LEVELS OF COMMUNICATION

1. Intra-personal Communication
Is also called “self-talk”
People's thoughts and inner communications strongly influence
perceptions, feelings, behavior, and self-esteem.
Positive self-talk provides a mental rehearsal for difficult tasks or situations
so individuals deal with them effectively and with increased confidence.
2. Inter-personal Communication
- Is a one-to-one interaction between a nurse and another person that often
occurs face-to-face.
- It is the level most frequently used in nursing situations and lies the heart
of nursing practice.
- Meaningful interpersonal communication results in an exchange of ideas,
problem solving, expression of feelings, decision making, goal
accomplishment, team building and personal growth.
3. Small – group communication
- Is the interaction that occurs when small number of people meet.
- It is usually goal directed and requires understanding of group dynamics.
- Communication in these situations should be organized, concise and
complete.
4. Public communication
- Is interaction with an audience.
- Nurses often speak with groups of consumers about health-related topics,
present scholarly work to colleagues at conferences, or lead classroom
discussions with peers or students.
- Public communication requires special adaptations in eye contact,
gestures, voice inflection and use of media materials to communicate
messages effectively.
5. Electronic communication
- Is the use of technology to create ongoing relationships with patients and
their health care team.
- An electronic portal enables patients to stay engaged and informed and
build a therapeutic relationship with the health care team.

Modes of Communication
1. Verbal Communication:
- Uses spoken or written words.
2. Nonverbal Communication: Uses gestures, facial expressions,
posture/gait, body movements, physical appearance (also body language).
Verbal Communication
- Verbal communication uses spoken or written words.
-Verbal language is a code that conveys specific meaning through a
combination of words.
The most important aspects of verbal communication are:
1) Vocabulary.
- Medical jargon
2) Denotative and Connotative Meaning.
-Some words have several meanings. Individuals who use a
common language share the denotative meaning.
-The connotative meaning is the shade or interpretation the
meaning of a word influenced by the thoughts, feelings, or ideas
that people have about the word.
3) Pacing.
- Conversation is more successful at an appropriate speed or pace
4) Intonation.
- Tone of voice dramatically affects the meaning of a message.
5) Clarity and Brevity.
- Effective communication is simple, brief, and direct.
Clarity is achieved by speaking slowly, enunciating clearly, and using
examples to make explanation easier.
Brevity is achieved by using short sentences and words that express
an idea simply and directly.
6) Timing and Relevance.
- Timing is critical in communication.
Nonverbal Communication
- Nonverbal communication includes the five senses and everything
that does not involve the spoken or written word.
- Nonverbal aspects of communication such as voice tone, eye
contact, and body positioning are often as important as verbal
messages (Dossey and Keegan, 2013).
- Thus, nonverbal communication is unconsciously motivated and
more accurately indicates a person's intended meaning than spoken
words (Stuart, 2013).
- When there is incongruity between verbal and nonverbal
communication, the receiver usually “hears” the nonverbal message
as the true message.
Nonverbal Communication
1)Personal Appearance.
- Personal appearance includes physical characteristics, facial expression,
and manner of dress and grooming.
- These factors communicate physical well-being, personality, social status,
occupation, religion, culture, and self-concept.

2)Posture and Gait.

- Posture and gait (manner or pattern of walking) are forms of self-
expression.
- The way people sit, stand, and move reflects attitudes, emotions, self-
concept, and health status.

3) Facial Expression.
- The face is the most expressive part of the body.
- Facial expressions convey emotions such as surprise, fear, anger,
happiness, and sadness.
- Some people have an expressionless face, or flat affect, which reveals little
about what they are thinking or feeling.

4)Eye Contact.
- People signal readiness to communicate through eye contact. Maintaining
eye contact during conversation shows respect and willingness to listen.
- Eye contact also allows people to closely observe one another.
- Lack of eye contact may indicate anxiety, defensiveness, discomfort, or lack
of confidence in communicating.
5) Gestures
- Gestures emphasize, punctuate, and clarify the spoken word.
- Gestures alone carry specific meanings, or they create messages with
other communication cues.
6) Sounds
- Sounds such as sighs, moans, groans, or sobs also communicate feelings
and thoughts.
7) Territoriality and Personal Space
- It is the need to gain, maintain, and defend one’s right to space.
- Territory is important because it provides people with a sense of privacy,
identity, security and control.

