busy medical-surgical setting. The idea of
“just talking to people” may make the student
feel as though he or she is not really doing
anything. The student must deal with his
or her own anxiety about approaching a
stranger to talk about very sensitive and per-
sonal issues. Development of the therapeutic
nurse–client relationship and trust takes
times and patience.- What if no one will talk to me?
Students sometimes fear that clients will re-
ject them or refuse to have anything to do
with student nurses. Some clients may not
want to talk or are reclusive, but they may
show that same behavior with experienced
staff; students should not see such behavior
as a personal insult or failure. Generally
many people in emotional distress welcome
the opportunity to have someone listen to
them and show a genuine interest in their
situation. Being available and willing to lis-
ten is often all it takes to begin a significant
interaction with someone.- Am I prying when I ask personal questions?
Students often feel awkward as they imagine
themselves discussing personal or distressing
issues with a client. It is important to remem-
ber that questions involving personal matters
should not be the first thing a student says to
the client. These issues usually arise after
some trust and rapport have been estab-
lished. In addition, clients genuinely are dis-
tressed about their situations and often want
help resolving issues by talking to the nurse.
When these emotional or personal issues are
addressed in the context of the nurse–client
relationship, asking sincere and necessary
questions is not prying but is using therapeu-
tic communication skills to help the client. - How will I handle bizarre or inappropriate
behavior?
The behavior and statements of some clients
may be shocking or distressing to the student
initially. It is important to monitor one’s fa-
cial expressions and emotional responses so
that clients do not feel rejected or ridiculed.
The nursing instructor and staff are always
12 Unit 1 CURRENTTHEORIES ANDPRACTICE
Box 1-
➤ AREAS OFPRACTICE
BASIC-LEVEL FUNCTIONS- Counseling
Interventions and communication techniques
Problem solving
Crisis intervention
Stress management
Behavior modification - Milieu therapy
Maintain therapeutic environment
Teach skills
Encourage communication between clients and
others
Promote growth through role-modeling - Self-care activities
Encourage independence
Increase self-esteem
Improve function and health - Psychobiologic interventions
Administer medications
Teaching
Observations - Health teaching
- Case management
- Health promotion and maintenance
ADVANCED-LEVEL FUNCTIONS- Psychotherapy
- Prescriptive authority for drugs (in many states)
- Consultation
- Evaluation
“What if I say the wrong thing?”