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 helpingStrives to achieve two major goalsHelp clients manage their problems in living more effectivelyHelp clients become more effective at helping themselves
5 The Helping Relationship CaringComfortingCommunicating
6 CaringMadeleine 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 feelsEgan (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 ComfortingMorse (1996): A complex process that includes discrete, transitory actions, such as listening”The comforting process is client-ledIt 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 ComfortRelates to Body Sensations and medical DxPsycho spiritual ComfortSelf esteem, sexuality, and meaning in their lifeBelief in a higher beingSocial ComfortRelates to interpersonal, family, and social relationshipsEnvironmental ComfortThe external part of the human experienceCultural Specific
10 Phases of Helping Four sequential phases Progress in succession Build on the one beforeNurse needs to identify and understand these phasesAble 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 faceNurse needs to recognize her own feelingsFocus on plan for information to be discussed
12 Nursing Skills for Preinteractive Phase Organize DataRecognize LimitationsSeek 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 BehaviorsDevelop TrustRespectful CultureConcernedMaintain ConfidentialityMutual participant in plan of care
15 Working PhaseThe client and nurse begin to see each other as unique individuals.Begin to explore thoughts and feelingsBegin to take action to meet goalsNurse helps client form long and short term goalsNurse reinforces successes and helps client to deal realistically with failure.
16 Nursing Skills for Working Phase Empathetic ListeningRespectGenuinenessConcretenessConfrontationDecision making and Goal setting
17 Termination PhaseNurse and client accept feelings of ending the relationshipThe 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 accomplishmentsExpress feelings about terminationAllows time for client to adjust to independenceFollow up support may be neededFollow up phone callsEase clients transition to independence
19 Communication “Any means of exchanging information or feelings between two or more people. It isa basic component of human relationships,including nursing.”
20 Communication Collect data Initiate Interventions Evaluate Outcomes Initiate ChangePrevent Legal ProblemsThe communication process:Intended to elicit a responseSenderMessageReceiverResponse
21 Modes of Communication Verbal ModePace and IntonationSimplicityClarityTiming and RelevanceAdaptableCredibleHumorNonverbal ModePersonal AppearancePosture/GaitFacial ExpressionGestures
22 Therapeutic Communication Promotes understandingEstablishes a constructive relationship between the nurse and the clientTherapeutic helping relationship is client and goal directedRespond to words and feelingsStrong emotions require more time
23 Therapeutic Communication Attentive Listening:Uses all senses—note key themesMost important technique in nursingBasic to all other techniquesRequires energy and concentrationReceives total message—verbal and nonverbal
24 Daily Communication 80% of working day is spent conversing Talking is not the same as communicatingBe clear and conciseLet the silence sitState your point up front, and back it upBe aware of body languageGood communication takes practice!