Download LWW PPT Slide Template Master

Chapter 4Making Professional
Goals a Reality
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Employment Opportunities Today
• Hospital inpatient settings
• Outpatient settings
• Home care
• Long-term care
• Community settings
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Competencies of the New Graduate
• Competencies identified by nursing organizations
– National Council of State Boards of Nursing
Competencies
– National League for Nursing Competencies
– Competencies expressed by other groups
• Employers’ expectations regarding competencies
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Top Ten Nursing Activities Rank Ordered
by Average Total Group Frequency
• Apply principles of infection control
• Provide care within the legal scope of practice
• Ensure proper identification of client when providing
care
• Practices in a manner consistent with a code of ethics
for registered nurses
• Prepare and administer medications, using rights of
medication administration
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Top Ten Nursing Activities Rank Ordered
by Average Total Group Frequency (cont.)
• Prioritize workload to mange time effectively
• Use approved abbreviations and standard terminology
when documenting care
• Maintain client confidentiality/privacy
• Provide individualized/client centered care consistent
with standards of practice
• Review pertinent data prior to medication administration
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Employers Expectation Regarding
Competencies
• Possess the necessary theoretic background for safe
client care and for decision-making
• Use the nursing process in a systematic way
• Recognize own abilities and limitations
• Use communication skills effectively with clients and
coworkers
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Employers Expectation Regarding
Competencies (cont.)
• Work effectively with assistive personnel, delegating, and
supervising nursing care tasks in an appropriate manner
• Provide accurate and complete documentation
• Possess proficiency in the basic technical nursing skills
• Possess basic skill in information technology
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Worker Related Competencies
• Demonstrate a commitment to a work ethic
• Function with acceptable speed
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Personal Career Goals
• Focusing your goals
• Setting your goals
– Short-term goals—encompass what you want to
accomplish this month and this year
– Long-term goals—where you want to be in your
profession five or more years from now
• Maintaining and enhancing your competence
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Letter of Application
• Letter of inquiry
• Excellent way to approach many prospective employers
• Sent with resume
• Present yourself positively through a well-written letter
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Preparing an Effective Resume
• Appearance
• Content
– Objective
– Credentials
– Education
– Employment history
– Additional experience
– References
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Successful Interviewing
• Learn about the potential employer
• Preparing questions for the interviewer
• Dressing for the interview
• Things to take on the interview
• Arriving at the interview
• Anticipating interview questions
• Telephone and online interviews
• Interview errors
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
It is not necessary to follow up after an interview has
been completed with a note of thanks.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• False
• Rationale: Following up after the interview has been
completed includes sending a note of thanks to the key
decision makers, and checking back to learn of decisions
about the position, and maintaining contact with the
institution if not selected if you still would like to be
considered for a position there.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Follow-Up Strategies
• Send a thank-you note to the key decision makers
• Check back to learn of decisions about the position
• Maintain contact with the institution if you are not
selected and still would like a position
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
When resigning from a position, communicating your
plans to the head of the department with a sufficient
time interval to allow the organization to find a
replacement is important.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• True
• Rationale: When resigning from a position,
communicating your plans to the head of the department
with a sufficient time interval to allow the organization to
find a replacement to fill your position leaves a
professional impression and may result in a more positive
reference.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Resignation
• Communicate plans to the head of the department
• Provide sufficient time interval to allow the organization
to find a replacement
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 5The World of
Healthcare Employment
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Understanding Organizations
• Mission statement and philosophy
• Organizational structure
• Types of structure
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mission Statement
• Includes information about critical elements of the
organization
• Explicitly outlines the purpose of the organization
• May contain the philosophy and goals of the group
• Serves as standard against which an organization’s
performance can be evaluated
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Organizational Structure
• Outlines formal working relationships
• Identifies who is accountable and responsible for the
various jobs within the organization
• Defines the division of labor—breaking work into pieces
or tasks, which are assigned to various individuals or
groups
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Structure
• Centralized—authority to make decisions is vested in a
few individuals
• Decentralized—individual employees are responsible for
making decisions in areas in which they have expertise
• Matrix—a second structure overlies the first, creating two
