science

Nurse Communication

(Verbal & Non-verbal)

Client communication

(Verbal & Non-verbal)

Nurse’s Thoughts &

Feelings Related to the

Interaction

Communication Technique

(Therapeutic/Non-Therapeutic)

Alternative or Revised Response

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15

16.

17.

18.

19.

20.

Nurs

e

Communication (Verbal & Non-verbal)

Client communication (Verbal & Non-verbal)

Nurse’

s

Thoughts &

Feelings Related to the Interaction

Communication Technique (Therapeutic/Non-Therapeutic)

Alternative or Revised Response

1.

Nonverbal: Knocks on the door

,

enters room, smiling, washes hands, SOLER (Morgan, 2020).

Verbal: Good morning sir, my name is Courtney, and I will be your nurse today. I’m interested in getting to know you. Do you mind if I come in and sit with you?

Nonverbal: client is sitting in a chair staring out the window, appears sad and tearful.

Verbal: Yes, I guess you can come in.

I am nervous since this is my first encounter with the client. I want to know what’s going on in his mind. I don’t want him to shut down.

Therapeutic:

self. This is the orientation phase of the client-nurse relationship.

offering

Same response

2.

Nonverbal: I am checking his name band and looking in the client’s MAR to verify I have the correct client.

Verbal: Keep your chin up Mr. Jones. Before we begin, can you please verify your full name and date of birth?

Nonverbal: Mr. Jones is watching me while I check his name band.

Verbal: My name is Russel Jones, my date of birth is April 20th, 1952.

Okay, Mr. Jones is alert and orientated to self. Mr. Jones is confirming his identity which confirms that I am talking with the correct client, and I am addressing him by his correct name.

Nontherapeutic:

making stereotyped comments, this a cliché expression and is meaningless in the nurse-client relationship.

This is an inappropriate therapeutic response. I should not tell Mr. Jones to keep his chin up. Instead, I would suggest saying “I am here to help you and we shall get through this together.” Talking about his loss of his

wife is reiterating his actions.

3.

Nonverbal: SOLER (Morgan, 2020).

Verbal: Mr. Jones, how are you feeling today?

Nonverbal: He is sitting in his chair and looking out the window. Mr. Jones looks at me.

Verbal: “fine I guess….”

I am generally concern that something is going on with Mr. Jones. He doesn’t seem like he is doing very well.

Therapeutic: opening, this Mr. Jones to initiative in th discussion.

broad

Instead of asking Mr. Jones how is feeling today, the nurse could have said “tell me what you are thinking about?”

allows

take e

4.

Nonverbal: Nodding,

looking at client.

Verbal: That’s good Mr. Jones, I’m glad that you are feeling okay.

Nonverbal: staring at the ground

Verbal: “Meh, I just don’t feel like talking this morning.”

Mr. Jones doesn’t want to talk this morning. Maybe I can ask him what is bothering him?

Nontherapeutic: approving or disapproving, the nurse is denouncing Mr. Jones behavior. She is accepting this behavior.

This is not therapeutic approach instead I could ask Mr. Jones “Mr. Jones, we all have those days when we don’t want to talk to anyone. Is there anything I can do to make you feel better?”

5.

Nonverbal: Remain silence, nodding.

Verbal: Everything will be alright Mr. Jones…

Nonverbal: angry, short, and agitated. Looks away from me.

Verbal: No, it won’t, I just want to get out of here. I don’t belong here!

Mr. Jones is getting very agitated and angry. He believes that he doesn’t belong here.

Nontherapeutic: giving reassurance, the nurse is devaluing the client’s feelings

Instead of telling Mr. Jones everything will be alright I could use a more therapeutic techniques broad opening which allows

the client to initiate the topic and interaction.

6.

Nonverbal: Concerned, nodding, looking at client.

Verbal: Mr. Jones, you feel angry that you don’t belong here, and you want to go home. Can you explain more why you feel angry?

