CommunicationCommunication

Unit I

Nursing 103

Nurses are HealersNurses are Healers

Communication: ObjectivesCommunication: 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.

The Helping RelationshipThe Helping Relationship

Nurse-Client Relationship referred to as interpersonal, therapeutic, and helping

Strives to achieve two major goals

1. Help clients manage their problems in living more effectively

2. Help clients become more effective at helping themselves

The Helping RelationshipThe Helping Relationship

CaringComforting Communicating

CaringCaring

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…”

EmpathyEmpathy

Nurses develop attentive listeningRespond 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.

ComfortingComforting

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.

Comfort Needs: Kolcaba Comfort Needs: Kolcaba (1991, 1995)(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

Phases of HelpingPhases of Helping

Four sequential phasesProgress in successionBuild on the one beforeNurse needs to identify and understand

these phasesAble to identify the progress of the

relationship

Preinteraction PhasePreinteraction Phase

Similar to the planning stage before an interview

Nurses have information before the face to face

Nurse needs to recognize her own feelingsFocus on plan for information to be

discussed

Nursing Skills for Nursing Skills for Preinteractive PhasePreinteractive Phase

Organize Data

Recognize Limitations

Seek Assistance

Introductory PhaseIntroductory 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.

Nursing Skills for Introductory Nursing Skills for Introductory PhasePhase

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

Working PhaseWorking Phase

The 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

goals Nurse reinforces successes and helps client

to deal realistically with failure.

Nursing Skills for Working Nursing Skills for Working Phase Phase

Empathetic Listening

Respect

Genuineness

Concreteness

Confrontation

Decision making and Goal setting

Termination PhaseTermination Phase

Nurse and client accept feelings of ending the relationship

The client has developed independence and and has no feelings of anxiety or dependence

Nursing Skills for Termination Nursing Skills for Termination PhasePhase

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

CommunicationCommunication

“Any means of exchanging information or

feelings between two or more people. It is

a basic component of human relationships,

including nursing.”

CommunicationCommunication

Collect data Initiate Interventions Evaluate Outcomes Initiate Change Prevent Legal

Problems

The communication process:

Intended to elicit a response

Sender Message Receiver Response

Modes of CommunicationModes of Communication

Verbal Mode Pace and Intonation Simplicity Clarity Timing and Relevance Adaptable Credible Humor

Nonverbal Mode Personal Appearance Posture/Gait Facial Expression Gestures

Therapeutic CommunicationTherapeutic 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

Therapeutic CommunicationTherapeutic 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

Daily CommunicationDaily Communication

80% of working day is spent conversingTalking 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!

““Be a Bridge, Not a Wall”Be a Bridge, Not a Wall”