Videbeck Ch 6, Therapeutic Communication Flashcards
What is therapeutic communication?
An interpersonal interaction between the nurse and the client focused on the client’s specific needs to promote effective information exchange.
It helps nurses understand and empathize with the client’s experience.
Why do all nurses need skills in therapeutic communication?
To effectively apply the nursing process and meet standards of care for their clients.
These skills are essential for providing high-quality patient care.
What are the goals of therapeutic communication? List at least three.
- Establish a therapeutic nurse-client relationship.
- Identify the most important client concern.
- Assess the client’s perception of the problem.
Additional goals include facilitating emotional expression, teaching self-care skills, and recognizing the client’s needs, implement interventions to address the client’s needs, and guide the client toward acceptable solutions.
What is the importance of establishing a therapeutic relationship?
It is one of the most important responsibilities of the nurse when working with clients.
Communication is essential for initiating, maintaining, and terminating this relationship.
What factors must a nurse consider for effective therapeutic communication?
- Privacy and respect of boundaries
- Use of touch
- Active listening and observation
These factors contribute to the effectiveness of the communication process.
True or False: Therapeutic communication is only about providing information to the client.
False
It involves understanding the client’s needs and fostering a two-way communication process.
Fill in the blank: Therapeutic communication helps in _______ the client’s expression of emotions.
[facilitating]
This is crucial for emotional support and understanding.
What is the role of a nurse in guiding the client during therapeutic communication?
To help the client identify a plan of action toward a satisfying and socially acceptable resolution.
This guidance is essential in empowering clients to take charge of their own care.
What is one of the goals of therapeutic communication?
Therapeutic nurse-client relationship
This goal focuses on creating a connection between the nurse and the client.
What is another goal of therapeutic communication?
Identify the client’s most important concerns and needs.
What does therapeutic communication aim to facilitate?
Client’s expression of emotions
What is a teaching goal of therapeutic communication?
Necessary self-care skills for Clients and families
What should be recognized in therapeutic communication?
The client’s needs
What is implemented in therapeutic communication?
Interventions that address the client’s needs.
What is guided in therapeutic communication?
The client is guided toward acceptable solutions to their concerns.
What is assessed in the therapeutic nurse-client relationship?
The most important client’s concerns; assess client’s perceptions
This assessment helps prioritize care based on the client’s view of their issues.
What is the focus of the therapeutic nurse-client relationship?
Client’s needs
Understanding and addressing the client’s specific needs is crucial for effective communication.
Fill in the blank: Therapeutic communication aims to recognize the client’s expression of _______.
emotions
Recognizing emotions is essential for effective therapeutic communication.
What is the comfortable distance for therapeutic communication between a nurse and a patient?
3 to 6 feet
What is active listening?
Refraining from other internal mental activities and concentrating exclusively on what the client says.
What does active observation entail?
Watching the speaker’s nonverbal actions as they communicate.
Who used observation as the first step in therapeutic interaction?
Peplau (1952).
What is the purpose of the nurse’s observation in therapeutic communication?
To observe the client’s behavior and guide them in giving detailed descriptions of that behavior.
What should the nurse do with the information obtained from observations?
Analyze the information, determine underlying needs, and connect pieces of information.
What misconception do students often have regarding therapeutic communication?
They must always be ready with questions the instant the client has finished speaking.
What can result from a nurse thinking ahead instead of actively listening?
The nurse may not understand the client’s concerns, leading to vague and superficial conversations.
What can superficial conversations lead nurses to incorrectly believe about clients?
That the client is not cooperating, repeating things, or not taking responsibility for getting better.
What often colors a nurse’s interpretation of a client’s message?
A person’s life experiences, knowledge base, values, and prejudices.
What is empathy in the context of therapeutic communication?
The ability to place oneself into the experience of another for a moment in time.
How can nurses develop empathy?
By gathering as much information about an issue as possible directly from the client.
What should nurses avoid to maintain effective therapeutic communication?
Interjecting their personal experiences and interpretations of the situation.
What are the five objectives of active listening and observation for nurses?
- Helps to recognize the issue that is most important to the client at this time
- Helps to know what further questions to ask the client
- Helps to understand the client’s perceptions of the issue instead of jumping to conclusions.
*Helps use therapeutic communication techniques.
*Helps objectively respond to message.
True or False: Active listening facilitates a nurse’s ability to interpret and respond to a client’s message subjectively.
False.
What is the purpose of accepting in therapeutic communication?
Indicating reception by acknowledging and validating the client’s feelings or statements
Examples include affirmations like ‘Yes.’ or ‘I follow what you said.’ Nodding. Does not indicate agreement and is nonjudgmental.
