Presence before questions
This client with schizophrenia sits silently on his bed, looking at the floor, and has already left two open-ended questions from the student unanswered this morning. The best response is to sit quietly with him, offering self and using therapeutic silence, which shows acceptance and leaves him free to speak when ready. Saying "I'll just sit here with you for a while" communicates that the nurse values him as a person and does not require him to perform or explain.
Why silence and offering self work
Offering self means making oneself available without conditions, such as "I'll stay with you." Therapeutic silence gives the client time to organize his thoughts and reduces pressure. Withdrawn clients and those who hear voices may find conversation demanding, and repeated questions can increase anxiety and withdrawal. A consistent, nondemanding presence builds the trust that later allows him to talk about his experiences.
| Response | Effect on this client |
|---|
| "How are you feeling right now?" | A third question after two unanswered ones adds pressure |
| "Let's go join the others in the dayroom." | Pushes a withdrawn client into a group too soon |
| "I'll just sit here with you for a while." | Shows acceptance without demanding speech |
| "You look sad. What's keeping you in here?" | Still demands an explanation he has not offered |
Why the other responses rank lower
Open-ended questions are generally therapeutic, but after two have gone unanswered, a third adds pressure on a silent client. Inviting him to the dayroom pushes him into group interaction before a one-to-one relationship has been built. Noting that he looks sad is a reasonable observation, but following it with "What's keeping you in here?" asks him to explain himself, which he has not offered to do. The nurse's presence comes first; questions and activities follow when he shows readiness.
Watch out! Therapeutic silence is not ignoring the client. The nurse stays attentive, maintains a relaxed posture, and observes for nonverbal cues, including signs that he may be responding to voices.
Exam takeaway
Key point! With a withdrawn, silent client, offer self and use therapeutic silence before asking more questions. Short, regular, nondemanding contacts build trust over time.