TABLE OF CONTENTS

Nursing as a Profession
A. Profession
1. Definition
2. Criteria
B. Nursing
1.
2.
3.
4.

Definition
Characteristics
Focus: Human Resources
Personal and Professional qualities of a nurse

C. History of Nursing
1. In the World
2. In the Philippines
D. Development of Modern Nursing
E. Growth of Professionalism
1. Profession
a.
b.
c.
d.

Specialized Education
Body of Knowledge
Ethics
Autonomy

F. Carpers four patterns of knowing

1.
2.
3.
4.
5.

Nursing Science
Nursing Ethics
Nursing Aesthetics
Personal Knowledge
Overview of the Professional Nursing Practice

Nursing Practice
a. Level of proficiency according to Benner (Novice, Beginner,
Competent, Expert)
b. Roles and Responsibilities of a professional nurse
c. Scope of Nursing Practice based on RA 9173
d. Overview of the Code of Ethics e. Professional/legal and
moral accountability/responsibility

6. Fields of Opportunities in Nursing

a. Institutional nursing
b. Hospital staff nursing (community health, nursing practice)
c. School nursing
d. Industrial nursing
e. Independent nursing
f. Nurses in education
g. Nursing in other fields
7. Communication Skills
a. Effective communication
b. Purposes of therapeutic communication
c. General guidelines for therapeutic
d. Components of communication
e. Criteria for effective verbal communication
f. Guidelines for active and effective listening
g. Guidelines for using touch
h. Development of consideration in communication
i. Communication with people who are: physically, cognitively
challenged and aggressive

NURSING AS A SCIENCE
A. Nursing Process
1. Assessment
2. Nursing diagnosis (as a concept and process)
3. Planning (long-term, short-term, priority setting, formulation of
objectives)
4. Intervention (collaborative, independent nursing interventions)
5. Evaluation ( formative, summative)
6. Documentation of plan of care/reporting
B. Health and Illness
1.Definition of Health, Wellness and well- being

2.Dimensions of wellness
3.Health-illness continuum
4.Stages of wellness and illness
5.Three levels of prevention
C. Levels of Care
1. Health Promotion
2. Disease promotion
3. Health maintenance
4. Curative
5.Rehabilitative
D. Basic Interventions using the Nursing Process to maintain:
1. Healthy lifestyle
2. Temperature regulation
3. Mobility and exercise
4. Hygiene and comfort
5. Safety, Security and Privacy
6. Psychosocial and Spiritual Concerns

NURSING AS AN ART
A. Definition of Art
1. Why is nursing an art
2. Concepts related to the art of nursing
3. Self-awareness
4. Self enhancement
5. Cultural diversity
6. Caring: An Integral Component of Nursing
7. Nursing-Client Relationship
a. Phases of therapeutic relationship
b. Therapeutic use of self
c. Characteristics of therapeutic relationship
8. Focus of nursing

Nursing as a Profession
Growth of profession
1. Profession
a. Specialized Education
A special school is a school catering for students who have special
educational needs due to severe learning difficulties, physical disabilities or
behavioural problems. Special schools may be specifically designed, staffed
and resourced to provide appropriate special education for children with
additional needs.
b. Body of Knowledge
The core teachings, skills and research in a field or industry. The body
of knowledge (BOK) often forms the foundation for the curriculum of most
professional programs or designations. It is the essential competencies
mastered by members, to receive accreditation before applying these
principles in practice. Mastery of the body of knowledge is generally
demonstrated by passing rigorous examinations at single or multiple levels.
c. Ethics
area of student5s that deals with idea about what is good and bad
behavior.
h. First, consideration of age can explain variance in a number of other
variables such as: relationship development and maturity for scholars
interested in relationship health, work experience for organizational health
communication scholars, technology competence for those interested in ehealth, as well as biological development (e.g., hormonal changes) that may
influence both communication behaviors and susceptibility to various
persuasive message attempts. A more nuanced understanding of the role of
age in health communication research alone would be an advance, but there
are several other developmental processes such as egocentrism (related to
social-cognitive immaturity), cognitive development, and moral development
that may explain more variance in communication variables of interest than
age alone.
A second current approach to considering development in communication
research--separate from measurement of a development variable or age-includes sampling by age or age proxy (grade). For example, studies related

to initiation risk behavior (e.g., studies of adolescent risk taking in schools

such as smoking, sexual initiation, or consumption of media violence) often
select studies by grade as a part of their sampling plan (e.g., 6, 8, and 10th
graders). Other similar approaches include sampling couples by lifespan or in
aging research (e.g., 20s, 40s and 60s). This age design approach is common
to campaign and message effect studies, including intervention studies, and
age is either covaried or used as a main effect variable (with consideration of
interaction effects).
Taken together, the present project proposes to synthesize and integrate a
broad range of research to best address how to incorporate development in
communication research. The first section of the paper will review and
compare research using these two approaches, and then propose both
design and measurement recommendations for research in the future.

i.

People with cognitive impairment have difficulty in communicating.

They have difficulty in understanding what is said to them. They
can, at times, become confused about whom you are, and they can
be confused about who they are. They can be confused about where
they are, what day of the week it is, and what year it is. People who
suffer from cognitive impairment do not have the ability to think
clearly and logically or they may only be able to do so once in a
while. There is no one single condition, illness, or disease that
causes cognitive impairment. People with cognitive impairment may
have had a stroke, they may be suffering from Alzheimers disease,
they may have had a head injury, or it may not be known why they
have lost the ability to be rational. The only certainty is that there
has been some illness, disease or accident that has permanently
damaged the parts of the brain that control the ability to think,
concentrate, and reason

A.Effective communication skills in nursing practice

(DH 2012). The Nursing and Midwifery Council (2008) highlights the
importance of communication in its code of conduct, stating that nurses
must meet peoples language and communication needs and share with
people, in a way they can understand, the information they want or need to
know about their health. Effective communication helps vulnerable patients
to cope with and make better decisions about their care and treatment