Therapeutic Communication Techniques

Therapeutic communication techniques are specific responses that
encourage the expression of feelings and ideas and convey acceptance and
respect.
Active Listening.
-Active listening means being attentive to what a patient is saying both
verbally and nonverbally.
 -Active listening enhances trust because you communicate acceptance
and respect for a patient. Several nonverbal skills facilitate attentive
listening, using the acronym SOLER (Townsend, 2012):
S - Sit facing the patient.
0 - Open position (i.e., keep arms and legs uncrossed).
L - Lean toward the patient.
E - Eye contact
- Establish and maintain intermittent eye contact to convey your
involvement and willingness to listen to what the patient is saying.
- Absence of eye contact or shifting the eyes gives the message that
you are not interested in what the patient is saying.
R – Relax
- It is important to communicate a sense of being relaxed and
comfortable with the patient.
- Restlessness communicates a lack of interest and a feeling of
discomfort to the patient.

Zones of Personal Space

Intimate Zone (0-8 inches)
Holding a crying infant,
Performing physical assessment,
Bathing, grooming, dressing, feeding, and toileting a patient,
Changing a patient's surgical dressing.

Personal Zone (18 inches-4 feet)

• Sitting at a patient's bedside,
• Taking a patient's nursing history,
• Teaching an individual patient,
Exchanging information at change shift.

Socio-Consultative Zone (9-12 feet)

• Giving directions to visitors in the hallway,
• Asking if families need assistance from the patient doorway,
• Giving verbal report to a group of nurses.
Public Zone (12 feet and more)
Speaking at a community forum,
Lecturing to a class of students,
Testifying at a legislative hearing.
Special Zones of Touch

Social Zone (Permission Not Needed)

Hands, arms, shoulders, back.

Consent Zone (Permission Needed)

Mouth, wrists, feet.

Vulnerable Zone (Special Care Needed)

Face, neck, front of body.

Intimate Zone (Permission and Great Sensitivity Needed)

Genitalia, rectum.

Communicating with Patients Who Have Special Needs

Patients Who Cannot Speak Clearly (Aphasia, Dysarthria, Muteness)
Patients Who Are Cognitively Impaired,
Patients Who Are Hearing Impaired,
Patients Who Are Visually Impaired,
Patients Who Are Unresponsive,
Patients Who Do Not Speak English.

Assessment: Factors Influencing Communication

Psychophysiological Context (Internal Factors Affecting Communication)
Relational Context (Nature of the Relationship Among Participants)
Situational Context (Reason for Communication)
Environmental Context (Physical Surroundings in which Communication
Occurs),
Cultural Context (Sociocultural Elements That Affect an Interaction).

FOCUS ON OLDER ADULTS Tips for Improved Communication with Older

Adults Who Have Hearing Loss (Arnold and Boggs, 2011)
Make sure the patient knows that you are talking.
Face the patient, be sure that your face/mouth is visible to him or her, and
do not chew gum or talk while chewing.
Speak clearly but do not exaggerate lip movement or shout.
Speak a little more slowly but not excessively slow.
Check if patient uses hearing aids, glasses, or other adaptive equipment.
Choose a quiet, well-lit environment with minimal distractions.
Allow time for the patient to respond. Do not assume that patient is being
uncooperative if he or she does not reply or takes a long time to reply.
Give the patient a chance to ask questions.
Keep communication short and to the point.
Ask one question at a time.

Metacommunication
-Metacommunication is a broad term that refers to all factors that influence
communication.
-Awareness of influencing factors helps people better understand what is
communicated (Arnold and Boggs, 2011).
For example
A nurse observes a young patient holding his body rigidly, and his voice is
sharp as he says, "Going to surgery is no big deal.” The nurse replies, “You
say having surgery doesn't bother you, but you look and sound tense. I'd like
to hear more about how you're feeling." Awareness of the tone of the verbal
response and the nonverbal behavior results in further exploration of the
patient's feelings and concerns.