directions for lines of authority, accountability, and
communication
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Authority and Accountability
• Authority—individual has the power or the right to take
action, give directions or commands, and make final
decisions
• Accountability—being obligated to answer for one’s
actions and, when certain tasks are delegated, for the
actions of others
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Organizational Relationships
• Organizational chart
• Chain of command
• Channels of communication
• Job descriptions
• Policies, protocols, procedures, and standards of care
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
Written job descriptions outline the roles and
responsibilities for all employees.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• True
• Rationale: Written job descriptions outline the roles and
responsibilities for all employees and are a necessary and
vital part of any organization.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Organizational Chart
• Graphic, pictorial means of portraying roles, and patterns
of interaction among a part of the system
• Formal chains of command
• Communication channels
• Authority for decision-making
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chain of Command
• Path of authority and accountability from individuals at
the top of the organization to those at the base of the
organization
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Channels of Communication
• Patterns through which messages are delivered within
the organization
• Reflects the chain of command
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Job Descriptions
• Written outline of the roles and responsibilities for all
employees
• Necessary and vital part of any organization
• Usually found in policy manuals
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Policies, Protocols, Procedures, and
Standards of Care
• Policies—designated plans or courses of action to be
taken in specific situations
• Protocols—detailed standard plans for patient care
• Procedures—written instructions describing the accepted
method for satisfactorily performing a particular nursing
activity
• Standards of care—authoritative statements that
describe a common or acceptable level of client care or
performance
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Shared Governance
• Form of practice model that involves decision-making in
which both the nursing staff and the management
participate
• Decentralized organization
• Often results in greater job satisfaction because of more
control over practice
• Effect of shared governance on the role of the manager
and staff nurse
• “Pros” and “cons” of a shared governance model
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Eight Essentials of Magnet Recognition
Program
• Support for education
• Clinically competent coworkers
• Autonomous nursing practice
• Positive RN and MD relationships
• Supportive nurse manager
• Control over nursing practice
• Adequate staffing
• Culture that values concern for the patient as paramount
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Care Delivery Patterns
• Case—nurse works with one patient and is expected to
meet all of the patient’s needs.
• Functional—nursing tasks are assigned to the various
employees on the unit according to the level of skills
required for performance.
• Team—unit has two or more teams composed of
variously educated care providers.
• Total patient care—nurse is assigned all care needs for
patient.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Care Delivery Patterns (cont.)
• Primary care—one nurse is assigned the responsibility for
the care of each patient from the time the patient is
admitted to the hospital until the patient is discharged
• Modular care—very similar to team nursing, with each
module stocked with own linens, medications, and
supplies
• Partnership model—patient care is provided to a group of
patients by a nurse and unlicensed nursing assistant
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Case Management
• Approach to delivery of all patient care services over
entire hospital stay
• Nurses may serve as case managers
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Grievance
• Alleged violation of the provisions of the contract or
institutional policies
• When a grievance arises, all steps must be followed as
outlined in order for the grievance to be addressed
effectively
• Must distinguish between the grievance and the
complaint
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Collective Bargaining
• Set of procedures by which employee representatives
and employer representatives negotiate to obtain a
signed agreement for:
– Wages and benefits
– Issues of seniority and layoffs
– Grievance procedures
– Termination procedures
– Working conditions
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
History of Collective Bargaining
• Passage of the National Labor Relations Act
• Further federal legislation
• American Nurses Association Activity
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bargaining and Negotiating
• Negotiate—bargain or confer with another party or
parties to reach an agreement
• Interest-based bargaining—nontraditional style of
bargaining that attempts to problem solving differences
between the labor and the industry
• Concession bargaining—process in which there is an
explicit exchange of reduced labor costs for
improvements in job security
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Understanding the Basic Concepts of
Collective Bargaining
• Unions and collective action
• Contracts
• Rules governing labor relations
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Settling Labor Disputes
• Mediation and arbitration
• Strikes and lockouts
• Reinstatement privilege
• Other methods of influencing settlement
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Issues Negotiated in Contracts
• Provisions for shared governance
• Mandatory and voluntary overtime
• Acuity-based staffing systems
• Use of temporary nurses
• Protections from reassignments and other issues related
to assignment of duties
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Issues Negotiated in Contracts (cont.)
