A nurse is caring for a patient with bipolar disorder who is in a manic phase and refuses to attend a scheduled group therapy session. Which response by the nurse best promotes therapeutic engagement?
“You have to attend the session, or you won’t make progress.”
“I’ll let your doctor know you’re refusing to participate.”
“Can you share what’s making you hesitant about group therapy today?”
“If you don’t go, you’ll miss out on important treatment.”
The Correct Answer is C
Choice A reason: Using coercive language, like stating attendance is mandatory for progress, undermines patient autonomy and may increase resistance, especially in a manic phase where defiance is common. This non-therapeutic approach hinders trust, making it incorrect for promoting engagement.
Choice B reason: Reporting refusal to the doctor without exploring the patient’s reasons dismisses their feelings and escalates authority rather than fostering collaboration. Therapeutic engagement requires understanding the patient’s perspective, making this response non-therapeutic and incorrect.
Choice C reason: Asking about the patient’s hesitation uses open-ended questioning, a therapeutic communication technique that encourages expression of feelings and builds trust. This aligns with psychiatric nursing principles to engage patients respectfully, especially during mania, making this the correct choice.
Choice D reason: Warning about missing treatment is mildly coercive and does not explore the patient’s reasons for refusal. It fails to address underlying concerns, such as anxiety or grandiosity, which are critical in mania, making this less therapeutic than exploring hesitancy.
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Correct Answer is B
Explanation
Choice A reason: Comparing the patient’s problems to others minimizes their experience, a non-therapeutic technique. It dismisses feelings, hindering trust and open communication, contrary to psychiatric nursing principles that emphasize validation, making this choice incorrect.
Choice B reason: Asking the patient to suggest solutions encourages self-reflection and empowerment, a therapeutic technique. It fosters autonomy and problem-solving, aligning with patient-centered care in mental health nursing, making this a correct choice for therapeutic communication.
Choice C reason: Expressing understanding and inviting further discussion validates the patient’s feelings, fostering trust. This empathetic, open-ended approach is a hallmark of therapeutic communication in psychiatric care, promoting a safe space for exploration, making this a correct choice.
Choice D reason: Suggesting the patient forget their problems is dismissive and non-therapeutic. It invalidates feelings and discourages exploration, contrary to psychiatric nursing goals of fostering insight and trust, making this choice incorrect for therapeutic communication.
Correct Answer is A
Explanation
Choice A reason: In Peplau’s orientation phase, the nurse establishes trust, fosters collaboration, and sets boundaries to build a therapeutic relationship. This foundation is critical for patients with psychiatric disorders, ensuring a safe space for engagement, making this the correct choice.
Choice B reason: Medication adherence is a clinical intervention addressed later, in the working phase, not orientation. The initial phase focuses on relationship-building, not specific treatments, making this choice incorrect for the orientation phase’s goals.
Choice C reason: Coping skill development occurs in the working phase, after trust is established. Orientation prioritizes relationship foundations like trust and boundaries, not skill-building, making this choice incorrect for the initial nurse-patient interaction phase.
Choice D reason: Long-term goals are addressed in the working or termination phases, not orientation, which focuses on establishing trust and rapport. Setting goals prematurely may hinder relationship-building, making this choice incorrect for the orientation phase.
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