(Donnelly and Neville 2008). However, maintaining effective communication

in busy healthcare environments where patients are vulnerable and staff are
frequently stressed requires advanced interpersonal skills, as well as an
awareness of self and others. A growing body of evidence demonstrates that
it is possible to improve and develop effective communication skills with
training (Maguire et al 1996, Fallow field et al 2002, Wilkinson et al 2008,
Connolly et al 2014). However, in recent years there has been a surge in
complaints about care and significant failings in communication and
attitudes of staff (Francis 2010, DH 2013a, 2013b, Royal College of Nursing
2013). The need to provide compassionate care is emphasised, but it is
difficult to clarify exactly what it is and how it can be demonstrated in
practice. One definition of compassion is a deep awareness of the suffering
of another coupled with the wish to relieve it (The Free Dictionary 2014). The
Oxford English Dictionary (2014) refers to the Latin origins of compassion,
compati, meaning suffer with. Peters (2006) defines compassion as a
deep feeling of connectedness with the experience of human suffering that
requires personal knowing of the suffering of others and results in caring
that comforts the sufferer. Compassionate care is also defined as a relational
activity that is concerned with the way in which we relate to other human
beings when they are vulnerable (Dewar et al 2011). The varied definitions
and understanding of what compassion is highlights the challenges of
demonstrating this complex connection with another person in nursing
practice. If nurses had a deep awareness of the suffering of every individual
they cared for, they could easily become overwhelmed and find it almost
impossible to function within a professional role. Compassionate nursing care
Empathy is perhaps a more realistic way of showing we appreciate and care
about the experiences of patients as they cope with difficult diagnoses,
treatments, symptoms of ill health and life-limiting illness. Empathy
verbalised by one person to another can offer support and comfort at times
of vulnerability, anxiety and distress. Empathy can be described as the
ability to set aside your own thoughts and feelings. This may sound easy, but
in practice nurses often have an overpowering desire to offer a solution,
information or reassurance to patients and relatives. The desire to help or
alleviate distress can dominate the thoughts and feelings of any healthcare
professional. The act of setting aside personal thoughts and feelings enables
active listening to take place. In addition, empathy means being willing to try
to perceive the world as it is for the other person. Being willing to view the
world of someone who is experiencing a high level of distress takes courage
and bravery. Finally, empathy is conveyed by expressing appreciation of the
other persons situation and feelings (Mearns and Thorne 2007). Complete

time out activity 1 Communication skills training A report from the Royal
College of Physicians (2014) on end of life care in hospitals in England found
that the majority of discussions with families and friends took place less than
two days before death. This finding may indicate some degree of reluctance
to engage in these sensitive discussions earlier in the patients illness, not
only by nursing staff but also by all members of the multiprofessional team
across health and social care, hospital and community settings. The report
recommends that training in communication skills should be mandatory for
all staff involved in caring for dying people. If healthcare professionals felt
more confident and competent to engage in these sensitive discussions,
more discussions would take place at a time when people who are dying and
those close to them are better able to prepare and adjust to the situation.
This is not a new recommendation. Improving Supportive and Palliative Care
for Adults with Cancer (National Institute for Health and Care Excellence
(NICE) 2004) described a four-level model for providing psychological support
to patients. The guidance stated that psychological distress is common and
these signs of distress are not readily recognised, with the result that people
fail to receive the support they require. All healthcare professionals,
regardless of grade, role or specialty, were noted as having a role in
identifying and responding to the distress of patients and their relatives
(NICE 2004). The core responsibility to be able to recognise distress and
respond in a helpful and supportive way continues to be highlighted in the
literature. However, healthcare professionals are failing in this core
responsibility to recognise and respond to the needs of patients in distress
(Francis 2013). These failings may in part be the result of inadequate formal,
structured or consistent communication skills training in pre and postregistration nursing courses. Nurses learn much about communication in
clinical practice from peers, senior staff and others, who may themselves
have received little or no communication skills training. This informal
approach can be effective for some, but it may offer little constancy or
opportunity for feedback and development. Promoting effective
communication in health care is demanding, complex and challenging
because of the nature of the work environment, which is often stressful and
pressurised, providing little time for communication. If nurses are to meet
these challenges in the future they need to be supported by high-quality,
evidence-based training. Nurses should receive regular communication skills
training if they are to feel confident and competent in their role. The benefits
for patients, carers and healthcare professionals are clear good
communication influences patients emotional health, symptom resolution,
function and physiological measures such as blood pressure, and it

decreases reported pain and drug use (Stewart 1995). Most nurses should be
able to remember a patient who had reduced pain as a result of feeling less
anxious and frightened. Fear has the potential to increase pain, and in the
labour ward it can impede the birthing progress (Otley 2011). Healthcare
professionals themselves experience benefit if they feel confident about
managing communication situations such as breaking bad news, handling
difficult questions and responding helpfully to strong emotions. Ramirez et al
(1996) and Taylor et al (2005) found that healthcare professionals experience
adverse psychological effects if they have not had sufficient training in
effective communication skills to match the demands of their role. The
availability and quality of communication skills training is variable, but some
workshops provide evidence that attendance and participation can have a
positive effect on clinical practice. Two such workshops are Connected
National Advanced Communication Skills Training, previously part of the
National Cancer Action Team Programme (The Royal Marsden 2014), and the
foundation-level half-day SAGE & THYME course (Connolly et al 2010, 2014).
Evidence-based communication skills training workshops have similar core
elements. These include theory and an evidence base; the participants
decide the content of the workshop and receive supporting handouts and
references. A presentation and/or demonstration is given of effective
communication skills in practice and participants have the opportunity to
practise skills and receive feedback in a structured format. The insight they
gain leads to a greater awareness of the way people communicate with
others, and their confidence and competence increases. Complete time out
activity 2 Barriers to e ective communication The following tasks are aimed
at raising awareness of the barriers to effective communication and
developing a common language and understanding of communication skills
(Box 1). This knowledge has the potential to improve effectiveness and focus
the consultation on the needs of the patient. By having a conscious
awareness of the potential barriers to effective communication, it is possible
to manage and minimise the effect of these barriers in the clinical
environment. Complete time out activity 3 E ective communication skills It is
essential that nurses have skills that keep the focus of communication on the
patient, that demonstrate active listening and assist with information giving
(Box 2). Examples of communication skills that are integral to nursing are
provided in Box 3. It is important that these skills are developed in preregistration training and further developed during preceptorship, clinical
supervision and mentorship throughout a nursing career to promote
confidence and competence in this area. Cues Cues can be anything you see
or hear when you are interacting with another. Cues are sometimes obvious,