• Provisions for orientation to the work environment and
continuing education
• Whistleblower protection
• Health and safety provisions such as free vaccines and
needle safety
• “Just cause” language provision for discipline and/or
termination
• Provisions for nursing and interdisciplinary practice
committees
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Issues Related to Collective Bargaining
and Nursing
• Collective action and professionalism
• Representation for nurses
• Activity of the American Nurses Association
• Decision to join or not to join
• Collective bargaining and the role of supervisor
• Changes in the number of bargaining units
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Changing Trends with Regard to Collective
Bargaining
• Thrust of collective bargaining in nursing
• Elimination of unions and strike breaking
• Impact of shared governance on collective bargaining
• Looking to the future
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 6Understanding the
Healthcare Environment and
Its Financing
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
Outpatient care is centered in the work of the traditional
hospital, which has become a hub for healthcare in most
communities.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• False
• Rationale: Acute care is centered in the work of the
traditional hospital, which has become a hub for
healthcare in most communities.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Classification of Healthcare Agencies
• Length of stay
– Average length of time in facility
• Ownership
– Governmental or public
– Proprietary or nonprofit
• Type of care
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Understanding Today’s Hospital
• The development of hospitals in the United States
• Factors affecting the development of hospitals
– Advances in medical science
– Development of medical technology
– Changes in medical education
– Growth of health insurance industry
– Greater involvement of the government
– Emergence of professional nursing
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Understanding Today’s Hospital (cont.)
• Hospital services for patients and families
• Hospitals as educational institutions
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acute Care Facilities
• Hub healthcare
• Care greater than 24 hours but normally less than 30
days
• Inpatient services
• Outpatient services
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Long-term care facilities provide many different types of
care. What facility provides care for those without the
ability to manage ADLs and who need ongoing care?
A. Nursing home
B. Assisted living center
C. Rehabilitation center
D. Ambulatory care setting
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
•
A. Nursing home
•
Rationale: Long-term care facilities provide many types of
care. Nursing homes provide care for those without the ability
to manage ADLs and who need ongoing care. Assisted-living
centers provide supportive services to those who can
manage most of their own activities of daily living.
Rehabilitation centers assist the individual in returning to
the maximum level of independence possible. Ambulatory
care settings provide care on an outpatient basis. This care
may range from simple office calls for common illnesses and
health promotion activities such as immunizations to the
performance of ambulatory surgery.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Long-Term Care
• Long-term care facilities provide many types of care.
• Nursing homes provide care for those without the ability
to manage ADLs and who need ongoing care.
• Assisted-living centers provide supportive services to
those who can manage most of their own activities of
daily living.
• Rehabilitation centers assist the individual in returning to
the maximum level of independence possible.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Long-Term Care Facility
• Nursing homes
• History of the nursing home
• Nursing home resident
• Health services in nursing homes
• Funding nursing home care
• Regulation of nursing home care
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Ambulatory Care Settings
• Healthcare provider offices
• Walk in clinics
• Provide care on an outpatient basis
• Range from simple office calls for common illnesses and
health promotion activities such as immunizations to the
performance of ambulatory surgery
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Community Agencies
• Public health agencies
• Home care agencies
• Hospice care
• Community mental health centers
• Adult day centers
• Ambulatory care dialysis centers
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Colleagues in Healthcare
• Roles of healthcare workers
• Access to primary healthcare
• Interdisciplinary teamwork
• Healthcare worker supply
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Paying for Healthcare
• Financing healthcare for individuals
– Personal payment
– Charitable care
– Health insurance plans
– Managed care organizations
– Health maintenance organizations
– State administered health plans
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Paying for Healthcare (cont.)
• Financing healthcare for individuals (cont.)
