Download Fostering Communication The Nurse

Fostering Communication:
The Nurse-Client Relationship
Carolyne Richardson-Phillips, MS, RN
PNU 145
Fall Term 2015
Pages 94 - 104
Learning Outcomes
By the end of this session, PN students will be able to:
1. List & describe the 4-basic roles that a nurse performs in a nurse-client
relationship
2. Describe the current role expectations for clients
3. List at least 5-principles that form the basis of the nurse-client relationship
4. Identify three phases of the nurse-client relationship
5. Describe the barriers to a therapeutic relationship
6. Explain the concept of communication
7. Explain the difference btwn social & therapeutic verbal communication
8. Discuss therapeutic & non-therapeutic communication techniques;
provide examples of each
9. List five factors that affect oral communication
10. Explain non-verbal communication
11. Describe 4 nonverbal techniques
12. Define communication zones
13. Discuss the difference between task-oriented touch & affective touch
14. List at least 5-situations in which affective touch may be appropriate
15. Discuss general cultural & gerontologic considerations in a nurse-client
relationship
Nursing Roles within the Nurse-Client Relationship
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Relationship- between two or more people over time
Established between nurse & client-when nursing services provided
Requires nurse to respond to client’s needs
Nurses provide services-skills for clients
• Promotes or restores health
• Cope with disorders that do not improve
• Helps client die with dignity
National Council of State Boards of Nursing (NCLEX-PN)
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Four categories established for client needs as structure for test plan
1. Safe & effective care environment
2. Health promotion & maintenance
3. Psychosocial integrity
4. Physiologic integrity
How does the nurse meet the client needs?
Nurses’ Roles within the Nurse-Client Relationship (cont’d)
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Nurse performs 4 basic roles
• Caregiver
• Educator
• Collaborator
• Delegator
Nurse as Caregiver
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Performs health-related activities that a sick client cannot perform
independently
Provide physical/emotional services so to restore or maintain
functional independence
Involves developing close emotional relationships-Become guide,
companion, interpreter-Establishes trust, help to reduce fear
Uses empathy-determine emotional state-need for support
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Look at Box 7-1, page 95
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Nurse as Educator
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Provides information
Provides health teaching pertinent to each
one’s needs and knowledge base
Examples:
• Diagnostic procedures
• Self-administration of medications
• Techniques for managing wound care
• Restorative exercises
• Diet
Avoid giving advise
Reserve the right of each person to make his/her own decisions (health
& illness care)
Share information on potential alternatives & promote one’s freedom to
choose
Support one’s ultimate decision
Nursing extends beyond original treatment facility: nurses –resources
for information about community health services which empowers
clients to become involved with their care
Nurse as Collaborator
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Work with others to achieve a common goal
Collaboration-Responsible for managing care and those that the
nurse delegates to give that care
Collaboration-When nurse –physician share information, exchange
findings with other health care workers
Nurse as Delegator
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One who assigns a task to someone
Need to know what tasks are legal & appropriate for particular
health care workers to perform
Responsible for checking that the task was completed- determine
resulting outcome
Accountable for inadequate care
Therapeutic Nurse-Client Relationship
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Desired outcome- moving toward
improving health
Therapeutic relationship: patient-centered
with focus on goal achievement
• Time-limited goals
• Relationship ends when goals achieved
Nurse encourages- patients to be actively involved, communicate,
question, assist in plan of care
See Box 7-2, page 96
Note difference between therapeutic relationship v. social
relationship
Underlying Principles of a Therapeutic Nurse
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Nurse:
• Treats patient as unique person
• Respects patient’s feelings
• Strives to promote physical, emotional, social spiritual well being
• Encourages one’s decision making/problem solving
• Accepts patient’s growth and change
• Communicates with words client understands
• Uses nursing process-individualize care
• Incorporates others for support
• Implements health care techniques –compatible with each one’s
values and cultural heritage
Phases of Nurse-Client Relationship
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Three Phases:
• Introductory phase- Period of getting acquainted
• Positive first impression: dress appropriately, being wellgroomed, smiling, making eye contact, greeting with a
handshake if acceptable, projecting confidence, avoid odors
• Client then initiates-identifies health issues
• Nurse demonstrates courtesy, active listening, empathy,
competency, appropriate communication skills
• Working phase: mutually enacting a plan
• Period during which tasks are performed
• Promotes independence-Participation of both sides
• Terminating phase-Period when relationship ends
• Both agree that health problems have improved
• Note that client can terminate
Barriers to A Nurse-Client Relationship
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Appearing unkempt
Failing to identify oneself
Mispronouncing or avoiding
client’s name
Using client’s first name
without permission
Sharing personal or work related
problems
Using crude or distasteful
language
Talking with someone in room
as if client not there
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Reveal confidential
information
Focus on nursing tasks rather
than client’s responses
Being inattentive to client’s
requests
Abandoning the client
Failure to keep promises
Going on break without
delegating care
Never treat adults as if they
are children
Communication Process
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Exchange of information
• Involves both sending & receiving
messages between two or more people
• Followed by feedback, indicating that
the information was understood or
requires further clarification
• Takes place simultaneously verbal &
nonverbal communication
Verbal Communication
• Communication- uses words- Includes speaking, reading, writing
• Helps nurse & client –gather facts
• Used to instruct, clarify & exchange ideas
Affected by
• Attention & concentration
• Motor function
• Language compatibility
• Sensory distractions
