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Accepting Conveys an attitude of reception and regard. Yes, I understand what you said.
Eye contact; nodding.
Giving recognition Acknowledging and indicating awareness; better than Hello, Mr. J. I notice that you made a
complimenting, which reflects the nurses judgment. ceramic ash tray in OT.
I see you made your bed.
Offering self Making oneself available on an unconditional basis, increas- Ill stay with you awhile.
ing clients feelings of self-worth. We can eat our lunch together.
Im interested in you.
Giving broad openings Allows the client to take the initiative in introducing the What would you like to talk about today?
topic; emphasizes the importance of the clients role in Tell me what you are thinking.
the interaction.
Offering general leads Offers the client encouragement to continue. Yes, I see. Go on.
And after that?
Placing the event in time Clarifies the relationship of events in time so that the nurse What seemed to lead up to . . .?
or sequence and client can view them in perspective. Was this before or after . . .?
When did this happen?
Making observations Verbalizing what is observed or perceived. This encourages You seem tense.
the client to recognize specific behaviors and compare I notice you are pacing a lot.
perceptions with the nurse. You seem uncomfortable when you. . . .
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Encouraging comparison Asking the client to compare similarities and differences in Was this something like . . .?
ideas, experiences, or interpersonal relationships. This helps How does this compare with the time
the client recognize life experiences that tend to recur as when . . .?
well as those aspects of life that are changeable. What was your response the last time
this situation occurred?
Restating Repeating the main idea of what the client has said. This Cl: I cant study. My mind keeps wandering.
lets the client know whether or not an expressed statement Ns: You have trouble concentrating.
has been understood and gives him or her the chance to Cl: I cant take that new job. What if
continue, or to clarify if necessary. I cant do it?
Ns: Youre afraid you will fail in this
new position.
Reflecting Questions and feelings are referred back to the client so that Cl: What do you think I should do about my
they may be recognized and accepted, and so that the client wifes drinking problem?
may recognize that his or her point of view has valuea good Ns: What do you think you should do?
technique to use when the client asks the nurse for advice. Cl: My sister wont help a bit toward
my mothers care. I have to do it all!
Ns: You feel angry when she
doesnt help.
Focusing Taking notice of a single idea or even a single word; works This point seems worth looking at more
especially well with a client who is moving rapidly from one closely. Perhaps you and I can discuss it
thought to another. This technique is not therapeutic, how- together.
ever, with the client who is very anxious. Focusing should
not be pursued until the anxiety level has subsided.
Exploring Delving further into a subject, idea, experience, or relation- Please explain that situation in more
ship; especially helpful with clients who tend to remain on a detail.
superficial level of communication. However, if the client Tell me more about that particular
chooses not to disclose further information, the nurse should situation.
refrain from pushing or probing in an area that obviously
creates discomfort.
Seeking clarification Striving to explain that which is vague or incomprehensible Im not sure that I understand. Would you
and validation and searching for mutual understanding. Clarifying the please explain?
meaning of what has been said facilitates and increases Tell me if my understanding agrees
understanding for both client and nurse. with yours.
Do I understand correctly that you
said . . .?
Presenting reality When the client has a misperception of the environment, the I understand that the voices seem real to
nurse defines reality or indicates his or her perception of the you, but I do not hear any voices.
situation for the client. There is no one else in the room but
you and me.
Voicing doubt Expressing uncertainty as to the reality of the clients per- I understand that you believe that to be
ceptions; often used with clients experiencing delusional true, but I see the situation differently.
thinking. I find that hard to believe (or accept).
That seems rather doubtful to me.
Continued
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Attempting to translate When feelings are expressed indirectly, the nurse tries to Cl: Im way out in the ocean.
words into feelings desymbolize what has been said and to find clues to the Ns: You must be feeling very lonely
underlying true feelings. right now.
Formulating a plan of action When a client has a plan in mind for dealing with what What could you do to let your anger out
is considered to be a stressful situation, it may serve to harmlessly?
prevent anger or anxiety from escalating to an unmanage- Next time this comes up, what might
able level. you do to handle it more appropriately?
Rejecting Refusing to consider or showing contempt for the Lets not discuss. . . .
clients ideas or behavior. This may cause the client I dont want to hear about. . . .
to discontinue interaction with the nurse for fear of Better to say: Lets look at that a little
further rejection. closer.
Approving or disapproving Sanctioning or denouncing the clients ideas or Thats good. Im glad that you. . . .
behavior; implies that the nurse has the right to pass Thats bad. Id rather you wouldnt. . . .
judgment on whether the clients ideas or behaviors Better to say: Lets talk about how your
are good or bad, and that the client is expected behavior invoked anger in the other clients
to please the nurse. The nurses acceptance of the at dinner.
client is then seen as conditional depending on the
clients behavior.
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Giving advice Telling the client what to do or how to behave implies I think you should. . . .
that the nurse knows what is best and that the client Why dont you. . . .
is incapable of any self-direction. It nurtures the client Better to say: What do you think you
in the dependent role by discouraging independent should do? or What do you think would be the
thinking. best way to solve this problem?
