1. Objectives
Nurse-Client Relationship • Explain the differences between a
nurse/client interaction versus a social
and Effective interaction
• Describe the nature of the nurse/client
Communication relationship
• Define the progressive phases of a
Techniques nurse/client interaction
• Discuss the different forms of
Nursing 53A communication and the importance of
each
Judy Ontiveros, RN, MSN • Report the major factors affecting the
nurse/client interaction
Fall 2010
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Characteristics of the Nurse-Client
Objectives Interaction
• Discuss principles of effective
therapeutic communication.
• Purpose
• Define and illustrate techniques • Therapeutic or Helping
of therapeutic communication. Relationship
• Interact effectively with patient, • Growth facilitating process
staff and peers.
• Discuss ways to report and
document important data • Initiation
accurately and in a timely
manner. • Development of trust/acceptance
• Discuss influences of cultural • Belief that nurse cares and wants
diversity in the communication
process.
to help
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Characteristics of the Nurse-Client Characteristics of the Nurse-Client
Interaction Interaction
• Intellectual and emotional bond • Empathy
• Focused on client • “Intellectual process that involves
• Respects the client as an individual understanding correctly another
person’s emotional state and point
• Includes patient in decision making
of view” Egan, 1998
• Considers ethical and cultural aspects
• End result is comfort and care
• Considers family relationships and
• Helping, healing relationship
values
• Respects confidentiality
• Focus on client’s well being
• Based on mutual trust, respect,
acceptance.
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2. Nature of the Nurse-Client Relationship Nature of the Nurse-Client Relationship
• Caring and Human Dignity • Caring – a multidimensional
• People, relationships, and things concept
matter. • Theories developed around this
• A positive difference is made for concept
clients • Leininger-Cultural Care
• Caring practice • Ray – Bureaucratic Caring
• Connection • Boykin and Schoenhofer-Nursing
• Mutual recognition as caring
• Involvement • Watson – Theory of Human Care
• Ability to give focused attention • Swanson – Theory of Caring
• Leave the egocentric self behind • Benner/Wrubel – Primacy of Caring
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Six C’s of Caring in Nursing Maintaining Caring Practice
• Compassion
• Participating in the experience of others • Care for thine ownself
• Competence • Healthy lifestyle
• Knowledge/skills to respond appropriately • Mind body therapies
• Confidence • Positive affirmations
• Fosters trust • Meditation
• Conscience • Yoga
• Personal responsibility • Reflection on practice
• Commitment • Journaling
• Desires, obligations, deliberation
• Comportment
• Professionalism
Caring, the Human Mode of Being. 2nd ed. M.S. Roach. 2002
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Phases of Nurse-Client Interaction Phases of Nurse-Client Interaction
• Preinteraction Phase • Working Phase
• Planning stage • Share each other’s uniqueness
• Introductory Phase • Deep sharing and concern about
• Orientation phase or prehelping the welfare of the client
• Observation • Caring
• Judgments • Empathy grows
• Three stages • Two stages
• Opening the relationship
• Exploring and understanding
• Clarifying the problem
• Facilitating and taking action
• Structure and formulate the plan
• Develop trust
• Dispel Resistive behaviors
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3. Factors Influencing Nurse-Client
Phases of Nurse-Client Interaction Interactions
• Termination • Age and Development
• Can be difficult and filled with • Perception/knowledge level
ambivalence • Value/belief
• May have some feelings of loss
• Emotion
• Summarizing/reviewing process
• Sense of accomplishment
• Sociocultural background/human
diversity
• Discussions on termination start
early in process • Role perception
• Follow-up phone calls • Environment/space/territory
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Factors Influencing Nurse-Client
Interactions
Forms of Communication
• Speech Patterns • Verbal
• Unknowing use demeaning or
patronizing language • Non-Verbal
• Elderspeak
• Gestures
• “we”
• “Honey” • Facial Expressions
• Loud, slow speech • Touch
• Referring to cultural traits • Strive for congruency between the
two
• Electronic Communications
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Principles of Therapeutic Communication Therapeutic Communication
Altruism • Purposeful
Autonomy • Goal-directed
Objectivity with sensitivity
• Focused on the patient
Empathy
Veracity
• Includes verbal and non-
Appropriate setting verbal communication
• Open/authentic exchange of
information by developing
rapport
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4. Therapeutic Communication Therapeutic Communication
• Questions are general to specific • Attentive to appearance
• Less intrusive questions to • General demeanor indicate interest
personal • Always greet in a professional
• Develop rapport and trust manner
• Give adequate time to respond • Avoid talking to others once begin
with patient
• Never answer own questions
• Avoid judgmental questions
• Use level of vocabulary matched
to patient
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Effective Communication Techniques Effective Communication Techniques
• Personalize the interview • Use open ended questions
• Convey sincerity • Prompt full answers
• Focus on patient • Provide more information
• Examples:
• Link questions to something • Tell me about your family
patient has talked about • What are your concerns in caring for
• Make transition statements as your new baby?
proceed through interview • Never ask “why”
• Close-ended questioned result in a
yes or no answer
• Use in biographic data
• Use in emergency situations
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Effective Communication Techniques Effective Communication Techniques
• Make Broad Opening Statements • Verbalize implied ideas
• Patient plays an active role in the • Restating what patient has said
• Adding some interpretation
interview
• Encourages further discussion
• Establishes priorities for Discussion
• Gives patient opportunity to verify what they
• Examples: said
• Tell me about your accident • Provide General Leads
• What brings you to the clinic today? • Inject leading phrases or responses
• Reflection • “Go on”, “And then what happened?”
