04/08/2023

COMMUNICATION AND INTERPERSONAL RELATIONSHIPS

Presented byRESMI G S

M Sc Nursing 1st year

INTRODUCTION Communication is a dynamic, reciprocal

process of sending and receiving messages. Communication is more than the act of talking and listening. From the first cry of a newborn to the whisper of a person who is dying, the primary purpose of a communication is to share information and obtain a response. People use communication to meet their physical, psychosocial, emotional and spiritual needs

DEFINITION

• Communication is ‘any act by which one person gives to or receives from person information about that person’s needs desires, perception, knowledge or affective states’. Communication may be intentional or unintentional, may involve conventional or unconventional signals, may take linguistic or non-linguistic forms and may occur through spoken or other modes.

LEVELS OF COMMUNICATION

• INTRAPERSONAL COMMUNICATION• INTERPERSONAL COMMUNICATION• GROUP COMMUNICATION

– PUBLIC SPEAKING

INTRAPERSONAL COMMUNICATION

• It is conscious internal dialogue, sometimes known as self-talk. It is language use or thought internal to the communicator. The individual becomes his or her own sender and receiver, providing feedback to him or herself in an ongoing internal process. It can be useful to envision intrapersonal communication occurring in the mind of the individual in a model which contains a sender, receiver and feedback loop.

INTERPERSONAL COMMUNICATION

• It is communication between two or more people.

• Face to Face conversation between two people is the most frequent form of interpersonal communication.

• Nurses use interpersonal communication to gather information during assessment, to teach about health issues to explain care and to provide comfort and support.

GROUP COMMUNICATION

• It is interaction that occurs among several people.

• Small group communication occurs when you engage in an exchange of ideas with two or more individuals at the same time.

PUBLIC SPEAKING

• It is a unique form of group communication. Generally the speaker addresses a dozen to hundreds of people, and varying degrees of interaction occur.

• Speaker may deliver a speech talk directly with a group of audience members or have open discussion with the group. It is at the heart of our economy, society and politics.

• Nurses often engage in public speaking to educate groups of people about health issues

THE COMMUNICATION PROCESS

• Communication requires a sender, a message, a receiver and a response or feedback.

• Communication is a two-way process involving the sending and the receiving of a message. Because the intent of communication is to elicit a response the process of ongoing; the receiver of the message then becomes the sender of a response, and the original sender then becomes the receiver.

Communication Process

•Message•Source (sender)•Channel•Receiver•Feedback (response)

The Communication Process

SENDER(encodes)

RECEIVER(decodes)

Barrier

Barrier

Message

Feedback/Response

MODES OF COMMUNICATION

• VERBAL COMMUNICATION• NONVERBAL COMMUNICATION

Factors in verbal and nonverbal modes of communication

• VERBALa) Pace and intonation b) Simplicity c) Clarity and brevity d) Timing and relevance e) Adaptability f) Credibility g) Humor

• NONVERBAL• Facial expression• Posture and Gait• Personal Appearance• Gestures• Touch

CHARACTERISTICS OF EFFECTIVE COMMUNICATOR

An effective verbal communicator:

• Clarifies• Listens• Encourages

empathically• Acknowledges• Restates/repeats

An effective nonverbal communicator:

• Relaxes• Opens up• Leans toward the other

person• Establishes eye contact• Shows appropriate

facial expressions

What are the most common ways we communicate?

Spoken Word

Written Word

Visual Images

Body Language

FACTORS INFLUENCING THE COMMUNICATION PROCESS

• Development, • Gender • Values And Perceptions, • Personal Space, • Territoriality Roles And Relationships, • Time• Environment, • Congruence• Interpersonal attitudes.

THERAPEUTIC COMMUNICATION

• Therapeutic communication means that nurses use their communication in such a way that it will be benefit to their patient.

• Therapeutic communication differs from normal communication in that it introduces an element of “empathy’’ into what can be traumatic experience for the patient and also the patient are made to feel validated.

IMPORTANCE OF THERAPEUTIC COMMUNICATION

• It impels a feeling of comfort in the face of patient.

• To increase self-worth or decrease psychological distress by collecting information to determine the illness, assessing and modifying the behaviour and providing health information.