What does broad openings technique entail in therapeutic communication?
Allowing the client to take the initiative in introducing the topic
Examples include questions like ‘Is there something you’d like to talk about?’ or ‘Where would you like to begin?’
Define consensual validation in therapeutic communication.
Searching for mutual understanding and accord in the meaning of the words
Examples include inquiries like ‘Tell me whether my understanding of it agrees with yours.’ ‘Are you using this word to convey that…?’
What is the purpose of encouraging comparison in therapeutic communication?
To ask that similarities and differences be noted
Examples include questions like ‘Have you had similar experiences?’
Fill in the blank: Encouraging description of perceptions involves asking the client to verbalize what they _______.
perceive
Examples include questions like ‘What is happening?’ or ‘What does the voice seem to be saying?’ or ‘Tell me when you feel anxious.’
What type of response is demonstrated by nodding in therapeutic communication?
Accepting-indicating reception
Nodding serves as a non-verbal affirmation of the client’s statements.
True or False: Encouraging description of perceptions is only about asking the client to express feelings.
False
It involves asking the client to verbalize their perceptions, which may include thoughts and sensory experiences.
What does encouraging description of perceptions help the client do?
Verbalize their perceptions
This can reduce anxiety by helping them articulate their thoughts and feelings.
What is the therapeutic communication technique that encourages a client to appraise the quality of their experiences?
Encouraging expression
Examples include questions like “What are your feelings in regard to…?” and “Does this contribute to your distress?”
Which therapeutic communication technique involves delving / examining further into a subject or an idea?
Exploring
Examples include asking “Tell me more about that.” and “Would you describe it more fully?”
What does the focusing technique in therapeutic communication involve?
Concentrating on a single point
For example, saying “This point seems worth looking at more closely.” “Of all the concerns you’ve mentioned, which is the most troublesome?”
Fill in the blank: The technique of _______ involves asking the client to consider appropriate behaviors in future situations.
Formulating a plan of action
An example is asking, “What could you do to let your anger out harmlessly?”
What is the purpose of general leads in therapeutic communication?
Giving encouragement to continue
Examples include prompts like “go on.” and “Tell me about it.” “And then?”
What does giving information in therapeutic communication entail?
Making available the facts that the client needs
This can include stating, “My name is…” or “Visiting hours are…”
What is the technique of giving recognition in therapeutic communication?
Acknowledging, indicating awareness
Examples include, “Good morning, Mr. S…” and “You’ve finished your list of things to do.”
What does making observations in therapeutic communication involve?
Verbalizing what the nurse perceives
For instance, saying, “You appear tense.” or “I notice that you’re biting your lip.”
What does offering self mean in the context of therapeutic communication?
Making oneself available
Examples include statements like, “I’ll sit with you awhile.”
“I’m interested in what you think”
What is the purpose of placing events in time or sequence in therapeutic communication?
Clarifying the relationship of events in time
Questions like, “What seemed to lead up to…?” are examples.
“When did this happen?”
What is the technique of presenting reality in therapeutic communication?
Offering for consideration that which is real
Examples include stating facts such as ‘I see no one else in the room’ or ‘Your mother is not here; I am a nurse.’
How does reflecting work in therapeutic communication?
Directing client actions, thoughts, and feelings back to client
For example, if a client says, ‘Do you think I should tell the doctor…?’ the nurse might respond, ‘Do you think you should?’
What does restating involve in therapeutic communication?
Repeating the main idea expressed by the client
For instance, if a client states, ‘I can’t sleep. I stay awake all night,’ the nurse might reply, ‘You have difficulty sleeping.’
What is the purpose of seeking information in therapeutic communication?
To make clear that which is not meaningful or vague
This can include phrases like ‘I’m not sure that I follow’ or ‘Have I heard you correctly?’
What does silence represent in therapeutic communication?
Absence of verbal communication, providing time for the client
It allows clients to put thoughts or feelings into words or regain composure.
What is the goal of suggesting collaboration in therapeutic communication?
Offering to share, discuss, and work with the client for their benefit
An example is, ‘Perhaps you and I can strive to discover the triggers for your anxiety.’
What does summarizing entail in therapeutic communication?
Organizing and summing up what has been discussed
Examples include, ‘Have I got this straight?’ or ‘During the past hour, you and I have discussed…’
What is the therapeutic communication technique that involves seeking to verbalize a client’s feelings expressed indirectly?
Translating into feelings
This technique helps clients articulate their emotions that they may not express directly.
Provide an example of the ‘translating into feelings’ technique.
Client: ‘I’m dead.’ Nurse: ‘Are you suggesting that you feel lifeless?’
