Therapeutic communication and nursing research

Communication items are highly predictable: the correct answer almost always acknowledges the client's feeling and keeps the conversation open. Research items are mostly definitions. Both are covered here.

Therapeutic techniques vs communication blocks

Therapeutic communication is client-centered and goal-directed. High-yield techniques:

• Active listening and silence: silence is an intervention, not awkwardness.
• Open-ended questions: "How are you feeling about the surgery?"
• Restating and paraphrasing: reflect the content back to confirm understanding.
• Reflection: direct feelings back, "You sound worried about the results."
• Clarifying and validating: "Tell me what you mean by 'strange feeling.'"
• Focusing and summarizing: keep the interaction purposeful.
• Offering self: "I will stay with you for a while."

Blocks to eliminate on sight:

Block	Example	Why it fails
False reassurance	"Everything will be fine."	Dismisses the feeling, closes discussion
Giving advice	"If I were you, I would..."	Removes client's decision-making
Why questions	"Why did you skip your pills?"	Sounds accusatory, provokes defensiveness
Changing the subject	"Let's talk about your diet instead."	Signals the topic is unwelcome
Approval or disapproval	"That was the right thing to do."	Makes acceptance conditional
Defending	"Your doctor is an excellent surgeon."	Ends exploration of the concern

The pattern for choosing answers: acknowledge the emotion, invite the client to say more, stay honest, and do not make it about you or the institution.

Nurse-client relationship phases

• Pre-interaction: the nurse reviews the record and examines personal feelings; the client is not yet involved.
• Orientation (introductory): introductions, establishing trust and rapport, setting the contract (purpose, duration, confidentiality and its limits), and identifying problems. Termination planning starts here.
• Working: the longest phase; the client explores problems and practices new behaviors; most interventions happen here. Transference and resistance often surface.
• Termination: summarize progress, evaluate goals, and manage separation feelings. Do not introduce new issues; refer instead. A client who suddenly regresses near discharge may be reacting to termination.

SBAR and handoff communication

SBAR structures urgent and handoff reports: Situation (who and what is happening now), Background (relevant history and medications), Assessment (current findings and what you think is going on), Recommendation (what you need, for example "please assess the client"). For telephone orders, write the order, read it back, and get confirmation; the prescriber countersigns within the period agency policy requires.

Patient teaching and health literacy

Teaching follows the nursing process: assess readiness and learning needs first. Motivation is the most important factor in learning, and pain, anxiety, or an unmet physiologic need blocks it. Match the domain to the method: cognitive (facts) uses discussion and printed material, affective (attitudes) uses role modeling and discussion of feelings, psychomotor (skills) requires demonstration and return demonstration. For low health literacy: use plain language, teach the most important point first, use pictures, and confirm understanding with teach-back ("Show me how you will draw up your insulin"), never with "Did you understand?"

Evidence-based practice and research basics

Evidence-based practice integrates the best current evidence with clinical expertise and the client's values and preferences. The strongest single-study design for cause and effect is the randomized controlled trial; systematic reviews and meta-analyses of RCTs sit at the top of the evidence pyramid, while expert opinion sits at the bottom.

Vocabulary the NLE tests: quantitative research measures variables numerically; qualitative research explores lived experience through interviews and themes. The independent variable is manipulated; the dependent variable is the outcome measured. Reliability is consistency of a measure; validity is whether it measures what it intends to.

Research ethics: informed consent must be voluntary and may be withdrawn anytime without penalty; participation never affects care. Anonymity means even the researcher cannot link data to identity; confidentiality means the researcher can but will not disclose. An ethics review board must approve studies involving human subjects, and vulnerable groups (children, prisoners, the cognitively impaired) receive extra protection. These principles trace to the Nuremberg Code, the Declaration of Helsinki, and the Belmont Report (respect for persons, beneficence, justice).

Key points

• Therapeutic answers acknowledge feelings and open dialogue; false reassurance, advice, and "why" questions are always wrong.
• Trust is established in orientation; most problem-solving occurs in the working phase; no new topics at termination.
• SBAR: Situation, Background, Assessment, Recommendation; read back telephone orders.
• Use teach-back and return demonstration to verify learning; assess readiness before teaching.
• EBP = best evidence + clinical expertise + client preference; RCTs and systematic reviews rank highest.
• Anonymity and confidentiality are different; consent is revocable without penalty.

Exam-day strategy

• In communication items, eliminate every option containing reassurance, advice, "why," or a subject change; what remains is usually the reflective answer.
• For research stems, underline whether the question asks design, variable, or ethics; most errors come from answering the wrong category.
• Teaching questions favor assessment of readiness first and return demonstration for skills.