1.

CUTTING AND DISSECTING

- These surgical instruments are sharp and are used to cut body tissue or surgical supplies.

NAMES DEFINITION AND USES

1. KNIFE/SCALPEL, BLADE - Holds scalpel blade.

- Act as a handle

DIFFERENT SURGICAL
BLADE ACCORDING TO
SIZES.

 SCALPEL #3 fits blade #9

- #17
 SCALPEL #4 fits blade
#18 - #26
SURGICAL SCISSORS

 MAYO STRAIGHT
SCISSOR

- also known as “suture scissor.

- it is used to cut sutures, dressings and drains.
-It has heavy blades.

 MAYO CURVED - It is used to cut or dissect heavy tissue and muscle.

SCISSOR - It has heavy curved blades.

 METZENBAUM - also known as “METZ”.

SCISSOR - It is used to cut and dissect delicate tissues.
- It has delicate blades, not suitable for cutting sutures, drains or
heavy tissues.

 LISTER BANDAGE - It is used to remove bandages and dressings.

SCISSOR - Probe tip is blunt; inserted under bandages with relative safety

 IRIS SCISSOR - It is made with sharp tips and are perfect for precise vascular and
neurological dissection and cutting of fine tissues.
- it is also widely used for opthalmic surgeries.

- Its jaws may be straight or cuved.

2.CLAMPING AND OCCLUDING
 These surgical instruments are used to compress blood vessels or hollow organs for
hemostasis or to prevent spillage of contents.
NAMES DEFINITION AND USES

 HEMOSTAT It is used to clamp small blood vessels or tag sutures. Its jaws may
be straight or curved.
- other name: CRILE, MOSQUITO, SNAP OR STAT

 KELLY - It is used to clamp larger blood vessels and tissues.

- available in short and long sizes.

- its jaws may be straight or curved.

Other name: ROCHESTER PEAN.

 RIGHT ANGLE - It is used to clamp hard to reach vessels and to place sutures
behind or around a vessel.

- a right angle with a suture attached is called a “tie on a passer”.

- other name: MIXTER

 HEMOCLIP APPLIER - it applies metal clips onto blood vessels and ducts which will
WITH HEMOCLIPS remain occluded.

3.GRASPING AND HOLDING

 It is a surgical instruments used to hold tissues. Drapes or sponges.

 ALLIS - it is used to grasp tissue.

- available in short and long sizes.

- “JUDD-ALLIS” holds intestinal tissue.

- “HEAVY ALLIS” holds breast tissue.

 BABCOCK - It is used to grasp delicate tissues such as intestine,

fallopian tube, ovary, appendix.

- Available in short and long sizes

 KOCHER - It is used for grasping tough, fibrous, slippery
tissues such as muscle and fascia. It may also be
used as a clamp.

- the jaws may be straight or curved. It has

horizontal serrations and one to two large inter
linking teeth at the tip.
Straight
- other name: OCHSNER

Curved

 FOERSTER SPONGE STICK - It is used to grasp sponges.

Foerster sponge forceps are imperative for
gynecologic surgery. Sponge forceps look like oval
tips and have serrations, the Foerster is utilized to
grip sponges throughout the surgical procedure. The
term Foerster is a symbolic term in German for
commitment to quality and precision. The ratchet
handle empowers the surgeon to grip the sponges
strongly.
- other name: SPONGE FORCEP

 BACKHAUS TOWEL CLIP - It is used to hold towels and drapes in place.

- The basic towel clamp design includes locking

handles and a tip, which may be curved or pointed,
and may have teeth for traction.

- other name: towel clip

 PICK UPS, THUMB FORCEPS AND - available in various lengths, with or with or
TISSUE FORCEPS without teeth, and smooth or serrated jaws.

THUMB FORCEP
- used to hold tissue in place when applying sutures.
- used to gently move tissues out of the way during
exploratory surgery.
- used to insert packing into or remove objects from
deep cavities.

TISSUE FORCEP

- Used for grasping and holding tissue, muscle or

skin surrounding a wound or incision.

 RUSSIAN TISSUE FORCEP - used to grasp tissue.

- to approximate tissue during wound closure.( eg.

Abdominal wall, fascia, uterus).

- to lift clots when evacuating hematomas

 ADSON PICK UP FORCEP - Used to grasp delicate tissue.

- with teeth; used to grasp the skin.

- other name: DURA FORCEP, BUNNY FORCEP

 DEBAKEY FORCEPS - Used to grasp delicate tissue particularly in

cardiovascular surgery.