– Medicaid
– Problems facing medicare and medicaid
– Military healthcare
– Other federal healthcare programs
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Patterns of Payment
• Fee for service payment
• Prospective payment
– Diagnosis-related groups
– Resource utilization groups
• Capitation
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cost Control in Healthcare
• Understanding increasing costs
– High technology and new facilities
– Changing patient profile
– Uninsured individuals
– Other factors affecting costs
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cost Control in Healthcare (cont.)
• Strategies for cost control
– Limiting hospital costs
– Preferred provider contracts
– Case management
– Vertically integrated healthcare systems
– Using acuity measures to determine costs
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cost Control in Healthcare (cont.)
• Strategies for cost control (cont.)
– Increasing the availability of mid level providers
– Changing fee structures
– Controlling fraud and abuse
– Other cost containment measures
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Concerns About Effective Use of Healthcare
• Access to care
– Economic
– Geographic
– Sociocultural
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
Access to healthcare must be considered in terms of
economic, geographic, and sociocultural access.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• True
• Rationale: Access to healthcare must be considered in
terms of economic, geographic, and sociocultural access.
A major concern in the system is those who do not have
access.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Access to Health
• Economic access
• Geographic access
• Sociocultural access
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
Quality is evaluated through peer review and the use of
outcome measures.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• True
• Rationale: Quality is evaluated through peer review and
the use of outcome measures, including key indicators,
and individual patient outcome standards.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Evaluation and Accreditation of Healthcare
Agencies
• Governmental approval
• Medicare/Medicaid certification
• The Joint Commission
• DNV accreditation
• Community health accreditation program
• National Committee for Quality Assurance
• Quality improvement organizations
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Outcome Measures for Evaluation
• Hospital healthcare outcomes
• Institutional outcome measurement
• Long-term care quality measures
• Home care quality indicators
• National health indicators
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
Power is exerted in the healthcare system by those who
control finances, those who control access, and those
with special knowledge.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• True
• Rationale: Power is exerted in the healthcare system by
those who control finances, those who control access,
and those with special knowledge. Traditionally, nurses
and consumers have experienced little power in the
system. Both are working to gain recognition and to
affect more significantly the way the system functions.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Power in the Healthcare System
• Regulatory power
• Third party payer power
• Physician power
• Consumer power
• Nurse power
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Implications for Nurses
• Cost control
• Well-being of the client
• Effective use of healthcare resources
• Changing healthcare system
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 4
Establishing Helping and
Healing Relationships
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication as Interaction
• Nursing
– Rely on effective communication to provide care
– Most valuable tool in health care setting
– Essential part of nurse-client relationship
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Interpersonal Component of
Professional Nursing
• Basis of helping relationship
– Exchange of meaning between individuals
– Shared system of symbols that have same meaning
– Sender, receiver
• Nurse-patient relationship
– Create new client attitudes, situations that will
influence client to live healthier
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Interpersonal Component of
Professional Nursing (cont’d)
• Business of the professional nurse
– Communication, purposeful use of communication in
nurse–client relationships
– Relationship should be “characterized by
compassion, continuity, and respect for the client’s
choice”
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Structure of Communication
• Communication
– Dynamic interaction between two or more people
– Exchange of ideas, goals, beliefs and values, feelings
– Affects self, others
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Structure of Communication (cont’d)
• Communication model
– Interpersonal (communication) source
– Message
– Encoder
– Channel
– Decoder
– Receiver
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Structure of Communication (cont’d)
• Reciprocal relationship
– Nurses simultaneously act, react by using nursing
process
– Clients’ meanings have equal effect on outcome of
purposeful relationships
– Process is “transactional”
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Structure of Communication (cont’d)
• Communication process is dynamic in nature
– Nurses must evaluate their actions, reactions when
using nursing process with client
– Validation of meanings is essential to achieving any
therapeutic goals in helping relationships
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Functions and Types of Communication
• Purposes
• Two interacting
concepts:
– Inquire
– Content value of
message
– Inform
– Persuade
– Interactional or
perceptual value of
message, participants
– Entertain
• Types
• Metacommunication
– Verbal
– Nonverbal
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Verbal Communication
• Requires functional physiologic, cognitive mechanisms
that produce, recognize, receive speech
• Developmental age
– Verbal, cognitive ability
• Cultural heritage
– Connotative meanings
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Verbal Communication (cont’d)
• Nurse needs to be concerned with these problems:
– Technical: How accurately can one transmit symbols
of communication?