THERAPEUTIC COMMUNICATION TECHNIQUES

• USING SILENCE• BEING SPECIFIC AND TENTATIVE• USING OPEN-ENDED QUESTIONS• USING TOUCH• RESTATING OR PARAPHRASING• SEEKING CLARIFICATION• PERCEPTION CHECKING OR SEEKING CONSENSUAL VALIDATION• OFFERING SELF• ACKNOWLEDGING• GIVING INFORMATION• CLARIFYING TIME OR SEQUENCE• PRESENTING REALITY• FOCUSING• REFLECTING• SUMMARISING AND PLANNING

BARRIERS TO COMMUNICATION

• STEREOTYPING• AGREEING AND DISAGREEING • BEING DEFENSIVE• CHALLENGING• PROBING• TESTING• REJECTING • CHANGING TOPICS AND SUBJECTS• UNWANTED REASSUARENCE• PASSING JUDGEMENT• GIVING COMMON ADVICE

FIVE WAYS TO FACILITATE THERAPEUTIC COMMUNICATION

• MAINTAIN PAIENT – CENTERED TEACHING• SUPPRESS PREJUDICES• CREATE A THERAPEUTIC ENVIRONMENT• BE ALERT TO NON VERBAL CLUES• ESTABLISH A TRUSTING RELATIONSHIP

INTERPERSONAL RELATIONSHIP

• An interpersonal relationship is a strong deep or close association / acquaintance between two or more people that may range in duration from brief to enduring. The nurse is an important of the health care team that must work in co-operation and harmony for the care of the patient. This co-operation and harmony depends upon the IPR that is maintained among the members of the health care team.

THEORETICAL ASSERTION• The purpose of nursing achieved though the establishment

of a human to human relationship.• The human condition is shared by all human being.• Most people at one time or another and in varying degrees

will experience joy, contentment, happiness and love.• All persons, at sometime in their lives will be confronted by

illness and pain.• The quality and quantity of nursing care delivered to an ill

human being is greatly influenced by nurse’s perception of the client.

• The term patient and nurses are stereotyped and only useful for communicate economy.

THEORETICAL ASSERTION (CONT.)• The roles of the nurse and patients must be

transcended to establish a human to human relatedness.

• Illness and suffering are spiritual encounters as well as emotional physical experience.

• Communication process enables the nurses to establish a human to human relationship and thereby fulfil the purpose of the nursing profession.

• Individual can be assisted top find meaning in the experience of illness and suffering then individual can cope with the problem exchanged by these experience.

THEORETICAL ASSERTION (CONT.)

• The spiritual and ethical values of the nurse, about illness suffering will determine the excellent top which she will be able to assist individuals and families to find meaning these difficult experiences.

• It is the responsibility of the professional nurse practitioner to assist individuals and families to find meaning in illness and suffering.

PRINCIPLES OF IPR

• Learn everyone’s, name and never address anyone by nick name.

• Respect every one’s individually. Each member of a team is as important as other.( Keep up the status of every member)

• Do not impose anything on anybody.• Keep emotions under control.• Do not give and take personal favour.• Don’t be afraid to admit ignorance

PRINCIPLES OF IPR (CONT.)

• The team leader should not make any excuse regarding his or her responsibility.

• Develop the habits of listening and focus attention on the problem.

• Do not do or say anything that will disturb others faith.

• Give importance to others and practice justice

PRINCIPLES OF IPR (CONT.)

• The members of team should be loyal, honest dependable and willing to carry out the directions of the team leader.

• There should be team spirit or team feeling among the members. Each member should work for the interest of the group.

• There should be mutual understanding between the members. They should be willing to give and take corrections.

PRINCIPLES OF IPR (CONT.)

• There should be delegation of responsibility in a group and every member should carry out his or her responsibility to the satisfaction of the groups.

• The relationship between the members of a group should be decent and considerate.

• Teach the newcomer about the job. Make sure that all the assignments are understood.

PRINCIPLES OF IPR (CONT.)

• The new comer of the group should feel; at home when he joins the group.

• Establish a good rapport among the member in order to achieve the aim.

• Every member should be familiar with organizations plan and the policies of the group.

• Be up to date with the information that is going around

PRINCIPLES OF IPR (CONT.)

• Avoid arguments in the group.• Talk in terms of other man’s interest.• Praise the slightest improvement made by

others. Use words of encouragement.• Have a smiling face always.• Prepare yourself mentally to accept the worst

if necessary.

CHARACTERSTICS OF IPR

• Helping relationship is a therapeutic relationship in nursing which promoting a psychological climate that brings a positive change in the client and promote his group.

• Facilitative characteristics • Action oriented

FACILITATIVE CHARACTERISTICS

• They are the essential message for the nurse to establish positive and supportive relationship with the client.

• These are condition that creates an emotional environment in which a patient feels comfortable and safe.

