Which answer would you pick?

i do not like either answer. first off, what the heck is wrong with asking your nurse about what is normal before and after surgery? i have not met too many people that are not concerned before surgery.

[color=yellow]steelers are the super bowl champs!!

(Wasn't the Superbowl over last month?!)

To the OP, please let us know what the professor says the rationale for the answer is when they let you know?

Sure thing.....I have her for clinical on Thurs so if I get a moment I will question her again about it and tell her where I was coming from- my rationale matched the one saying it's more open ended and that the fears weren't necessarity about the surgery itself.

I pulled a 89 on the test...my first B- but considering what the rest of the test was like ( not easy) I'm happy with it.

I know this isn't one of the choices, but what would be so wrong in answering the questions she actually had rather than ignoring them

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.

And I'm with you, Eric.

This is where these types of questions get me. I think the second answer is more appropriate, and I would be more likely to personally respond to it. "Tell me your fears about the surgery" is a demand and doesn't seem very therapeutic to me. I would ask the patient her concerns and guide the conversation to get at the real problem. I mean, if a nurse walks into your room and says, "You seem concerned", it seems obvious to me that the understood subject is "about the surgery". I don't think she'd be asking me if I was concerned about my car trouble, or my sick dog, or that my kid just got a nose piercing, or the state of affairs in the Middle East!

Doesn't basic interpersonal psychology tell you that to get a person to open up, show a bit of empathy? Mirror their expressions? Approach carefully?

I don't like this question, and I would stick to this approach in the real world. I'd tell them (instructors, NCLEX, whoever) what they want to hear, but I don't think I'd do that in practice.

I would've picked the 2nd one as well because that question can't be phrased more therepeutic. I think the 1st one is too "assuming" and like others have pointed out - you can't assume her worries is about the surgery as it very well might be about what happens after the surgery when she goes back home. She might be worried about working, her family, etc.... The 2nd options gets her to open up and tell you what is wrong.

We had a question like that once and the teacher said the book was wrong and she also agreed with us - you want the patient to open up and you never want to "assume" anything.

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.

Agreed. To label a patient with fears of upcoming surgery in a conversation violates what we were taught about therapeutic communication. But like you say it's all subjective and they can argue an answer any which way they want to, which is why there's no point in getting worked up about it... they're going to do this to you until you graduate. Fun ain't it?

I'd go with the second one too. If I was upset before a procedure and my nurse came at me with "Tell me your fears about the surgery" I'd cordially invite him/her to bite me. I mean...I get the rationale behind the first answer being correct, but that doesn't mean it's right, KWIM?

I would go with number 1. Because saying that she has "concerns" is like saying nursing school has a "bit" of homework.

You don't want to minimize her feelings.

(although, if i was in the postion, i would probably say "can you tell me what your fears are....")

Also, 'tell me your fears about the surgery' is a bit like asking for clarification of the obvious. Uh, let's see. Anesthesia, sharp objects, invasive procedure, pain, infection, failure to heal, pain, surgery doesn't work, pain.... aren't the fears pretty universal? Asking the more open ended question #2 makes more sense to me, assuming that you are actually interested in your patient's more specific concerns as to how this procedure will impact her life.

From Potter, Perry Fundamentals Of Nursing:

Sharing Observations

Nurses make observations by commenting on how the other person looks, sounds, or acts. Stating observations often helps the lient communicate without the need for extensive questioning, focusing, or clarification. This technique can help start a conversation with quiet or withdrown persons. The nurse does not state observations that might embarrass or anger the client, such as telling someone "You look a mess!" Even if such an observation is made with humor, the client can become resentful.

Sharing observations differs from making assumption, which means drawing unwarranted conclusions about the other person without validating them. Makin assumptions puts the client in the position of having to contradict the nurse. Examples might include the nurse interpretting fatigue as depression or assuming that untouched food indicates llack of interest in meeting nutritional goals. Making observations is a gentler and safer technique: "You look tired...," "You seem different today...," "I see you haven't eaten anything."

(Then under the heading of Asking for Explanations)... "You seem upset. What's on your mind?" is more likely to help the anzious client to communicate.

I went through all of this because I would have picked the second choice instantly. Plus the question said she was asking pre0op and post-op questions. Post-op isnt so focused on the surgery, but on what to expect, maybe diet concerns, maybe a friend died from this type of surgery, maybe they dont know how they will be able to get around, what do they do if they have to pee, when can I eat? (of course, lots more) Focusing on the surgery gives the client the expectation that the nurse is only interested in those specific concerns. Poop on that question!

Poop on that question!

Couldn't have said it better! In my family lingo, that question goes on the poophead list!

Poophead list: the continuously updated and rearranged list of men (and things) what done me wrong. My momma's the keeper of the list.