– Semantic: How precise are symbols in transmitting
intended message?
– Influential: How effectively does received meaning
affect conduct?
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nonverbal Communication
• Has more influence on
communication than
spoken words
– Kinesics
– Objects
– Proxemics
• Purposes
– Expressing emotion,
interpersonal attitudes
– Establishing, developing,
maintaining social
relationships
– Presenting self,
engaging in rituals,
supporting verbal
communication
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nonverbal Communication
• Motor or Kinesics
– Based on psychosocial,
cultural setting
– Misinterpretations can
produce communication
barriers
– Can hinder or facilitate
communication in nurseclient relationship
• Nurses must be aware
of client perceptions of
space, other nonverbal
cues, should strive for
congruence between
nonverbal, verbal
communication
– Proximity/space, touch,
gestures, eye contact,
silence, body language
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• A nurse who is seated behind a desk performs a health
history interview of a client in the clinic. The client is
reluctant to answer the nurse’s questions. The nurse
should consider which factor as a cause of the client’s
reluctance?
A.Developmental age
B.Symbolism
C.Influence
D.Space
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• D. Space
• Rationale: Nurses must be aware of client perceptions of
space and other nonverbal cues. The nurse performing
this interview is sitting behind a desk, which places space
and an inanimate object between the nurse and the
client. There is no data in the question to suggest client
age, influence of the nurse over the client, or symbols
that may be present in the room.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Metacommunication
• Integrative process or level
– Defines “what”, “who,” relationship between “what”
and “who” of communication process
• Nurses must evaluate communication in terms of
context, relationship among parts by searching for
themes
• When there are discrepancies between verbal, nonverbal
components of communication
– Discrepancies in message must be verbally validated
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Interpretation and Perception
• Interpretation
– Assigns meaning to
interpersonal interaction
• Perception
• Symbolization
• Perception
– Selection, organization
of sensations that
makes them meaningful,
is dependant on
socialization experiences
• Emotion, attitude
• Memory
• Language
• Thinking
• Varies among
individuals
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Interpretation and Perception (cont’d)
• Factors affecting perception in nurse-client relationship:
– Capacity for attention
– Perspectives bought to relationship
– Physical condition of receptors
• Anxiety
• Nurses must be constantly aware of power, influence of
perception on outcomes of communication
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Self-Concept and Interpersonal
Relationships
• Nurses must develop concepts of self that are effective in
facilitating potential for client growth
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Self-Concept and Interpersonal
Relationships (cont’d)
• Factors that influence nurse-client relationship:
– Self-concept of participants
– Confidence, self-assuredness
– Self-awareness
– Ability to
• Share self, power
• Establish, maintain, terminate relationships
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Tell whether the following statement is true or false:
• In order for the nurse to use nonverbal communication
effectively, the nurse must consider proximity and touch
as well other nonverbal cues.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• True.