FACILITATIVE CHARACTERISTICS (CONT.) • TRUST It may be defined as the belief that other will provide in

terms of need and distress trust fosters open therapeutic communication to foster the nurse’s act consistently, reliably and competently.

• EMPATHY It’s the ability to understand and enter the client’s frame

of reference. Empathy is sensing, comprehensive and sharing the client’s frame of reference beginning with the problem that the client recognises in other words. It is a phase of sensitive and objective look at what another person experiences.

FACILITATIVE CHARACTERISTICS (CONT.)

• CARING It is having a positive regard for another person.

It is basic in helping relationship. Nurses can show caring by expediting clients as who they are and respecting them as individuals. It promotes trust and decrease anxiety and distress.

• AUTONOMY AND MUTUALITY It is the ability to the self director. Mutuality

involves sharing with another. These are important in any helping relationship.

FACILITATIVE CHARACTERISTICS (CONT.)

• GENUINESS It is considered to be most basic of helping

conditions. The helper needs you be aware of his own feelings. He should be comfortable with who he is so that he does not lookout his own feelings from himself.

• NON POSSESSIVE WARMTH It simply means unconditional positive regard,

respect for others and praising the other

ACTION ORIENTATION

These are conditions that assist a person to move towards his goals.

Action oriented characteristic are used on the nurse patient relationship to progress beyond the initiation process.

• CONCRETENESS IN COMMUNICATION A person is helped when he is encouraged to express his

concern in specific and personal terms.• IMMEDIACY The nurse attends to any interpersonal process within the

therapeutic relation. • SENSITIVE CONFRONTATION It is non-judgemental point out of discrepancy in a helping

behaviour. It should be used carefully and should never used in earlier phase of therapeutic relationship.

INTERPERSONAL COMMUNICATION

• It occurs between two or more person with a goal to exchange messages.

• Most of the nurse’s day is spent communicating with the patient, family members and member of health care team.

• The nurses’ ability to communicate effectively at this level influences the nurses interpersonal sharing, problem solving, goal attainment, team building and effectiveness in critical nursing roles. (E.g.:- care giver, teacher, counsellor, leader, manager, and patient advocate)

MODEL PRESENTING HUMAN TO HUMAN RELATIONSHIP

• The model represents the interaction between the nurse and patient or recipient of her care.

• The major characteristics of this experience are that the nursing need of the individuals is met.

• The half circle at the point of original encounter indicates the possibility of and need for developing encounter into therapeutic relationships.

• As the interaction process progresses towards rapport the circle joins in to one full circle, representing that the potential for a therapeutic relationship has been attained.

MID-RANGE THEORY OF IPR• Hildegard Peplau’s (1952:1997) mid-range theory of

interpersonal relationships is considered an essential theory frame work for the study of interpersonal relationships.

• The model describes how the nurse-client relationship can facilitate the identification and accomplishments of therapeutic goals top enhance client and family well-being.

• In today’s health care environment nurse-client relationships are of short duration concise and effective. Despite the brevity of the relationship, Peplau’s basic principles partnership and terminating a relationship remain relevant.

• Peplau’s frame work for interpersonal relationships is applicable to all areas of nursing.

MAJOR CONCEPTS• The theory explains the purpose of nursing to help others

identify their felt difficulties.• Nurses should apply principles of human relations to the

problems that arise at all levels of experience.• Peplau’s theory explains the phases of interpersonal process,

roles in nursing situations and methods of studying nursing as an interpersonal process.

• Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal.

• The attainment of goal is achieved through the use of a series of steps following a series of pattern.

• The nurse and patient work together so both become mature and knowledgeable in the process.

DEFINITIONS

• Person- A developing organism that tries to reduce anxiety caused by needs.

• Environment- Existing forces outside the organism and in the context of culture.

• Health- A word symbol that implies forward movement of personality and other ongoing human process in the direction of creative, constructive, productive, personal and community living.

• Nursing- A significant therapeutic interpersonal process. It functions cooperatively with other human process that makes health possible for individuals in communities

PEPLAU’S SIX NURSING ROLES• Stranger: Receives the client the same way one meets a

stranger in other life situations, provides an accepting climate that builds trust.

• Resource role: Answers questions, interprets clinical treatment data, and gives information.

• Teaching role: Gives instructions and provides training, involves analysis and synthesis of the learner experience.

• Counselling role: Helps client understand and integrate the meaning of current life circumstances provide guidance and encouragement to make changes.

• Surrogate role: Helps client clarify domains of dependence, interdependence and independence and acts on client’s behalf as an advocate.

• Leadership role: Helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way.

