Guiding the Client in Problem-Solving and Empowering the Client to Change

Guiding the Client in Problem-Solving and Empowering the Client to Change

Many therapeutic situations involve problem-solving. The nurse is not expected to be an expert or to tell the client what to do to fix his or her problem. Rather, the nurse should help the client explore possibilities and find solu-tions to his or her problem. Often just helping the client to discuss and explore his or her perceptions of a problem stimulates potential solutions in the client’s mind. The nurse should introduce the concept of problem-solving and offer himself or herself in this process.

Virginia Satir (1967) explained how important the cli-ent’s participation is to finding effective and meaningful solutions to problems. If someone else tells the client how to solve his or her problems and does not allow the client to participate and develop problem-solving skills and paths for change, the client may fear growth and change. The nurse who gives advice or directions about the way to fix a problem does not allow the client to play a role in the process and implies that the client is less than competent. This process makes the client feel help-less and not in control and lowers self-esteem. The client may even resist the directives in an attempt to regain a sense of control.

When a client is more involved in the problem-solving process, he or she is more likely to follow through on the solutions. The nurse who guides the client to solve his or her own problems helps the client to develop new coping strategies, maintains or increases the client’s self-esteem, and demonstrates the belief that the client is capable of change. These goals encourage the client to expand his or her repertoire of skills and to feel competent; feeling effective and in control is a comfortable state for any client.

Problem-solving is frequently used in crisis intervention but is equally effective for general use. The problem-solving process is used when the client has difficulty finding ways to solve the problem or when working with a group of people whose divergent viewpoints hinder finding solutions. It involves several steps:

·    Identify the problem.

·    Brainstorm all possible solutions.

·    Select the best alternative.

·    Implement the selected alternative.

·    Evaluate the situation.

·    If dissatisfied with results, select another alternative and continue the process.

Identifying the problem involves engaging the client in therapeutic communication. The client tells the nurse the problem and what he or she has tried to do to solve it:

 Nurse: “I see you frowning. What is going on?” (making observation; broad opening)

Client: “I’ve tried to get my husband more involved with the children other than yelling at them when he comes in from work, but I’ve had little success.”

Nurse: “What have you tried that has not worked?” (encouraging expression)

Client: “Before my surgery, I tried to involve him in their homework. My husband is a math whiz. Then I tried TV time together, but the kids like cartoons and he wants to watch stuff about history, natural science, or travel.”

Nurse: “How have you involved your husband in this plan for him to get more involved with the children?” (seeking information)

Client: “Uh, I haven’t. I mean, he always says he wants to spend more quality time with the kids, but he doesn’t. Do you mean it would be better for him to decide how he wants to do this—I mean, spend quality time with the kids?”

Nurse: “That sounds like a place to start. Perhaps you and your husband could discuss this issue when he comes to visit and decide what would work for both of you.” (formulating a plan of action)

 It is important to remember that the nurse is facilitating the client’s problem-solving abilities. The nurse may not believe the client is choosing the best or most effective solution, but it is essential that the nurse supports the cli-ent’s choice and assists him or her to implement the chosen alternative. If the client makes a mistake or the selected alternative isn’t successful, the nurse can support the client’s efforts and assist the client to try again. Effec-tive problem-solving involves helping the client to resolve his or her own problems as independently as possible.