ELEMENTS OF PROFESSIONAL COMMUNICATION

• Courtesy
• Use of Names
• Trustworthiness
• Autonomy and Responsibility
• Assertiveness

AIDET is a technique developed by the Studer Group to enable health care

workers to provide accurate and timely communication to patients and
families while focusing on excellent patient service. It is a technique
commonly used in hospitals today.
The acronym stands for:
A - cknowledge,
I - ntroduce,
D - uration,
E - xplain, and
T - hank you.
Nurse-Health Care Team Relationships
-Communication with other members of the health care team affects
patient safety and the work environment.
-Breakdown in communication, lack of patient education, and poor health
care provider accountability is a frequent cause of serious injuries in health
care settings (TJC Resources, 2012).
-When patients move from one nursing unit to another or from one
provider to another, there is a risk for miscommunication.
-To address this risk health care providers, provide detailed hand-off reports
at end of shifts or when patients transfer off care units to ensure that
patients have a safe and smooth transition in care.
-The entire health care team collaborate and coordinate during patient
transition.
-Standardized discharge or transfer procedures and forms reduce the risk of
errors during patient transitions.
-Use of a common language such as the SBAR technique for communicating
critical information improves perception of communication and information
about patients between health care providers (De Meester et al., 2013).
The SBAR technique is a popular communication tool that standardizes
communication.
-The SBAR technique is a popular communication tool that standardizes
communication. SBAR is the acronym for Situation, Background,
Assessment, and Recommendation.
-Some organizations have added an introduction step (ISBAR) into the SBAR
process.
-The introduction step is used when health care providers do not actively
know one another.
-They start with an introduction, a description of their location, and their
role in caring for the patient (Marquis and Huston, 2015).
COMMUNICATION AND NURSING PRACTICE
- Communication is a lifelong learning process.
- Nurses make the intimate journey with patients and their families
from the miracle of birth to the mystery of death.
- As a nurse you communicate with patients and families to develop
meaningful relationships. Within those relationships you collect
relevant assessment data, provide education, and interact during
nursing interventions.
- The use of therapeutic communication promotes personal growth
and attainment of patients' health-related goals.
- Communication is the key to nurse-patient relationships and the
ability to deliver patient centered care.
- Good communication skills help to reduce the risks of errors.

Communication and Interpersonal Relationships

- Caring relationships formed among a nurse and those affected by

the nurse's practice are at the core of nursing.
- All behavior communicates, and all communication influences
behavior. For these reasons communication is essential to the
nurse-patient relationship. Nurses with expertise in communication
express caring (Ryan, 2005; Watson, 1985):
 Becoming sensitive to self and others.
 Promoting and accepting the expression of positive and
negative feelings.
 Developing caring relationships.
 Instilling faith and hope.
 Promoting interpersonal teaching and learning.
 Providing a supportive environment.
 Assisting with gratification of human needs.
 Allowing for spiritual expression
- Therapeutic communication occurs within a healing relationship
between a nurse and patient. A nurse’s communication can result in
both harm and good.
- Every nuance of posture, every small expression and gesture, every
attitude held – all have the potential to hurt or heal, affecting others
through the transmission of human energy.
 - Respect the potential power of communication and do not misuse
communication carelessly to hurt, manipulate, or coerce others.