for example, crying, or subtle, for example, if a patient looks away every
time treatment or results are talked about. While cues assist any interaction
to be patient-centred, there are other benefits. Zimmermann et al (2003)
reported using facilitative questions linked to cues to increase the probability
of more cues. The following is an example of an interaction in which a
facilitative question linked to a cue (selected cues are written in bold) is
used: Patient: I thought, after the surgery, I would bounce back, but that
hasnt happened. Nurse: Bounce back? Nurse uses sensitive reflection to
pick up the cue bounce back and waits for the patient to say more. Patient:
well, I suppose, I hoped I would be like I was before I got ill I know its
daft really I need to be patient with myself. Fletcher (2006) explored the
effect of facilitating the first patient cue, which appears to be important. If
this is missed, patient cues can drop off as the consultation progresses,
whereas open questions linked to a cue are notably more likely to lead to
further disclosures than unlinked open questions.
Patient: well, I suppose, I hoped I would be like I was before I got ill I
know its daft really I need to be patient with myself. Nurse: So you hoped
you would be like you were before you were ill, and you are finding it hard to
be patient with yourself as you recover how are you feeling about that?
The nurse uses reflection of what the patient has said to show it has been
heard, and acknowledgement to pick up the cue relating to being patient,
then a pause and tentative open directive question to find out more. By
recognising and acting on cues, the nurse is able to gain insight about the
effect of the illness on the patient in this example. Patient: Well, not very
happy. Im not a patient person, or one that sits about. I dont get looked
after, I do the looking after... I feel like everyone is managing without me
now, that Im not really needed anymore. There are few healthcare
professionals who do not feel they work under considerable time pressure,
and nurses experience it daily. Counter intuitively, recognising and
responding to cues improves time management. In studies that explored
cue-based consultations specifically, consultations were consistently shorter
by 10-12% (Levinson et al 2000, Butow et al 2002). If the consultation is led
by the patient and/or carer, the healthcare professionals conversation can
be tailored to elements that have been identified as important for the
patient, omitting non-relevant detail, and therefore less time is needed.
Complete time out activities 4 and 5 Various cues can be ascertained from
the quotes in time out activity 4. However, the quotes cannot also portray
whether the individuals concerned made eye contact or averted their eyes
while speaking, whether the individuals speech was loud, a whisper, slow or

fast, and other non-verbal cues are not known. In quote (A): Hello again, Im
really feeling much better and not sure that I need to be here taking up your
time, I hardly notice the pain now, picking up the three cues in bold would
enable the nurse to gain more insight into how this person is feeling and
coping with the current situation. Once the nurse has used skills such as
reflection to recognise and explore the cues that may indicate the patient is
attempting to minimise the symptoms or worry, the nurse could then ask is
there something else on your mind? to ensure there is the opportunity to
express additional thoughts, feelings or concerns before moving on with the
discussion. The final part of the conversation can explore any physical
symptoms and future appointments. In quote (B): Im not sleeping well at
all, I keep going over whats happened, I cant take it in, the pain is a bit
worse but Im sure that its me thinking about it all the time. My husband
keeps telling me to relax and not think about it, the listener hears about not
sleeping and pain, but the more significant cues for the nurse to recognise
and respond to are those highlighted. Using effective communication skills to
show you have heard that this person is trying to assimilate and adjust to the
news or situation has the potential to reduce anxiety and improve coping. In
quote (C): I am so angry, I should have been here last week but the
appointment card didnt arrive until the day after I was due to be here. More
time wasted before I get this thing sorted and I can get back to normal, the
important cues relate to the angry emotion, time and the future, which this
person hopes will be a time when he or she will have regained health. Anger
can often mask other difficult feelings such as fear. These cues provide
insight into how an individual is experiencing what is happening to him or her
and also how the individual is focus can be interpreted by nurses to gain
more insight into how this patient is feeling. While a nurse may come up with
a particular or several interpretations of what he may be feeling, the nurse
would need to ask the patient to check what he is thinking or feeling. The
nurse could communicate effectively with the patient by using open
questions and empathising.

The Importance of Therapeutic Communication in Healthcare

A.

The quality of a therapeutic relationship depends on the ability of

the healthcare provider to communicate effectively. The term
"therapeutic communication" is often used in the field of nursing;
however, the process isn't limited to nursing. Other healthcare

professionals, friends and family members of a patient can

implement the strategies of communicating in a therapeutic
manner. The ideal therapeutic exchange provides the patient with
the confidence to play an active role in her care.
B.

Facilitates Client Autonomy

C.

Therapeutic communication techniques, such as active listening,

infer autonomy or independence on the patient or client. Rather
than making assumptions about the client who is almost a stranger,
the healthcare professional facilitates therapeutic expression. The
client, ideally, will then become more comfortable sharing
potentially difficult information. The role of the healthcare
professional is then to use this information to help the client to
further investigate his own feelings and options. In the end, the
client gains more confidence in making decisions regarding his care.
Creates a Nonjudgmental Environment
Perhaps the most important characteristic of a therapeutic relationship

is the development of trust. Trust facilitates constructive communication; it

also

encourages

confidence

and

autonomy.

Being

nonjudgmental

is

necessary in verbal and nonverbal communication. People are acutely adept

at identifying nonverbal cues that may communicate something very
different from what is said.
Provides The Professional With a Holistic View of Their Client
An individual does not usually exist without a network of family, friends
and healthcare professionals. Therapeutic communication emphasizes a
holistic view of a person and his network of people who provide support. A
person's individual perspective regarding his health and life is viewed
through a lens built from the context of his experiences. Those experiences
cannot be ignored when communicating in a way that is therapeutic. Within
the therapeutic relationship, the individual is learning the skills of
communication with other people in his life, ideally also improving those
relationships.

