your
   psychiatrist—can you tell me why?”

Answer 18

b. “You say you look forward to the meeting, but you
appear anxious or unhappy.”

Question 19

7. Which student behavior is consistent with therapeutic
   communication?
   a. Offering your opinion when asked to convey support.
   b. Summarizing the essence of the patient’s comments in
   your own words.
   c. Interrupting periods of silence before they become awk- ward for the patient.
   d. Telling the patient he did well when you approve of his statements or actions.

Answer 19

b. Summarizing the essence of the patient’s comments in
your own words.

Question 20

8. James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for your day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?
   a. “There are no such things as demons. What you saw were hallucinations.”
   b. “It is not possible for anyone to enter your room at night. You are safe here.”
   c. “You seem upset. Please tell me more about what you experienced last night.”
   d. “That must have been frightening, but we’ll check on you at night and you’ll be safe.”

Answer 20

c. “You seem upset. Please tell me more about what you experienced last night.”

Question 21

What are 3 Therapeutic Communication Techniques

Answer 21

Using Silence

Active Listening

Paraphrasing

Restating

Reflecting

Exploring

Question 22

Active Listening

Answer 22

Active Listening
 Full attention, understanding, responding from nurse
 Noticing nonverbal communication from patient

Active listening enhances self-esteem and encourages the patient to direct energy toward finding ways to deal with prob- lems. This technique helps strengthen the patient’s ability to solve problems.

Question 23

Using silence

Answer 23

Can feel uncomfortable for the new nurse, but can
be extremely beneficial
 Not the absence of communication
 Reflection, gather thoughts
 Cognitive Slowing

Students and practicing nurses alike may find that, when the flow of words stops, they become uncomfortable. They may rush to fill the void with questions or idle comments. This response may cut off important thoughts and feelings the patient might be taking time to think about. Silence is not the absence of com- munication but a specific channel for transmitting and receiving messages. Therefore, the nurse learns to appreciate that silence is a significant means of influencing and being influenced by others.

Question 24

The nurse is currently in an interaction with a crying child who is expressing his feeling about losing his dog. The nurse intentionally doesn’t speak so she doesn’t miss out on key information. What therapeutic technique is he displaying?

A. Restating
B. Asking why
C. Using Silence
D. Actively listening

Answer 24

C. Using Silence

Question 25

Should the therapeutic technique “using silence” is in best use when speaking with children or adolescent?

A. Yes
B. No

Answer 25

B. No
Also, children and adolescents in particular tend to feel uncomfortable with silence, so this technique should be used sparingly, if at all, with young people.

Prolonged and frequent silences by the nurse may hinder a communication that requires verbal articulation. This technique may make the patient feel uncomfortable.

Question 26

In a _______ nurses focus, respond, and remember what the patient is saying verbally and nonverbally.

A. Restating
B. Asking why
C. Using Silence
D. Actively listening

Answer 26

D. Actively listening

Question 27

Which therapeutic communication technique is this?

“Tell me more about your relationship with your wife.” “Describe your relationship with your wife.”
“Give me an example of how you and your wife don’t get along.”

A. Restating
B. Exploring
C. Using Silence
D. Actively listening

Answer 27

B. Exploring

A technique that enables the nurse to examine
important ideas, experiences, or relationships more fully is exploring. For example, if a patient tells you he does not get along well with his wife, you will want to further explore this area. Possible openers include the following:

Dialogue
Patient: “No one likes me.”
Nurse: “Give me an example of one person who doesn’t like
you.”

Question 28

“You seem to be saying you don’t feel comfortable in social settings?’

A. Restating
B. Exploring
C. Using Silence
D. Paraphrasing

Answer 28

D. Paraphrasing

 Restate back the basic content of the patient’s
message, in different words

Prefacing statements with a phrase such as “You seem to be saying…” or “I’m not sure I understand” helps the nurse sort through a bewildering amount of details.

Question 29

if a patient remarks, “My life is empty… it has no meaning,” additional information may be gained by _____, “Your life is empty?”

A. Restating
B. Exploring
C. Using Silence
D. Paraphrasing

Answer 29

A. Restating

Repeats the main idea expressed. Gives the patient an idea of what has been communicated. If the message has been misunderstood, the patient can clarify it.

If a patient remarks, “My life is empty… it has no meaning,” additional information may be gained by restating, “Your life is empty?”

