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Chapter: Psychiatric Mental Health Nursing : Therapeutic Communication

How to Phrase Questions

The manner in which the nurse phrases questions is important.

How to Phrase Questions


The manner in which the nurse phrases questions is important. Open-ended questions elicit more descriptive information; yes/no questions yield just an answer. The nurse asks different types of questions based on the infor-mation the nurse wishes to obtain. The nurse uses active listening to build questions based on the cues the client has given in his or her responses.


In English, people frequently substitute the word feel for the word think. Emotions differ from the cognitive pro-cess of thinking, so using the appropriate term is impor-tant. For example, “What do you feel about that test?” is a vague question that could elicit several types of answers. A more specific question is, “How well do you think you did on the test?” The nurse should ask, “What did you think about…?” when discussing cognitive issues and “How did you feel about…?” when trying to elicit the client’s emo-tions and feelings. The fol-lowing are examples of different responses that clients could give to questions using “think” and “feel”:

Nurse: “What did you think about your daugh-ter’s role in her automobile accident?”

Client: “I believe she is just not a careful driver. She drives too fast.

Nurse: “How did you feel when you heard about your daughter’s automobile accident?”

Client: “Relieved that neither she nor anyone else was injured.”


Using active listening skills, asking many open-ended questions, and building on the client’s responses help the nurse obtain a complete description of an issue or an event and understand the client’s experience. Some cli-ents do not have the skill or patience to describe how an event unfolded over time without assistance from the nurse. Clients tend to recount the beginning and the end of a story, leaving out crucial information about their own behavior. The nurse can help the client by using tech-niques such as clarification and placing an event in time or sequence.



Asking for Clarification


Nurses often believe they always should be able to under-stand what the client is saying. This is not always the case: The client’s thoughts and communications may be unclear. The nurse never should assume that he or she under-stands; rather, the nurse should ask for clarification if there is doubt. Asking for clarification to confirm the nurse’s understanding of what the client intends to convey is para-mount to accurate data collection.


If the nurse needs more information or clarification on a previously discussed issue, he or she may need to return to that issue. The nurse also may need to ask questions in some areas to clarify information. The nurse then can use the therapeutic technique of consensual validation, or repeating his or her understanding of the event that the client just described, to see whether their perceptions agree. It is important to go back and clarify rather than to work from assumptions.

The following is an example of clarifying and focusing techniques:

Client: “I saw it coming. No one else had a clue this would happen.”

Nurse: “What was it that you saw coming?” (seeking information)

Client: “We were doing well, and then the floor dropped out from under us. There was little anyone could do but hope for the best.”

Nurse: “Help me understand by describing what ‘doing well’ refers to.” (seeking information)

“Who are the ‘we’ you refer to?” (focusing)

“How did the floor drop out from under you?” (encourag-ing description of perceptions)

“What did you hope would happen when you ‘hoped for the best’?” (seeking information)


Client’s Avoidance of the Anxiety-Producing Topic


Sometimes clients begin discussing a topic of minimal importance because it is less threatening than the issue that is increasing the client’s anxiety. The client is discuss-ing a topic but seems to be focused elsewhere. Active lis-tening and observing changes in the intensity of the non-verbal process help to give the nurse a sense of what is going on. Many options can help the nurse to determine which topic is more important:


1. Ask the client which issue is more important at this time.


2. Go with the new topic because the client has given non-verbal messages that this is the issue that needs to be discussed.


3. Reflect the client’s behavior, signaling there is a more important issue to be discussed.


4. Mentally file the other topic away for later exploration.


5. Ignore the new topic because it seems that the client is trying to avoid the original topic.


The following example shows how the nurse can try to identify which issue is most important to the client:

Client: “I don’t know whether it is better to tell or not tell my husband that I won’t be able to work anymore. He gets so upset whenever he hears bad news. He has an ulcer, and bad news seems to set off a new bout of ulcer bleedingand pain.”

Nurse: “Which issue is more difficult for you to confront right now: your bad news or your husband’s ulcer?” (encour-aging expression)



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