Nonverbal: tearful while looking at nurse

Verbal: Well last night, I locked myself in the bathroom and refused to come out. I have been sad and lonely since my wife died. My daughter thought I was going to harm myself which she called the police and brought me here.

The reason Mr. Jones is angry is because he is sad and lonely that his wife passed away. His daughter thought he was going to harm himself.

Therapeutic: the nurse is

focusing

on why Mr. Jones feels angry.

Asking him what brought him in earlier may have provided a more therapeutic response which could have resulted in him not becoming angry.

7.

Nonverbal: nodding

and

Nonverbal: Looking at nurse

Mr. Jones feels like his

This is not an

Verbal: What made you lock yourself in the bathroom and refuse to come out?

and staring out the window.

Verbal: I feel like my daughter doesn’t care about me and how I am feeling since my wife passed away.

daughter doesn’t care about him and his feelings about the loss of his wife. He is trying to get attention from his daughter.

indicating the existence of an external source of power, this allows Mr. Jones to blame his daughter for his actions instead of accepting the responsibility.

appropriate therapeutic response for Mr. Jones instead I should offer him silence and allow him to explain. Listening to everything he has to say is key.

8.

Nonverbal: Nods in understanding.

Verbal: Ok, Mr. Jones, Do I understand correctly that you said, “your daughter doesn’t care about you, and she doesn’t understand your

feelings since your wife passed away?”

Nonverbal: nodding and shaking his head.

Verbal: Yes. My daughter hasn’t been around much lately since my wife died.

Mr. Jones is feeling lonely because his daughter is not around much since his wife passed away. He wants some attention from his daughter.

seeking

I was able to clarify with Mr. Jones that I heard him correctly. If I didn’t clarify the

question, he may have thought that I didn’t understand what he was saying which could make him frustrated or stop talking.

clarification and

validation

. The nurse

is trying to clarify the feelings and increase between Mr. Jones

meaning of his the understanding and the nurse.

9.

Nonverbal: Nodding, SOLER (Morgan, 2020).

Verbal: What you really mean is that it’s been difficult since the loss of your wife and your daughter hasn’t been around for support?

Nonverbal: shaking his head.

Verbal: Yeah, my wife and I have been together for 45 years. She was my soulmate and whole world. We would do everything together. My daughter works so much

lately, I guess I just feel like she would be better off without me.

Mr. Jones is having a hard time coping with the loss of his wife.

His daughter seems to be someone he uses for a support system, but she isn’t around.

Nontherapeutic:

interpreting, the nurse

is trying to tell the client the meaning of his thoughts.

Instead of interpreting how the client feels I should allow Mr. Jones to let him tell me how he feels.

10.

Nonverbal: looking at the client.

Verbal: Okay, Mr. Jones. Please explain why you feel like your daughter would be better off without you.

Nonverbal: looking at the ground

Verbal: Well since she’s just so busy I figured that she didn’t need me anymore. I may have told her that I would

Mr. Jones is having a hard time not connecting with his daughter. She is a huge support system for him since his wife is gone.

Therapeutic: exploring, the nurse is trying to further gain information about the client’s feelings without pushing or probing the client to

Same response. However, it may be therapeutic to have a conversation with Mr. Jones and his daughter to clear the air.

rather not be here on earth anymore so I can be with my wife again.

not disclose information.

11.

Verbal: Why did you do that?

Nonverbal: embarrassed while looking at the ground.

Verbal: I guess I shouldn’t have told her that I would rather not be here on earth anymore. That probably made her worried and thought that I would harm myself.

Mr. Jones recognizes that what he said is wrong. He feels embarrassed of his actions.

Nontherapeutic: requesting an explanation

Using more of an exploring technique may have him tell me more about what happened in why he wanted to harm himself.

12.

Nonverbal: looking directly at the client.

Verbal: Mr. Jones, there is no one else in the room but you and me, would you ever physically harm yourself?

Nonverbal: shaking his head and tearful

Verbal: No, I don’t think I could physically harm myself. I know that my wife wouldn’t want that for me. I just miss her so much and thought that I was being a huge burden on my daughter.

