1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 7 The Nurse–Client Relationship

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship Relationship established between nurse and client Four categories of client needs designated by The National Council of State Boards of Nursing –Safe, effective care environment –Health promotion and maintenance

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) Four categories of client needs designated by The National Council of State Boards of Nursing (cont’d) –Psychosocial integrity –Physiologic integrity

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) The four basic roles performed by nurses: –The nurse as caregiver oPerforms health-related activities, contemporary caregiving role oDevelops close emotional relationships oUnderstands that illness and injury cause insecurity; uses empathy

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) The nurse as educator –Educates client about complex health care arena –Provides health teaching pertinent to each client’s needs, knowledge base –Avoids giving advice –Lets the client choose his health care

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) The nurse as educator (cont’d) –Shares information and potential alternatives –Empowers client involvement oSelf-help groups, rehabilitation, financial assistance, emotional support

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) The nurse as collaborator –Works with the team toward achieving a common goal –Responsible for managing care –Shares information with other health care workers

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) The nurse as delegator –One who assigns a task to someone –Legal, appropriate delegation –Inspects completed, delegated task –Accountable for inadequate care

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship Desired outcome: moving toward improved health –Client-centered: time-bound goals –Encourage active client involvement oFor communicating and questioning oFor planning care and retaining maximum independence

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) Underlying principles –Treats client as a unique person and respects client’s feelings –Promotes client’s physical, emotional, social, and spiritual well-being –Encourages client participation –Individualizes client care

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) Underlying principles (cont’d) –Accepts client’s potential for growth and change –Communicates using understood terms and language; incorporates client support system –Implements compatible health care techniques: client’s values and culture

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) Phases of the nurse–client relationship –Introductory phase oPeriod of getting acquainted oInitial interaction oClient initiates relationship: identifies one or more health problems

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) Phases of the nurse–client relationship (cont’d) –Introductory phase (cont’d) oNurses to demonstrate:  Courtesy and empathy  Active listening and competency  Appropriate communication skills

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) Phases of the nurse–client relationship (cont’d) –Working phase oMutually planning care: enact plan oParticipation from both sides oNurse promotes client independence

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) Phases of the nurse–client relationship (cont’d) –Terminating phase oNurse and client agree immediate health problems improved oCaring attitude and compassion facilitate client’s care transition

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) Barriers to a therapeutic relationship –Positive relationship with every client not possible oBest approach is to treat a client as you would like to be treated

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication Exchange of information Following feedback confirms understanding Occurs simultaneously –Verbal; Nonverbal Nurses develop skills for therapeutic interactions

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) Verbal communication –Using words: includes speaking, reading, and writing oTo gather facts oTo instruct, clarify, and exchange ideas –Factors: affect ability to communicate oAttention and concentration

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) Verbal communication (cont’d) –Factors: affect ability to communicate (cont’d) oLanguage compatibility and verbal skills oHearing and visual acuity oMotor functions involving the throat, tongue, and teeth

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) Verbal communication (cont’d) –Factors: affect ability to communicate (cont’d) oSensory distractions oInterpersonal attitudes oLiteracy and cultural similarities

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) Verbal communication (cont’d) –Nurse promotes factors enhancing communication; eliminates those interfering with expressed idea clarity Therapeutic verbal communication oSocial: superficial oTherapeutic: accomplish objective oAvoid non-therapeutic communication

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Verbal Communication Techniques

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nontherapeutic Communication

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) Verbal communication (cont’d) –Active listening: attending to/becoming fully involved in client reporting oPay attention to what clients say oAvoid communicating signals indicating boredom, impatience, or pretense of listening

25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) Verbal communication (cont’d) –Silence: intentionally withholding verbal commentary oEncourages client participation oCan relieve client anxiety by providing personal presence

26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Silence is a form of verbal communication.

27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Silence is a form of verbal communication.

28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) Nonverbal communication: exchange of information without using words –Kinesics: Body language Knowledge of kinesics important –Paralanguage: communicating through vocal sounds

29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) Nonverbal communication (cont’d) –Proxemics: use/relationship of space in communication oVaries according to cultural background oUnderstand client’s comfort zone

30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following defines personal space in proxemics? a. 4 to 12 feet b. 6 inches to 4 feet c. Within 6 inches d. More than 12 feet

31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer b. 6 inches to 4 feet According to the four zones in proxemics, personal space is defined as 6 inches to 4 feet. Social space is indicated by 4 to 12 feet. Intimate space is within 6 inches, and public space is more than 12 feet.

32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) Nonverbal communication (cont’d) –Touch: tactile stimulus produced by making personal contact Task-oriented touch Affective touch Must be used cautiously

33. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Affective touch involves the personal contact required when performing nursing procedures.

34. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Affective touch is used to demonstrate concern or affection. Task-oriented touch involves the personal contact required when performing nursing procedures.

35. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations Demonstrate respect for older clients to establish a trusting relationship Avoid quick and presumptuous approach Initially greet the client by giving your name and title Appropriate use of touch

36. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations (cont’d) Address the client using formal titles of respect Never treat older adults as children, uneducated Promote control over decisions Encourage reminiscing