# Situation: A nurse supervises nursing students on the psychiatric ward of a general hospital. The clients include adults with mood disorders, psychotic disorders, and neurocognitive disorders. Before each shift, the nurse reviews communication skills with the students. A student's process recording with a 60-year-old widower who has major depressive disorder reads: Client (tearful): "My wife died last month, and now I'm here." Student: "Let's talk about the art group this afternoon." Which analysis of the student's response is accurate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630149  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A nurse supervises nursing students on the psychiatric ward of a general hospital. The clients include adults with mood disorders, psychotic disorders, and neurocognitive disorders. Before each shift, the nurse reviews communication skills with the students.

A student's process recording with a 60-year-old widower who has major depressive disorder reads:
Client (tearful): "My wife died last month, and now I'm here."
Student: "Let's talk about the art group this afternoon."
Which analysis of the student's response is accurate?

## 보기

1. It is focusing, which narrows a scattered talk to one topic
2. It is a stereotyped comment that gives only a shallow, stock reply
3. It is changing the subject, as it leaves the concern he raised **✔ 정답**
4. It is giving information that orients him to the ward day

**정답: 3**

## 해설

Changing the subject moves the talk away from what the client raised, often from the nurse's own discomfort. Focusing also directs the talk to one topic, but it stays with the client's concern; here the student left his grief for a topic the client had not raised.

## 심화 해설

Identifying the communication error
The client, tearful and recently widowed, has just raised the most important topic in his life right now: the death of his wife a month ago and his admission. The student answers by moving to the afternoon art group. This is changing the subject, a nontherapeutic response in which the nurse steers the conversation away from what the client raised. The response leaves his grief unacknowledged and tells him, without words, that his loss is not something the student is willing to hear.

Why students change the subject
Changing the subject is often driven by the nurse's own discomfort rather than by any clinical reason. Grief, tears, and talk of death can make a beginning student anxious, and moving to a neutral topic relieves that anxiety for the student, not for the client. For a man with major depressive disorder who has suffered a recent loss, the effect can be harmful: he may conclude that his feelings are a burden, withdraw further, and become less willing to share hopeless or suicidal thoughts later. A process recording is valuable precisely because it lets the supervising nurse point out patterns like this so the student can recognize them.

Distinguishing focusing from changing the subject
Watch out! Focusing and changing the subject both narrow the conversation to one topic, so they are easy to confuse. The difference is whose topic it is. Focusing directs a scattered conversation toward a concern the client has raised, so the client can explore it in depth. Changing the subject moves to a topic the client did not raise and leaves the client's concern behind.

| Response | Whose topic | Effect |
| --- | --- | --- |
| Focusing | The client's own concern | Deepens discussion of what matters to the client |
| Changing the subject | A new topic chosen by the nurse | Avoids the client's concern and blocks communication |
| Stereotyped comment | No real topic; a cliche | Gives a shallow, stock reply such as "Hang in there" |
| Giving information | Facts the client needs | Therapeutic when the client needs or asks for the facts |

Why the other analyses are inaccurate
The reply was not a stereotyped comment, because it is not a cliche or empty reassurance; it is a shift of topic. Nor is it therapeutic giving information: the client did not ask about the ward schedule, and offering the timetable at this moment serves to avoid his feelings rather than meet an information need. A therapeutic alternative would stay with the feeling, for example, "You lost your wife only a month ago. That must be very painful," followed by silence or an open invitation to say more.

Exam takeaway
Key point! When a client raises a feeling or concern and the nurse's reply moves to an unrelated topic, label it changing the subject. Check whose concern the reply stays with: if it stays with the client's own concern, it is focusing; if it leaves it, it is changing the subject. With a grieving or depressed client, the therapeutic response acknowledges the loss and invites the client to talk.

## 임상 시나리오

Changing the SubjectReviewing a student's process recording
A tearful widower says his wife died last month. The student replies with the afternoon art group. Moving away from the concern the client raised is changing the subject, a nontherapeutic response.

Focusing also narrows the talk to one topic, but it stays with the client's own concern. The test is whose topic the reply follows.

A therapeutic reply acknowledges the loss, such as "You lost your wife only a month ago; that must be very hard," and then allows silence or invites him to say more.

CautionAvoiding grief with a depressed client can increase withdrawal and make him less likely to share hopeless or suicidal thoughts later.

## 핵심 개념

- **Changing the subject** — A nontherapeutic response that moves the conversation away from a concern the client raised.
- **Focusing** — A therapeutic technique that narrows a scattered conversation to one concern raised by the client.
- **Process recording** — A written, word-by-word account of a nurse-client interaction used to analyze communication.
- **Stereotyped comment** — A cliche or stock phrase that gives a shallow reply and discourages further talk.
- **Major depressive disorder** — A mood disorder with persistent low mood or loss of interest that impairs daily functioning.

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