Communication is emphasized on the NCLEX-RN® exam because it is critical to your success as a beginning practitioner. Therapeutic communication means listening to and understanding the client while promoting clarification and insight. It enables the nurse to form a working relationship with both the client and the health care team, using both verbal and nonverbal communication. Remember that nonverbal communication is the most accurate reflection of attitude. Therapeutic responses include the following:
|Using silence||Allows the client time to think and reflect; conveys acceptance. Allows the client to take the lead in conversation.|
|Using general leads or broad opening||Encourages the client to talk. Indicates your interest in the client. Allows the client to choose the subject.|
|Clarification||Encourages recall and details of a particular experience. Encourages description of feelings. Seeks explanation; pinpoints specifics.|
|Reflecting||Paraphrases what client says. Reflects on what client says, especially the feelings conveyed.|
There are many questions on the NCLEX-RN® exam that require you to select the correct therapeutic communication response. As with other NCLEX-RN® exam questions, one of the biggest errors that test takers commit when trying to answer this type of question is to look for the correct answer. Remember, you are selecting the best answer from the four possible answers that you are given.
To select the best answer, you must eliminate answer choices. Let’s look at some different answer choices you can eliminate:
“Don’t Worry” Answers
Eliminate answer choices that offer false reassurance. These type of responses discourage communication between the nurse and the client by not allowing the client to explore his or her own ideas and feelings. False reassurance also discounts what the client is feeling. Examples include:
“It’s going to be OK.”
“Don’t worry. Your doctors will do everything necessary for your care.”
“Let’s Explore” Answers
Another incorrect answer choice that many graduate nurses select is the choice that includes the word “explore.” On the NCLEX-RN® exam, avoid being a junior psychiatrist. It isn’t the nurse’s role to delve into the reasons why the client is feeling a particular way. The client must be allowed to verbalize the fact that he or she is sad, angry, fearful, or overwhelmed. Examples include:
“Let’s talk about why you didn’t take your medication.”
“Tell me why you really injured yourself.”
Eliminate answer choices that include “why” questions: ones that seek reasons or justification. “Why” questions imply disapproval of the client, who may become defensive. A “why” question can come in many forms, and need not always begin with “why.” Any response that puts the client on the defensive is nontherapeutic and therefore incorrect. Examples include:
“What makes you think that?”
“Why do you feel this way?”
Eliminate answer choices in which the nurse is telling the client what to do without regard for the client’s desires or feelings. Examples include:
Insisting that the client follow unit rules
Insisting that the client do what you command immediately
Eliminate answer choices in which the focus of the comment is on the nurse. Be careful, because these answer choices may sound very empathetic. The focus of your communication should always be on the client. Examples include:
“That happened to me once.”
“I know from experience this is hard for you.”
Eliminate answer choices that include closed-ended questions that can be answered with the words yes, no, or another monosyllabic response. Closed- ended questions discourage the client from sharing thoughts and feelings. Examples include:
“Are you feeling guilty about what happened?”
“How many children do you have?”
Eliminating these types of non-therapeutic responses that appear as answer choices is an effective strategy when answering therapeutic communication questions. Don’t simply look for the specific words that you see here; you may need to “translate” the answer choices into the above errors of therapeutic communication.
So how do you select the correct response? By choosing from the answer choices that are left! The correct response will usually contain one or both of the following elements:
Gives Correct Information
Offering information encourages further communication from the client. Examples of giving correct information include:
“You are experiencing acute alcohol withdrawal; you may see and feel things that aren’t real.”
“There are many reasons for memory loss; tell me more about what you have noticed.”
Is empathetic and reflects the client’s feelings
Empathy is the ability to perceive what another person experiences using that person’s frame of reference. Reflection communicates to the client that the nurse has heard and understands what the client is trying to communicate. When reflecting feelings, the nurse focuses on the feelings and not the content of what is said. The following are examples of empathetic, reflective statements include:
“I can see that you are frightened about being here.”
“You seem very upset. Tell me how you’re feeling.”
Let’s practice therapeutic communication with a few exam-style questions.
Practice Question 1
Step 1. Eliminate incorrect answer choices.
(1) This is a “don’t worry” response. There is no acknowledgment of the client’s fears.
(2) The focus of this response is on the nurse, not the client. Eliminate.
(3) It is within the scope of nursing practice for the nurse to respond to the client’s feelings. Don’t pass the responsibility to the physician. Eliminate.
(4) This answer choice responds to feelings and provides information. Keep it in consideration.
Step 2. Select an answer from the remaining choices.
One answer was not eliminated: (4). This is the correct answer. The nurse is empathetic, acknowledging that the client feels frightened, and provides information.
Practice Question 2
Step 1. Eliminate answer choices.
(1) This response gives false reassurance and discounts the client’s feelings. Eliminate it.
(2) This response is authoritarian: the nurse tells the client what to do. Eliminate it.
(3) This response reflects the fears of the client. The response is open-ended and allows the client to express what she is feeling. Keep it in for consideration.
(4) This response dismisses the feelings that the client is experiencing and gives advice. Eliminate it.
Step 2. Select an answer from the remaining choices.
You have eliminated three of the four answer choices. The correct answer is the only answer choice remaining, (3).