126 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP
Nurse: “Perhaps you and I can discuss some
potential changes you’d like to make.”(suggesting
collaboration)
In some therapeutic interactions, the client wants
only to talk to an interested listener and feel like he or
she has been heard. Often just sharing a distressing
event can allow the client to express thoughts and
emotions that he or she has been holding back. It
serves as a way to lighten the emotional load and re-
lease feelings without a need to alter the situation.
Other times, the client may need to reminisce and
share pleasant memories of past events. Older adults
often find great solace in reminiscing about events in
their life such as what was happening in the world
when they were growing up, meeting and marrying
their spouses, and so forth. Reminiscence is discussed
further in Chapter 21.
DIRECTIVE ROLE
When the client is suicidal, experiencing a crisis, or out
of touch with reality, the nurse uses a directive role,
asking direct, yes /no questions and using problem-
solving to help the client develop new coping mecha-
nisms to deal with present, here-and-now issues. The
following is an example of therapeutic communication
using a more directive role:
Nurse: “I see you sitting here in the corner of
the room away from everyone else.”(making obser-
vation)
Client: “Yeah, what’s the point?”
Nurse: “What’s the point of what?” (seeking
clarification)
Client: “Of anything”
Nurse: “You sound hopeless.”(verbalizing the
implied) “Are you thinking about suicide?”(seeking
information)
Client: “I have been thinking I’d be better off dead.”
The nurse uses a very directive role in this ex-
ample because the client’s safety is at issue.
As the nurse-client relationship progresses, the
nurse will use therapeutic communication to imple-
ment many interventions in the client’s plan of care.
The chapters in Unit IV that discuss mental illness
and disorders contain therapeutic communication
interventions and examples of how to use the tech-
niques effectively.
How to Phrase Questions
The manner in which the nurse phrases questions is
important. Open-ended questions elicit more descrip-
tive information; yes/no questions yield just an answer.
The nurse asks different types of questions based
on the information the nurse wishes to obtain. The
nurse uses active listening to build questions based on
the cues the client has given in his or her responses.
In English, people frequently substitute the word
“feel” for “think.” Emotions differ from the cognitive
process of thinking, so using the appropriate term is
important. For example, “What do you feel about that
test?” is a vague question that could elicit several
types of answers. A more specific question is, “How
well do you think you did on the test?” The nurse
should ask, “What did you think about... ?” when
discussing cognitive issues and “How did you feel
about... ?” when trying to elicit the client’s emotions
and feelings. Box 6-1 lists “feeling” words that are
commonly used to express or describe emotions. The
following are examples of different responses that
clients could give to questions using “think” and “feel”:
Nurse: “What did you think about your daughter’s
role in her automobile accident?”
Client: “I believe she is just not a careful driver.
She drives too fast.”
Nurse: “How did you feel when you heard about
your daughter’s automobile accident?”
Client: “Relieved that neither she nor anyone else
was injured.”
Using active listening skills, asking many open-
ended questions, and building on the client’s responses
will help the nurse obtain a complete description of an
issue or an event and understand the client’s experi-
ence. Some clients do not have the skill or patience to
describe how an event unfolded over time without as-
sistance from the nurse. Clients tend to recount the be-
ginning and the end of a story, leaving out crucial in-
formation about their own behavior. The nurse canBox 6-1
➤ “FEELING” WORDS
Afraid
Alarmed
Angry
Anxious
Ashamed
Bewildered
Calm
Carefree
Confused
Depressed
Ecstatic
Embarrassed
Enraged
Envious
Excited
Fearful
Frustrated
Guilty
Happy
HopefulHopeless
Horrified
Impatient
Irritated
Jealous
Joyful
Lonely
Pleased
Powerless
Relaxed
Resentful
Sad
Scared
Surprised
Tense
Terrified
Threatened
Thrilled
Uptight