Chapter 4 The Nurse-Client Relationship. 4-2 Copyright 2004 by Delmar Learning, a division of...
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Transcript of Chapter 4 The Nurse-Client Relationship. 4-2 Copyright 2004 by Delmar Learning, a division of...
4-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Communication
Communication is the exchange of thoughts, feelings, and other information.
The nurse-client relationship depends on effective communication.
4-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The Communication Process
Five Major Components• Sender• Message• Channel• Receiver• Feedback
4-5Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The Communication Process
The sender initiates the process of communication by generating a message.
The message is communicated via a channel, verbally, non-verbally, or in another symbolic form.
4-6Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The Communication Process
Channels• The visual channel allows for visual
observation and perception.• The auditory channel consists of spoken
words and other verbal cues.• The kinesthetic channel refers to physical
sensations mediated by touch.
4-7Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The Communication Process
The receiver infuses the message with meaning specific to her personal experience.
Physiological, psychological, and cognitive processes influence the receiver’s interpretation.
4-8Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The Communication Process
Feedback is information about the receiver’s perception of the message.
Feedback can either facilitate or impede effective communication.
4-9Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Characteristics of Effective Feedback
Descriptive, clear Provided in a supportive, non-threatening
manner Practical and appropriate for the
individual client Direct and honest
4-10Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Factors Influencing Communication
Perception Cultural Context Space and Distance Time
4-11Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Perception
Each person’s perceptions of the world are unique.
Perceptions are a function of social, cultural, and family experiences.
Misunderstandings occur when two people do not perceive the same meaning about a message.
4-12Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Space and Distance
The nurse demonstrates respect for each client’s culturally determined right to personal space and distance.
4-13Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Time
Quality time spent with the client allows her to feel cared for and valued.
The nurse should avoid appearing rushed while gathering important data and providing client education.
4-14Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Levels of Communication
Intrapersonal communication (self-talk), consists of ideas and information inside one’s own mind.
Interpersonal communication occurs between two people.
Group communication occurs with three or more individuals.
4-16Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Interdisciplinary Group Communication
The Health Care Team collaborates to assess client status and plan for effective client outcomes.
Breakdown of communication between different team members can interfere with the client’s treatment.
4-17Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The Health Care Team
Client Family Nurses Social Workers Physical Therapists Occupational Therapists
4-18Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Modes of Communication
Verbal Messages Nonverbal Messages Facial Expression Posture Gestures Touch Physical Appearance and Artifacts
4-19Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Therapeutic Communication
Is a vehicle for establishing a partnership between the nurse and the client.
Conveys to the client that he is cared for and understood.
4-20Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Therapeutic Communication
Purposeful and goal-directed Well-defined boundaries Client-centered Non-judgmental Uses specifically designed techniques
4-21Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Principles of Therapeutic Communication
Time the interaction to avoid distraction or fatigue.
Provide a comfortable and private environment.
Clarify the purpose of the interaction. Establish guidelines.
4-22Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Principles of Therapeutic Communication
Accept the client “as is.” Let the client take the lead through active
listening. Seek clarification by reflection and
restating.
4-23Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Barriers to Therapeutic Communication
Language and Cultural Differences Gender Health Status Developmental Level Emotions Communication Blocks
4-24Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Barriers to Therapeutic Communication
Language Barriers• Discrepancies in vocabulary usage and
expressions• Use of health care jargon
4-25Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nontherapeutic Communication Blocks
Intrusive self-talk or inappropriate responses• Certain responses that would be acceptable
during social conversation are not useful during therapeutic interaction.
• An inappropriate response may result in the client experiencing feelings of inadequacy, intimidation, or confusion.
4-26Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Communication, Critical Thinking, and the Nursing Process
Interpersonal skills and critical thinking are competencies that form the basis for successful application of the nursing process.
4-27Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Communication, Critical Thinking, and the Nursing Process
Critical Thinking and Assessment• The client’s sense of control is enhanced
when the nurse asks open-ended questions and pays attention to verbal and nonverbal messages.
4-28Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Communication, Critical Thinking, and the Nursing Process
Critical Thinking and Nursing Diagnosis• Careful attention to assessment data
provides a deeper understanding of the client’s experience and needs.
• Accurate analysis of assessment data leads to accuracy in diagnostic judgment.
4-29Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Communication, Critical Thinking, and the Nursing Process
Nursing diagnoses related to communication difficulties• Social Isolation related to impaired verbal
communication• Anxiety related to impaired verbal
communication• Self-Esteem Disturbance related to impaired
verbal communication
4-30Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Communication, Critical Thinking, and the Nursing Process
Planning and Outcome Identification• Effective therapeutic communication allows
the nurse and the client to work together to develop goals and identify appropriate outcomes.
4-31Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Communication, Critical Thinking, and the Nursing Process
Implementation• Alternative modes of communication can be
used in implementing a teaching plan.- Sign language- Gestures- Alphabet boards- Electronic communication devices
4-32Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Communication, Critical Thinking, and the Nursing Process
Evaluation• It is important to determine if communication
is a factor that impedes the client’s healing process.
- Verbal and nonverbal cues may indicate to the nurse the need for further client teaching.
- Interventions that might resolve this problem require consideration.