MAINTAINING CARING PRACTICE ✓ In its code of ethics, the

American Holistic Nurses

Association (2012) states that ‘the
nurse has a responsibility to model
health care behaviors. Holistic
nurses strive to achieve harmony in
their own lives and assist others
striving to do the same.”
✓ Individuals with high self-esteem
can critically problem solve and
tackle obstacles more effectively.
✓ Self-care practices build self-
esteem, leading to feelings of
comfort and accomplishment.
TYPES OF SELF-CARE
❖ Physical
❖ Social
❖ Mental
❖ Spiritual
❖ Emotional
CARE FOR SELF: HEALTHY LIFESTYLE
❖ Nutrition
❖ Activity & Exercise
❖ Recreation
❖ Avoiding Unhealthy
CARE FOR SELF Patterns
✓ Mayeroff (1990) describes caring CARE FOR SELF: MIND-BODY
for self as helping oneself grow and THERAPIES
actualize one’s possibilities. ❖ Meditation
✓ Self-care, when defined as ❖ Storytelling
responding to one’s own need to ❖ Music therapy
grow, is the opposite of the self- ❖ Yoga
complacency that often COMMUNICATING: A INTEGRAL
accompanies egoecentricity. ASPECTS OF NURSING
✓ Caring for self means taking the COMMUNICATION
time to nurture oneself. ➢ is a critical skill for nursing.
✓ This involves initiating and It is the process by which
maintaining behaviors that promote humans meet their survival
healthy living and well-being. needs, build relationships,
✓ Self-care focuses on care of the and experience emotions.
self in the deepest sense. ➢ In nurisng, communication
✓ Self-awareness and self-esteem is a dynamic process used
are initimately connected to self- to gather assessment
care. data, to teach and
✓ Each person is unique and persuade, and to express
possesses individual strengths and caring and comfort. It is an
weaknesses. integral part of the helping
✓ Self-care practices are relationships.
intentionally created by the self and ➢ Communication is the
vigilantly maintained. interchange of information
✓ This is a lifelong unfolding between two or more
process, leading to wholeness that people;
comes from and contributes to self- ➢ In other words, the exchange of ideas or
esteem. thoughts (talking and listening or writing and
 reading); thoughts are expressed to others FACTORS INFLUENCE COMMUNICATION
by gestures or body actions; a transmission PROCESS
of feelings or a more personal and social ➢ Development & Gender
interaction between people; ➢ Sociocultural characteristics
➢ Is any means of exchanging information or ➢ Values and perception
feelings between two or more people. ➢ Personal space and territoriality
➢ It is a basic component of human ➢ Roles and relationships
relationships, including nursing. ➢ Environment
➢ Intention: to obtain a response. ➢ Congruence
➢ Thus, communication is a process. ➢ Attitudes
➢ 2 Main Purposes: DEVELOPMENT
a. To influence others; ➢ Language and communication skills develop
b. To gain information through stages
➢ Communication can be described as helpful ➢ Communication techniques for children
or unhelpful. ○ Play
➢ Nurses who communicate effectively are ○ Draw, paint sculpt
better able to collect assessment data, ○ Storytelling, word games
initiate interventions, evaluate outcomes of ○ Read books; watch movies, videos
interventions, initiate change that promotes ○ Write
health, prevent the safety and legal problems GENDER
associated with nursing practice. ➢ Females and males communicate differently
➢ The communication process is built on a from early age
trusting relationship with a client and support ➢ Boys→ establish independence, negotiate status
people. ➢ Girls→ seek confirmation, intimacy
➢ Effective communication is essential for the SOCIOCULTURAL CHARACTERISTICS
establishment of a nurse-client relationship. ➢ Culture
ELECTRONIC COMMUNICATION ➢ Education
➢ Advantages ➢ Economic level
○ Fast VALUES AND PERCEPTION
○ Efficient ➢ Values→ standards that influence behavior
○ Legible ➢ Perception→ personal view of an event
○ Improves communication, continuity ➢ Unique personality traits, values,
of care experiences
➢ Disadvantages ➢ Validate
○ Client confidentiality risk PERSONAL SPACE
○ Socioeconomics ➢ Defined as distance people prefer in
○ Do not use email interactions with others
○ Urgent information ➢ Proxemics
○ Jeopardy to client’s health ○ Intimate distance→ frequently used by
○ Highly confidential information nurses
○ Abnormal lab data ○ Personal distance→ less overwhelming
➢ Other guidelines ○ Social distance→ increased eye contact
○ Agency-specific standards and ○ Out of reach for touch
guidelines ○ Public distance
○ Part of medical record ➢ Personal Space influences communication in
○ Consent, identify as confidential social and professional interactions.
EFFECTIVE WRITTEN COMMUNICATION Encroachment into another individual’s
➢ Does not convey nonverbal cues personal space creates tension.
➢ Same as verbal TERRITORIALITY
➢ Appropriate language and terminology ➢ Space and things
➢ Correct grammar, spelling, punctuation ➢ Individual considers as belonging to self
➢ Logical organization ➢ Knock before entering space
➢ Appropriate use and citation of resources ➢ May be visible
➢ Curtains around bed unit
 ➢ Walls of private room 1. Help clients manage their problems
➢ Removing chair to use at another bed in living more effectively and
ROLES AND RELATIONSHIPS develop unused or underused
➢ Between sender and receiver opportunities more fully.
➢ First meeting versus developing relationship 2. Help clients become better at
➢ Informal with colleagues helping themselves in their
➢ Formal with administrators everyday lives.
➢ Lengths of relationship 3. Help clients develop an action-
