Examples of How to Deal with “First” Qualifiers

For IBLCE Exam test-takers, I’ve previously written about how to determine what to do first in terms of assessing and sequencing specific actions for questions with first qualifiers and the best way to deal with qualifiers. But people in my review courses were struggling with how to apply those principles when faced with an exam question pertaining to a conversation with a client. So I want to build on my previous advice. Today, I’ll cite concrete examples of how to proceed in a conversation when you encounter a FIRST qualifier in the stem of the exam item.

Determine which type of question to ask in the situation

Should you ask a closed-ended question, or an open-ended question first?

A closed-ended question often starts with words such as “Do/did you…?” or “Have/will you…” or “Is/are…” Closed-ended questions might elicit a yes or no answer, or perhaps just a short answer.

Asking a closed-ended question isn’t necessarily a bad idea! Sometimes, we professionals need some simple, no-shades-of-gray answers. But we need to resist the temptation to ask the closed-ended questions too soon or too frequently.

Asking open-ended questions is a major strategy in data-gathering. Open-ended questions give the client plenty of leeway. For example, “How is breastfeeding going for you?” Let’s say there are four options as answers to a question with a first qualifier. Three options are closed-ended questions, and only one is an open-ended question. Pick the open-ended one!

Use empowering statements as a FIRST response

If the mother has a lot of energy around the topic, your first response is to empower her.

• Validation: Let her know her observation or concern is right. “That’s something I would be concerned about, too.”
• Supporting: Show respect and endorsement for her decision or behavior. “You and your baby look so happy!” It’s a simple but powerful supportive statement. And, if a mother is worried, provide a positive statement first before giving an explanation. It’s hard for a mother to “hear” a long-winded explanation before she feels supported.
• Reassurance: “He already weighs 12 pounds? Wow! You’re doing a remarkable job of growing your baby!”

Use reflective listening techniques

Healthcare professionals are often eager to jump to problem-solving. But often, that’s not the first thing to do.

In graduate school, I learned about reflection of feelings and reflection of content. Other people refer to it as reflective listening and empathetic listening. Whatever you call it, just listen first before you march into problem-solving. Here are a few examples:

• Reflection of feelings: “Oh, that must have been exhausting for you.”
• Reflection of content: “Okay, so I think I’m hearing you say that he had a total of 2 stools since yesterday at this time.”

Helping the mother come to a decision

If the mother is walking up to a decision, (“And I just don’t know what to do!”), your first response is to use statements, or a question to lead her to her decision. Here are some examples:

• How do you feel about the advice Dr. Smith gave?
• What would you like to do?

As you face these “first” questions, a FIRST response is often (not always!) listening to something, or responding to something, before doing something.

Answer the question!

Always pick the option that actually answers the question! Remember that some actions are interesting, appropriate, and perhaps even effective, but they don’t answer the question. Here’s a simple example of first qualifiers:

The mother has been taking large doses of antibiotics. She complains of itching and burning on her nipples. Her baby has white patches under his lips and on the inside of his cheeks. The baby appears frustrated when suckling, and the mother asks what she should do to help him “get back to nursing normally.” Which action would you take FIRST?

1. Ask the mother if she is leaking milk.
2. Determine if the baby has gained weight.
3. Inspect the baby’s diaper area.
4. Refer the mother to her doctor.

In this example, options A, B, and C are all good options for more data-gathering. But this problem needs fixing! And the mother is asking for help in getting things back to normal. Meanwhile, you already have more than enough data to warrant an appointment for medical help. Hence, in this case, pick option “D” (a “doing” response) FIRST.

I doubt that this covers everything you ever need to know about picking the right “first” response option, but hopefully it will help!

How comfortable are you with choosing the right answer with questions that have first qualifiers? Tell me in the comments below!