Developing Communication Skills

- Gaining expertise in communication requires both an understanding

of the communication process and reflection about one's
communication experiences as a nurse.
- Nurses who develop critical thinking skills make the best
communicators. They form therapeutic relationships to gather
relevant and comprehensive information about their patients.
- Critical thinking attitudes and ethical standards of care promote
effective communication. When you consider a patient's problems,
it is important to apply critical thinking and critical reasoning skills
to improve communication in assessment and care of the patient
(Arnold and Boggs, 2011).
For example, curiosity motivates a nurse to communicate and know
more about a person. Patients are more likely to communicate with
nurses who express an interest in them.
- Perseverance and creativity are also attitudes conducive to
communication because they motivate a nurse to communicate and
identify innovative solutions.
- A self-confident attitude is important because a nurse who conveys
confidence and comfort while communicating more readily
establishes an interpersonal caring relationship.
- It is challenging to understand human communication within
interpersonal relationships. Each individual bases his or her
perceptions about information received through the five senses of
sight, hearing, taste, touch, and smell (Arnold and Boggs, 2011). An
individual's culture and education also influence perception.
- You become more competent in the nursing process as your
communication skills develop. Use communication skills to gather,
analyze, and transmit information and accomplish the work of each
step of the process. Assessment, diagnosis, planning,
implementation, and evaluation all depend on effective
communication among nurse, patient, family, and others on the
health care team.
- Patients often experience high levels of anxiety when they are ill or
receiving treatment.
 Emotional intelligence (EI) is an assessment and communication
technique that allows nurses to better understand and perceive the
emotions of themselves and others. El enables a nurse to use self-
awareness, motivation, empathy, and social skills to build
therapeutic relationships with patients (Marquis and Huston, 2015).
Patients' emotions can negatively impact their self-care behaviors.
If a nurse understands a patient's perceptions and motivations, he
or she can help the patient make healthy behavior changes. Patients
feel more comfortable addressing their poor health habits when this
approach is used. This can lead to enhanced self-care behaviors and
improved patient outcomes (Fox, 2013; Shanta and Connolly, 2013).
- The nature of the communication process requires you to
constantly decide what, when, where, why, and how to convey a
message.
- A nurse's decision making is always contextual (i.e., the unique
features of any situation influence the nature of the decisions
made).
For example, the explanation of the importance of following a
prescribed diet to a patient with a newly diagnosed medical
condition differs from the explanation to a patient who has
repeatedly chosen not to follow diet restrictions.
- Effective communication techniques are easy to learn, but their
application is difficult.
- Deciding which techniques best fit each unique nursing situation is
challenging.
Communication with patients and families about illness such as
cancer or advance care planning can be stressful. Nurses may
experience grief and fatigue related to emotional exhaustion when
discussing these topics, especially when they have developed a
bond with patients or families. However, discussion of these
important and sensitive topics is linked to an increased quality of life
for the patients and or family members (Moore and Reynolds,
2013).
 1. Which therapeutic communication technique is being used in this
nurse-client interaction?

Client: "When I get angry, I get into a fistfight with my wife or I take it out on
the kids."

Nurse: "I notice that you are smiling as you talk about this physical
violence."

A. Encouraging comparison B. Exploring

C. Formulating a plan of action D. Making observations

The nurse is using the therapeutic communication technique of making

observations when noting that the client smiles when talking about physical
violence. The technique of making observations encourages the client to
compare personal perceptions with those of the nurse

2. Which therapeutic communication technique is being used in this

nurse-client interaction?

Client: "My father spanked me often."

Nurse: "Your father was a harsh disciplinarian."

A. Restatement B. Offering general leads

C. Focusing D. Accepting

The nurse is using the therapeutic communication technique of

restatement. Restatement involves repeating the main idea of what the
client has said. The nurse uses this technique to communicate that the
client's statement has been heard and understood.

3. Which therapeutic communication technique is being used in this

nurse-client interaction?

Client: "When I am anxious, the only thing that calms me down is alcohol."

Nurse: "Other than drinking, what alternatives have you explored to

decrease anxiety?"

A. Reflecting B. Making observations

C. Formulating a plan of action D. Giving recognition

The nurse is using the therapeutic communication technique of formulating

a plan of action to help the client explore alternatives to drinking alcohol.
The use of this technique, rather than direct confrontation regarding the
client's poor coping choice, may serve to prevent anger or anxiety from
escalating.

4. The nurse is interviewing a newly admitted psychiatric client. Which

nursing statement is an example of offering a "general lead"?

A. "Do you know why you are here?"

B. "Are you feeling depressed or anxious?"
C. "Yes, I see. Go on."
D. "Can you chronologically order the events that led to your admission?"
The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic
communication technique of a general lead. Offering a general lead
encourages the client to continue sharing information.

5. A nurse states to a client, "Things will look better tomorrow after a

week that’s for ssure." This is an example of which communication
technique?
A. The therapeutic technique of "giving advice"
B. The therapeutic technique of "defending"
C. The nontherapeutic technique of "presenting reality"
D. The nontherapeutic technique of "giving false reassurance"
The nurse's statement, "Things will look better tomorrow after a good
night's sleep." is an example of the nontherapeutic technique of giving false
reassurance. Giving false reassurance indicates to the client that there is no
cause for anxiety, thereby devaluing the client's feelings.