Question 30

What communication technique is this

Patient: “Nurse, do you think I really need to be hospital-
ized?”
Nurse: “What do you think, Kelly?”
Patient: “I don’t know. That’s why I’m asking you.”

A. Restating
B. Reflecting
C. Using Silence
D. Paraphrasing

Answer 30

B. Reflecting

Reflecting. Reflection is a means of assisting patients to better understand their own thoughts and feelings. Reflecting may take the form of a question or a simple statement that conveys the nurse’s observations of the patient when discussing sensitive issues.

Question 31

Therapeutic communication techniques ‘ questions

Answer 31

Open-ended
 Encourages the patient to share more information about a experience, feeling etc…

• “What do you perceive as your biggest problem right now?” * “What is an example of some of the stresses you are under
  right now?”
• “How would you describe your relationship with your wife?”
  Because open-ended questions are not intrusive and do not

Closed-ended
 Can give specific needed information
 Used sparingly

Have you had thoughts of harming yourself or others

Question 32

Projective questions and The miracle question

Answer 32

Projective questions
 “What if”
 Facility the patient’s thinking about problems differently
 Can help to identify priorities

 The miracle question
 Goal setting
 Asked deliberately and dramatically

Question 33

Projective questions examples

Answer 33

with a “what if” to help people articulate, explore, and identify thoughts and feelings.

• If you had three wishes, what would you wish for?
• If you could go back and change how you acted in (a situation/
  significant life event), what would you do differently now?
• What would you do if you were given $1 million with no
  strings attached?

Question 34

Miracle question

Answer 34

The miracle question is a goal- setting question that helps patients to see what the future would look like if a particular problem were to vanish.

example
Nurse: “We’ve talked about some serious topics. Now I am going to ask you an unusual question, one that might really make you think. What if while you were sleeping tonight a miracle occurred. When you wake up in the morning how will your life be different if this miracle came true?”

Question 35

Nontherapeutic communication techniques.

Answer 35

 Excessive questioning
 Multiple questions
 Conveys lack of respect

 Giving approval or Disapproval
 Patient may be overwhelmed, vulnerable
 Can sway the patient

 Giving advice
 Interfering with the patient’s ability to make decisions

 Why questions
 Demands an explanation
 Implies a wrongdoing

Changing the subject

Making value judgments

Falsely reassuring

Question 36

Excessive questioning examples , what to say vs not what to say

Answer 36

Excessive questioning—asking multiple questions (particu- larly closed-ended) consecutively or rapidly—casts the nurse in the role of interrogator who demands information without respect for the patient’s willingness or readiness to respond.

Excessive questioning: “Why did you leave your husband? Did you feel angry with him? What did he do to you? Would you consider going back to him?”

More therapeutic approach: “Tell me about the situation between you and your husband.”

Question 37

Giving approval or disapproval

Answer 37

Implies the patient is doing the right thing—and that not doing it is wrong.

May lead the patient to focus on pleasing the nurse or clinician; denies the patient the opportunity to change her mind.

“I’m proud of you for applying for that job.”
“I agree with your decision.”

Making observations:
“I noticed that you applied for that job.”
“What factors will lead up to your changing your
mind?”
Asking open-ended questions; giving a broad opening:
“What led to that decision?”

Question 38

Cultural rules of communication

Answer 38

Several areas may be difficult for nurses in interpreting verbal and nonverbal messages from patients from different cultures. They are:
1. Communication style.
2. Use of eye contact.
3. Perception of touch.
4. Cultural filters.

Question 39

Use of eye contact.

Answer 39

Some cultures consider direct eye contact disrespectful and improper. Individuals may have been taught to avoid eye con- tact with authority figures such as nurses, physicians, and other healthcare professionals.]

On the other hand, in other cultures, direct and sustained eye contact indicates that the person listens or trusts, is somewhat aggressive, or, in some situations, is sexually interested. These cultures may interpret avoidance of eye contact by another per- son as being disinterested, not telling the truth, or avoiding the sharing of important information.

Question 40

Perception of Touch

Answer 40

However, some people perceive personal touch within the context of the nurse-patient relationship as an invasion of privacy. Touch may be 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.

Students are urged to find out if their facility has a “no touch” policy. This is particularly important when working with ado- lescents and children who have experienced inappropriate touch. They may not know how to interpret therapeutic touch from the healthcare worker.

ASK IF YOU CAN TOUCH

Question 41

Is it impossible to listen to people in an unbiased way?