Reduces Risk of Unconscious Influence By The Professional

It's human nature to want to infer some part of yourself into an
interaction; however, in order for therapeutic communication to occur, it's
important to temper your influence. Therapeutic communication requires
maintaining an acute awareness of what is being said as well as any
nonverbal cues. Communicating that you are open to hearing what a person
has to say while folding your arms creates confusion and inconsistency that
can mar a healthy interaction. Be aware of your tone of voice and any
reactions.
This nursing best practice guidelines a comprehensive document providing
resources necessary for the support of evidence-based nursing practice in
the area of establishing therapeutic relationships. The document needs to be
reviewed and applied, based on the specific needs of the organization or
practice setting as well as the needs and wishes of the client. Guidelines
should not be applied in a cookbook fashion but as a framework to assist in
decision making for individualized client care, as well as ensuring that
appropriate structures and supports are in place to provide the best possible
care. Nurses, other health care professionals and administrators who are
leading and facilitating practice changes will find this document valuable for
the development of policies, procedures, protocols, educational programs,
assessment and documentation tools, etc. It is recommended that the
nursing best practice guideline be used as a resource tool. Nurses providing
direct client care will benefit from reviewing the recommendations, the
evidence in support of the recommendations and the process that was used
to develop the guidelines. However, it is highly recommended that
organizations or practice settings adapt these guidelines in formats that
would be user-friendly for daily use. Organizations wishing to use the
guideline may decide to do so in a number of ways: Assess current nursing
and health care practices using the recommendations in the guideline.
Identify recommendations that will address recognized needs in practice
approaches or gaps in services. Systematically develop a plan to implement
the recommendations using associated tools and resources. Implementation
resources will be made available through the RNAO website to assist

individuals and organizations to implement nursing best practice guidelines.

RNAO is interested in hearing how you have implemented this guideline.
Please contact us to share your story. Quotes from nurses and other
organizational members who have implemented this guideline are shared
throughout this document. The quotes were gathered from the pilot
implementation evaluation report (Edwards et al, 2001).

Communication

Human interaction

Verbal and nonverbal

Written and unwritten

Planned and unplanned

Conveys thoughts and ideas

Transmits feelings

Exchanges information

Means various things

Communication, continued

Effective communication

Intrapersonal level self-talk

Clear communication essential

Client safety

Collaboration with diverse team challenged by

Current health care environment

Professional communication and collaboration

Cultural gaps

Available resources and technology

The Communication Process

Sender

Source-encoder

Message

What is actually said/written, body language

How words are transmitted channel

Receiver

Listener decoder perception of intention

Response Feedback

Verbal Communication

Pace and intonation

Simplicity

Clarity and brevity

Congruence

Timing and relevance

Adaptability

Credibility

Humor

Nonverbal Communication

Body language

Gestures, movements, use of touch

Essential skills: observation, interpretation

Personal appearance

Posture and gait

Facial expression of self, others; eye contact

Gestures

Cultural component

Factors Influence Communication Process

Development & gender
Sociocultural characteristics
Values and perception
Personal space and territoriality
Roles and relationships
Environment
Congruence
Attitudes
Development

Language and communication skills develop through stages

Communication techniques for children

Play

Draw, paint, sculpt

Storytelling, word games

Read books; watch movies, videos

Write

Gender

Females and males communicate differently from early age

Boys establish independence, negotiate status

Girls seek confirmation, intimacy

Sociocultural Characteristics

Culture

Education

Economic level

Criteria for effective Communication

Elements
CRITERIA

and

Performance

Criteria

ELEMENT

PERFORMANCE

1. Use effective communication skills in complex situations

1.1 Apply principles of effective communication, with an
understanding of communication processes and factors that
facilitate and inhibit communication
1.2 Maximise opportunities for staff to involve clients, family and
carers in their care and treatment
1.3 Take into account the roles and responsibilities of various
health care personnel involved in communicating in complicated
situations
1.4 Complete all documentation detailing complicated and
difficult situations complying with legal requirements
1.5 Apply a respectful and confidential manner throughout all
communications
1.6 Provide a therapeutic environment in all interactions with
clients through a caring, sensitive, confident and reassuring manner
1.7 Demonstrate politeness, respect
interactions with clients, family and carers

and

empathy

in

all

1.8 Use health terminology correctly in written and verbal

communication with clients, family, carers and colleagues, using
accurate spelling and pronunciation.
2. Deliver complex information effectively
2.1 Deliver complex information in a manner that is clearly
understood by clients, carers, colleagues and others
2.2 Allow time for complex information to be comprehended
taking into account people's differing levels of understanding
2.3 Actively encourage clients, family and carers to share their
information
2.4 Confirm the understanding of information by clients, carers,
colleagues and others
2.5 Communicate effectively in an emergency situation in line
with the health organisation policy and procedure and in
consultation/collaboration with registered nurse
2.6 Address stressful situations using effective communication
skills or refer to the most appropriate health care team member for
resolution
2.7 Deliver complex information to clients/carers in a manner
that enhances understanding and prevents 'information overload'
3. Identify and address actual and potential constraints to
communication
3.1 Identify actual and potential
communication in the workplace

constraints

to

effective

3.2 Identify and apply communication strategies and techniques

appropriate to a range of varying complicated situations
3.3 Identify early signs of potential complicated or difficult
situations
3.4 Implement strategies to address complicated or difficult
communication situations in line with relevant policies and
procedures and within scope of role

