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Using silence
- gives the person time to collect thoughts or think through a point.
- EX: encouraging a person to talk by waiting for the answer.
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Accepting
- Indicates that the person has been understood. An accepting statement does not necessary indicate agreement but is nonjudmental. (nurses should not imply understanding when (s)he does not understand)
- EX: "yes." , "uh-huh", "I follow what you say"
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Giving recognition
- Indicates awareness of change and personal efforts. Does not imply good or bad, right or wrong.
- EX: "good morning Mr. James", "you've combed your hair today", "I see you've eaten your whole lunch".
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Offering self
- Offers presence, interest, and a desire to understand. Is not offered to get the person to talk or behave in a specific way.
- EX: "I would like to spend time with you", "I'll stay here and sit with you awhile".
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Offering general leads
- Allow the other person to take direction on the discussion. indicates that the nurse is interested in what comes next.
- EX: "go on", "and then?", "tell me about it".
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Giving broad openings
- Clarifies that the lead is to be taken by the pt. However, the nurse discourage pleasantries and small talk.
- EX: "where would you like to begin", "what are you thinking about"," what would you like to discuss".
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Placing the events in time or sequences
- Puts events and actions in better perspective. Notes cause-and-effect relationships and identifies patterns of interpersonal difficulties.
- EX: "what happened before?", "when did this happen?"
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Making observations
- Calls attention to the person's behavior (e.g. trembling, nail biting, restless mannerisms). Encourages pts to notice the behavior and describe thoughts and feelings for mutual understanding. helpful with mute and withdrawn ppl.
- EX: "you appear tense", "I notice you are biting your lips", "You appear nervous whenever John enters the room"
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Encouraging description of perception
- Increases the nurse's understanding of the pt's perception. Talking abt feelings and difficulties can lessen the need to act them out inappropriately.
- EX: "what do theses voices seem to be saying?", "what is happening now?", "tell me when you feel anxious."
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Encouraging comparison
- Brings out recurring themes in experiences or interpersonal relationships. Helps the person clarify similarities and differences.
- EX: "has this ever happen before?", "Is this how you felt when ...?", "was it something like ...?"
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Restating
- Repeats the main idea expressed. Gives the pt an idea of what has been communicated. If the msg has been misunderstood, the pt can clarify.
- EX: Patient "I can't sleep. I stay awake all nigh." Nurse "You have difficulty sleeping?"
- Patient "I don't know ... he always have some excuse for not coming over or keeping our appt". Nurse "You think he no longer wants to see you?".
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Reflecting
- Directs questions, feeling, and ideas back to the pt. Encourages the pt to accept his/her own ideas and feelings. Acknowledges the pt's right to have opinions and make decisions, and encourages the pt to think of self as a capable person.
- EX: Patient"what should I do abt my husband's affair?" Nurse"what do you think you should do?"
- patient"My brother spends all of my money and then has the nerve to ask for more" Nurse"you feel angry when this happens?"
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Focusing
- Concentrate attention on a single pt. It is specially useful when the pt jumps from topic to topic. If a person is experiencing a severe or panic level of anxiety, the nurse should not persist until the anxiety lessens.
- EX: "This pt you are making abt leaving school seems worth looking at more closely"
- "you've mentioned many times. lets go back to your thinking of ending it all"
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Exploring
- Examines certain ideas, experiences, or relationships more fully. If the patient chooses not to elaborate by answering no, the nurse does not probe or pry. In such a case, the nurse respects the pt's wishes.
- EX: "tell me more abt that", "would you describe it more fully?", "could you talk abt how it was that you learned your mom was dying of cancer?"
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Giving information
- Makes facts the person need available. Supply knowledge to which decisions can be made or conclusions drawn. For example, the pt needs to know the role of the nurse; the purpose of the nurse-patient relationship; and the time, place, and duration of the meeting.
- EX: "My purpose for being here is ...", "the medication is for ...", "the test will determine ..."
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Seeking clarification
- Helps pts clarify their own thoughts and maximize mutual understanding b/t nurse and pt.
- EX: "im not sure I follow u", "what would you say is the main pt of what u just said?", "give an example of a time you thought everyone hated you".
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Presenting reality
- Indicates what is real. The nurse does not argue or try to convince the pt, just describes personal perceptions or facts abt the situation.
- EX: "That was Dr. Todd, not a man from the Mafia.", "that was the sound of a car backfiring.", "your mother is not here; I'm the nurse"
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Voicing doubt
- Undermines pt's believes by not reinforcing the exaggerated or false perceptions.
- EX: "isn't that unusual?", "really?", "that's hard to believe."
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Seeking consensual validation
- Clarifies that both the nurse and pt share mutual understanding of communications. Helps the pt become clearer abt what he or she is thinking.
- EX: "tell me whether my understanding agrees with yours."
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Verbalizing the implied
- Puts into concrete terms what the pt implies, making the pt's communication more explicit.
- EX: pt "I can't talk to u or anyone else, its a waste of time" Nurse "Do u feel that no one understands u?"
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