A. Yes
B. No

Answer 41

A. Yes

It is important to recognize that it is impossible to listen to people in an unbiased way. In the process of socialization, we develop cultural filters through which we listen to the world around us (Egan, 2013). Cultural filters are a form of cultural bias or cultural prejudice that determines what we pay attention to and what we ignore.

Question 42

The clinical interview has what categories

Answer 42

 Pace
 Setting/Seating

-ENSURE THAT YOU ARE SAFE
- DO NOT INVADE SPACE
-SIT NEXT TO DOOR
-ESTABLISH DISTANT(TABLE IN MIDDLE)
-LEAN INTO PATIENT TO ESTABLISH

Question 43

Pace in Clinical Interview

Answer 43

As previously discussed, psychiatric conditions may cause changes in the ability to process information.

*Major depressive disorder, for example, tends to slow thinking. Therefore, it is critical to any kind of counseling to permit the patient to set the pace of the interview, no matter how slow or halting the progress may be. In the case of mania, which speeds up thought processes and also impairs them, counseling sessions may be shorter and more frequent.

DONT RUSH - GO AS PACE OF PATIENT

Question 44

Setting in Clinical Interview

Answer 44

Effective communication can take place almost anywhere. Establishing a setting that enhances feelings of security is important to the therapeutic relationship. A conference room or a quiet part of the unit that has relative privacy but is within view of others is ideal. Sometimes, patients are cared for in their home. This provides the nurse a valuable opportunity to assess the patient in the context of everyday life.

Safety
 Privacy
 Noise
 Distractions

Question 45

What is the proper seating for a nurse conducting an interview with a patient with a psychiatric disorder

Answer 45

Safety and psychological comfort in terms of exiting the room is an additional consideration. The patient should not be positioned between the nurse and the door.

In cases where behavior escalation occurs, it may be necessary to exit the room. At the same time, you should position yourself in such a way that does not make the patient feel trapped in the room.

THE NURSE ALWAYS CLOSER TO THE DOOR

Question 46

What is the best seating to observe nonverbal styles of communication when nurse is conducting a interview.

A. Back to back
B. Side to side
C. Face to face
D. side to face

Answer 46

C. Face to face

Seating arrangements can be face-to-face with a table in between, face-to-face with no table, at an angle with a table in between, or at an angle with no table. Some people believe that face-to-face with a table suggests a power differential and that the desk serves as a barrier. However, face-to-face discussion does facilitate the best reading of nonverbals.

Question 47

While talking with a client diagnosed with major depressive disorder, a nurse notices the client is unable to maintain eye contact. The client’s chin lowers to the chest. The client looks at the floor. Which aspect of communication has the nurse assessed?
a. Nonverbal communication
b. A message filter
c. A cultural barrier
d. Social skills

Answer 47

a. Nonverbal communication

ANS: A
Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the client’s social skills or an existing cultural barrier.

Question 48

During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the client’s hand. Select the correct analysis of the nurse’s behavior.
a. It shows empathy and compassion. It will encourage the client to continue to express feelings.
b. The gesture is premature. The client’s cultural and individual interpretation of touch is unknown.
c. The client will perceive the gesture as intrusive and overstepping boundaries.
d. The action is inappropriate. Psychiatric clients should not be touched.

Answer 48

b. The gesture is premature. The client’s cultural and individual interpretation of touch is unknown.

ANS: B
Touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment is completed regarding the way in which the client will perceive touch. The incorrect options present prematurely drawn conclusions.

Question 49

During a one-on-one interaction with the nurse, a client frequently looks nervously at the door. What is the best comment by the nurse regarding this nonverbal communication?
a. “I notice you keep looking toward the door.”
b. “This is our time together. No one is going to interrupt us.”
c. “It looks as if you are eager to end our discussion for today.”
d. “If you are uncomfortable in this room, we can move someplace else.”

Answer 49

a. “I notice you keep looking toward the door.”

Making observations and encouraging the client to describe perceptions are useful therapeutic communication techniques for this situation. The other responses are assumptions made by the nurse.

Question 50

A client of color says to a Caucasian nurse, “There’s no sense talking about how I feel. You wouldn’t understand because you live in a white world.” What is the nurse’s best action ?
a. Explain, “Yes, I do understand. Everyone goes through the same experiences.”
b. Say, “Please give an example of something you think I wouldn’t understand.”
c. Reassure the client that nurses interact with people from all cultures.
d. Change the subject to one that is less emotionally disturbing.

Answer 50

. Say, “Please give an example of something you think I wouldn’t understand.”