3.5 Clarify roles of other health professionals involved in

complicated communication situations
3.6 Clarify and address the issues and needs of people taking
into account differing cultures, religious practices, language,
physical disability and emotional state HLTEN502B Apply effective
communication skills in nursing practice Date this document was
generated: 27 May 2012 Approved Page 5 of 17 Commonwealth
of Australia, 2012 Community Services and Health Industry Skills
Council ELEMENT PERFORMANCE CRITERIA
4. Evaluate effectiveness of communication in complicated
situations
4.1 Document and report outcomes of communication strategies
to address complicated situations
4.2 Refer to appropriate health personnel when situation is
outside own role and responsibility
4.3 Assist in assessing the effectiveness of communication
strategies in complicated situations
4.4 Ensure debriefing sessions are available for self and staff
following difficult situations
5. Use information technology
5.1 Use computers and related information technology to support
nursing practice
5.2 Comply with organisation protocols
communication with clients, family and carers

for

electronic

5.3 Use information technology, including the internet to access

data appropriate to own role and organisation requirements
5.4 Use basic computing and word processing skills to access,
develop and manipulate information in line with own role and
organisation requirements
6. Lead small group discussions
6.1 Monitor and respond appropriately to changing group
dynamics

6.2 Clarify the purpose of group meetings

discussion in line to achieve identified objectives

and manage

6.3 Implement appropriate meeting procedures and roles of

members to support effective contribution to discussion. HLTEN502B
Apply effective communication skills in nursing practice Date this
document was generated: 27 May 2012 Approved Page 6 of 17
Commonwealth of Australia, 2012 Community Services and Health
Industry Skills Council ELEMENT PERFORMANCE CRITERIA
7. Give and receive feedback for performance improvement
7.1 Use feedback as a tool to achieve performance improvement
7.2 Use appropriate language and a respectful manner to
achieve performance improvement through feedback
7.3 Apply strategies to deliver constructive outcomes from giving
and receiving feedback
7.4 Assess own performance as a basis for assessing the
performance of others and providing feedback
7.5 Undertake mentoring
Enrolled/Division 2 nurse

within

scope

of

practice

of

8. Use the principles and processes of open disclosure effectively

8.1 Apply organisation principles and processes of
disclosure in consultation/collaboration with registered nurse

open

8.2 Follow organisation processes for notifying adverse events to

clients, family or carers
8.3 Outline potential impact of adverse events on clients, family
and carers
8.4 Communicate effectively with clients after an adverse event
in consultation/collaboration with registered nurse
8.5 Address own role and responsibilities in relation to open
disclosure in line with organisation policies and procedures
8.6 Apply principles and practices of risk management and
quality
improvement
in
regard
to
open
disclosure
in

consultation/collaboration with registered nurse Required Skills and

Knowledge REQUIRED SKILLS AND KNOWLEDGE This describes the
essential skills and knowledge and their level required for this unit.
HLTEN502B Apply effective communication skills in nursing practice
Date this document was generated: 27 May 2012 Approved Page 7
of 17 Commonwealth of Australia, 2012 Community Services and
Health Industry Skills Council REQUIRED SKILLS AND KNOWLEDGE
Essential knowledge:
The candidate must be able to demonstrate essential knowledge
required to effectively do the task outlined in elements and
performance criteria of this unit, manage the task and manage
contingencies in the context of the identified work role This includes
knowledge of:
Confidentiality principles
Group dynamics
Issues and needs of clients taking into account differing
cultures, religious practices, languages, physical disabilities and
emotional disorders
Legal implications of documentation/duty of care
Medical terminology
Potential constraints to effective communication
Principles of informed consent
Principles, processes and practices of open disclosure
Risk assessment in critical and non-critical clinical situations
Statutory framework within which nursing takes place Essential
skills: It is critical that the candidate demonstrate the ability to
effectively do the task outlined in elements and performance
criteria of this unit, manage the task and manage contingencies in
the context of the identified work role This includes the ability to:
Apply Professional Standards of Practice:

 ANMC code of conduct

ANMC code of ethics
ANMC national Enrolled/Division 2 nurse competency standards
state/territory Nurse Regulatory Nurses Act
state/territory Nursing and Midwifery Regulatory Authority
standards of practice
scope of nursing practice decision making framework
Apply problem solving skills, including an ability to use tools
and techniques to solve problems, analyse information and make
decisions that require discretion and confidentiality
Comply with:
open disclosure processes
principles of informed consent
Communicate effectively with clients and other staff
HLTEN502B Apply effective communication skills in nursing practice
Date this document was generated: 27 May 2012 Approved Page 8
of 17 Commonwealth of Australia, 2012 Community Services and
Health Industry Skills Council REQUIRED SKILLS AND KNOWLEDGE
Provide
requirements

mentoring

in

line

with

jurisdictional

regulatory

Recognise and address the special needs of clients

Record assessment outcomes according to organisation policy
and procedures which may include electronic data systems
Report and record clinical information using appropriate
medical terminology
Use information technology to support nursing practice
Use interpersonal skills, including working with others, empathy
with clients, family and colleagues, using sensitivity when dealing

with people and relating to persons from differing cultural, spiritual,

social and religious backgrounds
Use oral communication skills (language competence) required
to fulfil job roles as specified by the health environment. Advanced
oral communication skills include interviewing techniques, asking
questions, active listening, asking for clarification from client or
other persons, negotiating solutions, acknowledging and responding
to a range of views. The work may involve using interpreters
Use written communication skills (literacy competence)
required to fulfil job roles as specified by health environment. The
level of skill may range from reading and understanding client
reports and documentation to completion of written reports
Utilise organisation protocols for electronic communication
Evidence Guide EVIDENCE GUIDE The evidence guide provides
advice on assessment and must be read in conjunction with the
Performance Criteria, Required Skills and Knowledge, the Range
Statement and the Assessment Guidelines for this Training Package.
Critical aspects for assessment and evidence required to
demonstrate this competency unit:
The individual being assessed must provide evidence of
specified essential knowledge as well as skills
Observation of performance in a work context is essential for
assessment of this unit
Consistency of performance should be demonstrated over the
required range of workplace situations and should occur on more
than one occasion and be assessed by a registered nurse
HLTEN502B Apply effective communication skills in nursing practice
Date this document was generated: 27 May 2012 Approved Page 9
of 17 Commonwealth of Australia, 2012 Community Services and
Health Industry Skills Council EVIDENCE GUIDE Context of and
specific resources for assessment:
Where, for reasons of safety, access to equipment and
resources and space, assessment takes place away from the
workplace, simulations should be used to represent workplace