ADDITIONAL ROLES INCLUDE

• Technical expert• Consultant• Health teacher• Tutor• Socializing agent• Safety agent• Manager of environment • Mediator• Administrator• Recorder observer• Researcher

PHASES OF INTERPERSONAL RELATIONSHIP

• The nurse-client relation is therapeutic not social in

nature.• It is always client centred and goal directed.• It is objective rather than subjective. The intent of a

professional relationship is for client behaviour to change.

• It is a limited relationship, with the goal of helping the client find more satisfying behaviour patterns and coping strategies and increase self worth.

• It is not for mutual satisfaction.

PHASES OF INTERPERSONAL RELATIONSHIP (CONT.)

• Peplau’s developmental stages parallel to the nursing process.

• The orientation phase correlates with the assessment phase of the nursing process.

• The identification component of the working phase corresponds to the planning phase, where as the exploitation phase parallels the implementation phase.

• The final resolution phase of the relationship corresponds to the evaluation phase of the nursing process.

PRE INTERACTION PHASE

• The pre interaction phase is the only one in which the client does not directly participate. Awareness of professional goal is important.

• The preinteraction phase occurs before you meet the client. In this phase you will gather information about the client. In this phase, the nurse and client do not have direct communication.

• First phase in Peplau’s theory is orientation phase.

ORIENTATION PHASE

• The nurse enters the relationship in the “Stranger” role and begins the process of developing trust by providing the client with basic information about the nurse and essential information about the purpose, nature, and time available for the relationship.

• It is also referred to as the introductory or the prehelping phase is important because it sets the tone for the rest of the relationship.

ORIENTATION PHASE (CONT.)

• It begins when you meet the client. • The goal in this phase is to establish rapport

and trust. • This phase begins with introductions,

followed by an initial exchange of information.

• During this phase verbal and nonverbal communication occurs.

WORKING PHASE / IDENTIFICATION PHASE

• It is the planning phase. The conversation in the working phase turns active problem solving related to assess health care needs.

• Clients are able to discuss deeper, more difficult issues and experiment with new role and actions.

WORKING PHASE/ IDENTIFICATION PHASE (CONT.)

• Working phase focuses on self direction and self management to whatever extent is possible in promoting the clients health and well-being.

• It is the active part of the relationship. • During this phase, caring is communicated,

thoughts and feelings are expressed, mutual respect is maintained, and honest verbal and nonverbal expression occurs.

• Key communication goals are to assist the client to clarify feelings and concerns

EXPLOITATION PHASE

• Use of professional assistance for problem solving alternatives.

• Individual feels as an integral part of the helping environment.

• The principles of interview techniques must be used in order to explore, understand and adequately, deal with the underlying problem.

• Patient may fluctuate on independence.• Nurse aids the patient in exploiting all avenues of

help and progress made towards the final step.

TERMINATION PHASE

• In the termination phase, the nurse and client evaluate the client’s responses to treatment, and explore the meaning of the relationship and what goals have been achieved. Nurses need to be sufficiently aware of their own feelings so that they may use them constructively without imposing them on the client.

• Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both become mature individuals.

TERMINATION PHASE (CONT.)

• The termination phase is the conclusion of the relationship, whether at the end of the nurse’s shift or on the client’s discharge from the unit, facility or service. If communication has been effective, the termination phase prepares the nurse and client for future interactions

INTERPERSONAL THEORY AND NURSING PROCESS

• Both are sequential and focus on therapeutic relationship.

• Both use problem solving techniques for the nurse and patient to collaborate on, with the end purpose of meeting the patient needs.

ASSESSMENT Data collection and analysis

(Continuous). May not be a felt need.

ORIENTATION Non continuous data

collection Felt need. Define needs

NURSING DIAGNONSIS PLANNING Mutually set goals

IDENTIFICATION Interdependent goal setting

IMPLEMENTATION Plans initiated towards achievement of

mutually set goals May be accomplished by patient nurse or

family.

EXPLOITATION Patient actively seeking

and drawing help Patient initiated

EVALUATION Based on mutually expected behaviour May led to termination and initiation

RESOLUTION Occurs after other phases

are completed successfully. Leads to termination.

CONCLUSION• Communication is essential wherever there are

people living and working together. Interpersonal relationship is also an important factor in our day to day communication, especially in the field of nursing. Considerable thought and attention have been given to the subject of IPR. Nursing is a caring profession and basically the primary role of a nurse is to render on effective harmonious relationship to the patient so both communication and interpersonal relationship are both sides of a coin.

…in the new global and diverse workplace requires

excellent communication skills!

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