Chapter 4

The Nurse-Client Relationship

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Communication

Communication is the exchange of thoughts, feelings, and other information.

The nurse-client relationship depends on effective communication.

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The Communication Process

Five Major Components• Sender• Message• Channel• Receiver• Feedback

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A Communication Model

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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.

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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.

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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.

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The Communication Process

Feedback is information about the receiver’s perception of the message.

Feedback can either facilitate or impede effective communication.

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Characteristics of Effective Feedback

Descriptive, clear Provided in a supportive, non-threatening

manner Practical and appropriate for the

individual client Direct and honest

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Factors Influencing Communication

Perception Cultural Context Space and Distance Time

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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.

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Space and Distance

The nurse demonstrates respect for each client’s culturally determined right to personal space and distance.

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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.

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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.

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Self-Talk

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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.

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The Health Care Team

Client Family Nurses Social Workers Physical Therapists Occupational Therapists

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Modes of Communication

Verbal Messages Nonverbal Messages Facial Expression Posture Gestures Touch Physical Appearance and Artifacts

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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.

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Therapeutic Communication

Purposeful and goal-directed Well-defined boundaries Client-centered Non-judgmental Uses specifically designed techniques

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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.

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Principles of Therapeutic Communication

Accept the client “as is.” Let the client take the lead through active

listening. Seek clarification by reflection and

restating.

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Barriers to Therapeutic Communication

Language and Cultural Differences Gender Health Status Developmental Level Emotions Communication Blocks

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Barriers to Therapeutic Communication

Language Barriers• Discrepancies in vocabulary usage and

expressions• Use of health care jargon

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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.

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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.

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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.

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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.

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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

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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.

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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

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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.