NMC CBT Communication and Interpersonal Skills 2 — Questions and Answers
Question 1: A patient with limited English proficiency is admitted. According to NMC standards, what is the most appropriate approach for effective communication?
- Ask a family member to interpret during clinical discussions
- Use professional interpreter services for all significant clinical conversations (Correct answer)
- Speak slowly and loudly to help the patient understand
- Use medical terminology as it is more universal
Correct answer: Use professional interpreter services for all significant clinical conversations
Professional interpreter services should be used for significant clinical conversations to ensure accurate, confidential, and unbiased communication.
The NMC Code requires clear communication using a range of methods. Professional interpreters (face-to-face or telephone) ensure accuracy for significant conversations such as consent, diagnosis, and treatment plans. Family members may censor or misinterpret information. Children should never interpret. Written translated materials and visual aids can supplement verbal communication.
Question 2: When breaking bad news, which communication framework is recommended for structuring the conversation?
- The SBAR framework
- The SPIKES protocol (Correct answer)
- The NEWS2 assessment tool
- The ABCDE approach
Correct answer: The SPIKES protocol
The SPIKES protocol (Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary) is widely used for breaking bad news.
SPIKES provides a structured approach: Setting (private room, sitting down); Perception (what the patient already knows); Invitation (how much they want to know); Knowledge (clear, simple information in small chunks); Emotions (acknowledge with empathy); Strategy/Summary (next steps). SBAR is for clinical handover, not breaking bad news.
Question 3: A nurse uses the SBAR tool to hand over a deteriorating patient. What does the 'R' in SBAR stand for?
- Response
- Recommendation (Correct answer)
- Review
- Report
Correct answer: Recommendation
In SBAR, 'R' stands for Recommendation, where the nurse states what they believe should happen next.
SBAR: Situation (what is happening now), Background (relevant clinical history), Assessment (what the nurse thinks the problem is), Recommendation (what the nurse suggests should happen). The Recommendation component empowers nurses to advocate clearly, e.g., 'I recommend urgent review.' SBAR is endorsed by NHS Improvement.
Question 4: When documenting in nursing notes, which principle must be followed according to NMC record-keeping standards?
- Records should be completed at the end of the shift
- Entries should be made as soon as possible after the event (Correct answer)
- Abbreviations should be used freely to save time
- Only significant events need documenting
Correct answer: Entries should be made as soon as possible after the event
NMC standards require entries as soon as possible after the event to ensure accuracy and completeness.
The NMC Code requires clear and accurate records. Principles include: record close to the event; write clearly and legibly; include date, time, and signature; avoid unapproved abbreviations; document assessments, decisions, actions, and outcomes; never alter or destroy records. All care interactions should be documented, not just significant events.
Question 5: A patient becomes angry and shouts about waiting times. What is the most appropriate initial response?
- Firmly tell the patient their behaviour is unacceptable
- Acknowledge their frustration and use active listening to de-escalate (Correct answer)
- Walk away and return when they've calmed down
- Contact security immediately
Correct answer: Acknowledge their frustration and use active listening to de-escalate
Acknowledging frustration and using active listening demonstrates empathy and is the most effective initial de-escalation strategy.
De-escalation techniques: acknowledge feelings; use a calm, even tone; maintain open body language; actively listen without interrupting; use empathetic statements; offer practical solutions. This validates emotions and reduces anger. If it escalates despite de-escalation, ensure safety, set clear boundaries, and involve senior staff or security.
Question 6: Which best describes 'therapeutic communication' in nursing practice?
- Communication focused on gathering clinical data efficiently
- Purposeful interaction that promotes the patient's wellbeing and supports the nurse-patient relationship (Correct answer)
- Verbal communication using only open-ended questions
- Communication that occurs exclusively during formal assessments
Correct answer: Purposeful interaction that promotes the patient's wellbeing and supports the nurse-patient relationship
Therapeutic communication is purposeful, patient-centred interaction that promotes wellbeing and builds the therapeutic relationship.
Therapeutic communication includes: active listening; open-ended questioning; reflecting and paraphrasing; appropriate silence; empathy and genuineness; summarising; and non-verbal skills. It differs from social communication in being goal-directed, patient-focused, and within professional boundaries. The NMC Code emphasises treating people as individuals with dignity.
NMC CBT Communication and Interpersonal Skills 2
A patient with limited English proficiency is admitted.
According to NMC standards, what is the most appropriate approach for effective communication?