The Nurse-Client Relationship
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Communication, the process of transmitting thoughts, feelings, facts, and other information, includes verbal and nonverbal behavior. The nurse-client relationship depends on effective communication.



The Components of Communication Process

Sender Message Channel Receiver





A Communication Model


The Communication Process


Initiates the process of communication by generating a message. The message is communicated via a channel, verbally, non-verbally, or in another symbolic form.


The Communication Process • Message – Derived from sender’s internal and external experiences. – 5/3/12 . Includes internal or external stimuli.

– – 5/3/12 .The Communication Process • Channels – The visual channel allows for visual observation and perception. The auditory channel consists of spoken words and other verbal cues. The kinesthetic channel refers to physical sensations mediated by touch.

– 5/3/12 . Physiological.The Communication Process • Receiver – The receiver infuses the message with meaning specific to personal experience. and cognitive processes influence the receiver’s interpretation. psychological.

– Can either facilitate or impede effective communication. . 5/3/12 .The Communication Process • Feedback – Information about the receiver’s perception of the provide the sender with information about the receiver’s perception of a situation.

nonthreatening manner Given in a timely manner (as soon as possible after the behavior or the message) Usable and appropriate to client needs 5/3/12 ü ü ü Clear and unambiguous .CHARACTERISTICS OF EFFECTIVE FEEDBACK ü ü ü Specific rather than general Descriptive Provided in a supportive.

Factors Influencing Communication Ø Perception Cultural Context Space and Distance Time 5/3/12 Ø Ø Ø .

cultural. Perceptions are a function of social. 5/3/12 q q . Misunderstandings occur when two people do not perceive the same meaning about a message. and family experiences.Perception q Each person’s perceptions of the world are unique.

The nurse demonstrates respect for each client’s culturally determined right to personal space and distance. 5/3/12 .Space and Distance Proxemics .the study of the distance between people and objects .

pulse.Types of Personal Space Types Description Nursing Implications Intimate distance (0 to • Reserved for people • Nurses often must 18 inches around the who feel close intrude on this space person’s body) to provide • Vision is affected in care that it is restricted to • Explain intention to one client portion of the other’s • Respect client’s body. and 5/3/12 blood pressure) . respiratory rate. may be distorted space as much as possible • Tone of voice may • May be used for seem louder comforting and protecting • Body smells • Therapeutic noticeable examples: —Rocking a toddler • Increased sensation —Administering a of body heat massage —Checking vital signs (temperature.

Types of Personal Space Types Personal distance (zone extends 1.5 to 4 feet around person’s body) Description • Usually maintained with friends • Vision is clear since more of the other person is visible • Tone of voice is moderate Nursing Implications • Better able to read nonverbal communication at this distance • Therapeutic examples: —Conversation between client and nurse usually occurs in this zone • Sensations of body smells and heat are —1-to-1 teaching lessened —Counseling 5/3/12 .

Types of Personal Space Types Description Nursing Implications Social or public distance (zone extends from 4 feet and beyond) • Generally used when conducting impersonal Business • Therapeutic examples: —Making rounds —Leading a group —Teaching a • Communication class is more formal and less intense • Sensory involvement is less intense • Increased eye contact 5/3/12 .

infrequent contact.Time • Quality time spent with the client allows her to feel cared for and valued. frequent contact than to prolonged. The amount of time spent in communicating depends on the client’s needs. 5/3/12 . • Ex. The client who is seriously ill or nontrusting may respond better to brief.

Levels of Communication Intrapersonal communication (self-talk). consists of ideas and information inside one’s own mind. 5/3/12 .

Self-Talk 5/3/12 .

• Interpersonal communication is the process that occurs between two people either in face-to-face encounters. 5/3/12 . over the other communication media.

occurs with three or more individuals. The nurse should be aware of the various nonverbal messages derived from the spatial arrangement of group members • • 5/3/12 . This level of communication is complex because of both the number of people communicating intrapersonally and interpersonally and the combinations of the people involved.• Group communication .

