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Thursday, April 2, 2009

Nontherapeutic Communication Techniques for NLE, NCLEX & CGFNS Exams

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NurseReview.Org - Nontherapeutic Communication Techniques - Presentation Transcript

NurseReview.Org - Nontherapeutic Communication Techniques - Presentation Transcript

1. NONTHERAPEUTIC COMMUNICATION TECHNIQUES TECHNIQUES EXAMPLES RATIONALE Advising – telling the client “Why don’t you…” Implies the client cannot handle life decisions and what to do; giving an opinion Value judgments like “should”, only the nurse knows what is best for the client. or making decisions for client “ought”, “good”, “bad” Giving approval – sanctioning “That’s good.” Saying what the client thinks or feels if “good” implies that the client’s behavior or ideas “I’m glad that…” the opposite is “bad”. Approval, then, tends to limit the client’s freedom to think, speak, or act in a certain way. This can lead to the client’s acting in a particular way just to please the nurse. Disapproving – denouncing the “That’s bad.” Disapproval implies that the nurse has the right to pass client’s behavior or ideas “I’d rather you wouldn’t…” judgment on the client’s thoughts or actions. It further implies that the client is expected to please the nurse. Agreeing – indicating accord “That’s right.” Approval indicates the client is “right” rather than “wrong.” with the client “I agree.” This gives the client the impression that he is “right” because of agreement with the nurse. Opinions and conclusions should be exclusively the client’s. When the nurse agrees with the client, there is no opportunity for the client to change his mind without being “wrong”. Disagreeing – opposing the “That’s wrong.” Disagreeing implies the client is “wrong.” Consequently the client’s ideas “I definitely disagree with…” client feels defensive about his point of view or ideas. “I don’t believe that.” Challenging – demanding proof “But how can you be President of Often the nurse believes that if he can challenge the client from the client the United States?” to prove unrealistic ideas, the client will realize there is “If you are dead, why is your heart no “proof” and then will recognize reality. Actually beating?” challenging causes the client to defend the delusions or misperceptions more strongly than before. Testing – appraising the client’s “Do you know what kind of hospital These types of questions force the client to try to recognize degree of insight this is?” his problems. The client’s acknowledgment that he “Do you still have the idea that…?” doesn’t know these things may meet the nurse’s needs but is not helpful for the client. Defending – attempting to “This hospital has a fine reputation.” Defending what the client has criticized implies that he has protect someone or “I’m sure your doctor has your best no right to express impressions, opinions or feelings. something from verbal attack interest in mind.” Telling the client that his criticism is unjust or unfounded does not change the client’s feelings but only serves to block further communication. Interpreting – making “What you really mean is…” The client’s thoughts and feelings are his own, not to be conscious that which is “Unconsciously you’re saying…” interpreted by the nurse or for hidden meaning. Only unconscious to client; telling the client can identify or confirm the presence of the client the meaning of his feelings. or her experience Generalization “most…” “All the doctors…” “best…” “Always…” “only…” “Anybody…” “Somebody…” “Nobody” Negative words Never, avoid, do not, confront, limit, inhibit, persuade, insist Time Most of the time, sometime, anytime, all the time, everytime, later Promise Never tell at patient “Not to tell” Questions answerable with a Yes/No
2. False Reassurance – indicating “I wouldn’t worry about that.” Attempts to dispel the client’s anxiety by implying that there there is no reason for anxiety “Everything will be all just fine.” is not sufficient reason for concern completely devalue or other feelings of discomfort Cheery words the client’s feelings. Vague reassurances without accompanying facts are meaningless to the client. Stereotyped comments – “It’s for your own good.” Social conversation contains many clichés and much offering meaningless clichés “Keep your chin up.” meaningless chit-chat. Such comments are of no value or trite comments “Just have a positive attitude and in the nurse-client relationship. Any automatic you’ll be better in no time.” responses will lack the nurse’s consideration or thoughtfulness. Belittling feelings expressed – Client: “I have nothing to live for… I When the nurse tries to equate the intense and misjudging the degree of the wish I was dead.” overwhelming feelings the client has expressed to client’s discomfort Nurse: “Everybody gets down in the “everybody” or to the nurse’s own feelings, the nurse dumps.” OR “I’ve felt that way implies that the discomfort is temporary, mild, self- myself.” limiting, or not very important. The client is focused on his or her own worries and feelings; hearing the problems or feelings of others is not helpful. Giving literal responses – Client: “They’re looking in my head Often the client is at a loss to describe his feelings, so such responding to a figurative with a television camera.” comments are the best he can do. Usually it is helpful comment as though it were a Nurse: “Try not to watch television.” for the nurse to focus on the client’s feelings in OR “What channel?” statement of fact response to such statements. Humor - Being overly cheerful Indiscriminate use belittles client, screen to avoid therapeutic intimacy Not listening and underloading Interrupting client Nontherapeutic – failure to listen actively Remaining silent & unresponsive Not picking up cues Failing to give feedback Overloading or overwhelming Client: “I’d like to die.” Nurse may not understand the client. May result in poor client– talking rapidly, asking Nurse: “Did you have visitors last listening skills. for more information than can evening?” The nurse takes the initiative for the interaction away from be absorbed at one time Asking two questions at once the client. This usually happens because the nurse is Changing the subject Changing subjects inappropriately uncomfortable, doesn’t know how to respond, or has a Talking rapidly topic he or she would rather discuss. Incongruence – sending verbal “Please stay calm” but voice is a Nurse loses client’s trust and nonverbal messages that shrill contradict one another Rejecting – refusing to consider “Let’s not discuss…” When the nurse rejects any topic, he closes it off from or showing contempt for the “I don’t want to hear about…” exploration. In turn, the client may feel personally client’s ideas or behaviors rejected along with his ideas. Using denial or invalidation – Client: “I’m nothing.” The nurse denies the client’s feelings or the seriousness of refusing to admit that a Nurse: “Of course you’re something the situation by dismissing his comments without problem exist – everybody’s something.” attempting to discover the feelings or meaning behind Client: “I’m dead.” them. Nurse: “Don’t be silly.” Probing – persistent questioning “Now tell me about this problem. Probing tend to make the client feel used or invaded. of the client You know I have to find out.” Clients have the right not to talk about issues or “Tell me your psychiatric history.” concerns if they choose. Pushing and probing by the nurse will not encourage the client to talk. Indicating the existence of an “What makes you say that?” The nurse can ask, “What happened?” or “What events external source – attributing “What made you do that?” led you to draw such a conclusion?” But to question the source of thoughts, “Who told you that you were a “What made you think that?” implies that the client was feelings, and behavior to prophet?” made or compelled to think in a certain way. Usually others or to outside the nurse does not intend to suggest that the source is influences external but that is often what the client thinks. Requesting an explanation – “Why do you think that?” There is a difference between asking the client to describe asking the client to provide Why do you feel that way?” what is occurring or has taken place and asking him to reasons for thoughts, explain why. Usually a “why” question is intimidating. feelings, behaviors, events In addition, the client is unlikely to know “why” and may become defensive trying to explain himself.

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