 MAYO-HEGAR NEEDLE HOLDER - Used to hold needles when suturing. It has groove
to hold needle within jaws.

- they may also be placed in the sewing category.

4.RETRACTING AND EXPOSING INSTRUMENTS

- These are used to hold back or retract organs or tissue to gain exposure to the operative site. They are
either “self-retaining” (stay open on their own) or “manual” (held by hand). when identifying
retractors, look at the blade, not the handle.

 DEAVER RETRACTOR (manual) - is used to retract deep abdominal or chest

incisions. Available in various widths.

 RICHARDSON RETRACTOR (manual) Is used to retract deep abdominal or chest incisions.

 ARMY-NAVY RETRACTOR (manual) - is used to retract shallow or superficial incisions.

- other name: USA, US army.

 GOULET RETRACTOR (manual) - is used to retract shallow and superficial incisions.

 MALLEABLE OR RIBBON RETRACTOR - is used to retract deep wounds or incision. May be bent to
(manual) various shapes.

 WEITLANER RETRACTOR (self-retaining) - is used to retract shallow incisions.

 GELPI RETRACTOR (self-retaining) - is used to retract shallow incisions.

- fairly traumatic. It is NOT used to retract soft tissue

surgery.

- often used for orthopedic and neurological procedures.

- is used to retract wound edges during deep abdominal

procedures.
 BALFOUR WITH BLADDER BLADE (self-
retaining)
OTHER COMMON SURGICAL INSTRUMENTS
 STAPLERS AND CLIPS

Used for reanastomosis of viscera, vessel ligation, and excision of specimens. Can be one-time use, reloadable,
manual, or electronically powered. Staples come in multiple sizes.

- Creates a linear staple line; no cutting function.

Used in ligation and anastomosis. May be curved.
 Linear Stapler

 Linear Cutter

- Creates a linear cut and immediately staples both

free edges. Used in separation and anastomosis.

Circular Cutter

- Performs circular cut and staple. Used in

reanastomosis of hollow viscera, e.g., large bowel.

Clips

- Used in the ligation of vessels, may be metal or

absorbable material. Open and lap applicators.

ENERGY SYSTEMS

- Broad term used to describe various methods of cutting tissue or sealing vessels. May use electricity or sonic
waves. Available in open or laparoscopic forms.
Electrosurgery - Instrument that cuts or cauterizes tissue via an alternating
electrical current. Open (shown) and laparoscopic
(Ligasure®) applications.

- Other name: CAUTERY PENCIL

Ultrasonic: (Harmonic®) - uses high-frequency sound to concurrently cut and

seal tissue. Less thermal spread than electrosurgery,
but more time consuming.

Endostapler - Used in laparoscopic procedures, provides

simultaneous cutting and stapling. May be manual or
electronic. Some feature articulating heads to
accomplish more difficult placement.

LAPAROSCOPIC INSTRUMENTS

- Many instruments are similar to those used in open surgery, adapted to fit through narrow ports placed through the
skin. Laparoscopic work is then conducted via the ports.

 Camera - The camera is the hand-held component and

connects to a variety of lenses. There are usually
settings for focus and white balance.

 Lens - Available in multiple viewing angles to achieve

better visualization of anatomical structures. May
require occasional defogging.

Light Source - Fiber optic cable connects to lens and illuminates

field of vision. Caution around internal structures as
light output can be hot.

Insufflator - Injects carbon dioxide into the abdominal cavity to create a

working space for trocar placement and surgical procedures

Veress Needle: -One method of achieving pneumoperitoneum.

Consists of blind placement of needle into abdomen
and subsequent injection of gas.

- available in three length: 80 mm, 100 mm and 120

mm.
 Trocars - Trans-abdominal working ports where laparoscopic
instruments are inserted. Also for insufflation or
removal of specimens. Available in multiple sizes,
e.g., 5 mm, 10mm, and 12 mm.