This exchange illustrates how the nurse helps the client clarify their emotional state.
What is the technique called that involves voicing what the client has hinted at or suggested?
Verbalizing the implied
This technique encourages clients to express their feelings more openly.
Give an example of ‘verbalizing the implied’.
Client: ‘I can’t talk to you or anyone. It’s a waste of time.’ Nurse: ‘Do you feel that no one understands?’
This shows how the nurse interprets the client’s feelings of isolation.
What does the technique ‘voicing doubt’ involve?
Expressing uncertainty about the reality of the client’s perceptions
This technique can help clients reevaluate their thoughts.
Provide an example of ‘voicing doubt’.
‘Isn’t that unusual?’ ‘Really?’ ‘That’s hard to believe.’
These statements encourage clients to reflect on their beliefs.
What is the advising technique in non-therapeutic communication?
Telling the client what to do
Examples include phrases like ‘I think you should…’ and ‘Why don’t you…’
What does the agreeing technique indicate in a therapeutic context?
Indicating accord with the client
Examples include responses like ‘That’s right.’ and ‘I agree.’
What is the effect of belittling feelings expressed by a client?
Misjudging the degree of the client’s discomfort
An example is responding to a statement of despair with ‘Everybody gets down in the dumps.’
What does the challenging technique involve?
Demanding proof from the client
Examples include questions like ‘But how can you be president of the United States?’
What is the purpose of defending in non-therapeutic communication?
Attempting to protect someone or something from verbal attack
Examples include statements like ‘This hospital has a fine reputation.’
How does disagreeing manifest in a therapeutic context?
Opposing the client’s ideas
Examples include phrases like ‘That’s wrong.’ and ‘I definitely disagree with…’
What does disapproving indicate in communication with a client?
Denouncing the client’s behavior or ideas
Examples include statements such as ‘That’s bad.’ and ‘I’d rather you wouldn’t…’
What is the implication of giving approval in a therapeutic setting?
Sanctioning the client’s behavior or ideas
Examples include affirmations like ‘That’s good.’ and ‘I’m glad that…’
What does giving literal responses entail?
Responding to a figurative comment as though it were a statement of fact
For example, responding to ‘They’re looking in my head with a television camera.’ with ‘Try not to watch television.’
What does indicating the existence of an external source involve?
Attributing the source of thoughts, feelings, and behaviors to others or outside influences
Examples include questions like ‘What makes you say that?’
What is the technique of interpreting in non-therapeutic communication?
Asking the client to make conscious what is unconscious; telling the client the meaning of their experience
Examples include phrases like ‘What you really mean is…’ or ‘Unconsciously you’re saying…’
What does introducing an unrelated topic involve?
Changing the subject
Example: Client says, ‘I’d like to die.’ Nurse responds with, ‘Did you have visitors last evening?’
What are stereotyped comments in non-therapeutic communication?
Offering meaningless clichés or trite comments
Examples include ‘It’s for your own good.’ or ‘Just have a positive attitude and you’ll be better in no time.’
What is probing in the context of non-therapeutic communication?
Persistent questioning of the client
Examples include ‘Now tell me about this problem. You know I have to find out.’
What does reassuring entail in non-therapeutic communication?
Indicating there is no reason for anxiety or other feelings of discomfort
Examples include ‘I wouldn’t worry about that.’ or ‘Everything will be alright.’
What does rejecting mean in non-therapeutic communication?
Refusing to consider or showing contempt for the client’s ideas or behaviors
Examples include ‘Let’s not discuss…’ or ‘I don’t want to hear about…’
What is the technique of requesting an explanation?
Asking the client to provide reasons for thoughts, feelings, behaviors, and events
Examples include ‘Why do you think that?’ or ‘Why do you feel that way?’
What does testing involve in non-therapeutic communication?
Appraising the client’s degree of insight
Examples include ‘Do you know what kind of hospital this is?’ or ‘Do you still have the idea that…?’
What does using denial mean in non-therapeutic communication?
Refusing to admit that a problem exists
Example: Client says, ‘I’m nothing.’ Nurse responds, ‘Of course you’re something-everybody’s something.’
What are cues in the context of nursing communication?
Cues are verbal or nonverbal messages that signal key words or issues for the client.
What is the function of active listening in nursing?
Finding cues is a function of active listening.
What are overt cues?
Overt cues are clear, direct statements of intent.
Give an example of an overt cue.
An example of an overt cue is ‘I want to die.’
What are covert cues?
Covert cues are vague or indirect messages that need interpretation and exploration.
Give an example of a covert cue.
An example of a covert cue is ‘Nothing can help me.’
How can the nurse respond to covert cues?
