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Communication by liwenting



  Unit I

Nursing 103
Nurses are Healers
    Communication: Objectives
 List key characteristics of a nurse/client
  helping relationship.
 Define the terms caring and empathy.
 Describe the phases of a helping
 Describe types of communication used
  nursing care.
 Practice therapeutic communication skills.
     The 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 Relationship
 Caring
 Comforting
 Communicating
 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…”
 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.
 Morse (1996): A complex process that
  includes discrete, transitory actions, such as
 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
           (1991, 1995)
   Physical Comfort                 Social Comfort
    Relates to Body                   Relates to interpersonal,
    Sensations and medical            family, and social
    Dx                                relationships
   Psycho spiritual                 Environmental
    Comfort                           Comfort
    Self esteem, sexuality, and       The external part of the
    meaning in their life             human experience
    Belief in a higher being          Cultural Specific
         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
       Preinteraction Phase
 Similar to the planning stage before an
 Nurses have information before the face to
 Nurse needs to recognize her own feelings
 Focus on plan for information to be
           Nursing Skills for
         Preinteractive Phase
   Organize Data

   Recognize Limitations

   Seek Assistance
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.
Nursing Skills for Introductory
   Put client at ease.
   Use relaxed , attentive    Respectful Culture
    attitude.                  Concerned
   Not easy for clients to    Maintain
    accept help in many         Confidentiality
    situations.                Mutual participant in
   Resistive Behaviors         plan of care
   Develop Trust
           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
 Nurse reinforces successes and helps client
  to deal realistically with failure.
     Nursing Skills for Working
   Empathetic Listening      Concreteness

   Respect                   Confrontation

   Genuineness               Decision making and
                               Goal setting
        Termination Phase
 Nurse and client accept feelings of ending
  the relationship
 The client has developed independence and
  and has no feelings of anxiety or
Nursing Skills for Termination
 Summarize or review         Follow up support
  the hospitalization          may be needed
  with a focus on
  accomplishments             Follow up phone calls
 Express feelings about
                              Ease clients transition
 Allows time for client
                               to independence
  to adjust to

“Any means of exchanging information or
 feelings between two or more people. It is
 a basic component of human relationships,
 including nursing.”
   Collect data                The communication
   Initiate Interventions       process:
   Evaluate Outcomes           Intended to elicit a
   Initiate Change              response
                                Sender
   Prevent Legal
    Problems                    Message
                                Receiver
                                Response
   Modes of Communication
Verbal Mode                 Nonverbal Mode
 Pace and Intonation       Personal Appearance
 Simplicity                Posture/Gait
 Clarity                   Facial Expression
 Timing and Relevance      Gestures
 Adaptable
 Credible
 Humor
    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
    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
      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!
“Be a Bridge, Not a Wall”

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