Laparoscopic Instruments - Hand-held and shafted implements used to work

through trocars. Can perform grasping, retracting,
cutting, cauterizing, and other

MAJOR SURGICAL INSTRUMENTS MINOR SURGICAL INSTRUMENTS

 Kelly curved  Kelly curved
 Kelly straight  Kelly straight
 Hemostat/mosquito curved  Hemostat/mosquito curved
 Hemostat/mosquito straight  Hemostat/mosquito straight
 Allis  Towel clips
 Towel clips  Thumb forcep
 Pean curved  Tissue forcep
 Pean straight  Army navy retractor
 Thumb forcep  Scalpel #3
 Tissue forcep  Scalpel #4
 Richardson retractor
 Baby richardson retractor
 Scalpel #3
 Scalpel #4
NOTE: Philippine setting

PRIOR TO THE START OF THE CASE:

 Check all instruments to ensure that they are free of bio-burden (tissue, blood, or other debris). Any
instrument found to contain bio-burden must be removed and replaced. In some cases, it may be
necessary to replace the entire tray.
 Check all instruments to ensure that they are in good working order. Inspect tips for mal-alignment.
Check scope shafts to ensure that they are straight (not bent or warped), and inspect ratchet for proper
closure. If you find a damaged instrument, remove it from the field immediately and get a
replacement that is in good working order. Never use a damaged instrument on a patient.
 Do not place heavy instruments on top of delicate ones.
 Never place rigid endoscopes beneath other instruments as this could cause bending or warping of the
shaft. Separate rigid endoscopes into their own tray which has holders to keep the shafts straight.
DURING THE CASE:
 Do not use saline to wipe or soak instruments, it can corrode or pit the metal. Wipe instruments clean
or place them in a soaking basin that contains sterile water.
 Do not place a damaged instrument back on the tray. Set it aside and get another one.
 Do not use an instrument for any function other than the one for which it was designed. ( e.g, don’t
use metzenbaum scissor to cut dressings). such use can damage the instrument.
 Do not toss or drop instruments onto the table. Handle them carefully.

AT THE END OF THE CASE:

 Tag damaged instruments according to institutional policy. Set them aside for repair.
 Place heavy instruments on the bottom of the tray and place more delicate instruments on the top.
 Separate rigid endoscopes from other instruments and return them in their storage cases. This action
protects the endoscopes from potential bending and damage.
 Clean and process all instruments according to the manufacturer;s recommendations and following
institutional policy.

BLADE
MAYO CURVE
MAYO STRAIGHT
KELLY CURVE (4)
ALLIS (4)
NEEDLE HOLDER (2)
THUMB FORCEP
TISSUE FORCEP

THERAPEUTIC COMMUNICATION TECHNIQUES

Technique Examples Rationale
Accepting— “Yes.” “I follow what An accepting response indicates the nurse
indicating you said.” Nodding has heard and followed the train of
reception thought. It does not indicate agreement
but is nonjudgmental. Facial expression,
tone of voice, and so forth also must
convey acceptance or the words lose their
meaning.
Broad openings “Is there something Broad openings make it explicit that the
— allowing the you’d like to talk client has the lead in the interaction. For
client to take about?” the client who is hesitant about talking,
the initiative in “Where would you broad openings may
introducing the like to stimulate him or her to take the initiative.
topic begin?”
Consensual “Tell me whether For verbal communication to be
validation— my understanding meaningful, it is essential that the words
searching for of it agrees with being used have the same meaning for
mutual yours.” “Are you both or all participants. Sometimes, words,
understanding, using this word to phrases, or slang terms have different
for accord in the convey that…?” meanings to different people and can be
meaning of the easily
words misunderstood.
Encouraging “Was it Comparing ideas, experiences, or
comparison— something relationships brings out many recurring
asking that like…?” “Have themes. The client benefits from making
similarities and you had these comparisons because he or she
differences be similar might recall past coping strategies that
noted experiences?” were effective or remember that he or
she has survived a
similar situation.
Encouraging “Tell me when you To understand the client, the nurse must
description of feel anxious.” see things from his or her perspective.
perceptions— “What is Encouraging the client to fully describe
asking the happening?” ideas may relieve the tension the client is
client to “What does the feeling, and he or she might be less likely
verbalize what voice seem to be to
he or she saying?” take action on ideas that are harmful or
perceives frightening.
Encouraging “What are The nurse asks the client to consider
expression— your feelings people and events in light of his or her
asking the in regard own values. Doing so encourages the
client to to…?” client to make his or her own appraisal
appraise the “Does this contribute rather than to accept the opinion of
quality of his to your distress?” others.
or her
experiences