6. A client diagnosed with post-traumatic stress disorder is admitted to

an inpatient psychiatric unit for evaluation and medication
stabilization. Which therapeutic communication technique used by
the nurse is an example of a broad opening?
A. "What occurred prior to the rape, and when did you go to the emergency
department?"
B. "What would you like to talk about?"
C. "I notice you seem uncomfortable discussing this."
D. "How can we help you feel safe during your stay here?"
The nurse's statement, "What would you like to talk about?" is an example
of the therapeutic communication technique of giving broad openings.
Using a broad opening allows the client to take the initiative in introducing
the topic and emphasizes the importance of the client's role in the
interaction

7. A nurse is assessing a client diagnosed with schizophrenia for the

presence of hallucinations. Which therapeutic communication
technique used by the nurse is an example of making observations?

A. "You appear to be talking to someone I do not see."

B. "Please describe what you are seeing."

C. "Why do you continually look in the corner of this room?"

D. "If you hum a tune, the voices may not be so distracting."

The nurse is making an observation when stating, "You appear to be talking

to someone I do not see." Making observations involves verbalizing what is
observed or perceived. This encourages the client to recognize specific
behaviors and make comparisons with the nurse's perceptions

8. An instructor is correcting a nursing student's clinical worksheet.

Which instructor statement is the best example of effective
feedback?

A. "Why did you use the client's name on your clinical worksheet?"

B. "You were very careless to refer to your client by name on your clinical
worksheet."

C. "Surely you didn't do this deliberately, but you breeched confidentiality

by using the client's name."

D. "It is disappointing that after being told, you're still using client names on
your worksheet."

The instructor's statement, "Surely you didn't do this deliberately, but you
breeched confidentiality by using the client's name." is an example of
effective feedback. Feedback is a method of communication to help others
consider a modification of behavior. Feedback should be descriptive,
specific, and directed toward a behavior that the person has the capacity to
modify and should impart information rather than offer advice or criticize
the individual.

9. After assertiveness training, a formerly passive client appropriately

confronts a peer in group therapy. The group leader states, "I'm so
proud of you for being assertive. You are so good!" Which
communication technique has the leader employed?
A. The nontherapeutic technique of giving approval
B. The nontherapeutic technique of interpreting
C. The therapeutic technique of presenting reality
D. The therapeutic technique of making observation
The group leader has employed the nontherapeutic technique of giving
approval. Giving approval implies that the nurse has the right to pass
judgment on whether the client's ideas or behaviors are "good" or "bad."
This creates a conditional acceptance of the client.

10. A client who frequently exhibits angry outbursts is diagnosed with

antisocial personality disorder. Which appropriate feedback should
a nurse provide when this client experiences an angry outburst?
A. "Why do you continue to alienate your peers by your angry outbursts?"
B. "You accomplish nothing when you lose your temper like that."
C. "Showing your anger in that manner is very childish and insensitive."
D. "During group, you raised your voice, yelled at a peer, left, and slammed
the door."
The nurse is providing appropriate feedback when stating, "During group,
you raised your voice, yelled at a peer, left, and slammed the door." Giving
appropriate feedback involves helping the client consider a modification of
behavior. Feedback should give information to the client about how he or
she is perceived by others. Feedback should not be evaluative in nature or
be used to give advice

11. A client diagnosed with dependant personality disorder states, "Do

you think I should move from my parent's house and get a job?"
Which nursing response is most appropriate?
A. "It would be best to do that in order to increase independence."
B. "Why would you want to leave a secure home?"
C. "Let's discuss and explore all of your options."
D. "I'm afraid you would feel very guilty leaving your parents.
The most appropriate response by the nurse is, "Let's discuss and explore all
of your options." In this example, the nurse is encouraging the client to
formulate ideas and decide independently the appropriate course of action.

12. A mother rescues two of her four children from a house fire. In the
emergency department, she cries, "I should have gone back in to
get them. I should have died, not them." What is the nurse's best
response?
A. "The smoke was too thick. You couldn't have gone back in."
B. "You're feeling guilty because you weren't able to save your children."
C. "Focus on the fact that you could have lost all four of your children."
D. "It's best if you try not to think about what happened. Try to move on."
The best response by the nurse is, "You're experiencing feelings of guilt
because you weren't able to save your children." This response utilizes the
therapeutic communication technique of reflection which identifies a
client's emotional response and reflects these feelings back to the client so
that they may be recognized and accepted.

