1. The Nurse Client Relationship
Chapter 7

2. What type of relationship will you develop with your patient?
Professional relationship develops when you provide nursing services to the patient.
Relationship may be with patient, family, care providers or friends of patient.
Must maintain professionalism when engaging in this relationship – the style and manner of how you communicate is essential!

3. The Nurse Client Relationship
Requires the nurse to respond to the client’s needs.
The four categories of these needs are: a) safe and effective environment
b) Health promotion and maintenance
c) Psychosocial integrity
d) Physiologic integrity

4. How do nurses meet these needs?
Nurse performs four basic roles:
Caregiver refer to box 7-1 & 2 pg 82-83
Educator (educate without giving advice on treatment decisions)
Collaborator – works with all health care team members to achieve common goal
Delegator- must know what tasks are legal and appropriate to delegate

5. Therapeutic Relationship
Goal is to move patient towards health or recovery.
Is patient centered with a focus on achieving the goal of return to health for the patient.
Is time limited – relationship ends when goal of health is achieved.

6. Therapeutic Relationship Is Not:
As per Ohio Board of Nursing,
A STUDENT SHALL NOT:
Engage in sexual conduct with a client
b) Engage in conduct that may be interpreted as sexual
c) Engage in verbal behavior that is seductive or sexually demeaning to a client; or
d) Engage in verbal behavior that may be interpreted as seductive or sexually demeaning to a client.

7. Therapeutic Relationship is not:
A social relationship (remember empathy)
About you or your problems or personal life
About the clients personal life which does not directly affect the care

8. Therapeutic Relationship is about:
Providing professional care to the patient.
Demonstrating and practicing patient advocacy.
Nurses should encourage and expect their patients to be active players in their health care.
Patients are encouraged to communicate, question, assist in planning care and to retain as much independence as possible. (who does this statement remind you of?)

9. Responsibilities of nurse and patient – EXAMPLE:
CURRENT KNOWLEDGE
PERFORM TECHNICAL SKILLS SAFELY
COMMITTED TO PATIENT CARE
BE AVAILABLE AND COURTEOUS
ALLOW PATIENT PARTICIPATION
REMAIN OBJECTIVE
BE A PATIENT ADVOCATE
PROVIDE EXPLANATIONS IN TERMS THE PATIENT CAN UNDERSTAND
PROMOTE INDEPENDENCE
HOWEVER- YOU NEVER DIVULGE MEDICAL INFORMATION TO THE PATIENT FROM THE CHART – MD IS RESPONSIBLE FOR GIVING THIS INFORAMTION TO PATIENT!
PATIENT
IDENTIFY CURRENT PROBLEM
DESCRIBE WHAT THEY EXPECT TO HAPPEN
ANSWER QUESTIONS HONESTLY
PROVIDE ACCURATE HISTORY AND SUBJECTIVE DATA
PARTICIPATE TO FULLEST EXTENT
BE OPEN AND FLEXIBLE
COMPLY WITH PLAN OF CARE
KEEP APPOINTMENTS FOR FOLLOW UP CARE

10. How do you foster a therapeutic relationship with your patients?
Treat every patient as an individual person
Respect their feelings
Strive to promote their physical, emotional, social, and spiritual well being
Encourage patient to problem solve
Accept that a patient can grow and change
Communicate in a way the patient understands
Incorporate the patients support system into their care plan
Provide care techniques which are acceptable to the patient’s values and cultural beliefs.

11. Phases of the nurse-patient relationship
Introductory-getting to know your patient. May have preconceived notions about a patient which are then confirmed or dismissed.
Nurse needs to display: courtesy, empathy, competency, and appropriate communications

12. Phases of the nurse-patient relationship
Working phase-mutually planning and implementing the patients plan of care.
How do you see Orem’s theory here?

13. Phases of the nurse-patient relationship
Terminating phase-nurse/patient relationship is self limiting. Relationship ends when the patient’s immediate health problems are solved and the patient moves on to either home or another care facility.

14. Barriers to professional relationship
Unprofessional appearance or behavior
Don’t identify yourself
Don’t address the patient by correct name
Showing no interest in patients concerns
Sharing personal information in front of staff
Using crude/offensive language
Gossiping
Focus on nursing task rather than patient
Ignoring the patients requests, abandoning, fail to keep promises, failure to keep patient informed.

15. Communication
Exchange of information which involves both sending and receiving information.
Nurse needs to clarify that message was understood or that it needs further clarification.
Communication takes place both verbally and nonverbally

16. Verbal communication
Communication which involves words which can either be spoken, read or written.
Used to gather facts, instruct, clarify and exchange ideas

17. Verbal communication
What should the nurse assess in order to verify what method she will use to communicate information to her patient? As related to verbal, writing and reading?

18. Verbal communication
Listening: be an active listener; pay attention to your patient! Don’t look elsewhere or interrupt – but do encourage the patient to remain focused on the conversation.
Therapeutic silence-withholding comment in order to encourage the patient to participate or elaborate further.

19. Nonverbal communication
Exchange of information without using words – involves what is not said.
People have less control over this than they do verbal communication – why is that?
Nonverbal techniques: kinesics, paralanguage, proxemics, and touch

20. Nonverbal communication
Kinesics: body language-facial expressions, posture, gestures, and body movement
Paralanguage: vocal sounds that are not actually language
Proxemics: space between you and your patient, due to closeness of touch, care etc. some patients may interpret this as sexual-be careful maintain professionalism at all times!
Intimate space: within 6 inches
Personal space: 6 inches to 4 feet
Social space: 4 to 12 feet
Public space: 12 or more feet

21. Nonverbal communication
Touch: tactile stimulus produced by making personal contact with another person or object.
Two types of touch;
Task oriented-personal contact required in order to complete nursing care
Affective touch-used to demonstrate concern or affection. (use carefully and when appropriate)

22. COMMUNICATION!!!!!!
Nursing diagnosis: Impaired communication related to:
Definition: Decreased, delayed, or absent ability to receive, process, transmit, and use a system of symbols to communicate
What type of patients may experience this?

23. Impaired communication related to: cerebral injury
What is the nursing priority?
Patient outcome or goal: Within one hour of admission to floor the patient will establish some form of verbal or nonverbal communication
Nursing Interventions to achieve this goal?

24. Nursing interventions
Assess communication ability, ask simple questions that evaluate ability to repeat words, interpret, follow directions, and express feelings – allow ample time to respond
Speak slowly, use short sentences, never shout, never use baby talk, provide alternative means of communication
Arrange speech therapy consult for significant deficits
Help patient with repetitive exercises for verbal and physical rehabilitation

25. Caring/Nursing Acts
What Is the difference?