• Verbal skills
• Interpersonal attitudes
• Hearing & visual acuity
• Literacy
• Environment
• Culture
Verbal Communication (cont’d)
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Nurses need to consider when speaking
• Pace-rhythm & intonation: indicate interest, anxiety, boredom, fear
• Simplicity of words
• Clarity & brevity
• Timing & relevance
• Adaptability
• Credibility: always be honest
• Humor
Therapeutic Verbal Communication
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Using words & gestures to accomplish objectives
• Helps nurse when exploring problems or encouraging feelings
• Never assume a quiet uncommunicative client is problem-free or
understands everything; Don’t probe or pry-wait/be patient and
may respond
• Emotionally charged clients should be allowed to express their
emotions w/o fear of retaliation; approach delicately-remain nonjudgmental, come back later to talk w/ them about their concerns
Listening: very important part of communication
Active listening: includes attending to and becoming fully involved
in the conversation-both verbal and nonverbal
• Requires energy & concentration
• Allows for a meaningful interaction
• Avoid signals of boredom, impatience,
or the pretense of listening
Therapeutic Verbal Communication (cont’d), p. 98
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Silence: allows time for considering how to proceed or arouses
client’s anxiety to the point that it stimulates more verbalization
• Encourages one to participate in verbal conversations
• Helps in relieving anxiety-by having a personal presence
• Offers a brief period – so able to process information received
• May be used as a camouflage for fear, or to express contentment
• Used for introspection when need to explore feelings or to pray
• Broad opening
• Giving information
• Direct questioning
• Open-ended questioning
• Reflecting
• Paraphrasing
• Verbalizing what has been
implied
Non-therapeutic Verbal Communication Techniques
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Giving false reassurance: trivializing patient’s feelings-&
discourages further discussion -everything will work out just fineYou’ve got nothing to worry about
Using clichés: worthless advice, “Keep a stiff upper lip”
Giving approval or disapproval: holds client to a rigid standard
Agreeing: does not allow pt to change his/.her mindDisagreeing: may intimidates client-makes pt feel foolish-That’s
not true-Where did you get this information
Demanding an explanation: puts client on defensive
Giving advice: discourages independence-=problem solving and
decision making
Defending: strong allegiance and any disagreement is unacceptable
Belittling: disregards how pt responds as an individual
Patronizing: treats client condescendingly --like they can’t make a
decision
Changing the subject: alters direction of client’s thought system
Nonverbal Communication
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Exchange of information without using words-spoken or written
Body language-gestures, body movements, use of touch, physical
appearance
Less control over non-verbal than verbal
Messages communicated more accurately thru non-verbal
Nonverbal Communication -Kinesics
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Body language
• Facial expressions
• Posture
• Gestures
• Body movements
• Clothing style & accessories
Nonverbal Communication-Paralanguage
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Vocal sounds that are not actually words
• Taking a deep breath to indicate surprise
• Clucking the tongue-indicates disappointment
• Whistling-get someone’s attention
• Crying, laughing, moaning
Nonverbal Communication-Proxemics
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Use and relationship of space to communication
Varies among people from different cultural backgrounds
4 Space Zones:
• Intimate space = within 6 inches
• Personal space = 6 inches to 4 feet
• Social space = 4 to 12 feet
• Public space = more than 12 feet
Nonverbal Communication-Touch
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Can be task-oriented, affective or both
• Task-oriented-personal contact required when performing
nursing procedures
• Affective- demonstrate caring & concern
• Nurse needs to be sensitive to how clients respond
• Therapeutic use for lonely-uncomfortable, near death,
anxious, insecure, frightened, disoriented, visually impaired,
sensory deprived
Task- Orientated & Affective Touch
Cultural Communication Considerations
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Language: Speech patterns and habits; determine if client
understands English
Styles of speech and expression
Eye contact
Touch
Space
Concept of time
View of Health and health care
Communicating with Special Populations
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The Joint Commission is adamant that Nurses-need to find ways to
communicate with clients
Clients: Verbally impaired-deaf-cognitive deficits-dementia, stroke,
Alzheimer’s disease, artificial airways, wired jaws
• Verbally Impaired: provide paper & pencil/pen or “magic
slate”, cards, charts, communication boards
• Hearing Impaired: may be able to write information, and the
materials above or those born deaf-may use American Sign
Language (ASL), webcam-video camera
Communicating: Alzheimer’s Disease
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Progressive, deteriorating brain disorder
• Memory loss-classic symptom, also disturbances in behavior, &
loss of ability to care for self
• Problems –speaking, difficulty expressing one-self, reading,
writing
Techniques to use: gain client’s attention-use name and approach
from the front
• Smile, maintain eye contact, be relaxed,
• Speak naturally, avoid long words, sentences
• Wait for a response, rephrase information, show patience
• Use visual cues, pantomimes
• Avoid correcting or arguing with client
Gerontologic Considerations
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Show Respect
Approach slowly
Exchange names-utilizing
client’s last name
Do not use demeaning terms
Do not ignore client & talk to
someone else in room (act as if
client is not there)
Do not treat like a child
Utilize touch & eye contract
appropriately
Sit face to face
Provide good lighting
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Inquire about whether or not
client has any special needsHearing (hearing aids, sit
closer, sit on the best side,
vision (glasses)
Speak in a normal tone with
distinct pronunciation of
words
Promote as much control
over decisions as possible
Encourage reminiscing
Allow the older clients the
ability to pace their care
Nursing Process
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Assessment
Diagnosis
Planning
Interventions
Evaluation
References
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Pictures retrieved from web site on June 12, 2015 from http://
oogleimages.com
Timby, B. K. (2013), (10th ed.). Fundamental Nursing Skills and
Concepts. Philadelphia, PA: Lippincott Williams & Wilkins