Mr. Jones doesn’t want to hurt himself. He understands that his wife wouldn’t want that for him. He is sad that she is gone and doesn’t have enough support.

presenting reality

Same response. Mr. Jones tells me that he wouldn’t physically harm himself because he knows that his wife wouldn’t approve of his decision. He needs a safety plan as he does not currently have suicidal ideation.

13.

Nonverbal: Nod’s and looks at client.

Verbal: Okay Mr. Jones, tell me how you feel like a burden towards your daughter since your wife passed.

Verbal: Well, you see my daughter use to come over twice a week when my wife was alive. Now, she barely comes over once a week. She is always working and when

we talk, I just feel like I’m not important to her.

Mr. Jones is feeling alone and doesn’t have any support from his daughter.

probing, the nurse is pushing the client to for answers. This could make the client defensive.

Allowing Mr. Jones to “go on” since he stated before that he feels like he is a huge

burden on his daughter would be more therapeutic.

14.

Nonverbal: remains silence, allowing Mr. Jones to provide more information.

Verbal: Go on….

Nonverbal: staring at nurse

Verbal: I just feel like I am not important to her because she doesn’t come over anymore. I want to spend more time with her because she is the only family I have left.

Mr. Jones feels that he is unimportant because his daughter doesn’t want to spend time with him. She is his only support system since his wife is gone.

Therapeutic: general lead

offering a

Asking Mr. Jones is he has any other family members or friends around may allow him to not focus on his daughter.

15

Nonverbal: Nodding.

Verbal: Unconsciously you’re saying you have been sad and lonely since your wife passed away. You don’t want to harm yourself. You feel like you’re a huge burden on your daughter, and you want to spend more time with your daughter since she is the only family you have.

Nonverbal: shakes his head

Verbal: Yeah, that pretty much sums it up.

Mr. Jones agrees that the information he has

provided is correct. I am going to propose some ideas that would make him feel less lonely or possibly having a talk with his daughter when she comes in.

is telling the client the meaning of his feelings and thoughts.

I should restate what Mr. Jones has told me so I can develop a trusting and working relationship with Mr. Jones. Then together we can develop a safety plan that benefits him. Either providing him with National Suicide prevention lifeline (1800-273-8255) or counselor.

16.

Nonverbal: maintain eye contact and smiling.

Verbal: Mr. Jones sounds like you have felt deep loss and grief about losing a loved one recently while having to be here. That must be very difficult for you.

Nonverbal: Nod’s head

Verbal: It really has been difficult. She was my soulmate for 45 years. I just feel like a piece of me is missing since she’s gone.

This has been a

difficult time for Mr. Jones. He has been feeling so much pain and loss from losing his wife. I need to ask him different questions, so we don’t focus on his suffering but willing for him to grieve.

verbalizing the implied

At this time, asking Mr. Jones to come up with a plan of care would be more beneficial for the next time he feels sad and lonely.

17.

Nonverbal: Nodding, providing eye contact, touches Mr. Jones hand.

Verbal: Mr. Jones, everybody feels like a piece of them is missing when they lose a loved one. I understand how you feel.

Nonverbal: uncertain and nods his head in agreeance

Verbal: If you say so….

Mr. Jones is now confused and feels that he is compared to others.

Nontherapeutic: belittling feelings expressed, this can cause the client to feel insignificant and unimportant.

I don’t understand how he feels. Instead, I should ask Mr. Jones if I could stay with him for a while to make him comfortable.

18.

Nonverbal: looking at client.

Verbal: Mr. Jones, what could you do differently if you are faced with this situation in the future?

Nonverbal: looks at nurse

Verbal: Well, I guess I could go for a walk. I used to like going for walks in the evening.

Mr. Jones use to like going for walks in the evening. I can encourage him to do activities that make him happy instead of being sad.

formulation a plan of

action

I should have noticed while he was staring out the window during our conversation that he was watching the people outside walking. I could have asked him earlier if this is something he enjoyed doing.

19.

Nonverbal: remains silent, looking at the client, nodding.

