Download Timby: Fundamental Nursing Skills and Concepts

Chapter 7
The Nurse–Client
Relationship
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Nursing Roles Within the
Nurse–Client Relationship
• Relationship established between nurse and
client
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• The four basic roles performed by nurses:
– The nurse as caregiver
o Performs health-related activities,
contemporary caregiving role
o Develops close emotional relationships
o Understands that illness and injury
cause insecurity; uses empathy
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• The nurse as educator
– Educates about complex health care
– Provides health teaching pertinent to each
client’s needs, knowledge base
– Lets the client choose his health care
– Shares information and alternatives
– Empowers client involvement
o rehabilitation, financial assistance,
emotional support
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• The nurse as collaborator
– Works with the team toward achieving a
common goal
– Responsible for managing care
– Shares information with other health care
workers
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• The nurse as delegator
– One who assigns a task to someone
– Necessary knowledge
– Inspects completed task
– Accountable for inadequate care
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The Therapeutic Nurse–Client Relationship
• Desired outcome: restored health
• Underlying principles
– Treats client as a unique person and
respects client’s feelings
– Promotes client’s physical, emotional,
social, and spiritual well-being
– Encourages client participation
– Individualizes client care
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• Underlying principles (cont’d)
– Accepts client’s potential for growth and
change
– Communicates using understood terms
and language; incorporates client
support system
– Implements compatible health care
techniques: client’s values and culture
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• Phases of the nurse–client relationship
– Introductory phase
o Period of getting acquainted
o Client initiates relationship: identifies
one or more health problems
o Nurses to demonstrate:
 empathy
 Active listening and competency
 Appropriate communication skills
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– Working phase
o Mutually planning care: enact plan
o Participation from both sides
o Nurse promotes client independence
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– Terminating phase
o Nurse and client mutually agree on the
improved immediate health problems
o Caring attitude and compassion
facilitate client’s care transition
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• Barriers to a therapeutic relationship
o Best approach is to treat a client as
you would like to be treated
o Box 7-3
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Communication
• Exchange of information between two people
• Followed by feedback to confirm
understanding
• Occurs simultaneously
– Verbal and nonverbal communication
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• Verbal communication
– Using words: includes speaking, reading,
and writing
o To gather facts
o To instruct, clarify, and exchange ideas
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– Factors: affect ability to communicate
o Attention and concentration
o Language compatibility and verbal skills
o Hearing and visual acuity
o Motor functions involving the throat,
tongue, and teeth
o Sensory distractions
o Interpersonal attitudes
o Literacy and cultural similarities
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– Therapeutic verbal communication
– "Using words and gestures to accomplish a
particular objective"
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Therapeutic Verbal Communication
Techniques
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• Verbal communication (cont’d)
– Listening
o Pay attention to what clients say
o Avoid communicating signals indicating
boredom, impatience, or pretense of
listening
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• Verbal communication (cont’d)
– Silence
o Encourages client participation
o Intentionally withholding verbal
commentary
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Nontherapeutic Communication
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• Nonverbal communication
– Exchange of information without using
words
– Manner used affects meaning
o Kinesics (Body language)
(e.g. facial expression, gestures body
movements, clothing style, posture…)
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– Paralanguage (Vocal sounds that are not actually words) such as:
–
Deep breath to indicate surprise.
–
Whistling to get someone's attention.
–
Crying, laughing.
–
Volume, pitch.
– Proxemics
(Use and relationship of space to
communication)
o Varies according to cultural background
o Understand client’s comfort zone
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– Touch
o Tactile stimulus produced by making
personal contact
 Task-oriented touch
 Affective touch
End
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