Exploring— “Tell me more about When clients deal with topics superficially,
delving further that.” “Would you exploring can help them examine the issue
into a subject or describe it more fully?” more fully. Any problem or concern can be
an idea “What kind of work?” better understood if explored in depth. If the
client expresses an unwillingness to explore a
subject, however, the nurse must respect his or
her wishes.
Focusing— “This point seems The nurse encourages the client to
concentrating on worth looking at more concentrate his or her energies on a single
a single point closely.” point, which may prevent a multitude of
“Of all the concerns factors or problems from overwhelming the
you’ve mentioned, client. It is also a useful technique when a
which is most client jumps from one topic to another.
troublesome?”
Formulating a “What could you do to It may be helpful for the client to plan in
plan of action— let your anger out advance what he or she might do in future
asking the client harmlessly?” similar situations. Making definite plans
to consider kinds “Next time this comes increases the likelihood that the client will
of behavior likely up, what might you do cope more effectively in a similar situation.
to be appropriate to handle it?”
in future
situations
General leads “Go on.” “And General leads indicate that the nurse is
— giving then?” “Tell listening and following what the client is
encourageme me about it.” saying without taking away the initiative for
nt to continue the interaction. They also encourage the client
to continue if he or she is hesitant or
uncomfortable about the topic.
Giving “My name is …” Informing the client of facts increases his or
information — “Visiting hours are …” her knowledge about a topic or lets the client
making available “My purpose in being know what to expect. The nurse is functioning
the facts that the here is …” as a resource person. Giving information also
client needs builds trust with the client.
Giving “Good morning, Mr. S Greeting the client by name, indicating
recognition — …” “You’ve finished awareness of change, or noting efforts the
acknowledging, your list of things to client has made all show that the nurse
indicating do.” recognizes the client as a person, as an
awareness “I notice that you’ve individual. Such recognition does not carry the
combed your hair.” notion of value, that is, of being “good” or
“bad.”
Making “You appear tense.” Sometimes clients cannot verbalize or make
observations— “Are you themselves understood. Or the client may not
verbalizing what uncomfortable be ready to talk.
the nurse when…?”
perceives “I notice that you’re
biting your
lip.”
Offering self— “I’ll sit with you The nurse can offer his or her presence,
making oneself awhile.” “I’ll interest, and desire to understand. It is
available stay here with important that this offer is unconditional; that
you.” is, the client does not have to respond
“I’m interested in verbally to get the nurse’s
what you think.” attention.
Placing event in What seemed to lead Putting events in proper sequence helps both
time or sequence up to…?” “Was this the nurse and the client to see them in
—clarifying the before or after…?” perspective. The client may gain insight into
relationship of “When did this cause-and-effect behavior and consequences
events in time “ happen?” or the client may be able to see that perhaps
some things are not related. The nurse may
gain information about
recurrent patterns or themes in the client’s
behavior
Presenting reality “I see no one else in the When it is obvious that the client is
— offering for room.” “That sound misinterpreting reality, the nurse can indicate
consideration that was a car what is real. The nurse does this by calmly
which is real backfiring.” “Your and quietly expressing his or her perceptions
mother is not here; I or the facts, not by way of arguing with the
am a nurse.” client or belittling his or her experience. The
intent is to indicate an alternative line of
thought for the client to consider, not to
“convince” the client
that he or she is wrong.
Reflecting— Client: “Do you think I Reflection encourages the client to recognize
directing client should tell the and accept his or her own feelings. The nurse
actions, thoughts, doctor…?” indicates that the client’s point of view has
and feelings back Nurse: “Do you think value and that the client has the right to have
to client you should?” opinions, make decisions, and think
Client: “My brother independently.
spends all my money
and then has nerve to
ask for more.”
Nurse: “This causes you
to feel
angry?”
Restating— Client: “I can’t sleep. I The nurse repeats what the client has said in
repeating the stay awake all night.” approximately or nearly the same words the
main idea Nurse: “You have client has used. This restatement lets the
expressed difficulty sleeping.” client know that he or she communicated the
Client: “I’m really mad, idea effectively. This encourages the client to
I’m really upset.” continue. Or if the client has been
Nurse: “You’re really misunderstood, he or she can clarify his or
mad and her thoughts.
upset.”
Seeking “I’m not sure that I The nurse should seek clarification
information— follow.” “Have I heard throughout interactions with clients. Doing so
seeking to make you correctly?” can help the nurse to avoid making
clear that which is assumptions that understanding has occurred
not meaningful or when it has not. It helps the client
that which articulate thoughts, feelings, and ideas more
is vague clearly.

