Chapter 4 The Nurse-Client Relationship

4-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Communication  Communication is the exchange of thoughts, feelings, and other information.  The nurse-client relationship depends on effective communication.

4-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Communication Process  Five Major Components Sender Message Channel Receiver Feedback

4-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. A Communication Model

4-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Communication Process  The sender initiates the process of communication by generating a message.  The message is communicated via a channel, verbally, non-verbally, or in another symbolic form.

4-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

4-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Communication Process  The receiver infuses the message with meaning specific to her personal experience.  Physiological, psychological, and cognitive processes influence the receiver’s interpretation.

4-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Communication Process  Feedback is information about the receiver’s perception of the message.  Feedback can either facilitate or impede effective communication.

4-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Characteristics of Effective Feedback  Descriptive, clear  Provided in a supportive, non-threatening manner  Practical and appropriate for the individual client  Direct and honest

4-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Influencing Communication  Perception  Cultural Context  Space and Distance  Time

4-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Perception  Each person’s perceptions of the world are unique.  Perceptions are a function of social, cultural, and family experiences.  Misunderstandings occur when two people do not perceive the same meaning about a message.

4-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Space and Distance  The nurse demonstrates respect for each client’s culturally determined right to personal space and distance.

4-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Time  Quality time spent with the client allows her to feel cared for and valued.  The nurse should avoid appearing rushed while gathering important data and providing client education.

4-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Levels of Communication  Intrapersonal communication (self-talk), consists of ideas and information inside one’s own mind.  Interpersonal communication occurs between two people.  Group communication occurs with three or more individuals.

4-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Self-Talk

4-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Interdisciplinary Group Communication  The Health Care Team collaborates to assess client status and plan for effective client outcomes.  Breakdown of communication between different team members can interfere with the client’s treatment.

4-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Health Care Team  Client  Family  Nurses  Social Workers  Physical Therapists  Occupational Therapists

4-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Modes of Communication  Verbal Messages  Nonverbal Messages  Facial Expression  Posture  Gestures  Touch  Physical Appearance and Artifacts

4-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Therapeutic Communication  Is a vehicle for establishing a partnership between the nurse and the client.  Conveys to the client that he is cared for and understood.

4-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Therapeutic Communication  Purposeful and goal-directed  Well-defined boundaries  Client-centered  Non-judgmental  Uses specifically designed techniques

4-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Principles of Therapeutic Communication  Time the interaction to avoid distraction or fatigue.  Provide a comfortable and private environment.  Clarify the purpose of the interaction.  Establish guidelines.

4-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Principles of Therapeutic Communication  Accept the client “as is.”  Let the client take the lead through active listening.  Seek clarification by reflection and restating.

4-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Barriers to Therapeutic Communication  Language and Cultural Differences  Gender  Health Status  Developmental Level  Emotions  Communication Blocks

4-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Barriers to Therapeutic Communication  Language Barriers Discrepancies in vocabulary usage and expressions Use of health care jargon

4-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nontherapeutic Communication Blocks  Intrusive self-talk or inappropriate responses Certain responses that would be acceptable during social conversation are not useful during therapeutic interaction. An inappropriate response may result in the client experiencing feelings of inadequacy, intimidation, or confusion.

4-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Communication, Critical Thinking, and the Nursing Process  Interpersonal skills and critical thinking are competencies that form the basis for successful application of the nursing process.

4-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Communication, Critical Thinking, and the Nursing Process  Critical Thinking and Assessment The client’s sense of control is enhanced when the nurse asks open-ended questions and pays attention to verbal and nonverbal messages.

4-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Communication, Critical Thinking, and the Nursing Process  Critical Thinking and Nursing Diagnosis Careful attention to assessment data provides a deeper understanding of the client’s experience and needs. Accurate analysis of assessment data leads to accuracy in diagnostic judgment.

4-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Communication, Critical Thinking, 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

4-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

4-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Communication, Critical Thinking, and the Nursing Process  Implementation Alternative modes of communication can be used in implementing a teaching plan. -Sign language -Gestures -Alphabet boards -Electronic communication devices

4-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Communication, Critical Thinking, and the Nursing Process  Evaluation It is important to determine if communication is a factor that impedes the client’s healing process. -Verbal and nonverbal cues may indicate to the nurse the need for further client teaching. -Interventions that might resolve this problem require consideration.