ENVIRONMENT oriented prevention mentality in
➢ Can facilitate effective communication their lives.
➢ Key factors ● A helping relationships may develop over
○ Comfort weeks of working with a client, or within
○ Privacy minutes.
CONGRUENCE ● The key to the helping relationships are:
➢ Congruence a. The development of trust and
○ Verbal and nonverbal aspects acceptance between the nurse and
match the client.
○ Seen by nurse and clients b. An underlying belief that the nurse
➢ Incongruence cares about and wants to help the
○ Sender’s true in body language client
➢ Improving nonverbal communication ● The personal and professional
○ Relax; use gestures judiciously characteristics of the nurse and the client
○ Practice; get feedback on nonverbal influence that helping relationship.
ATTITUDES ● Age, gender, appearance, diagnosis,
➢ Interpersonal attitudes education. Values, ethnic, and cultural
➢ Attitudes convey beliefs, thoughts, feelings background, personality, expectations, and
➢ Caring, warmth, respect, acceptance setting can all affect the development of the
➢ Facilitate communication nurse-client relationship.
➢ Condescension, lack of interest, coldness ● Considerate of all these factors, combined
➢ Inhibit communication with good communications skills and sincere
➢ Effective nursing communication interest in the client’s welfare, will enable the
➢ Significantly related to client satisfaction nurse to create a helping relationships.
➢ Respect ● Characteristics of helping relations are:
BARRIERS TO COMMUNICATION ● Is an intellectual and emotiional
➢ Stereotyping bond between the nurse and the
➢ Agreeing and Disagreeing client and is focused on the client.
➢ Being defensive ● Respects the clients as an
➢ Challenging individual, including
➢ Probing ○ Maximizing the clients
➢ Testing abilities to participate in
➢ Rejecting decision making and
➢ Changing topics treatments.
➢ Unwarranted reassurance ○ Considering ethnic and
➢ Passing judgment cultural aspects
➢ Giving common advice ○ Considering family
THERAPEUTIC COMMUNICATION relationships and values
HELPING REALTIONSHIPS ● Respects client confidentiality
● Nurse-client relationships are referred to by ● Focuses on the clients well-being
some as interpersonal relationships, by ● Is based on mutual trust, respect,
others as therapeutic relationships, and by and acceptance.
still others as helping relationships. ➢ Whatever the practice setting, the nurse
● Helping is a growth-facilitating process that establishes some type of helping relationship
strives to achieve three basic goals (Egan, in which mutual goals (outcomes) are set
2014): with the client or, if the client is unable to
 participate, with support people. Although ➢ Sympathy is the fact or power of sharing
special training in counseling techniques is the feelings of another and actually
advantageous, there are many ways of experiencing what another person is
feeling. Sympathy may actually impair the
helping clients that do not require special
nurse’s ability to care the patient because
training. the nurse’s emotional experience may
DEVELOPING HELPING RELATIONSHIPS cloud professional judgement.
➔ Listen actively ➢ Compassion is a feeling of deep
➔ Help to identify what the person is feeling. sympathy or desire to understand
➔ Put yourself in the other person’s another’s experience accompanied by a
shoes(i,e.,,empathize). desire to relieve suffering. Patient
suffering may include physical symptoms
➔ Be honest
such as pain, nausea, and shortness of
➔ Be genuine and credible breath: psychological symptoms such as
➔ Use your ingenuity. mood, coping, and relationship issues;
➔ Be aware of cultural differences that may social problems such as family concerns;
affect meaning and understanding. community, and financial issues; and
➔ Maintain client confidentiality. problems within the spiritual realm such
➔ Know your role and your limitations. as faith and finding meaning and closure.
Compassionate caring is often included in
➢ Often clients who are troubled are unable to
description of nursing services.
identify or to label their feelings and ➢ Empathy is educated compassion or the
consequently have difficulty working them intellectual understanding of the emotional
out or talking about them. state of another person. It can be
➢ Responses such as “You seem angry about described as the nurse’s desire to
taking orders from your boss” or “You sound understand what a patient is experiencing
from the patient’s perspective. Empathy
as if you’ve been lonely since your wife died”
allows nurses the ability to actually see
can help clients recognize what they are the world from the patient’s point of view
feeling and talk about it. without experiencing the emotional
content. This intellectual understanding
● Help to identify what the person is allows the nurse to identify the patient’s
feeling. concerns more clearly and intervene more
specifically.
➢ Nurses incorporate an empathetic desire to
understand the patient’s experience
combined with a compassionate goal to
alleviate suffering. There is probably a
spectrum of professional empathy and
compassion in nursing. While newer nurses
may have a greater desire to understand the
experiences of their patients, more
experienced nurses tend to use their
empathetic desires more efficiently to assess
and understand the patient’s experience,
Nursing is often described as providing define the patient’s needs, set goals with the
empathetic or compassionate care to patient, deliver appropriate interventions,
patients. assess patient outcomes.