Silence—absence Nurse says nothing but

Silence often encourages the client to
of verbal continues to maintainverbalize, provided that it is interested and
communication, eye contact and expectant. Silence gives the client time to
which provides conveys interest. organize thoughts, direct the topic of
time for the client interaction, or focus on issues that are most
to put thoughts or important. Much nonverbal behavior takes
feelings into place during silence, and the nurse needs to
words, to regain be aware of
composure, or to the client and his or her own nonverbal
continue talking behavior.
Suggesting “Perhaps you and I can The nurse seeks to offer a relationship in
collaboration— discuss and discover which the client can identify problems in
offering to share, the triggers for your living with others, grow emotionally, and
to strive, and to anxiety.” improve the ability to form satisfactory
work with the “Let’s go to your room, relationships. The nurse offers to do things
client for his or her
and I’ll help you find with, rather than for, the client.
benefit what you’re
looking for.”
Summarizing— “Have I got this Summarization seeks to bring out the
organizing and straight?” important points of the discussion and seeks
summing up that “You’ve said that….” to increase the awareness and understanding
which has gone “During the past hour, of both participants. It omits the irrelevant
before you and I have and organizes the pertinent aspects of the
discussed….” interaction. It allows both client and
nurse to depart with the same ideas and
provides a sense of closure at the completion
of each discussion.
Translating into Client: “I’m dead.” Often what the client says, when taken
feelings—seeking Nurse: “Are you literally, seems meaningless or far removed
to suggesting that you feel from reality. To understand, the nurse must
verbalize client’s lifeless?” concentrate on what the client might be
feelings that he or Client: “I’m way out in feeling to express him or herself this way.
she expresses only the ocean.”
indirectly Nurse: “You seem to
feel lonely
or deserted.”
Verbalizing the Client: “I can’t talk to Putting into words what the client has implied
implied— voicing you or anyone. It’s a or said indirectly tends to make the discussion
what the client has waste of time.” less obscure. The nurse should be as direct as
hinted at or Nurse: “Do you feel possible without being unfeelingly blunt or
suggested that no one obtuse. The client may have difficulty
understands?” communicating directly. The nurse should
take care to express only what is fairly
obvious; otherwise, the nurse may be
jumping to
conclusions or interpreting the client’s
communication.
Voicing doubt— “Isn’t that unusual?” Another means of responding to distortions
expressing “Really?” “That’s hard of reality is to express doubt. Such expression
uncertainty about to believe.” permits the client to become aware that
the reality of the others do not necessarily perceive events in
client’s the same way or draw the same conclusions.
perceptions This does not mean the client will alter his or
her point of view, but at least the nurse will
encourage the client to reconsider or
reevaluate what has happened.

