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