13. A newly admitted client diagnosed with obsessive-compulsive

disorder (OCD) washes hands continually. This behavior prevents
unit activity attendance. Which nursing statement best addresses
this situation?
A. "Everyone diagnosed with OCD needs to control their ritualistic
behaviors."
B. "It is important for you to discontinue these ritualistic behaviors."
C. "Why are you asking for help if you won't participate in unit therapy?"
D. "Let's figure out a way for you to attend unit activities and still wash your
hands."
The most appropriate statement by the nurse is, "Let's figure out a way for
you to attend unit activities and still wash your hands." This statement
reflects the therapeutic communication technique of formulating a plan of
action. The nurse attempts to work with the client to develop a plan
without damaging the therapeutic relationship or increasing the client's
anxiety.
14. A client tells the nurse, "I feel bad because my mother does not
want me to return home after I leave the hospital." Which nursing
response is therapeutic?
A. "It's quite common for clients to feel that way after a lengthy
hospitalization."
B. "Why don't you talk to your mother? You may find out she doesn't feel
that way."
C. "Your mother seems like an understanding person. I'll help you approach
her."
D. "You feel that your mother does not want you to come back home?"
This is an example of the therapeutic communication technique of
restatement. Restatement is the repeating of the main idea that the client
has verbalized. This lets the client know whether or not an expressed
statement has been understood and gives him or her the chance to
continue, or clarify if necessary.

15. A client's younger daughter is ignoring curfew. The client states,

"I'm afraid she will get pregnant." The nurse responds, "Hang in
there. Don't you think she has a lot to learn about life?" This is an
example of which communication block?

A. Requesting an explanation
B. Belittling the client
C. Making stereotyped comments
D. Probing
This is an example of the nontherapeutic communication block of making
stereotyped comments. Clichés and trite expressions are meaningless in a
therapeutic nurse-client relationship.

16. Which nursing statement is a good example of the therapeutic

communication technique of giving recognition?
A. "You did not attend group today. Can we talk about that?"
B. "I'll sit with you until it is time for your family session."
C. "I notice you are wearing a new dress and you have washed your hair."
D. "I'm happy that you are now taking your medications. They will really
help."
This is an example of the therapeutic communication technique of giving
recognition. Giving recognition acknowledges and indicates awareness. This
technique is more appropriate than complimenting the client which reflects
the nurse's judgment
 17. A client is struggling to explore and solve a problem. Which nursing
statement would verbalize the implication of the client's actions?
A. "You seem to be motivated to change your behavior."
B. "How will these changes affect your family relationships?"
C. "Why don't you make a list of the behaviors you need to change."
D. "The team recommends that you make only one behavioral change at a
time."
This is an example of the therapeutic communication technique of
verbalizing the implied. Verbalizing the implied puts into words what the
client has only implied or said indirectly.

18. A student nurse tells the instructor, "I'm concerned that when a
client asks me for advice, I won't have a good solution." Which
should be the nursing instructor's best response?
A. "It's scary to feel put on the spot by a client. Nurses don't always have the
answer."
B. "Remember, clients, not nurses, are responsible for their own choices and
decisions."
C. "Just keep the client's best interests in mind and do the best that you
can."
D. "Set a goal to continue to work on this aspect of your practice."
Giving advice tells the client what to do or how to behave. It implies that
the nurse knows what is best and that the client is incapable of any self-
direction. It discourages independent thinking.

19. Which nursing statement is a good example of the therapeutic

communication technique of focusing?
A. "Describe one of the best things that happened to you this week."
B. "I'm having a difficult time understanding what you mean."
C. "Your counseling session is in 30 minutes. I'll stay with you until then."
D. "You mentioned your relationship with your father. Let's discuss that
further."
This is an example of the therapeutic communication technique of focusing.
Focusing takes notice of a single idea or even a single word and works
especially well with a client who is moving rapidly from one thought to
another.
 20. After fasting from 10 p.m. the previous evening, a client finds out
that the blood test has been canceled. The client swears at the
nurse and states, "You are incompetent!" Which is the nurse's best
response?

