Communication

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
relationship.
 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
 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…”
 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.
 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.
 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
 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
 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
 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
Phase
 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
goals
 Nurse reinforces successes and helps client
to deal realistically with failure.
 Nursing Skills for Working
Phase
 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
dependence
Nursing Skills for Termination
Phase
 Summarize or review  Follow up support
the hospitalization may be needed
with a focus on
accomplishments  Follow up phone calls
 Express feelings about
termination
 Ease clients transition
 Allows time for client to independence
to adjust to
independence
 Communication

“Any means of exchanging information or

feelings between two or more people. It is

a basic component of human relationships,

including nursing.”
 Communication
 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
nonverbal
 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”