Amber Phair

Oct 2022

1511-mid term outline

Phases of the nurse-client relationship

1. Pre-interaction phase:
 nurse’s responsibilities- become aware of the client’s situation (read the chart)
 think about the environment for interaction
 Be aware of own feelings and biases, remain objective
2. Orientation or interaction phase:
 Establish rapport and trust:
 NOD (name occupation and duty), acknowledge client by name or greeting they
are comfortable with
 Clarify the purpose of the relationship (why you are there)
 Identify client needs and expectations
 How client perceive present health status
 What’s the story
 Open ended questions then become more focused questions
 Best way to meet goals
 Clearly state length of relationship
3. Working phase:
 Active problem-solving or interventions
i. Actions are implemented towards identified needs (comfort, action, knowledge)
ii. Nurse is aware of client ability to make decisions about care and participate in
care
iii. Always assessing for evidence that needs are being met or if new needs arise
4. Termination or resolution phase:
 Brining the relationship to a close
i. Can be difficult
ii. Explore how the goals have been met
iii. Evaluate:
1. Where needs correctly identified
2. Interventions adequate and appropriate
3. Client progressing towards max health and well being
4. Plan to continue care at home/ another settling

CNO standard statements

1) Therapeutic communication
a. Nurses use a wide range of effective communication strategies and interpersonal skills to
appropriately establish, maintain, re-establish, and terminate the nursing relationship
2) Client centered care
a. Involves advocacy, empowerment and respect for the client’s autonomy, voice, self-
determination, and participation in decision making
3) Maintaining boundaries
a. Nurses are responsible for effectively establishing and maintaining the limits of
boundaries in the therapeutic nurse client relationship
i. Limitations imposed by legal, ethical, and professional standards
ii. Guides professional behavior

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Oct 2022

iii. Boundary violations and crossings

4) Protecting the client from abuse
a. Nurses protect the client from harm by ensuring that abuse is prevented, or stopped and
reported
b. (Physical, emotional, psychological, financial, sexual)

CNA ethical values (7) (principles of nursing)

1. Providing safe, compassionate, 4. Honoring dignity

competent, and ethical care 5. Maintain privacy and confidentiality
2. Promoting health and wellbeing 6. Promoting justice
3. Promoting and respecting informed 7. Being accountable
decision-making

examples of verbal and nonverbal communication techniques

Verbal Non-verbal
Denotive Eye contact
- Literal definition found in dictionary Gestures
Connotative Proxemics
- Subject and created from emotional - Intimate space <18 inch
experience (assumed meaning) - Personal space 18in – 4 ft
- Bypassing - Social space > 12 ft
- Miscommunication may occur when Facial expressions – 7 universals
diverse meanings are assigned to the same - Happiness
word - Sadness
- Contempt
- Surprise
- Fear
- disgust
- Anger

components of the communication model

referent: motivation for communication

sender: person who initiates conversation
receiver: person who receives message

examples of therapeutic and nontherapeutic communication-verbal and non- verbal

Therapeutic communication Non-therapeutic communication

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 Amber Phair
Oct 2022

verbal Non-verbal Verbal Non-verbal

Open ended questions Silence Negative responses Negative body gestures
Clarification Actively listening Giving advice Not paying attention
Probing Eye contact False assurances Distracted manor
Paraphrasing Touch Overgeneralizing
Sharing observations Reducing distance Belittling
summarizing Expressed disapproval
Closed ended questions
Changing subject
Automatic responses
professional boundaries of nurse to client

- Represent invisible structures and limitations imposed by legal, ethical, and professional
standards that respect nurse and clients’ rights
- Guides professional behavior
- Nurses have the responsibility to function within professional boundaries, recognize the
vulnerable situation of the client
A nurse maintains boundaries by:

- developing a plan of care with the client that aims to meet the client’s needs.
- following the plan of care; and
- recognizing that certain practice settings require increased vigilance to maintain boundaries.
- not accepting a gift from a client unless, in the rare instance, the refusal will harm the therapeutic
relationship.

delivery of client centred care

respect and dignity - promote respect /dignity (listen and honor client perspectives)
information sharing - enhances communication
participation – encourage clients to be apart of the process
collaboration - support a team-based approach to care
client centered care is a holistic approach its about the whole person not just a symptom

Barriers to effective communication

- anxiety
- stereo typing and bias
- over/under involvement
- violation of personal space
- time limitations (perceived as too little time)
- cultural issues
- gender differences

Contributors to effective therapeutic communication

- Trust
- Respect

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Oct 2022

- Professional intimacy
- Empathy
- Power
- Client satisfaction with care
- Sense of accomplishment with interventions

empathetic vs sympathetic responses

Empathetic Sympathetic
Communicated understanding Non therapeutic communication of over
Ex I can see that your worried what can I do to identifies with clients feelings
help Ex- that sucks it happened
Better it wasn’t me
Providing gender inclusive care

- provide care unconditionally o practice cultural sensitivity

- ask how client would like to be referred o use therapeutic relationship
to building activities
- don’t assume anything always ask o avoid medical jargon
- use gender neutral language
CARE process
- reduce barriers
o establish trust C- connect with your client
o demonstrate caring and empathy
A - appreciate the clients situation
o empower client
o recognized and reduce anxiety R – respond to clients needs
o maintain appropriate personal
E – engage the client collaborative care
space

Caring for culturally diverse clients, use of interpreters