Psychiatric Mental Health Nursing by Videbeck

120 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP

(Continued)

Techniques Examples Rationale

Interpreting—asking to

make conscious that

which is unconscious;

telling the client the

meaning of his or her

experience

Introducing an unrelated

topic—changing the

subject

Making stereotyped

comments—offering

meaningless clichés or

trite comments

Probing—persistent ques-

tioning of the client

Reassuring—indicating

there is no reason for

anxiety or other feelings

of discomfort

Rejecting—refusing to

consider or showing

contempt for the client’s

ideas or behaviors

Requesting an explanation—

asking the client to provide

reasons for thoughts,

feelings, behaviors, events

Testing—appraising the

client’s degree of insight

Using denial—refusing to

admit that a problem

exists

“What you really

mean is.. .”

“Unconsciously you’re

saying.. .”

Client:“I’d like to die.”

Nurse:“Did you have

visitors last evening?”

“It’s for your own good.”

“Keep your chin up.”

“Just have a positive atti-

tude and you’ll be better

in no time.”

“Now tell me about this

problem. You know I have

to find out.”

“Tell me your psychiatric

history.”

“I wouldn’t worry about

that.”

“Everything will be all right.”

“You’re coming along just

fine.”

“Let’s not discuss.. .”

“I don’t want to hear

about.. .”

“Why do you think that?”

“Why do you feel that

way?”

“Do you know what kind of

hospital this is?”

“Do you still have the idea

that... ?”

Client:“I’m nothing.”

Nurse:“Of course you’re

something—everybody’s

something.”

Client:“I’m dead.”

Nurse:“Don’t be silly.”

The client’s thoughts and feelings are his or her

own, not to be interpreted by the nurse or for

hidden meaning. Only the client can identify or

confirm the presence of feelings.

The nurse takes the initiative for the interaction

away from the client. This usually happens

because the nurse is uncomfortable, doesn’t

know how to respond, or has a topic he or she

would rather discuss.

Social conversation contains many clichés and

much meaningless chit-chat. Such comments

are of no value in the nurse–client relationship.

Any automatic responses will lack the nurse’s

consideration or thoughtfulness.

Probing tends to make the client feel used or

invaded. Clients have the right not to talk about

issues or concerns if they choose. Pushing and

probing by the nurse will not encourage the

client to talk.

Attempts to dispel the client’s anxiety by implying

that there is not sufficient reason for concern

completely devalue the client’s feelings. Vague

reassurances without accompanying facts are

meaningless to the client.

When the nurse rejects any topic, he or she

closes it off from exploration. In turn, the client

may feel personally rejected along with his or

her ideas.

There is a difference between asking the client to

describe what is occurring or has taken place

and asking him to explain why. Usually a “why”

question is intimidating. In addition, the client is

unlikely to know “why” and may become defen-

sive trying to explain himself or herself.

These types of questions force the client to try to

recognize his or her problems. The client’s

acknowledgement that he or she doesn’t know

these things may meet the nurse’s needs but is

not helpful for the client.

The nurse denies the client’s feelings or the

seriousness of the situation by dismissing his

or her comments without attempting to

discover the feelings or meaning behind them.

Adapted from Hays, J. S., & Larson, K. (1963). Interactions with patients.New York: Macmillan.

If a client has difficulty attending to a conversa-
tion and drifts into a rambling discussion or a flight of
ideas, the nurse listens carefully for a theme, a topic
around which the client composes his or her words.
Using the theme, the nurse can assess the nonverbal
behaviors that accompany the client’s words and build
responses based on these cues. In the following exam-
ples of identifying themes, the underlined words are

themes and cues to help the nurse formulate further

communication.

Theme of sadness:

Client: “Oh, hi, nurse.”(face is sad; eyes look

teary; voice is low, with little inflection)

Nurse: “You seem sad today, Mrs. Venezia.”

Client: “Yes, it is theanniversaryof myhus-

band’s death.”

Table 6-2