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Chapter 4
The Nurse-Client
Relationship
Communication
 Communication is the exchange of
thoughts, feelings, and other information.
 The nurse-client relationship depends on
effective communication.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
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The Communication Process
 Five Major Components
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Sender
Message
Channel
Receiver
Feedback
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A Communication Model
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The Communication Process
 The sender initiates the process of
communication by generating a
message.
 The message is communicated via a
channel, verbally, non-verbally, or in
another symbolic form.
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The Communication Process
 Channels
• The visual channel allows for visual
observation and perception.
• The auditory channel consists of spoken
words and other verbal cues.
• The kinesthetic channel refers to physical
sensations mediated by touch.
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The Communication Process
 The receiver infuses the message with
meaning specific to her personal
experience.
 Physiological, psychological, and
cognitive processes influence the
receiver’s interpretation.
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The Communication Process
 Feedback is information about the
receiver’s perception of the message.
 Feedback can either facilitate or impede
effective communication.
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Characteristics of Effective
Feedback
 Descriptive, clear
 Provided in a supportive, non-threatening
manner
 Practical and appropriate for the
individual client
 Direct and honest
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Factors Influencing
Communication
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Perception
Cultural Context
Space and Distance
Time
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Perception
 Each person’s perceptions of the world
are unique.
 Perceptions are a function of social,
cultural, and family experiences.
 Misunderstandings occur when two
people do not perceive the same
meaning about a message.
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Space and Distance
 The nurse demonstrates respect for each
client’s culturally determined right to
personal space and distance.
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Time
 Quality time spent with the client allows
her to feel cared for and valued.
 The nurse should avoid appearing
rushed while gathering important data
and providing client education.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
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Levels of Communication
 Intrapersonal communication (self-talk),
consists of ideas and information inside
one’s own mind.
 Interpersonal communication occurs
between two people.
 Group communication occurs with three
or more individuals.
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Self-Talk
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Interdisciplinary Group
Communication
 The Health Care Team collaborates to
assess client status and plan for effective
client outcomes.
 Breakdown of communication between
different team members can interfere
with the client’s treatment.
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The Health Care Team
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Client
Family
Nurses
Social Workers
Physical Therapists
Occupational Therapists
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Modes of Communication
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Verbal Messages
Nonverbal Messages
Facial Expression
Posture
Gestures
Touch
Physical Appearance and Artifacts
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Therapeutic Communication
 Is a vehicle for establishing a partnership
between the nurse and the client.
 Conveys to the client that he is cared for
and understood.
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Therapeutic Communication
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Purposeful and goal-directed
Well-defined boundaries
Client-centered
Non-judgmental
Uses specifically designed techniques
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Principles of Therapeutic
Communication
 Time the interaction to avoid distraction
or fatigue.
 Provide a comfortable and private
environment.
 Clarify the purpose of the interaction.
 Establish guidelines.
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Principles of Therapeutic
Communication
 Accept the client “as is.”
 Let the client take the lead through active
listening.
 Seek clarification by reflection and
restating.
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Barriers to Therapeutic
Communication
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Language and Cultural Differences
Gender
Health Status
Developmental Level
Emotions
Communication Blocks
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Barriers to Therapeutic
Communication
 Language Barriers
• Discrepancies in vocabulary usage and
expressions
• Use of health care jargon
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Nontherapeutic
Communication Blocks
 Intrusive self-talk or inappropriate
responses
• Certain responses that would be acceptable
during social conversation are not useful
during therapeutic interaction.
• An inappropriate response may result in the
client experiencing feelings of inadequacy,
intimidation, or confusion.
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Communication, Critical Thinking,
and the Nursing Process
 Interpersonal skills and critical thinking
are competencies that form the basis for
successful application of the nursing
process.
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Communication, Critical Thinking,
and the Nursing Process
 Critical Thinking and Assessment
• The client’s sense of control is enhanced
when the nurse asks open-ended questions
and pays attention to verbal and nonverbal
messages.
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Communication, Critical Thinking,
and the Nursing Process
 Critical Thinking and Nursing Diagnosis
• Careful attention to assessment data
provides a deeper understanding of the
client’s experience and needs.
• Accurate analysis of assessment data leads
to accuracy in diagnostic judgment.
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Communication, Critical Thinking,
and the Nursing Process
 Nursing diagnoses related to
communication difficulties
• Social Isolation related to impaired verbal
communication
• Anxiety related to impaired verbal
communication
• Self-Esteem Disturbance related to impaired
verbal communication
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Communication, Critical Thinking,
and the Nursing Process
 Planning and Outcome Identification
• Effective therapeutic communication allows
the nurse and the client to work together to
develop goals and identify appropriate
outcomes.
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Communication, Critical Thinking,
and the Nursing Process
 Implementation
• Alternative modes of communication can be
used in implementing a teaching plan.
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Sign language
Gestures
Alphabet boards
Electronic communication devices
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Communication, Critical Thinking,
and the Nursing Process
 Evaluation
• It is important to determine if communication
is a factor that impedes the client’s healing
process.
- Verbal and nonverbal cues may indicate to the
nurse the need for further client teaching.
- Interventions that might resolve this problem
require consideration.
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