Verbal: That’s good. I’m glad that you have found a solution that works for you.

Nonverbal: smiling

Verbal: Yes, me too.

Mr. Jones seems excited about how to cope with this new solution.

Nontherapeutic: approving, the client may be trying to please the nurse.

Using silence would encourage Mr. Jones to organize his thoughts and how he feels about using this new coping method.

20.

Nonverbal: smiling and excited.

Verbal: That sounds beautiful Mr. Jones. I am happy that we have a plan. I will come back in an hour to check on you. Please let me know if you need anything.

Nonverbal: smiling and nodding

Verbal: Okay, I don’t need anything, but I will let you know if I do. Thank you, Courtney, I am glad we talked. I feel much better about things.

Mr. Jones shared a lot of information about himself and how he can cope with his loss. He doesn’t want to die but he feels lonely. Mr. Jones is learning how to deal with his coping

skills and will be successful when he can be discharged.

self. Mr. Jones is aware that I am her for him and that he i not alone.

I am happy with my conversation with Mr. Jones. We were able to develop a plan in which he is comfortable with. I could have offered different solutions

earlier in the conversation however Mr. Jones was able to create a plan on his own.

Nurse Communication (Verbal & Non-verbal)

Client communication (Verbal & Non-verbal)

Nurse’s Thoughts &

Feelings Related to the Interaction

Communication Technique (

T

herapeutic

/Non-

Therapeutic

)

Alternative or Revised Response

1.

NV: At eye level and squared up to Mrs. Alverez with full eye contact.

V: I said my name is Michaela and I will be your nurse. Can I have your name and date of birth. How would you like me to address you?

NV: Mrs. Alverez

was

facing the window and looking outside while answering the questions with arms crossed. V: She stated that she was Lisa Alverez, and she was born April 29, 198

7.

She would like to be addressed as Lisa.

The

patient is

off and not necessarily wanting to be part of the conversations and could be potentially wanting to be out there and not part of her problems.

because

Could have been more direct by saying what would you like me to call you? This might have been more direct and given the patient a better idea to what the nurse wanted.

of offering a

giving

broad opening

reak the

re out

how

he

w they ressed

the start.

wanting to b ice and figu to start to build t relationship by knowing ho want to be add to not offend the patient from

2.

NV: Remaining focused and facing the patient.

V: Lisa I noticed that you brought yourself in today and I was wondering if you could tell me more about why you brought yourself in?

NV: Still facing the window, but at times during the conversations starts to make some eye contact, but only for a second or two.

V: She states that she has noticed that she can not control her anxiety anymore and is constantly worrying about her kids and when her kids are gone, she is calling the place that they are at every 5 minutes, or she ends up picking up her children 2 hours early because they are in her sight. She also states why am I telling you this, I do

This is a step in the right direction because she is starting to describe what is going on and putting her thoughts in words but

is also trusting the nurse enough about talking something so sensitive.

and it is

It was not a bad question but could have done a better evolving the relationship with more generic questions before diving into it

. The

nurse could have asked how you are doing today or something along those lines.

technique

of

how

exploring

and getting

a better idea of what is

n in the s life and

nt is coping

going o person’ the patie with what is happening.

not even know you.

3.

NV: Still facing Lisa and leaning in a little bit to look intent and interested, the nurse was a little anxious about possibly make the situation worse.

V: Thank you for sharing Lisa and I noticed that you seem a little anxious to share your experience, but I hope you

understand

that this information stay between your care team and you. We are just wanting to try our best to help you, but we do nee to understand where your anxiety is coming from.

NV: Arms are still crossed, and she still has little to no eye contact, but she is starting to slightly turn to face the nurse.

V: I guess thank you for helping me, I just have never had anyone care about my feelings or try to understand where I am coming from. My husband works a lot and growing up my parents never cared what I did. I was gone for 5 days and they did not even notice.

Connection is starting to form, and the patient is starting to understand that the nurse is there to help, and the patient is now willing to open more.

as trying to

sible

nding and

get the

pen more. ue was ervations.