A. "Do you believe that I was the cause of your blood test being canceled?"
B. "I see that you are upset, but I feel uncomfortable when you swear at
me."
C. "Have you ever thought about ways to express anger appropriately?"
D. "I'll give you some space. Let me know if you need anything."
This is an example of the appropriate use of feedback. Feedback should be
directed toward behavior that the client has the capacity to modify.

21. During a nurse-client interaction, which nursing statement may

belittle the client's feelings and concerns?
A. "Don't worry. Everything will be alright."
B. "You appear uptight."
C. "I notice you have bitten your nails to the quick."
D. "You are jumping to conclusions."
This nursing statement is an example of the nontherapeutic communication
block of belittling feelings. Belittling feelings occur when the nurse
misjudges the degree of the client's discomfort, thus a lack of empathy and
understanding may be conveyed.

22. A client in the unit tells the nurse, "I should have died because I am
totally worthless." In order to encourage the client to continue
talking about feelings, which should be the nurse's initial response?

A. "How would your family feel if you died?"

B. "You feel worthless now, but that can change with time for sure."

C. "You've been feeling sad and alone for some time now?"

D. “That’s great that you have come in for help."

This nursing statement is an example of the therapeutic communication

technique of reflection. When reflection is used, questions and feelings are
referred back to the client so that they may be recognized and accepted

23. Which nursing response is an example of the nontherapeutic

communication block of requesting an explanation?
A. "Can you tell me why you said that?"
B. "Keep your chin up. I'll explain the procedure to you."
C. "There is always an explanation for both good and bad behaviors."
D. "Are you not understanding the explanation I provided?
This nursing statement is an example of the nontherapeutic communication
block of requesting an explanation. Requesting an explanation is when the
client is asked to provide the reason for thoughts, feelings, behaviors, and
events. Asking "why" a client did something or feels a certain way can be
very intimidating and implies that the client must defend his or her behavior
or feelings.

24. A client states, "You won't believe what my husband said to me

during visiting hours. He has no right treating me that way." Which
nursing response would best assess the situation that occurred?

A. "Does your husband treat you like this very often?"

B. "What do you think is your role in this relationship?"

C. "Why do you think he behaved like that?"

D. "Describe what happened during your time with your husband."

This is an example of the therapeutic communication technique of

exploring. The purpose of using exploring is to delve further into the
subject, idea, experience, or relationship. This technique is especially
helpful with clients who tend to remain on a superficial level of
communication

25. Which therapeutic communication technique should the nurse use

when communicating with a client who is experiencing auditory
hallucinations?

A. "My sister has the same diagnosis as you and she also hears voices."

B. "I understand that the voices seem real to you, but I do not hear any
voices."

C. "Why not turn up the radio so that the voices are muted."

D. "I wouldn't worry about these voices. The medication will make them
disappear."
This is an example of the therapeutic communication technique of
presenting reality. Presenting reality is when the client has a misperception
of the environment. The nurse defines reality or indicates his or her
perception of the situation for the client.

26. Which nursing statement is a good example of the therapeutic

communication technique of offering self?

A. "I think it would be great if you talked about that problem during our
next group session."

B. "Would you like me to stay here with you, and accompany you to your
electroconvulsive therapy treatment?"

C. "I notice that you are offering help to other peers in the milieu."

D. "After discharge, would you like to meet me for lunch to review your
outpatient progress?"

This is an example of the therapeutic communication technique of offering

self. Offering self makes the nurse available on an unconditional basis,
increasing client's feelings of self-worth. Professional boundaries must be
maintained when using the technique of offering self.

27. A client slammed a door on the unit several times. The nurse
responds, "You seem angry." The client states, "I'm not angry."
What therapeutic communication technique has the nurse
employed?

A. Making observations

B. Verbalizing the implied

C. Reflection

D. Encouraging descriptions of perceptions

This is an example of the therapeutic communication technique of

verbalizing the implied. The nurse is putting into words what the client has
only implied by words or actions. Denial is the refusal of the client to
acknowledge the existence of a real situation, the feelings associated with
it, or both.