conditions as closely as possible, prior to assessment in the

workplace Method of assessment
Observation in work place or simulated situations
Written assignments/projects
Case study and scenario as a basis for discussion of issues and
strategies to contribute to best practice
Questioning verbal and written
Role play/simulation Access and equity considerations:
All workers in the health industry should be aware of access
and equity issues in relation to their own area of work
All workers should develop their ability to work in a culturally
diverse environment
In recognition of particular health issues facing Aboriginal and
Torres Strait Islander communities, workers should be aware of
cultural, historical and current issues impacting on health of
Aboriginal and Torres Strait Islander people
Assessors and trainers must take into account relevant access
and equity issues, in particular relating to factors impacting on
health of Aboriginal and/or Torres Strait Islander clients and
communities Related unit: This competency unit incorporates the
content of:
HLTEN402B Communicate effectively in a nursing role
HLTEN502B Apply effective communication skills in nursing practice
Date this document was generated: 27 May 2012 Approved Page 10
of 17 Commonwealth of Australia, 2012 Community Services and
Health Industry Skills Council Range Statement RANGE STATEMENT
The Range Statement relates to the unit of competency as a whole.
It allows for different work environments and situations that may
affect performance
Common terms associated with communication may include
Active listening

 Argument
Body language
Brainstorming
Counselling
Debate
Discussion
Electronic aids
Empathy
Facial expression
Interview
Intimate space
Non-verbal communication - space, gesture, expression,
posture, dress, voice tone, gaze
Public space
Reflective listening
Self disclosure
Social space
Symbols and pictures
Sympathy
Touch
Trust
Verbal communication

Written
communication
HLTEN502B
Apply
effective
communication skills in nursing practice Date this document was

generated: 27 May 2012 Approved Page 11 of 17 Commonwealth

of Australia, 2012 Community Services and Health Industry Skills
Council RANGE STATEMENT
Effective communication may include the use of:
Non-verbal communication
Establishing rapport
Empathy and sympathy
Honesty and openness
Active and reflective listening
Conflict resolution
Therapeutic touch
Use of personnel with special communication skills eg.
Use of interpreters Communication process must include:
Information
Encoder / sender
Decoder / receiver
Channel
Message
Feedback HLTEN502B Apply effective communication skills in
nursing practice Date this document was generated: 27 May 2012
Approved Page 12 of 17 Commonwealth of Australia, 2012
Community Services and Health Industry Skills Council RANGE
STATEMENT
Factors affecting communication may include:
Age
Bereavement and grief

 Cognitive impairment
Culture
Discrimination
Educational background
Emotional state
Environment (e.g. noise)
Gender
Illness
Language
Non-verbal communication
Pain and discomfort
Perceptions
Personal bias
Physical constraints to hearing, sight and speech
Socialisation
Stereotyping
Stress
Urgency of situation
Values and beliefs Complicated or difficult situations may include:
Post suicide attempts
Drug and alcohol affected people
Disabilities
Hearing impaired

 Personal threat
Aggression
Anger
Emergency and crisis situations
Trauma
Death
Grief and loss HLTEN502B Apply effective communication skills in
nursing practice Date this document was generated: 27 May 2012
Approved Page 13 of 17 Commonwealth of Australia, 2012
Community Services and Health Industry Skills Council RANGE
STATEMENT Open disclosure includes:
The provision of an open, consistent approach to communicating
with clients following an adverse event
Expressing regret for what has happened, keeping the client
informed and providing feedback on investigations
Includes steps taken to prevent an event from happening
Provides information that enables systems of care to be changed
or to improve client safety (Open Disclosure - a handbook for health
care professionals to assist with the implementation of the open
disclosure standard, Safety and Quality Council. 2005)
Oral communication may include:
Responding to questions and delivering health care environment
information
Interpretation of complicated situations
Questioning, clarifying and confirming information
Explaining information , procedures and descriptions
Constraints to effective communication may include:
Environment difficulties

 Family and/or friends involvement

Language difficulties
Hearing and/or speech impairments
Religious, social, spiritual or cultural factors
Emotional state An adverse event means:
An incident in which unintended harm resulted to a person
receiving care (Open Disclosure - a handbook for health care
professionals to assist with the implementation of the open
disclosure standard, Safety and Quality Council. 2005) HLTEN502B
Apply effective communication skills in nursing practice Date this
document was generated: 27 May 2012 Approved Page 14 of 17
Commonwealth of Australia, 2012 Community Services and Health
Industry Skills Council RANGE STATEMENT
Stressful situations may be:
Staff centred Client centred Terms associated with group
dynamics may include: Leadership styles Teams Group
behaviours Cooperation Diversity Conflict Consensus
Internal conflict Interpersonal conflict Aggression Assertion
Passivity Time management Trust Forming Brain storming
Performing Mourning/reforming Characteristics of effective
partnerships include: Confidentiality Trust Self reflection
Social conversation Use of health care environment and
professional standards Effective and constructive feedback
Evaluation of all performances Use of constructive comments
Accountability for own actions and evaluation Performance
appraisal against role statement and/or environment contract
Professional development based on personal and professional
identified needs Remediation as identified by self and/or others
Self assessment strategies may include: Setting goals Journal
writing Reflective learning principles Professional development
activities Performance appraisal Evaluating own performance
Health terminology may include (but should not be limited to):
Anatomy and physiology terms Medical conditions Medical

investigations and procedures Abbreviations for medical and

pharmacological terms Names of equipment and instruments
Medico-legal terminology Conflict resolution strategies may include:
Win/win Win/lose Lose/lose Compromising Confronting
Withdrawing Forcing Peace maker Three-part statement
Broken record HLTEN502B Apply effective communication skills in
nursing practice Date this document was generated: 27 May 2012
Approved Page 16 of 17 Commonwealth of Australia, 2012
Community Services and Health Industry Skills Council RANGE
STATEMENT Meeting procedures may include: Types of meetings
(formal, semi-formal, informal) Handover Agenda formation
Purpose of the meeting Attendees Duration of meeting Day,
date, time and venue Key roles (chairperson, note-taker)
Summarising and evaluating processes Terms associated with
meetings may include: Agenda Minutes Apologies Business
arising General business Propose Second Motion
Parliamentary procedure Consensus Compromise Concession
Interview Standards Benchmark Feedback Evaluation
Constructive criticism Accountability Performance appraisal
Performance management Professional development Strategic
plan Remediation Evaluation of own performance Self
disclosure Reflective learning principles Profession

