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IBLCE Study Tip #7: Active Listening

I am still getting questions about how to answer counseling items on the exam. Let
me say that most of it boils down to Brammer & MacDonald’s classic framework:

  1. Listening (attending, paraphrasing, clarifying)
  2. Leading
  3. Reflecting
  4. Challenging
  5. Interpreting
  6. Informing

The key is to ask yourself, “What is going on here?” and then determine which of those six things you need to respond with.

OK, I am going to demonstrate some of these counseling methods and techniques by using a subject near and dear to your heart:

Candidate: Preparing for this exam is more than I can handle. I know I’m a good nurse and I thought I knew my stuff but after I took your Practice Exam, I only got a 65. And I’m thinking … I have a stack of books 6 feet high! I’ve read every word of every book! Now I’m in the pits all over again, and the exam is less than 2 weeks away.

Marie: Oh, you sound pretty bummed out! (Reflecting feelings: I’m thinking that she is so hyped up that she will not be able to hear any advice until I can reflect her feelings.)

Candidate: Yes, I am. I just really thought I’d do better on the Practice Test. I mean, when I was in nursing school I pushed myself to get 90s all of the time. Now here I am, paying money to take this exam and all I can get is a lousy 65 — and it’s only a practice exam! It’s not even the real thing!

Marie: You feel like you’re defeated before you even start. (Reflecting feelings.)

Candidate: Yes, yes! That’s exactly what I feel! Defeated before I even start!

Marie: (Thinking that we can now move to facilitating, since she has gotten in touch with what she really feels, and felt “listened to.”) Okay, let’s go back to getting a 65% on Practice Exam A. Pick 5 questions that gave you the most trouble, and we can discuss them. (Clarifying.)

Candidate: Oh sure, yes, I can tell you a few right off the bat. I missed that one on the malaria. I said, “don’t drink the water,” but that wasn’t the right answer.

Marie: No, no, it wasn’t. Do you know why you got that item wrong? Maybe you don’t know much about malaria? Or maybe you didn’t read the question carefully? Or you picked the right answer first and then erased it and write in the wrong answer? Any other ideas for why you got this one wrong? (More clarifying, and this time with “leading” words. Trying to determine what the real problem is.)

Candidate: Good grief, I just didn’t know anything about malaria! I really didn’t have the faintest idea what the answer was. But you brought up some good points. I also missed some questions on the practice test because I didn’t read carefully or because — in a fit of anxiety and trepidation — I changed the right answer and wrote down the wrong answer!

Marie: Shucks, if you already know your downfalls, you’re halfway to solving your test-taking issues and passing the exam! You’ve just realized 3 things that are messing you up! Bam, bam, bam! If you fix those you’ll be in fairly good shape! (Clarifying; building hope for problem resolution.)

Candidate: You think so?

Marie: Yes, I do. I really do. I just finished teaching my Review course for the 87th time. That means I’ve seen 87 groups of people, all going through what you’re going through, and once they identify their downfalls, they can pull themselves up, dust themselves off, and pass that pesky exam! (Challenging the person to move to problem resolution.)

Candidate: So you really think there’s hope for me?

Marie: Most definitely! I’m thinking, though, that the malaria is something you didn’t have a wealth of information about because you didn’t have any experience with it. Is that true? (Interpreting.)

Candidate: Right. No experience at all.

Marie: Yeah, most of us don’t do very well with stuff we haven’t actually encountered in clinical practice. But I’m thinking of all of the other stuff you’ve talked to me about — medications for newborns, caring for basically well postpartum mothers, knowing hormones that govern MER, that sort of thing — and you do really well with those things! Remember that the topics or issues or diseases that you have encountered over the last 20 years of being a nurse will far exceed those that you haven’t encountered. (Praising the person for what she does well, but at the same time, informing her of the root of her problem: not knowing material that she has not been exposed to in the clinical setting.)

Candidate: OK, then I guess I should try to hone in on the “foreign” diseases.

Marie: Yup! I think that would serve you well! And, next time you go online, be sure to print out that analysis of the Practice Exam, and see how you did in each category. That will help, too.

Candidate: Oh RIGHT! I forgot about that. Okay, I can do that. I think I’m also going to re-do the practice exam again.

Marie: OK, let me know you how you do! (Termination and follow-up.)

Notice how, by employing different counseling methods and techniques with actively listening, I have helped the candidate move from a “this is awful” headset to a “I can do this” headset.

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  1. Leah

    Wow, Marie. I feel a teenzy bit relieved just from reading your study tips. Yesterday, I started feeling this dormant turbulence of panic stirring inside me because I haven’t done any studying. I have been dealing with extraordinary personal and family tribulations. So, I called the main BO # yesterday evening in a desperate attempt to calm my inner ruckus by hearing some of your clever, mothering antidotes (though, I didn’t expect anyone to answer @ 7pm on a Friday night). Reading your blog has helped, thank you for your posts. I’m going to take the practice exam cold and go from there. I would still love any personal words of wisdom you could share with me. <3 Leah

  2. Marie Biancuzzo RN MS IBCLC

    Ah! I’m so glad I could relieve at some of your anxiety! The personal and family issues–yeah, believe me, I’ve been there, done that and it really messes with your head. The best thing you can do for yourself is to clear your head, and just focus on the exam. Got a charge out of it that you called at 7 PM on Friday evening. I didn’t leave until shortly before that–I would have happy told you, You can do this!!!

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