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NURSE-PATIENT RELATIONSHIP

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Def:...........
 This is therapeutic relationship achieved during nurse-
patient relationship
NB: The therapeutic relationship differs from the social or
intimate relationship because it focuses on the needs,
experiences, feelings, and ideas of the client only.

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 Purpose of nurse-patient relationship
 Identify the most important client concern at that moment
(the client-centered goal).
 Assess the client’s perception of the problem as it
unfolds.
 Facilitate the client’s expression of emotions.

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 Teach the client and family necessary self-care skills.
 Recognize the client’s needs.
 Implement interventions designed to address the client’s
needs.
 Guide the client toward identifying a plan of action to a
satisfying and socially acceptable resolution.

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 Teacher

 Caregiver

 Advocate

 Parent surrogate
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1. Pre-interaction
2. Orientation
3. Working
4. Resolution or termination.

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 Pre-interaction: occurs prior to meeting a patient; the
nurse reviews available data on the patient to anticipate
health needs and formulate a preliminary plan of care.
 Orientation: the nurse and patient meet and get to know
each other.
 This phase begins as an interpersonal relationship that
lays the foundation for a nurse-patient relationship.

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 Working phase: the patient and nurse work together to
attain mutual goals.

 Termination phase: focused on a smooth transition as

care is passed to other caregivers.

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 Caring
 Openness
 Objectivity
 Respect
 Interest
 Understanding

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 Consistency
 Treating the client as a human being
 Suggesting without telling
 Approachability
 Listening
 Keeping promises
 Honesty

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 Virtually all patients and family members feel some

degree of anxiety, tension, or fear as they face the stress

of managing a patient care situation and interacting

with patient care providers.

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Cont’d..........
 The emotions of anxiety, tension, and fear are key
communication risk factors that are present in many
patient care situations.
 These emotions create stress in the nurse-patient
relationship.

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 Patients feel threatened when they believe they are not
understood or when they do not understand what is
happening to them, and they react physically and
emotionally to the situation.
 If you fail to communicate effectively to establish a

collaborative relationship early in such a situation,

patients and families can become very distressed.
 Any time a patient is acting distressed, you should

assume that needs are not being met and use the patient-
safe communication process to establish a collaborative
relationship.

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1. Assertiveness- The assertive nurse:
 Is confident
 Asks for information or cooperation clearly
 Can say no to requests without feeling guilty
 Makes honest statements
 Keeps a relaxed and open posture
 Maintains direct eye contact and hand gestures
 Can control her/his temper when people get angry

and start to yell.

 Asks questions to understand and analyze a situation

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2. Managing professional identity
i)Manners
 Nurses should carefully choose how to conduct themselves

during professional relationships

ii)Appearance (includes a particular hair style, choice of
makeup, and clothing)
 The professional dress of a nurse transmits powerful

messages to patients, their families, colleagues, and the

public at large.
 Managing appearance in nursing conveys nonverbal

purposeful messages of a positive image of

professionalism.

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iii)Setting
 In nursing, it refers to the privacy we create for the
patient.
 Nurse’s ability to manipulate the setting is needed to
create a safe, confidential environment.
 Examples: Nurses knock before entering a room and
pull privacy curtains around the patient prior to
performing procedures.

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a. Recognizing their feelings
b. Taking sometime to cool off
c. Taking responsibility for their own feelings

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 Nurses have social permission to touch
people.
 Social permission means that people will

allow and actually expect nurses to touch

them during procedures.
 Patients also allow and expect nurses to

provide comforting touches.

 Most patients willingly accept and

welcome touches from nurses and nursing

students.

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 The primary factor that determines how a
patient will respond to touch is the intention
of the touch.
 The meaning of the touch relates to the

situation, the timing, and the manner in

which the touch is delivered.

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 Formal,
 Informal
 Unconscious.
 Formal communication is any official method
of communicating with people.
 The communication may be passed orally or

in written form.
 The message flows from top to bottom, for

example, from the top management to staff

at the lower levels, following the hierarchy or
chain of command in the particular
organization
 Formal communication mainly involves giving
instructions to be followed and clarifying the
roles of staff in the organizations.
 It also emphasizes the use of available

resources to achieve the desired goals.

 Formal communication flows in three

directions, namely:
1. Downward communication
2. Upward communication
3. Horizontal communication
 This is where the communication flow comes
from top management to the lowest level.
 The communication channels used include oral
messages, telephone calls, written
communication in the form of circular letters,
memoranda, pamphlets or posters.
 The main advantage of downward
communication is that it is received immediately
and is not distorted.
 For example, the district public health nurse may
request the nurse working in a health centre to
submit a written report on a monthly basis to
their office.
 This type of communication flows from staff
at lower and middle levels to the top
management.
 This provides feedback regarding

organizational progress, a consultative forum

to improve the quality of service and a means
for staff to request clarification of goals
and/or additional resources.
 In horizontal communication the communication
flow occurs between heads of departments or
supervisors who are at the same level.
 The nurses in-charge of medical and surgical
departments/wards consult one another.
 The supervisors at the same level exchange ideas
on common goals in order to improve the quality
of patient care.
 The supervisors may discuss the common
problems affecting their departments with a view
of getting solutions to recommend to the top
management for approval.
 Informal communication is an unofficial form
of communication between groups of people
in the organization.
 The messages are discussed casually and are
not recognized by the management.
 Informal communication is also known as the
'grapevine'.
 The grapevine is a form of information
containing some half-truths and may
emanate from the staff at the lower or middle
levels in the organization.
 Unconscious communication is where a wrong
meaning has been transferred because of the way
the communication has been conveyed
unconsciously to the receiver.
 Usually the sender of the message is unaware
that their behavior is sending the wrong signals.
 For example, if you appear quite casual when
giving important information, the recipient will
misinterpret the importance of the information
because of the manner in which you speak.
 Therefore, it is important for health workers to
be aware of unconscious communication.