1. Communication
Unit I
Nursing 103

2. Nurses are Healers

3. Communication: Objectives
List key characteristics of a nurse/client helping relationship.
Define the terms caring and empathy.
Describe the phases of a helping relationship.
Describe types of communication used nursing care.
Practice therapeutic communication skills.

4. The Helping Relationship
Nurse-Client Relationship referred to as interpersonal, therapeutic, and helping
Strives to achieve two major goals
Help clients manage their problems in living more effectively
Help clients become more effective at helping themselves

5. The Helping Relationship
Caring
Comforting
Communicating

6. Caring
Madeleine Leininger (1984): The essence of nursing and the dominant, distinctive, and unifying feature of nursing.
Jean Watson (1985): A set of universal human values;kindness, concern, love of self and others.
Miller (1995): “Intentional action that conveys physical and emotional security and genuine connectedness to another person…”

7. Empathy Nurses develop attentive listening
Respond in ways that indicate understanding of how client feels
Egan (1998), Empathy “can be seen as an intellectual process that involves understanding correctly another person’s emotional state and point of view”
Communicate understanding to client.

8. Comforting
Morse (1996): A complex process that includes discrete, transitory actions, such as listening”
The comforting process is client-led
It occurs in response to those cues presented by a client.
Clients themselves are attempting personal comfort—the nurse supports these attempts.

9. Comfort Needs: Kolcaba (1991, 1995)
Physical Comfort
Relates to Body Sensations and medical Dx
Psycho spiritual Comfort
Self esteem, sexuality, and meaning in their life
Belief in a higher being
Social Comfort
Relates to interpersonal, family, and social relationships
Environmental Comfort
The external part of the human experience
Cultural Specific

10. Phases of Helping Four sequential phases Progress in succession
Build on the one before
Nurse needs to identify and understand these phases
Able to identify the progress of the relationship

11. Preinteraction Phase Similar to the planning stage before an interview
Nurses have information before the face to face
Nurse needs to recognize her own feelings
Focus on plan for information to be discussed

12. Nursing Skills for Preinteractive Phase
Organize Data
Recognize Limitations
Seek Assistance

13. Introductory Phase Sets the tone for the rest of the relationship.
Closely observe each other and form judgments about each others behavior.
Opening relationship, clarifying the problem, building trust.

14. Nursing Skills for Introductory Phase
Put client at ease.
Use relaxed , attentive attitude.
Not easy for clients to accept help in many situations.
Resistive Behaviors
Develop Trust
Respectful Culture
Concerned
Maintain Confidentiality
Mutual participant in plan of care

15. Working Phase
The client and nurse begin to see each other as unique individuals.
Begin to explore thoughts and feelings
Begin to take action to meet goals
Nurse helps client form long and short term goals
Nurse reinforces successes and helps client to deal realistically with failure.

16. Nursing Skills for Working Phase
Empathetic Listening
Respect
Genuineness
Concreteness
Confrontation
Decision making and Goal setting

17. Termination Phase
Nurse and client accept feelings of ending the relationship
The client has developed independence and and has no feelings of anxiety or dependence

18. Nursing Skills for Termination Phase
Summarize or review the hospitalization with a focus on accomplishments
Express feelings about termination
Allows time for client to adjust to independence
Follow up support may be needed
Follow up phone calls
Ease clients transition to independence

19. Communication “Any means of exchanging information or
feelings between two or more people. It is
a basic component of human relationships,
including nursing.”

20. Communication Collect data Initiate Interventions Evaluate Outcomes
Initiate Change
Prevent Legal Problems
The communication process:
Intended to elicit a response
Sender
Message
Receiver
Response

21. Modes of Communication
Verbal Mode
Pace and Intonation
Simplicity
Clarity
Timing and Relevance
Adaptable
Credible
Humor
Nonverbal Mode
Personal Appearance
Posture/Gait
Facial Expression
Gestures

22. Therapeutic Communication
Promotes understanding
Establishes a constructive relationship between the nurse and the client
Therapeutic helping relationship is client and goal directed
Respond to words and feelings
Strong emotions require more time

23. Therapeutic Communication
Attentive Listening:
Uses all senses—note key themes
Most important technique in nursing
Basic to all other techniques
Requires energy and concentration
Receives total message—verbal and nonverbal

24. Daily Communication 80% of working day is spent conversing
Talking is not the same as communicating
Be clear and concise
Let the silence sit
State your point up front, and back it up
Be aware of body language
Good communication takes practice!

25. “Be a Bridge, Not a Wall”