NONTHERAPEUTIC COMMUNICATION TECHNIQUES

Techniques Examples Rationale
Advising—telling the “I think you should …” Giving advice implies that only the nurse
client what to do “Why don’t you …” knows what is best for the client.
Agreeing— “That Approval indicates the client is “right”
indicating accord ’s rather than
with the client right. “wrong.” This gives the client the
” “I impression that he or she is “right”
agre because of agreement with the nurse.
e.” Opinions and conclusions should be
exclusively the client’s. When the nurse
agrees with the client, there is no
opportunity for the client to change his
or her mind without being “wrong.”
Belittling feelings Client: “I have nothing to When the nurse tries to equate the
expressed— live for intense and overwhelming feelings the
misjudging the … I wish I was dead.” client has expressed to “everybody” or to
degree of the Nurse: “Everybody gets the nurse’s own feelings, the nurse
client’s implies that the discomfort is temporary,
down in
discomfort mild, self-limiting, or not that important.
the dumps,” or “I’ve felt
The client is focused on his or her own
that way myself.”
worries and feelings; hearing the
problems or feelings of others is not
helpful.
Challenging— “But how can you be Often, the nurse believes that if he or she
demanding proof president of the United can challenge the client to prove
from the client States?” “If you’re dead, unrealistic ideas, the client will realize
why is your heart there is no “proof” and then will
recognize reality. Actually, challenging
beating?”
causes the client to defend the delusions
or misperceptions more strongly than
before.
Defending— “This hospital has a fine Defending what the client has criticized
attempting to reputation.” implies that he or she has no right to
protect someone or “I’m sure your doctor has express impressions, opinions, or
something from your best interests in feelings. Telling the client that his or her
verbal attack criticism is unjust or unfounded does not
mind.”.
change the client’s feelings but only
serves to block further communication
Disagreeing— That’s wrong.” “I definitely Disagreeing implies the client is “wrong.”
opposing the disagree with …” “I don’t Consequently, the client feels defensive
client’s ideas “ believe that.” about his or her point of view or ideas.
Disapproving— “That’s bad.” “I’d rather Disapproval implies that the nurse has
denouncing the the right to pass judgment on the client’s
client’s behavior or you wouldn’t …” thoughts or actions. It further implies
ideas that the client is expected to please the
nurse.
Giving approval— “That’s good.” “I’m glad Approval, then, tends to limit the client’s
sanctioning the that …” Saying what the freedom to think, speak, or act in a
client’s behavior or client thinks or feels is certain way. This can lead to the client’s
ideas “good” implies that the acting in a particular way just to please
the nurse.
opposite is “bad.”
Giving literal Client: “They’re looking in Often, the client is at a loss to describe
responses— my his or her feelings, so such comments are
responding to a head with a television the best he or she can do. Usually, it is
figurative comment camera.”Nurse: “Try not to helpful for the nurse to focus on the
as though it were a client’s feelings in response to such
watch television” or “What
statement of fact statements.
channel?”
Indicating the “What makes you say The nurse can ask, “What happened?” or
existence of an that?” “What made you do “What events led you to draw such a
external source— that?” “Who told you that conclusion?”However, to question,
attributing the you were a prophet?” “What made you think that?” implies that
source of thoughts, the client was made or compelled to
feelings, and think in a certain way. Usually, the nurse
behaviors to others does not intend to suggest that the
or to outside source is external, but
influences that is often what the client thinks.
Interpreting—asking “What you really mean is The client’s thoughts and feelings are his
to make conscious …” or her own, not to be interpreted by the
that which is nurse for hidden meaning. Only the client
“Unconsciously you’re
unconscious; telling can identify or confirm the presence of
the client the meaning saying …”
feelings.
of his or her
experience
Introducing an Client: “I’d like to die.” The nurse takes the initiative for the
unrelated topic— Nurse: “Did you last interaction away from the client. This
evening?” usually happens because the nurse is
uncomfortable, doesn’t know how to
respond, or has a topic he or she would
rather discuss. The client’s thoughts and
feelings are his or her own, not to be
interpreted by the nurse for hidden
meaning. Only the client can identify or
confirm the presence of feelings.
Making “It’s for your own good.” Social conversation contains many
stereotyped “Keep your chin up.” “Just clichés and much meaningless chit-chat.
comments—offering have a positive attitude Such comments are of no value in the
meaningless clichés and you’ll be better in no nurse–client relationship. Any automatic
or trite comments responses lack the nurse’s consideration
time.”
or thoughtfulness.
Probing—persistent “Now tell me about this Probing tends to make the client feel
questioning of the problem. You know I used or invaded. Clients have the right
client have to find out.” “Tell not to talk about issues or concerns if
me your they choose. Pushing and probing by
psychiatric history.” the nurse will not encourage the client
to talk.
Reassuring— “I wouldn’t worry about Attempts to dispel the client’s anxiety
indicating there is that.” “Everything will be by implying that there is not sufficient
no reason for alright.” reason for concern completely devalue
anxiety or other “You’re coming along the client’s feelings. Vague reassurances
feelings of just fine.” without accompanying facts are
discomfort meaningless to the client.
Rejecting— “Let’s not discuss …” “I When the nurse rejects any topic, he or
refusing to don’t want to hear about she closes it off from exploration. In
consider or …” turn, the client may feel personally
showing rejected along with his or her ideas.
contempt for
the client’s
ideas or behaviors
Requesting an “Why do you think There is a difference between asking the
explanation— that?” “Why do you feel client to describe what is occurring or has
asking the client to that way?” ta
provide reasons for ken place and asking him or her to
thoughts, feelings, explain why. Usually, a “why” question is
behaviors, and intimidating. In addition, the client is
events unlikely to know “why” and may become
defensive
trying to explain him or herself.
Testing—appraising “Do you know what kind These types of questions force the client
the client’s degree of hospital this is?” “Do to try to recognize his or her problems.
of insight you still have the idea The client’s
that…?” acknowledgment that he or she doesn’t
know these things may meet the nurse’s
needs but is not helpful
for the client.
Using denial— Client: “I’m nothing.” The nurse denies the client’s feelings or
refusing to admit Nurse: “Of course you’re the seriousness of the situation by
that a problem course you’re something— dismissing his or her comments without
exists everybody’s attempting to discover the feelings or
something.” Client: “I’m meaning behind them.
dead.”
Nurse: “Don’t be silly.”