A male client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from nurse Julia?
A. “Why didn’t you get someone else to drive you?”
B. “Tell me how you feel about the accident.”
C. “You should know better than to drink and drive.”
D. “I recommend that you attend an Alcoholics Anonymous meeting.”
Correct Answer: B. “Tell me how you feel about the accident.”
An open-ended statement or question is the most therapeutic response. It encourages the widest range of client responses, makes the client an active participant in the conversation, and shows the client that the nurse is interested in his feelings. mix open-ended questions with focus questions. Open-ended questions may allow the patient to express their thoughts and feelings, and focused questions allow the interviewer to obtain important details with yes or no answers in a more time-efficient manner.
Option A: Asking the client why he drove while intoxicated can make him feel defensive and intimidated. The first question posed in the interview is often open-ended. For example, “What is the main reason you seek medical assistance today?” This provides an opportunity for the interviewer to allow the patient to share their concerns, and the interviewer can show he or she is actively listening. This includes listening without judgment and displaying concern for the patient during communication.
Option C: A judgmental approach isn’t therapeutic. During the interview, meaningful questions inquired positively will reduce defensiveness from the patient. Often this can be accomplished by suggesting or sharing a common behavior associated with the actions of the patient. For example, the interviewer may convey the commonality for people to consume alcohol when under stress. It then becomes acceptable to inquire if this is also occurring with the patient. The patient may feel a sense of trust and therefore share pertinent information.
Option D: By giving advice, the nurse suggests that the client isn’t capable of making decisions, thus fostering dependency. At the conclusion of the patient interview, an appropriate transition statement to begin the physical exam may be, “Is there anything else that you would like to share with me before I start the physical examination?” This statement serves 2 purposes. First, it elicits any additional information the patient deems necessary, and second, it signals a transition to the physical exam. Lastly, before concluding the interview, it is important to discuss the probable follow-up plan and further treatment. In the outpatient setting, this may include admission to the hospital or going home and returning for a follow-up appointment at a designated time.