A client says to the nurse, "I don't do anything right. I'm such a loser." The nurse makes which therapeutic… - DHS Staff Nurse - 2018 (Shift-2nd)

DHS Staff Nurse - 2018 (Shift-2nd)

Mental Health Nursing

Hard

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

The correct response uses the therapeutic technique of restating, which involves repeating the main thought the client has expressed.
This technique shows the nurse is actively listening, validates the client's message, and encourages them to elaborate on their feelings and thoughts.
By phrasing it as a question, it gently prompts the client to explore the breadth of their statement ('I don't do anything right'), which can lead to a more productive conversation.
It avoids judgment, advice, or disagreement, keeping the focus entirely on the client's perspective.

Option A: This is an example of false reassurance. Such statements minimize the client's current distress and can make them feel like their problems are not being taken seriously, effectively blocking further communication.
Option C: This response is disagreeing with the client. Contradicting the client's feelings, even with positive intent, invalidates their perception and can make them defensive or less willing to share.
Option D: This is a non-therapeutic response that both disagrees with and labels the client. It invalidates the client's expressed feeling ('loser') and replaces it with a potentially stigmatizing label ('sick'), which shifts the focus from the emotion to a condition.

Clinical Relevance

Nursing practice connection: Use the key finding related to Therapeutic Communication Techniques to guide bedside assessment, documentation, and the next nursing action.
Mastering therapeutic communication is a core competency in nursing, essential for building trust and rapport with patients, especially in mental health settings.
Using techniques like restating allows the nurse to gather more accurate assessment data about the client's thoughts and feelings, leading to better care planning.
What if the client's statement was, 'I'm such a loser, I might as well end it all'? The nurse's priority would immediately shift. While acknowledging the feeling is still important, the primary focus becomes a direct suicide risk assessment (e.g., 'Are you having thoughts of harming yourself?'). Safety always comes first.

How to Approach the Question

First, identify that the question is asking for the most therapeutic response, which requires knowledge of therapeutic communication principles.
Analyze the client's statement: 'I don't do anything right. I'm such a loser.' This is a clear expression of low self-esteem and negative self-perception.
Evaluate each option against the goals of therapeutic communication: to encourage expression of feelings, build trust, and facilitate problem-solving.
Eliminate options that are known communication barriers. 'Everything will get better' is false reassurance. 'You do things right all the time' and 'You are not a loser' are forms of disagreeing.
Identify the option that facilitates further communication. 'You don't do anything right?' uses the technique of restating, which invites the client to elaborate on their feelings without judgment.

Concept Tested & Keywords

Concept Tested: Therapeutic Communication Techniques
Stem keywords: therapeutic statement, client, nurse, I don't do anything right, loser
Lead-in keywords: which therapeutic statement

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E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) p. 102-104

E6 Nursing Fundamentals Potter Perry 12e Part 2 p. 124-126