NURSING AS A SCIENCE
A. The Nursing Process
NURSING PROCESS
The common thread uniting different types of nurses who work in
varied areas is the nursing processthe essential core of practice for
the registered nurse to deliver holistic, patient-focused care.
ASSESSMENT
An RN uses a systematic, dynamic way to collect and analyze
data about a client, the first step in delivering nursing care.
Assessment includes not only physiological data, but also
psychological, sociocultural, spiritual, economic, and life-style factors
as well. For example, a nurses assessment of a hospitalized patient in
pain includes not only the physical causes and manifestations of pain,
but the patients responsean inability to get out of bed, refusal to
eat, withdrawal from family members, anger directed at hospital staff,
fear, or request for more pain mediation. A nursing diagnosis may be
part of the nursing process and is a clinical judgment about individual,
family, or community experiences/responses to actual or potential
health problems/life processes.
NURSING DIAGNOSIS
are developed based on data obtained during the nursing
assessment. Whereas a medical diagnosis identifies a disorder, a
nursing diagnosis identifies problems that result from that disorder.
PLANNING
Based on the assessment and diagnosis, the nurse sets
measurable and achievable short- and long-range goals for this patient
that might include moving from bed to chair at least three times per
day; maintaining adequate nutrition by eating smaller, more frequent
meals; resolving conflict through counseling, or managing pain through
adequate medication. Assessment data, diagnosis, and goals are
written in the patients care plan so that nurses as well as other health
professionals caring for the patient have access to it.
IMPLEMENTATION
Nursing care is implemented according to the care plan, so
continuity of care for the patient during hospitalization and in
preparation for discharge needs to be assured. Care is documented in
the patients record.
Collaborative - facilitate better patient outcomes. The healthcare
team works as a group utilizing individual skills and talents to reach
the highest of patient care standards. A multidisciplinary plan of care
should be decided by all of the team members.
Independent - These are actions that the nurse is able to initiate
independently.

EVALUATION
The outcome of a summative assessment can be used
formatively, however, when students or faculty take the results and
use them to guide their efforts and activities in subsequent courses.

DOCUMENTATION OF CARE PLAN

is anything written or printed that is relied on as a record of proof for
authorized persons. Documentation and reporting in nursing are needed for
continuity of care it is also a legal requirement showing the nursing care
performed or not performed by a nurse.
B. HEALTH AND ILLNESS
WHO definition of Health

Health is a state of complete physical,

mental and social well-being
and not merely the absence of disease or infirmity.

Wellness

The condition of good physical and mental health, especially when

actively maintained by proper diet, exercise, and avoidance of risky
behavior. A dynamic state of health in which an individual progresses
toward a higher level of functioning, achieving an optimum balance
between internal and external environments.

DIMENSIONS OF WELLNESS
Social Wellness
is the ability to relate to and connect with other people in our
world. Our ability to establish and maintain positive relationships with
family, friends and co-workers contributes to our Social Wellness.
Emotional Wellness
is the ability to understand ourselves and cope with the
challenges life can bring. The ability to acknowledge and share feelings
of anger, fear, sadness or stress; hope, love, joy and happiness in a
productive manner contributes to our Emotional Wellness. Spiritual
Wellness
is the ability to establish peace and harmony in our lives. The
ability to develop congruency between values and actions and to
realize a common purpose that binds creation together contributes to
our Spiritual Wellness.
Environmental Wellness
is the ability to recognize our own responsibility for the quality of
the air, the water and the land that surrounds us. The ability to make a
positive impact on the quality of our environment, be it our homes, our
communities or our planet contributes to our Environmental Wellness.

Occupational Wellness
is the ability to get personal fulfilment from our jobs or our
chosen career fields while still maintaining balance in our lives. Our
desire to contribute in our careers to make a positive impact on the
organizations we work in and to society as a whole leads to
Occupational Wellness.
Intellectual Wellness
is the ability to open our minds to new ideas and experiences
that can be applied to personal decisions, group interaction and
community betterment. The desire to learn new concepts, improve
skills and seek challenges in pursuit of lifelong learning contributes to
our Intellectual Wellness.
Physical Wellness
is the ability to maintain a healthy quality of life that allows us to
get through our daily activities without undue fatigue or physical
stress. The ability to recognize that our behaviors have a significant
impact on our wellness and adopting healthful habits (routine check
ups, a balanced diet, exercise, etc.) while avoiding destructive habits
(tobacco, drugs, alcohol, etc.) will lead to optimal Physical Wellness.
CONCEPT OF HEALTH ANG ILLNESS CONTINUUM:
Health and disease lie along a continuum and there is no single cut-off point.
The lowest point on the health and disease spectrum is death and highest
point corresponds to the WHO definition of positive health .

