A patient has talked constantly throughout the group therapy ...

[fahad]

A patient has talked constantly throughout the group therapy session, often repeating the same comments. Other members were initially attentive then became bored, inattentive, and finally sullen. Which comment by the nurse leader would be most effective?
 
  a. Say to everyone, Most of you have become quiet. I wonder if it might be related to concerns you may have about how the group is progressing today.
  b. Say to everyone, One person has done most of the talking. I think it would be helpful for everyone to say how that has affected your experience of the group.
  c. Say to everyone, I noticed that as our group progressed, most members became quiet, then disinterested, and now seem almost angry. What is going on?
  d. Say to the talkative patient, You have been doing most of the talking, and others have not had a chance to speak as a result. Could you please yield to others now?

Question 2

During a group therapy session, a newly admitted patient suddenly says to the nurse, How old are you? You seem too young to be leading a group. Select the nurse's most appropriate response.
 
  a. I am wondering what leads you to ask. Please tell me more.
  b. I am old enough to be a nurse, which qualifies me to lead this group.
  c. My age is not pertinent to why we are here and should not concern you.
  d. You are wondering whether I have enough experience to lead this group?

[bpool94]

Answer to Question 1

ANS: A
The most effective action the nurse leader can take will be the one that encourages the group to solve its own problem. Pointing out changes in the group and asking members to respond to them lays the foundation for a discussion of group dynamics. Asking members to respond to the talkative patient puts that patient in an awkward position, likely increasing her anxiety. As anxiety increases, monopolizing behavior tends to increase as well, so this response would be self-defeating. Asking members what is going on is a broader opening and might lead to responses unrelated to the issue that bears addressing; narrowing the focus to the group process more directly addresses what is occurring in the group. Focusing on the talkative patient would be less effective and involves the leader addressing the issue instead of members first attempting to do so themselves (giving them a chance to practice skills such as assertive communication).

Answer to Question 2

ANS: D
A question such as this is common in the initial phase of group development when members are getting to know one another, dealing with trust issues, and testing the leader. Making explicit the implied serves to role model more effective communication and prompts further discussion of the patient's concern. Asking the patient to tell the leader more about the question focuses on the reason for the member's concern rather than on the issue raised (the experience and ability of the leader) and is a less helpful response. I am old enough to be a nurse and age is not pertinent are defensive responses and fail to address the patient's valid concern.