This is a good way to have the patient understand that she is not trying to harm the patient, but it could have been better to add a question that would help get the information instead of relying on the patient to give the information.

the nurse w clear a pos misundersta was able to patient to o

The techniq making obs

4.

NV: The nurse sits there facing the patient, leaning in, and staying focused on the patient and the patient’s non-verbal’s V: I see,

and what

happened after those five days?

NV: Facing the nurse, sitting a little more upright and arms are now laying on top of her lap.

V: After those five days my parents became even worse. I forgot to mention I was 7 when that happen. But there was a time I became very sick and ended up with an appendicitis and I had to call my grandma to come help me. Eventually my parents showed up and showed the nurses that they were great parents and cared about me. I do not want my children to feel the same way I do.

The patient is trusting the nurse even more and the conversation is explaining more about what is going on in the patient and what might help the patient.

were used,

offering a and

event in ence. niques more of an

ng and

ast that

caused the

Could have just did the general lead to get different information instead of what happened after the five days. The nurse could have just said go on.

techniques and it was general lead placing the time or sequ These tech helped get understandi about her p might have problem.

5.

NV: Still maintaining the conversation while at eye level, eye contact, and leaning in. V: I sense that you think your

NV: Patient is fully part of the conversation, full eye contact, but hands are not sitting still as conversation continues.

The conversation is still going in the right direction and the patient is willing to talk

were used by

the feelings

The question could be restated by asking her feelings toward her parents and how she

techniques in this situation

restating

anxiety is based on your childhood experience and worrying about if you are there for your kids enough.

V: I guess you could say that is true, I feel bad putting the blame on my parents because they are my parents, but I was treated horribly by them.

about topics that make her uncomfortable but feels safe to let those feelings out.

of the patient and giving them a clearer picture to what they are explaining.

thinks it has impacted her parenting.

6.

NV: Still maintaining eye

contact and being intrigued in the conversation.

V: How do you think this anxiety is affecting you today?

NV: Maintaining eye contact with the nurse and still fully facing the nurse, silent for a few minutes thinking about how it has affected her today. V: Now that I really think about it, it has affected me a lot through my choices about myself and then my choices about my children.

This was a good question, and it made the patient truly think about her current situation and how the anxiety from her past is affecting her now.

technique

The question could have been more specific about wanting specifics about what is going on instead of a general question.

and it was and tryi the relatio between her parents and her current situation.

ng to figure out nship

NV: Still maintaining eye contact and being intrigued in the conversation.

V: Why do you say that?

NV: Looks confused for a second about the statement, but still facing the nurse.

V: I guess my past has made me very anxious with my own children and wanting to make sure they are always okay, and it has led to forgetting to eat and feeling sick to my stomach.

This idea is interesting, and it allowed the patient to add more specifics to the pervious question.

Non-therapeutic

tting he

The response would have been better if I stated “ Yes, I see, please go on” instead of asking her why.

technique it was asking a “why” question and pu the patient on t defensive.

8.

V: I understand that you realize that you forgot to eat and feel sick, but do you realize that you lost 15 pounds? Don’t you realize the risk to your health by losing so much weight so quickly?

NV: She turns toward the window after the question and is staring out the window thinking.

V: (Nothing was stated)

This line of questions was not great, but it is showing that I am judging her choices.

to
or

This could have been presented better by making it sound more empathic accusatory. I could have said “Let’s talk about your daily eating routine. Tell me what you eat on a typical day.”

technique of

requesting an

explanation

. The

patient does not owe me an explanation her weight loss whether or not she understand

s the

risks involved.

9.

NV: Still maintaining eye contact and being intrigued in the conversation and leaning in a bit more to feel she can talk and remain silenced. V: (The nurse said nothing)

NV: Lisa is starting to turn back around to the nurse and looked less defensive and calm again.

V: I did not think I lost that much, but it makes since because the only time I eat is with my children because I do not have to worry about them because they are there with me. But when they are gone and I am supposed to have me time or time with my husband, I become sick and do not feel like eating until I calm down and usually takes a couple hours after I see them. At that point I still do not feel hungry.

