Counseling items on the lactation exam still seem a mystery to some candidates. Honestly, I think the key here is knowing how to apply basic communication skills. Most of it boils down to the classic framework from Brammer & MacDonald’s highly acclaimed book, The Helping Relationship: Process and Skills.
- Listening (attending, paraphrasing, clarifying)
The key is to ask yourself, “What is going on here?” Then determine which of those six responses you need to use and stay true to basic communication skills.
Today, I’ll break away from my usual format. Instead, I’ll demonstrate some of these counseling methods and techniques by using a subject near and dear to your heart: Exam prep!
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 Exam. 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 I’ve used some basic communication skills and can now move to facilitating. I’m thinking she is now in touch with what she really feels, and she 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 the real problem.)
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 exam 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 three 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 125th time. That means I’ve seen and taught 125 groups of people. (Using basic communication skills to create some commonality between speakers.) They’re 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, basic communication skills, that sort of thing — and you do really well with those topics! 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 home 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 one of my Practice Exams, 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, good idea. Let me know you how you do! (Termination and follow-up.)
Notice how, by employing basic communication skills and different counseling methods and techniques with actively listening, I have helped the candidate move from a “this is awful” mindset to a “I can do this” mindset.
Listening is one of the main keys to good communication skills. Sure, providing good information is helpful and important, but it’s imperative to actively listen to a client. IBCLCs need to have a solid foundation in communication skills to effectively help their clients.
Per the IBLCE Candidate Information Guide, “… starting with examination applications for the April 2021 examination administration and those administrations following, in addition to the 90 hours of lactation specific education, five (5) hours of education focused on communication skills will be required.” Consult the full Candidate Information Guide for more details. This means, if you plan to submit your candidate application November 2020 or later, you will need these 5 communication hours.
Have you been in a situation where you felt like you weren’t being heard? How do you practice basic communication skills? Share your thoughts in the comments below!