❖ · 4 terms are frequently used to describe

the emotional work of nursing

➢ Altruism is defined as (1) understanding

the experience of another involving self-
sacrifice or (2) unselfish regard and/or
devotion to others. Continuing self-
sacrifice by nurses may lead to emotional
exhaustion and burnout (Henderson,
2001).
➢ To facilitate nurse-client interaction, To assess the client’s communication
recognize the language (s) and/or dialect (s) abilities, the nurse determines
the client uses. communication impairments or barriers and
➢ Provide a bilingual interpreter as needed for communication style.
clients who have limited English language
skills.
➢ Remember that culture may
➢ BE AWARE OF CULTURAL
influence when and how a client
DIFFERENCES THAT MAY AFFECT
speaks.
MEANING AND UNDERSTANDING
➢ Obviously, language varies
➢ To maintain the client’s right to privacy,
according to age and development.
share information only with other health care
➢ With children, the nurse observes
professionals as needed for effective care
sounds, gestures, and vocabulary.
and treatment.
➢ MAINTAIN CLIENT CONFIDENTIALITY
➢ Every person has unique strengths and NURSING MANAGEMENT: ASSESSING
problems.
➢ When you feel unable to handle some Language deficits
problems, the client should be informed and
referred to the appropriate health ➢ Determine the client’s primary language for
professional. communicating and whether a fluent
➢ Clarify functions and roles, specifically what interpreter is required.
is expected of the client, the nurse, and the ➢ The language skills of some clients who use
primary care provider English as a second language may be
➢ KNOW YOU ROLE AND YPUR inadequate to meet their needs.
LIMITATIONS
Sensory deficits

The ability to hear, see, feel, and smell are important

adjuncts to communication. Deafness can significantly
alter the message the client receives; impaired vision
alters the ability to observe nonverbal behavior, such
as a smile or a gesture; inability to feel and smell can
impair the client’s abilities to report injuries or detect
the smoke from a fire. For clients with severe hearing
impairments, follow these steps:

● Look for a medical alert bracelet (or necklace

or tag) indicating hearing loss.
● Determine whether the client wears a
hearing aid and whether it is functioning.
● Observe whether the client is attempting to
see your face to read lips.
● Observe whether the client is attempting to
use hands to communicate with sign
language.

ASSESSING: IMPAIRMENTS TO
COMMUNICATION
Cognitive Impairments

➢ Any disorder that impairs cognitive

functioning (e.g., cerebrovascular disease,
Alzheimer’s disease, and brain tumors or
injuries) may affect a client’s ability to use
and understand language.
➢ These clients may develop total loss of
speech, impaired articulation, or the inability
to find or name words.
➢ Certain medications such as sedatives,
antidepressants, and neuroleptics may also
impair speech, causing the client to use
incomplete sentences or to slut words. ➢ If the communication issue is due to the
➢ The nurse assesses whether these clients client having a problem coping, the
respond when asked question and, if so, diagnoses of fear or Anxiety may be more
assesses the following: Is the client’s speech appropriate.
fluent or hesitant?Does the client use words ➢ Other NANDA nursing diagnoses (Herdman
correctly? Can the client comprehend & Kamitsuru, 2014) used for clients
instructions as evidenced by following experiencing communication problems that
directions? involve impaired verbal communication as
the etiology could include the following:
● Anxiety related to impaired verbal
communication
● Powerlessness related to impaired
verbal communication
● Situational Low Self-Esteem related
to impaired verbal communication
● Social Isolation related to impaired
verbal communication
● Impaired Social Interaction related
to impaierd verbal communication.
➢ When a nursing diagnosis related to
Structural deficits impaired verbal communication has been
made, the nurse and client determine
➢ Structural deficits of the oral and nasal outcomes and begin planning ways to
cavities and respiratory system can alter a promote effective communication.
person’s ability to speak clearly and ➢ The overall client outcome for individuals
spontaneously. Example include cleft palate, with Impaired Verbal Communication is to
artificial airways sucha as an endotracheal reduce or solve the factors impairing the
tube or tracheostomy, and laryngectomy communication.
(removal of larynx). Extreme dyspnea ➢ Specific nursing interventions will be planned
(shortness of breath) can also impair speech from the stated etiology. Examples of
patterns. outcome criteria to evaluate the
effectiveness of nursing interventions and
Paralysis achievements of clients goals folllow.