Probing Persistent questioning of the client; pushing for answers Tell me how your mother abused you when you
to issues the client does not wish to discuss. This were a child.
causes the client to feel used and valued only for what Tell me how you feel toward your mother
is shared with the nurse and places the client on the now that she is dead.
defensive. Now tell me about. . . .
Better technique: The nurse should be
aware of the clients response and discontinue
the interaction at the first sign of discomfort.
Defending Attempting to protect someone or something from No one here would lie to you.
verbal attack. To defend what the client has criticized You have a very capable physician. Im
is to imply that he or she has no right to express ideas, sure he only has your best interests in mind.
opinions, or feelings. Defending does not change the Better to say: I will try to answer your
clients feelings and may cause the client to think the questions and clarify some issues regarding
nurse is taking sides against the client. your treatment.
Requesting an explanation Asking the client to provide the reasons for thoughts, Why do you think that?
feelings, behavior, and events. Asking why a client Why do you feel this way?
did something or feels a certain way can be very intimi- Why did you do that?
dating, and implies that the client must defend his or Better to say: Describe what you were
her behavior or feelings. feeling just before that happened.
Indicating the existence Attributing the source of thoughts, feelings, and behavior What makes you say that?
of an external source to others or to outside influences. This encourages the What made you do that?
of power client to project blame for his or her thoughts or behav- What made you so angry last night?
iors on others rather than accepting the responsibility Better to say: You became angry when
personally. your brother insulted your wife.
Belittling feelings expressed When the nurse misjudges the degree of the clients Cl: I have nothing to live for. I wish I were
discomfort, a lack of empathy and understanding may dead.
be conveyed. The nurse may tell the client to perk up Ns: Everybody gets down in the dumps at
or snap out of it. This causes the client to feel insignif- times. I feel that way myself sometimes.
icant or unimportant. When one is experiencing discom- Better to say: You must be very upset. Tell
fort, it is no relief to hear that others are or have been in me what you are feeling right now.
similar situations.
Making stereotyped Clichs and trite expressions are meaningless in a Im fine, and how are you?
comments nurse-client relationship. When the nurse makes empty Hang in there. Its for your own good.
conversation, it encourages a like response from the Keep your chin up.
client. Better to say: The therapy must be difficult
for you at times. How do you feel about your
progress at this point?
Continued
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Interpreting With this technique the therapist seeks to make conscious What you really mean is. . . .
that which is unconscious, to tell the client the meaning Unconsciously youre saying. . . .
of his or her experience. Better technique: The nurse must leave
interpretation of the clients behavior to the
psychiatrist. The nurse has not been prepared
to perform this technique, and in attempting
to do so, may endanger other nursing roles
with the client.
Introducing an unrelated Changing the subject causes the nurse to take over the Cl: I dont have anything to live for.
topic direction of the discussion. This may occur in order to Ns: Did you have visitors this weekend?
get to something that the nurse wants to discuss with Better technique: The nurse must remain
the client or to get away from a topic that he or she open and free to hear the client and to take in
would prefer not to discuss. all that is being conveyed, both verbally and
nonverbally.
the client, and trust is enhanced. A climate is estab- CLINICAL PEARL Ensure that eye contact conveys warmth and
lished within the relationship that promotes open- is accompanied by smiling and intermittent nodding of the head,
ness and honest expression. and does not come across as staring or glaring, which can create
Several nonverbal behaviors have been designated intense discomfort in the client.
as facilitative skills for attentive listening. Those listed
here can be identified by the acronym SOLER:
R: Relax. Whether sitting or standing during the
S: Sit squarely facing the client. This gives the
interaction, the nurse should communicate a
message that the nurse is there to listen and is
sense of being relaxed and comfortable with
interested in what the client has to say.
the client. Restlessness and fidgetiness commu-
O: Observe an open posture. Posture is consid- nicate a lack of interest and may convey a feel-
ered open when arms and legs remain ing of discomfort that is likely to be transferred
uncrossed. This suggests that the nurse is to the client.
open to what the client has to say. With a
closed posture, the nurse can convey a some- Process Recordings
what defensive stance, possibly invoking a sim-
Process recordings are written reports of verbal inter-
ilar response in the client.
actions with clients. They are verbatim (to the extent
L: Lean forward toward the client. This conveys that this is possible) accounts, written by the nurse
to the client that you are involved in the inter- or student as a tool for improving interpersonal com-
action, interested in what is being said, and munication techniques. The process recording can
making a sincere effort to be attentive. take many forms, but usually includes the verbal and
E: Establish eye contact. Direct eye contact is nonverbal communication of both nurse and client.
another behavior that conveys the nurses The exercise provides a means for the nurse to ana-
involvement and willingness to listen to what lyze both the content and pattern of the interaction.
the client has to say. The absence of eye con- The process recording, which is not considered doc-
tact, or the constant shifting of eye contact, umentation, is intended to be used as a learning tool
gives the message that the nurse is not really for professional development. An example of one
interested in what is being said. type of process recording is presented in Table 6-5.