• Rationale: Nurses must be aware of client perceptions of
space and other nonverbal cues such as touch, gestures,
eye contact, silence, and body language.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Principles of Communication in
Collaborative Relationships
• Collaborative relationship
– Sharing of responsibility, authority for nursing
process with clients
– Share essential information
– Verify conclusions based on client data
– Plan, implement nursing care
– Clients report success or failure of nursing
interventions or propose alternate courses of action
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Principles of Communication in
Collaborative Relationships (cont’d)
• Principles of communication that facilitate collaboration:
– Presence
• “Being there” or gift of “self” produces deep
personal connection for participants
– Empathy
• Communicating understanding of how others feel,
what or why they feel the way they do
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Principles of Communication in
Collaborative Relationships (cont’d)
• Principles of communication that facilitate collaboration:
– Respect
• Feeling or showing deferential regard or esteem
– Genuineness
• State of being real, honest, sincere
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Helping Relationships: The Nurse As
Helper
• Nurse-client relationship has power to transform lives
• Nurse assumes role of helper, facilitator
– Client strengths used to facilitate helping relationship
• Nurses use self, expertise as therapeutic tools to assist
client to overcome threats to health, well-being or to
obtain optimal health
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nature of Helping in Progressive Stages of
the Nurse–Client Relationship
• Stages of nurse–client relationship vary according to
purpose
• Peplau’s phases of relationship
– Orientation phase
– Identification phase
– Exploitation phase
– Resolution phase
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Other Approaches to Therapeutic
Relationship Development
• Many other approaches to therapeutic relationship
• Four-, five-stage models exist, most have introductory
phase and termination phase
• Trust is important base for therapeutic relationship
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Roles of the Nurse in Therapeutic
Relationships
• Roles of nurse vary depending on client needs,
responses; at times, roles overlap
– Stranger, surrogate, resource, caregiver, teacher,
leader, counselor, critical thinker
• Success of therapeutic relationships relies on nurse
consistency in
– Demonstrating deep respect, listening intently
– Affirming client thoughts, concerns, needs
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mutuality in Responsibility and Decision
Making
• Reciprocal relationships are basis of nursing process
• Therapeutic reciprocity
– Mutual
– Collaborative
– Probabilistic
– Instructive
– Empowering
– Enhancing
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Tell whether the following statement is true or false:
• The nurse may assume the role of teacher, counselor,
and mentor in the nurse-client relationship.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• False.
• Rationale: Roles of the nurse vary depending on client
needs and responses. At times these roles overlap and
may include: stranger, surrogate, resource, caregiver,
teacher, leader, counselor, and critical thinker. A nurse
may serve as a mentor to another nurse.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication and the Phenomenon of
Anxiety
• Congruence among
– role prescription
– role description
– role expectations results
in ideal nurse–client
relationship
• Differences in them
cause communication to
break down
• Anxiety: tension state
resulting from actual or
anticipated negative
appraisal during
communication process
– Nurses must learn
stress-reduction
strategies for
themselves that they
can share with clients
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Caring and Noncaring Nursing Practices:
Therapeutic and Nontherapeutic
Communication Techniques
• Caring: essence of nursing, basis of therapeutic
communication
– Effective listening, sharing, supporting, respecting
– Spends time with clients, identifies relationships
– Makes connections based on knowledge,
conceptualizes trends and patterns
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Caring and Noncaring Nursing Practices:
Therapeutic and Nontherapeutic
Communication Techniques (cont’d)
• Caring: essence of nursing, basis of therapeutic
communication
– Summarizes appropriately, explains purposes of
activities
– Identifies nonverbal meanings while engaging in
clinical practice activities
– Makes unexpected visits to client rooms to offer
professional nursing services
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Caring and Noncaring Nursing Practices:
Therapeutic and Nontherapeutic
Communication Techniques (cont’d)
• Noncaring behaviors communicate these attitudes:
–
“You have no value.”
– “I am not interested.”
– “Actually, I’m bored.”
• Defensive behavior is nontherapeutic
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Outcomes of Helping Relationships
• Increased client understanding of personal responsibility,
accountability for health (learning)
• Client’s attainment of optimal health, perceived
satisfaction in relationship
• Enables clients to speak freely when they have questions
or concerns
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Healing Relationships: The Nurse’s Role
In Healing
• Nurses aim to facilitate wholeness in others through
interaction based on mutuality of purpose
– Illness recovery
– More healthy lifestyle
– Transition to peaceful death
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Helping & Healing Relationships with
Colleagues & Other Health Team Members
• Developing healthy helping relationships requires
meaningful conversations by using these principles for
communication:
– Intention
– Listening
– Advocacy
– Inquiry
– Silence
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Summary and Significance to Practice
• Nurses develop helping, healing relationship with clients
• Mastery of communication is necessary for
– Carrying out agenda of life
– Promoting health, healing
• Clients
• Interdisciplinary health team
• Nurses
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins