2What 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!
3The Nurse Client Relationship Requires the nurse to respond to the client’s needs.The four categories of these needs are: a) safe and effective environmentb) Health promotion and maintenancec) Psychosocial integrityd) Physiologic integrity
4How do nurses meet these needs? Nurse performs four basic roles:Caregiver refer to box 7-1 & 2 pg 82-83Educator (educate without giving advice on treatment decisions)Collaborator – works with all health care team members to achieve common goalDelegator- must know what tasks are legal and appropriate to delegate
5Therapeutic 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.
6Therapeutic Relationship Is Not: As per Ohio Board of Nursing,A STUDENT SHALL NOT:Engage in sexual conduct with a clientb) Engage in conduct that may be interpreted as sexualc) Engage in verbal behavior that is seductive or sexually demeaning to a client; ord) Engage in verbal behavior that may be interpreted as seductive or sexually demeaning to a client.
7Therapeutic Relationship is not: A social relationship (remember empathy)About you or your problems or personal lifeAbout the clients personal life which does not directly affect the care
8Therapeutic 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?)
9Responsibilities of nurse and patient – EXAMPLE: CURRENT KNOWLEDGEPERFORM TECHNICAL SKILLS SAFELYCOMMITTED TO PATIENT CAREBE AVAILABLE AND COURTEOUSALLOW PATIENT PARTICIPATIONREMAIN OBJECTIVEBE A PATIENT ADVOCATEPROVIDE EXPLANATIONS IN TERMS THE PATIENT CAN UNDERSTANDPROMOTE INDEPENDENCEHOWEVER- YOU NEVER DIVULGE MEDICAL INFORMATION TO THE PATIENT FROM THE CHART – MD IS RESPONSIBLE FOR GIVING THIS INFORAMTION TO PATIENT!PATIENTIDENTIFY CURRENT PROBLEMDESCRIBE WHAT THEY EXPECT TO HAPPENANSWER QUESTIONS HONESTLYPROVIDE ACCURATE HISTORY AND SUBJECTIVE DATAPARTICIPATE TO FULLEST EXTENTBE OPEN AND FLEXIBLECOMPLY WITH PLAN OF CAREKEEP APPOINTMENTS FOR FOLLOW UP CARE
10How do you foster a therapeutic relationship with your patients? Treat every patient as an individual personRespect their feelingsStrive to promote their physical, emotional, social, and spiritual well beingEncourage patient to problem solveAccept that a patient can grow and changeCommunicate in a way the patient understandsIncorporate the patients support system into their care planProvide care techniques which are acceptable to the patient’s values and cultural beliefs.
11Phases 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
12Phases of the nurse-patient relationship Working phase-mutually planning and implementing the patients plan of care.How do you see Orem’s theory here?
13Phases 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.
14Barriers to professional relationship Unprofessional appearance or behaviorDon’t identify yourselfDon’t address the patient by correct nameShowing no interest in patients concernsSharing personal information in front of staffUsing crude/offensive languageGossipingFocus on nursing task rather than patientIgnoring the patients requests, abandoning, fail to keep promises, failure to keep patient informed.
15CommunicationExchange 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
16Verbal communicationCommunication which involves words which can either be spoken, read or written.Used to gather facts, instruct, clarify and exchange ideas
17Verbal communicationWhat 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?
18Verbal communicationListening: 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.
19Nonverbal 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
20Nonverbal communication Kinesics: body language-facial expressions, posture, gestures, and body movementParalanguage: vocal sounds that are not actually languageProxemics: 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 inchesPersonal space: 6 inches to 4 feetSocial space: 4 to 12 feetPublic space: 12 or more feet
21Nonverbal 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 careAffective touch-used to demonstrate concern or affection. (use carefully and when appropriate)
22COMMUNICATION!!!!!!Nursing diagnosis: Impaired communication related to:Definition: Decreased, delayed, or absent ability to receive, process, transmit, and use a system of symbols to communicateWhat type of patients may experience this?
23Impaired 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 communicationNursing Interventions to achieve this goal?
24Nursing interventions Assess communication ability, ask simple questions that evaluate ability to repeat words, interpret, follow directions, and express feelings – allow ample time to respondSpeak slowly, use short sentences, never shout, never use baby talk, provide alternative means of communicationArrange speech therapy consult for significant deficitsHelp patient with repetitive exercises for verbal and physical rehabilitation