NCLEX Wednesday #13 – Therapeutic Communication
Wherever you are in nursing school, you’ve already learned that part of being a great nurse is being a great communicator. How you speak and listen to patients is hugely important to successful treatment—something even the writers of NCLEX questions know.
When you take the National Council Licensure Examination, there’s a good chance you’ll come across questions asking you to choose the “best response” and most “therapeutic response.” These may be mental health questions, but they’re just as likely to be any type of client situation, especially those dealing with a client experiencing stress and anxiety. They’re less intuitive than you may think, so you need to prepare for questions about therapeutic communication. To start, consider these NCLEX study tips:
1. Focus on the client
Of all our NCLEX study tips, that little phrase might be repeated most. Focusing on the client is crucial for many situations, therapeutic communication included. When choosing the best and most therapeutic response, look for the answer that focuses on the client’s concerns. Avoid telling the client that you “know how they feel.” This takes the focus from the client and puts it on the nurse.
2. Seek more information
Sometimes the best and most therapeutic response is asking for more information. If a clients is distressed, she may not be able to articulate her needs immediately. Look for responses that encourage the client to “tell more” about what she is feeling. This kind of response will better inform you as the nurse about information—and shows the client you care and validate her concerns. Often these are open-ended statements by the nurse, and may be a mere restatement of the client’s original statement.
3. Always validate the client
It’s common for nurses to feel frustrated and exasperated by clients sometimes, especially if they seem to overreact about a situation. Vocalizing that, even tactfully, is never the best or therapeutic response. Avoid choosing the options that invalidate the client’s concerns, such as “don’t worry” and “everything is going to be all right.” Even if these sound reassuring to your ears, what they’re really doing is dismissing the client’s fears and worries with a short, careless phrase.
4. Listen, don’t tell
You’ll show much more respect for the client’s beliefs and viewpoints by not telling them what they should and should not do. It’s likely you’ll have your own opinions or advice on the situation, but those will never be the best responses in mental health or high stress scenarios. A big part of therapeutic communication is therapeutic listening, so always opt for this option over dictating your ideas and opinions.
5. Ask open-ended questions
Along the same vein of seeking more information, try to avoid closed-ended statements where the client could answer the question in one or two words. These tend to be questions that begin with “Do you—” or “Does this—” which a client can answer as yes or no. Look for options that encourage the client to express his/her feelings.
6. Avoid aggressive language
Obviously you’ll never think a combative response is the best or most therapeutic, but you also need to be wary of questions that could trigger a defensive reaction. If you ask questions beginning with “why” or “what were you thinking,” you at least verbally presume the client has done something wrong. He might have, but this never encourages the client to further express himself; instead, it automatically puts the client on the defense, which is never good therapeutic communication.
Happy studying, and see you with more NCLEX study tips next week!
– Cheryl Armstrong, MS, RN
– Britt Baer, RN, MSN-HCSM, SANE
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