The nurse can explore the covert cue to clarify the client’s intent and protect the client.
What is a common characteristic of suicidal people regarding their feelings?
Most suicidal people are ambivalent about whether to live or die.
What type of question can the nurse use when they suspect self-harm or suicide?
The nurse can use a yes-or-no question to elicit a clear response.
Fill in the blank: Cues can be buried in what a client says or can be acted out in the _______.
[process of communication]
True or False: Cues are only verbal messages.
False
What can cue words introduced by the client help the nurse with?
Cue words can help the nurse know what to ask next or how to respond.
What can relieve pressure on students worried about what question to ask next?
Understanding cues can relieve pressure on students.
What are vocal cues?
Nonverbal sound signals transmitted along with content such as voice volume, tone, pitch, intensity, emphasis, speed, and pauses.
Vocal cues augment the sender’s message.
How can volume in vocal cues affect communication?
Indicates emotions such as anger, fear, happiness, or deafness.
Volume refers to the loudness of the voice.
What does tone in vocal cues signify?
Indicates whether someone is relaxed, agitated, or bored.
Tone can change the perception of the message.
What is pitch in vocal cues?
Varies from shrill and high to low and threatening.
Pitch can affect the emotional tone of the message.
Define intensity in the context of vocal cues.
The power, severity, and strength behind the words, indicating the importance of the message.
Intensity can emphasize urgency or seriousness.
What does emphasis refer to in vocal cues?
Accents on words or phrases that highlight the subject or give insight into the topic.
Emphasis helps to clarify important points.
How is speed measured in vocal cues?
By the number of words spoken per minute.
Speed can convey urgency or calmness.
What role do pauses play in vocal cues?
Contribute to the message by adding emphasis or feeling.
Pauses can alter the meaning of a statement.
What does a high-pitched rapid delivery of a message often indicate?
Anxiety.
Rapid delivery can signal nervousness.
What is circumstantiality in communication?
The use of extraneous words with long, tedious descriptions.
It can indicate confusion about what is important.
What do slow, hesitant responses often indicate?
Depression, confusion, and difficulty finding the right words.
This can also reflect reminiscing or searching for correct terms.
True or False: It is important for the nurse to assume they know what the client is feeling based on vocal cues.
False.
Nurses should validate nonverbal indicators rather than assume.
Fill in the blank: The _______ of speaking can indicate a person’s emotional state, such as anxiety or calmness.
speed
What role does the nurse assume in nondirective therapeutic communication?
Nondirective role
The nurse guides the conversation but does not dictate the topics.
Who identifies the problem to be discussed in a nondirective therapeutic interaction?
The client
The client is responsible for identifying their concerns and goals.
What skills does the nurse use to identify the topic of concern?
Active listening skills
Active listening helps the nurse understand the client’s needs.
What is the focus of information-gathering in nondirective therapeutic communication?
The client
Information-gathering is centered on the client’s concerns.
What is the primary goal of therapeutic communication in this context?
Achieving the goal within the time limits of the conversation
The conversation is structured to meet the client’s identified goals.
Fill in the blank: The nurse uses _______ and open-ended questions to collect information.
broad openings
Broad openings allow clients to express themselves freely.
What type of questions does the nurse use to facilitate client discussion?
Open-ended questions
These questions encourage clients to elaborate on their feelings and concerns.
What is an example of a client-centered goal?
The client will discuss concerns about their 16-year-old who is having trouble in school
This goal reflects the client’s specific concern.
True or False: In nondirective communication, the nurse does most of the talking.
False
The client does most of the talking while the nurse guides the interaction.
List three examples of client-centered goals from the text.
- Discuss concerns about a 16-year-old in school
- Describe difficulty with medication side effects
- Share distress about son’s drug abuse
These examples illustrate various concerns clients may have.
What is the significance of the nurse’s guiding role in therapeutic communication?
Facilitating the client’s expression of feelings and identification of issues
The nurse’s guidance helps clients clarify their thoughts and emotions.
Fill in the blank: The client will identify the greatest concerns they have about being a _______.
single parent
This goal highlights a specific area of concern for the client.
What role does a nurse take when a client is suicidal or in crisis?
Directive role
This role involves asking direct yes-or-no questions and employing problem-solving techniques.
What type of questions does a nurse use in a directive role?
Direct yes-or-no questions
These questions are aimed at guiding the client through their crisis.
What is the primary focus of the nurse’s intervention in a directive role?
Helping the client develop new coping mechanisms
This is essential for managing present issues effectively.
Fill in the blank: The nurse uses _______ to assist clients in developing coping strategies.
problem-solving techniques
Problem-solving is critical in crisis intervention.