This action was good, and the conversation is going in the right direction again.

of silence. patient

k about her d what the rying to get

o

Could have asked a more specific questions about what she thinks has caused the weight loss. But the silence technique allowed the patient to think and respond the way that helps the patient more.

and the use It gave the time to thin answers an nurse was t the patient t understand.

10.

NV: Still maintaining eye contact and being intrigued in the conversation and showing the acceptance of what the patient answered.

V: It must be very difficult for you to have to deal with so many emotions on top of the physical problems you are dealing with too.

NV: She remained in the same position of being intrigued and maintaining eye contact. But she lets out a sigh.

V: It is. But I have no idea how to control my emotions and this anxiety? And I don’t know what to do with my children. I came in to get help, what do you think I should do?

Good step in the right direction because the patient is now asking the questions out loud and is asking for the nurse’s opinion, which means there is a connection.

which was the implied the patient

and what

m in and se

s the
patient is

There could have been a question instead of just a response because this could be interpreted wrong and break the trust. Could have asked if there is a relationship between the anxiety and health problems and how it could be fixed.

technique,

verbalizing and having real underst brought the that the nur

understand

difficulty the having.

11.

V: Why don’t you tell your husband that he needs to help you more with the children.

NV: Sitting in silence, she thinks about what she could do and eventually letting out another sigh.

V: I guess that I could but I’m not sure how he really can help me since he works so much.

Not good. She seems a little upset with my comment about asking her husband to help. I think she may be shutting down.

I could have asked her “What does your husband think about helping you more with the children when he gets home from work?

technique, giving

advice

. Telling the hat to do ow what

.

patient w implies I kn best for her

12.

NV: Seems unsure, but her

Patient is relaxing and

Luckily the patient

V: I’m sorry. I shouldn’t have told you what to do, that is a discussion for you and your husband to have.

body is relaxing, but is still a little rigid.

V: Thank you for the apology. Yes, I think that would be a good conversation to have when I feel more rested and more like my old self. I am always tired.

can continue the conversation without the nursing asking the questions and feels comfortable asking the nurse questions.

technique, which helps the patient understand that you agree with their cho

be there to help with

the choices apologizing f her feel uncomfortable.

accepting,

accepted my apology so I wouldn’t have changed anything here.

ice and will

and or makin

13.

V: Is there something that helped you fall asleep before having children of your own or when you were younger?

NV: Thinking hard about the question, staring at the floor by the nurse’s feet, but then moves her eyes up to talk to the nurse.

V: ummm. Yes, there was, the one good thing my mom would do for me was if I woke up from a nightmare, she would offer me a nice warm cup of milk and would tell the nanny to play me a lullaby on a jewelry box I used to have.

The nurse is asking questions that makes the patient think about her life and about what would help her. This idea improves the conversation because it makes the patient feel very centered.

Therapeutic

The question could have made them regress and bring out more anxiety to think about their past. The question should have been, have you tried anything throughout your entire life that

might have helped a

little bit with your sleep?

encouraging

, which patient to

mething tha hem with situation for them

comparison

allows the think of so might help t their current that worked in the past.

14.

V: Do you think you could try this now?

NV: Has a slight smile, sitting upright, and concentrating on the nurse, and maintaining the eye contact.

V: I think I could, I do not have the jewelry box anymore. But I could probably find it on YouTube or something like that.

The patient is becoming very relaxed and the conversation is coming to answers about what will help the patient when she leaves and goes home.

This question could have been a little less direct because then it may seem more like

the nurse is suggesting then allowing the patient to come up with it. The question could be changed to is there something like this that you could try?

technique, reflecting,

e

which allows the patient to restate their ideas without the nurse stating them for them. It sets patient to understand their problems and trust th nurse is listening and wanting to help.

V: That sounds like a great idea. So far, we have talked about a lot of things to try and do, are you able to restate to

NV: Sitting upright, concentrating hard on the ideas, and maintaining eye contact.