• Influenced by group dynamics. • The logical outcomes are group cohesiveness • The logical outcome of one-to-oneand group communication is the development of theproductivity. • The group is the major support for the client • The nurse is the major support for theduring the interaction. Reusch).g. with assistance from solving are done by the client. interpersonal theory. client during the interaction. Peplau. with inputthe leader. each with own unique perceptions. • Problem identification and problem solving • Problem identification and problemare done by the group.Differences between One-to-One and Group Communication One-to-One Interactions Group Interactions •One sender and one receiver. 5/3/12 .. communication(e. Rogers. approach (e. from the nurse.. and terminating a• Requires understanding of underlying therapeutic nurse-client relationship.g. psychoanalytic approach. each with• Numerous senders and receivers. modalities as well as a theoretical framework to • Requires understanding of nurse-clientguide both interventions and interpretations relationship theory. nurse-client relationship. unique perceptions. and an overall theoreticalmodel). • Influenced by dynamics of creating. maintaining.

social 5/3/12 . 1. Communication—The nurse actively listens to the client to determine needs.Interdisciplinary Communication The Health Care Team collaborates to assess client status and plan for effective client outcomes. 2. Collaboration—The nurse works with multidisciplinary team members (i. Critical thinking—The nurse uses cognitive processes to decide which groups are congruent with the client’s needs..e. 3.

refer to the movement of body parts. speed. comfort. It can be used to soothe. Nonverbal Messages . 5. and establish rapport.are messages communicated without words: that a powerful nonverbal medium for communication. Verbal Messages . contradict. relaxation. or Posture indicates anxiety. and negative or positive self-image. and volume. inflection.(specific types of nonverbal . Gestures .give clues that support. 2. Physical Appearance .Modes of Communication 1. 3. 4. 5/3/12 1. grunts and other nonlanguage vocalizations. through body language Facial Expression . Touch .includes paraverbal cues: tone and pitch of voice.

Ø 5/3/12 .Therapeutic Communication Ø Is the use of communication for the purpose of creating a beneficial outcome for the client. Conveys to the client that he is cared for and understood.

Characteristics of Therapeutic Communication q q q q q Purposeful and goal-directed Well-defined boundaries Client-centered Non-judgmental Uses specifically designed techniques 5/3/12 .

and nonverbal cues and signals of the client.put aside personal prejudices. or when the client is distracted by environmental stimuli Setting the stage . feelings. Establish guidelines for the therapeutic interaction Accepting the client .curiosities. paraverbal. Active listening – Pay attention to the verbal. during change of shift. and focus on them when they occur. 5/3/12 Ø Ø Ø . and values are more receptiveto the feelings and behaviors of the client.Ø Principles of Therapeutic Communication Time and place .Assure is unwise to plan to talk with a client during visiting hours.

Elements of Therapeutic Communication • • • • • • Empathy Trust Honesty Validation Caring Active listening 5/3/12 .

Definition The Elements of Therapeutic Communication Behaviors of the Nurse Outcomes Empathy: An emotional Verbal comments: linkage between two or • “This must make you more people through feel sad. • Provides the client with clues that the nurse is following and understanding what is being said. 5/3/12 . involves Nonverbal actions: trying to imagine what it • A nod of the head to must be like to be in indicate understanding another person’s situation • Mirroring the client’s facial expression in a genuine way. • Enables the nurse and client to relate better. • Promotes understanding of the client’s feelings and condition.” which feelings are communicated.

• Makes the client feel comfortable with the nurse. 5/3/12 .Definition The Elements of Therapeutic Communication Behaviors of the Nurse • Ensure confidentiality. open. • Do exactly what you say you will do for the client. • Be consistent. • Sets up the foundation of the therapeutic relationship. • Be consistently friendly. • Arrive on time. • Return when you say you will. and honest. • End the session on time. rather than guarded or afraid. Outcomes Trust: The client’s belief that the nurse will behave predictably and competently while respecting the client’s needs • Provides the basis for progress during future encounters.

• Accept yourself. • Promotes the development of trust. and reassurance. frank. Consequently.Definition The Elements of Therapeutic Communication Behaviors of the Nurse Outcomes Honesty: The ability to • Provide realistic be truthful. modified as needed. sincere • Avoid false reassurance. 5/3/12 . the way your feelings behavior with and reactions affect the the client can be client. • Enables the nurse to gain personal • Develop insight into insight.

respected. and understood.” • Clarifies communication. ” • “Let me be sure I understand what you are saying.” • “Tell me what you understand about what I just said.Definition The Elements of Therapeutic Communication Behaviors of the Nurse Verbal comments: • “So you are saying that ... 5/3/12 . Outcomes Validation: Listening to the client and responding congruently in order to be sure that the nurse and client have the same understanding of a problem or issue • Helps the client to feel accepted.