➢ If verbal impairment is combined with

paralysis of the upper extremities that
impairs the client’s ability to write, the nurse
should determine whether the client can
point, nod, shrug, blink, or squeeze a hand.
Any of these gestures could be used to
devise a beginning communication system.
 Client Communication

➢ To establish whether client outcomes have

been met in relation to communication, the
nurse must listen actively, observe nonverbal
cues, and use therapeutic communication
skills to determine that communication was
effective.
➢ Examples of statements indicating outcome
achievement include “Using picture board
effectively to indicate needs “The client
stated, ‘I listened more closely to my
daughter yesterday and found out how she
feels about our divorce.”

Nurse Communication

➢ For nurses to evaluate the effectiveness of

their own communication with clients,
process recordings are frequently used.
➢ A process recording is a verbatim (word for
word) account of a conversation.
➢ It can be taped or written and includes all
verbal and nonverbal interactions of both the
client and nurse.

Employ Measures to Enhance Communication NURSING MANAGEMENT: EVALUATING

➢ First determine how the client can best TEACHING: AN INTEGRAL COMPONENT OF
receive messages: by listening, by looking, NURSING
through touch, or through an intrepreter.
➢ Ways to help communiaction include ➢ Teaching client education is a major aspect
keeping words simple and concrete of nursing practice
discussing topics of interest to the client. ➢ Teaching clients and families about their
➢ It is often helpful to use alternative health needs is a major role of the nurse.
communication strategies such as word ➢ An important independent nursing functiion
boards, pictures, or paper and pencil. ❖ Is defined as a system of activities intended
➢ Often interpreters can assista client and to produce learning
nurse to communicate when the client lacks ❖ The teaching process is intentionally
fluency in the dominant language. designed to produce specific learning
➢ Some hospitals have a list of interpreters for ❖ Teaching-learning process involves dynamic
various languages who can assist at the interaction between teacher and learner.
bedside. ❖ Each participant in the process
➢ If the clients support person offers to communicates information, emotions,
interpret, it is important to ask the client’s perceptions, and attitudes to the other
permission, for the sake of confidentiality.
Then instruct the person interpreting to
translte as precisely as possible, whithout
interruption.

Educate the Client and Support People

➢ Sometimes clients and support people can

be prepared in advance for communication
problems, for example, before an intubation
or throat surgery.
➢ By explaining anticipated problems, the
client is often less anxious when problems
arise.
➢ Evaluation is useful for both client and nurse
communication.
 support, simple to complex learning,
repitition, timing, environment, emotions,
physiological events, cultural aspects, and
psychomotor ability.
● Many adults in the United States use the
Internet to access health information.
● Nurses need to know and integrate this
technology into their teaching plans.
● Low healthy literacy is a silent epidemic. It is
associated with poor health outcomes and
higher health care costs.

NURSING MANAGEMENT: NURSING PROCESS

● ASSESSING
➔ Using the “teach back” technique helps the
nurse assess the client’s understanding of
what was taught.
● PLANNING
➔ Teaching strategies chosen by the nurse
should be suited to the client and to the
material to be learned.
➔ A teaching plan is written plan consisting of
learning outcomes, content to teach, and
strategies to use in teaching the content.
➔ The plan must be revised when the client’s
needs change or the teaching strategies
Teaching and Learning prove ineffective.

● Three main theories of learning are

behaviorism, cognivitism, and humanism.
● A number of factors affect learning,
including: age and developmental stage,
motivation, readiness, active involvement,
relevance, feedback, nonjudgemental
 ● EVALUATING
➔ Evaluating the teaching-learning process is
both an ongoing and a final process in which
the client, nurse, and support people
determine what has been learned.

Evaluating Learning

● The process of evaluating learning is the

same as evaluating client achievement of
desired outcomes for other nursing
diagnoses.
● Learning is measured against the
predetermined learning outcomes selected in
the planning phase of the teaching process.
● Thus, the outcomes serve not only to direct
the teaching plan but also to provide
outcome criteria for evaluation:
● For example, the outcome “Selects foods
that are low in carbohydrates” can be
evaluated by asking the client to name such
foods or to select low-carbohydrate foods
from a list
● DOCUMENTING
➔ Documentation of client teaching is essential
to communicate the teaching to other health
professionals and to provide a record for
legal purposes.