V: Yes, I can. For my anxiety away from my children I am going to start painting again to

The conversation is not an easy conversation, but it is a conversation that needs to be had to ensure that the patient understands they are

a

Could get rid of the fluff and get straight to the point, to help the patient and not make them more confused. Could have said how about we restate our

technique, formulating

a plan of action

used and it helps the patient come up with plan that will help them with their

me what we are going to try during our anxious moments.

keep my mind busy, but to also know they are always with me. This idea should help control my anxiety and help me with eating when my kids are not around. The next thing we are going to try is the music and warm milk at night to help me fall asleep to feel that I am okay.

in good hands. But it does take some hard work for the patient to do for it to work for the patient.

problems and can bounce their ideas off the nurse. It allows a plan to be formed and ideas to be said out loud.

plan and ideas now for clarification.

16.

V: This is a perfect plan! You seem a little more relaxed.

NV: seems calm and has eye contract with the nurse and has a slight smile on her face and body is relaxed.

V: I am, thank you for helping me talk through my problems to come up with a plan and how I will get better for myself and for my children.

The patient is trusting the nurse and understanding the thoughts and feelings behind the nurse and that she can trust the nurse to help her with this plan.

The statement was fine but could have maybe left out the last part because she is relaxed, but what was needed was the accepting part at this time in the conversation.

technique, accepting

e
nd

is used to show the patient that we agre with their decision a that it might help them.

17.

V: Well hang in there. All of these changes are for your own good, you will see.

NV: Looking at me with a strange look on her face. V: How do you know these changes will be good for me. You don’t know what it is like for me. I think you should leave now.

Oh boy, I shouldn’t have said that. She is right, I do not know if these changes will be good or not. And now she asked me to leave her room. I think I just lost the rapport I was building with her.

The question could have been said in a different way that did not make it seem like the nurse knew that all of these changes would be good for her. I could have said, “What do you think of the plans so far? Do you think they are manageable?”

making a

stereotyped comment.

Trite expressions are meaningless.

18.

V: I did it again, I am so sorry. You are right, I have no idea if these changes will work for you. The changes we made had a lot of your input, so what I meant was that I hope these changes we discussed will help you. Would you help writing them out to take home?

NV: She looks at the nurse with some tears in her eyes because she is upset, and I believe it is with me. V: Okay, I understand what you meant. I’m sorry that I overreacted too. I just have so much on my mind. Thank you,

I appreciate it and understand

(patient is starting to yawn

The conversation is back on track, and she realized that I did not mean any ill will but that the way I stated it did not come out the

right way. Boy, I still need to practice my communication techniques.

The statement could have left out the part of having the patient remind the nurse because this brings up doubt and anxiety for the patient about being able to make

the call. This idea could cause problems and break the trust they formed.

technique, restati

the plan and lettin the patient know t they are in control their treatment go

hat of als.

19.

V: You seem like you are getting tired, do you want me to go and come back later and we can work on writing out the plan together for you to take home?

NV: Her eyes are droopy, and she looks very sleepy. V: Yes, I really would like to take a nap, but would you just sit with me until I fall asleep?

The patient is trusting and is willing to fall asleep and it is important for the patient that the nurse remain there. This idea shows the trusting relationship.

the

ants hat

The questions could have been restated to make the patient suggest a nap and not the nurse suggestion.

technique, making

observations

w that and w e the ing w

used to sho nurse sees to make sur patient is giv they need.

20.

V: Okay, I will remain here until you fall asleep if that will make you feel comfortable. Later I will come back and we can work on your plan.

NV: The patient relaxes down in bed and starts to close her eyes, and her body looks fully relaxed.

V: Yes, please. I just am so used to have the kids around and do not want to feel so alone. Thank you!

The relationship is full of trust, and the patient is willing to allow the nurse to help her and trusting that she will be there and advocate for her.

I think it ended on a positive note.

technique, offerin

g self

was used to make

patient feel comfortable, and not used for the nurse’s sake.