to show support. .Definition The Elements of Therapeutic Communication Behaviors of the Nurse Outcomes Caring: The level of Nonverbal actions: emotional involvement • Seeking the client out each day. 5/3/12 • Makes the client feel accepted. • Provides the client with the knowledge that the nurse is willing to help. • Using tactile messages. such as a pat on the back. • Paying attention to the client’s needs. between the nurse and the client • Spending quality time with the client.

noticing • Making eye contact. and signals from better understanding identifying underlying the client. • Promotes understanding Active listening: of the client. • Listening between the lines.Definition The Elements of Therapeutic Communication Behaviors of the Nurse Outcomes • Taking time to listen. • Enhances the client’s self-esteem. • Allows the client to language. of the problem(s). 5/3/12 . and clues. feelings • Analyzing and validating • Promotes problem throughout the conversation. • Suspending judgment. • Helps the client gain a enhancements. express self more nonverbal and • Responding to verbal freely. solving by the client. Hearing and interpreting • Giving the client your undivided attention. paraverbal and nonverbal leads.

Definition The Elements of Therapeutic Communication Behaviors of the Nurse • Understanding the feelings behind the facts. • Noticing discrepancies between facts and feelings. Outcomes 5/3/12 . • Noticing things omitted such as topics that the client should be discussing but avoids. • Using communication principles and techniques to be a sounding board.

Barriers to Therapeutic Communication Ø Ø Ø Ø Ø Ø Ø Ø Language Culture Gender Health status Developmental level Emotions Health care jargon Communication blocks 5/3/12 .

Issues if the client and nurse do not share the same basic language. – 5/3/12 .Barriers to Therapeutic Communication Language – Discrepancies in vocabulary usage and expressions.

What is acceptable in one culture might be taboo in another.Barriers to Therapeutic Communication Culture – – Differences transcend spoken language. 5/3/12 .

Avoid rigid preconceptions about gender-based communication differences. – 5/3/12 .Barriers to Therapeutic Communication Gender – Men and women differ in communication styles.

Barriers to Therapeutic Communication Health status – The presence of pain. confusion. 5/3/12 . and perception alterations (hearing or vision loss) impact communication processes.

5/3/12 .Barriers to Therapeutic Communication Developmental level – Consider the client’s level before attempting to communicate.

Barriers to Therapeutic Communication Emotions – – Avoid treating the client as a “disease. Balance personal emotions with the client’s.” Remember that the client is a human being. – 5/3/12 .

– – 5/3/12 .Barriers to Therapeutic Communication Health care jargon – Used by health care providers to “distance” themselves from clients. Avoid “talking down” to clients. Use plain English at every opportunity.

Barriers to Therapeutic Communication Communication blocks – – – – – – – Reassuring Agreeing Approving Defending Using yes-or-no questions Using stereotyped comments Changing focus 5/3/12 .

Barriers to Therapeutic Communication – – – – – – – Judging Blaming Belittling the client’s feelings Advising Rejecting Disapproving Probing 5/3/12 .

5/3/12 . Critical Thinking. and the Nursing Process Interpersonal skills and critical thinking are competencies that form the basis for successful application of the nursing process.Communication.

Communication. Critical Thinking. and the Nursing Process Assessment – The client’s sense of control is enhanced when the nurse asks open-ended questions and pays attention to verbal and nonverbal messages. 5/3/12 .

Communication. – 5/3/12 . and the Nursing Process Nursing Diagnosis – Careful attention to assessment data provides a deeper understanding of the client’s experience and needs. Critical Thinking. Accurate analysis of assessment data leads to accuracy in diagnostic judgment.

and the Nursing Process Nursing diagnoses related to communication difficulties – Social Isolation related to impaired verbal communication Anxiety related to impaired verbal communication Self-Esteem Disturbance related to impaired verbal communication – – 5/3/12 .Communication. Critical Thinking.

and the Nursing Process Planning and Outcome Identification – Effective therapeutic communication allows the nurse and the client to work together to develop goals and identify appropriate outcomes. 5/3/12 . Critical Thinking.Communication.

• • • Sign language Gestures Alphabet boards Electronic communication devices 5/3/12 • .Communication. Critical Thinking. and the Nursing Process Implementation – Alternative modes of communication can be used in implementing a teaching plan.

Critical Thinking. • 5/3/12 . • Verbal and nonverbal cues may indicate to the nurse the need for further client teaching. Interventions that might resolve this problem require consideration.Communication. and the Nursing Process Evaluation – It is important to determine if communication is a factor that impedes the client’s healing process.

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