Which answer would you pick?

[BoonersmomRN]

We had a test review today and I can't say I still agree with the answer.

The vignette was a 30 yr old woman in for gastric bypass surgery who seems concerned and is asking alot of questions about what will happen before and after - which is the best therapeutic approach to get her to talk?

The only 2 viable answers were:

" Tell me your fears about the surgery"

or

" You seem concerned. Can you tell me about what is worrying you?"

I chose the 2nd one but my prof says it's the 1rst one ( she said key word surgery)....but alas I disagree.

Anyone? I'd just like a rationale....my instructor wouldn't go into depth on this one.

[Kelly_the_Great]

We had a test review today and I can't say I still agree with the answer.

The vignette was a 30 yr old woman in for gastric bypass surgery who seems concerned and is asking alot of questions about what will happen before and after - which is the best therapeutic approach to get her to talk?

The only 2 viable answers were:

" Tell me your fears about the surgery"

or

" You seem concerned. Can you tell me about what is worrying you?"

I chose the 2nd one but my prof says it's the 1rst one ( she said key word surgery)....but alas I disagree.

Anyone? I'd just like a rationale....my instructor wouldn't go into depth on this one.

Okay, yeah, th' 1st addressess "surgery" yet the 2nd addressess "concerns" vs. "fears."

[Elizabeth Hanes, BSN, RN]

Well, I can see why the correct answer would be the first one. You want the patient to focus on expressing to you her specific fears about the surgery, so you can answer her questions and give her some peace of mind.

The second choice is too general. "Tell me what's worrying you" is vague. You want her to open up about her surgery fears, not about, say, her financial anxieties.

I agree, though, that there's a very fine distinction between the two choices -- too fine a line, if you ask me.

[bowkerj]

I would chose the first as well. My thought process is: I already know what's bothering her since she is asking questions about the procedure - so I wouldn't say, "Tell me what's bothering you..." because I already know what her concern is. I would ask her to elaborate on her fears regarding surgery.

I can see how this is a very tricky question though, it is hard to tell what to chose!

[BoonersmomRN]

Thanks you all...helps with the rationale! Questions like this make me want to pull my hair right out of my head!

[Marie_LPN, RN, LPN, RN]

The first answer gets to the point.

[EricJRN, MSN, RN]

BoonersMom,

I'm with you on this one for three reasons.

First reason: The first answer seems to assume too much. It's not open-ended enough. The patient might have fears about something other than the surgery itself, and choice #2 would better elicit that information. Ex: The pt may be worried about whether she can drive or take care of her cat, or about the finances involved if the stay ends up being extended. You might not get that info if the pt thinks you're all business and only want to discuss the surgery itself.

Second reason: The phrase 'you seem concerned' shows that the nurse is paying attention and shows empathy.

Third reason: 'Can you tell me...' is phrased a little gentler than 'Tell me.'

The pt knows she is about to undergo surgery, so I don't think including the word 'surgery' in your questioning would be necessary.

If you use the principles of therapeutic communication, I think this one's pretty clear. Your instructor may have avoided going in depth because she wasn't confident with the material. It doesn't sound like this area is her strong point.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

Questions like these are the reasons why I don't miss nursing school!

[jgwe4e]

I agree with EricEnfermero. I'd choose the second answer. The first answer labels her emotion as fear and assumes the cause is surgery. Following principles of therapeutic communication you would not assume you know what she is feeling or why. I also agree that "can you tell me" sounds gentler and would be more appropriate.

[DecafMom]

I would have chosen the second answer, and I'm pretty certain my instructor would as well. It has been beaten into our heads to never assume that we know what is going on, and to always ask open-ended questions. It just proves my point that a lot of nursing questions are subjective.

[SFCardiacRN]

Nursing school is teaching you critical thinking. That is the rationale for the first question being "right". In actuality, I think the second is better. The patient may have other concerns. Perhaps they've changed their mind about code status!

[ava'smomRN]

i would have chosen the first one also, becaues like someone said, its obvoius her concerns are about the surgery. though soemthing else may be bothering her also, its better to get to the issue at hand first and thats her surgery