• Seek Clarification
• Repeating or paraphrasing a
• Clarify vague or confusing statements
person’s words or questions
• I’m not sure I understand, could you
• Promotes further explanation and explain?
descussion
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5. Effective Communication Techniques Effective Communication Techniques
• Listen actively
• Silence
• Enhances assessment
• Organize your thoughts
• Concentrates attention on what patient is
• May be uncomfortable saying
• Observe non-verbal cues • Enables you to consider subtle messages
• Posture, facial expressions, body • Block out environmental distractions
movements • Attentive behavior
• Open Body Language • Occasional verbal responses
• Non-verbal cues • Share Perceptions
• Maintain eye contact • Share observation with person
• Sitting relaxed • “You appear to have some physical
• Arms unfolded, lean toward patient discomfort today”
• Facial expressions neutral • “It seems to me that ……”
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Effective Communication Techniques Communication Patterns to Avoid
• Confront Contradictions • Displaying Inappropriate Body Language
• Explore contradiction directly • Continuous eye contact
• “You tell me your not upset but you • Too intrusive and intimidating
look like your about to cry” • Know cultural norms
• Review the Discussion • Avoid showing alarm, anxiety, anger
• Close with some type of summary • Avoid standing over the person
• Discuss main points • Portrays inequality and domination
• Review in relation to goals of • Proceeding Too Quickly
interview • Avoid rushing through long list of
questions
• No time to reflect on responses
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Communication Patterns to Avoid Communication Patterns to Avoid
• Offering Advice • Minimizing Feelings
• Generally not helpful • Disagreeing with person’s feelings =
• May discourage decision making
denying person right to his/her own
• “What would you do?” to “What would you
feelings
like to do?”
• Abruptly Changing Subjects • “There is nothing to worry about”
• Disconcerting and disrupt rapport • Demonstrates lack of understanding or
• Use transitional phrases when moving from empathy
one subject to another • Offering False Assurance
• Acting Defensively
• Unfair and unrealistic
• Don’t defend people being criticized
• Implies judgment and inhibit further • Denies reality of situation
expression of feelings • Forces person to hide fears and anxiety
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6. Cultural Considerations
Communication Patterns to Avoid
• Profound effect on way people
communicate
• Jumping to Conclusions • Sensitivity to culture influences interviews
• Always check out the facts • Cultural difference of great impact
• Overweight • Language
• Verbal communication patterns
• Wants to loose weight
• Nonverbal communication patterns
• Breast Cancer patient
• Cultural variations
• wants to have mastectomy • Beliefs about health and illness
• Conclusions represent • Ways to express pain and emotions
personal values and • Manner of decision making about health
and health care
judgments • May need to consult others of same
• May antagonize patient cultural on how to best communicate
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Cultural Considerations Cultural Communication Guidelines
• Translators
• Observe Personal Space • Rosters of translators
• Distance between individuals • Family members or friends
• Touch • May not always be objective
• Reluctant to divulge personal information
• Appropriate Eye Contact
• Child, different gender, different age-group
• Rude, intrusive, immodest • Right to confidentiality and privacy
• Disrespectful for a woman to make compromised
contact with man
• Avoid Slang and Jargon
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Cultural Communication Guidelines Cultural Communication Guidelines
• Interpret Nonverbal Behavior
• Understand Variations in
• Clues for whether you are being
Disclosing Personal Information
understood
• Direct questioning viewed as intrusive,
• Frown / blank stare
rude, embarrassing
• Understand Variations in • May be reluctant to participate in the
Expressions of Emotion and Pain interview or give vague responses
• Crying may be childish or self-indulgent • Determine Family Decision-
• Other vocal and physical in expressions Making Processes
of pain • How are decisions made and by whom
• Who responds to questions when the
patient asked
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7. Report and Documentation SBAR Communication
• Change of Shift Reports • Standardize communication among
health care workers
• Continuity of care
• Promotes patient safety
• Oral report
• Improves efficiency
• Given by charge nurse on all patients
• Acronym
• Given between care givers
• Situation
• Tape Recorded • Background
• Walking Rounds • Assessment
• Walk from bed to bed • Recommendations
• Patient included in information shared • Uses
• Report focused on patient • Calling physician
• No socialization • Handing off to another nurse
• Transferring patients to another facility or
• Patient Record Forms level of care
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