STAGES OF HEALTH
Stage 1: Symptom Experience
The person is aware that something is wrong. A person usually
recognizes a physical sensation or a limitation in functioning but does not
suspect a specific diagnosis.
Stage 2: Assumption of the Sick People
If symptom persist and become severe, clients assume the sick role. At
this point, the illness becomes a social phenomenon, and sick people seek
confirmation from their families and social groups that they are indeed ill and
that they be excused from normal duties and role expectations.
Stage 3: Medical Care Contact

If symptoms persist despite the home remedies, become severe or

require emergency care, the person is motivated to seek professional health
services. In this stage the client seeks expert acknowledgement of the illness
as well as the treatment.
Stage 4: Dependent Client Role
The client depends on health care professionals for the relief of
symptoms. The client accepts care, sympathy and protection from the
demands and stresses of life. A client can adopt the dependent role in a
health care institution, at home, or in a community setting. The client must
also adjust to the disruption of a daily schedule.
Stage 5: Recovery and Rehabilitation
This stage can arrive suddenly, such as when the symptoms appeared.
In the case of chronic illness, the final stage may involve in an adjustment to
a prolong reduction in health and functioning.
Three Levels of Prevention:

Primary prevention aims to prevent disease or injury before it ever

occurs. This is done by preventing exposures to hazards that cause
disease or injury, altering unhealthy or unsafe behaviours that can lead
to disease or injury, and increasing resistance to disease or injury
should exposure occur.

Secondary prevention - aims to reduce the impact of a disease or

injury that has already occurred. This is done by detecting and treating
disease or injury as soon as possible to halt or slow its progress,
encouraging personal strategies to prevent reinjury or recurrence, and
implementing programs to return people to their original health and
function to prevent long-term problems.

Tertiary prevention - aims to soften the impact of an on going illness

or injury that has lasting effects. This is done by helping people
manage long-term, often-complex health problems and injuries (e.g.
chronic diseases, permanent impairments) in order to improve as much
as possible their ability to function, their quality of life and their life
expectancy.

C. LEVELS OF CARE HEALTH PROMOTION

is directed toward increasing the level of well-being and self actualization.
Health Promotion strategies are often political because they emphasize
addressing structural systemic inequities and have a strong philosophy of
social justice. Health promotion is guided by these principles:
Health promotion addresses health issues in contexts

 Health promotion supports a holistic approach

Health promotion requires a long term perspective
Health promotion is multisectoral
Health promotion draws knowledge from social, economic, political,
environmental, medical, nursing sciences and first hand experiences.
HEALTH MAINTENACE -the goal to preserve, protect, and support the
health of individuals and families in communities across a spectrum of health
problems/life processes.
DESEASE PROMOTION -the goal of advancement toward an optimal state
of wellness through the prevention of illness and advancement of wellness
for individuals and families in communities across a spectrum of health
problems/life processes.
CURATIVE
Care refers to a specific style of medical treatment and therapies provided to
a patient with the main intent being to improve or eliminate symptoms that
the patient is experiencing and to cure the patient's overall medical
problems. Examples of curative care include antibiotics, chemotherapy, or a
cast for a broken limb. All of these courses of action aim to improve, and
eventually eliminate overall symptoms.
Curative or Aggressive Care
Curative care is also commonly known as and referred to as aggressive
care. Just as it sounds, aggressive care is a proactive approach to medical
treatment that aggressively aims to eliminate medical issues, rather than
simply minimizing their impact. A patient that is receiving aggressive care
will typically receive medication, have access to technology, undergo surgery
and take any other measures that could be considered effective approaches
to treat an illness.
Chemotherapy for cancer, dialysis treatment, radiation therapy, surgery, the
use antibiotics, and any other medical interventions specifically designed to
preserve and prolong life could all be considered forms of aggressive care.
With aggressive care comes hope. Typically, when a patient receives
aggressive care, it is an indication that there is a belief, among the medical
professionals working with the patient, or at least among friends and family
members of the patient authorizing the treatment, that the patient may
potentially recover, or will at least be able to continue living at a reasonable
quality.
When it no longer appears that the patient has a legitimate chance to
recover, or continue to live with a decent quality of life, doctors may suggest

ending aggressive care. While this may sound like giving up on the patient,
such a decision is actually made with the patients best interest in mind.
Once a patient reaches a point where curative care is no longer helpful or
effective, the quality of life decreases. At this point, patients may prefer to
go out peacefully, rather than continue to fight.
HEALTHY LIFE STYLE
According to the World Health Organization (WHO), Health is a state of
complete physical, mental, and social well-being. Interestingly enough,
health is not simply defined as just the absence of disease. The actual
definition of Healthy Living is the steps, actions and strategies one puts in
place to achieve optimum health. Healthy Living is about taking
responsibility and making smart health choices for today and for the future.
Eating right, getting physically fit, emotional wellness, spiritual wellness and
prevention are all apart of creating a healthy lifestyle. Since the entire YOU,
meaning all aspects of ones self, must work in harmony to achieve wellness,
you need to put balanced energy into each aspect of yourself.
TEMPERATURE REGULATION
A homeostatic process in which an organism modulates its internal
body temperature. Maintenance of a constant internal body temperature
independent
from
the
environmental
temperature:
mammalian
thermoregulation.
HYGIENE
is a set of practices performed for the preservation of health. According
to the World Health Organization (WHO), " refers to conditions and practices
that help to maintain health and prevent the spread of diseases.
Factor Influencing Individual Hygienic Practices Factor Variables:

Culture North American culture places a high value on cleanliness.

Many North Americans bathe or shower once or twice a day, whereas
people from some other cultures bathe once a week. Some cultures
consider privacy essential for bathing, whereas others practice
communal bathing. Body odor is offensive in some cultures and
accepted normal in others. Religion Ceremonial washings are practiced
by some religion
Environment Finances may affect the availability f facilities for bathing.
For example, homeless people may not have warm water available;
soap, shampoo, shaving lotion, and deodorants may be too expensive
for people who have limited resources.
Developmental Level Children learn hygiene in home. Practices vary
according to the individuals age; for example, preschoolers can carry
out most tasks independently with encouragement.

Health and Energy Ill people may not have the motivation or energy to
attend to hygiene. Some clients who have neuromuscular impairments
may be unable o perform hygienic care. Personal Preferences Some
people prefer a shower to tub bath. People have different preferences
regarding the time of bathing (e.g. morning versus evening)
Skin Care General Guidelines for Skin Care An intact, healthy skin is the
bodys first line of defense The degree to which the skin protects the
underlying tissues from injury depends on the amount of subcutaneous
tissue and the dryness of the skin. Moisture in contact with the skin
can result in increased bacterial growth and irritation.
Body odors are caused by resident skin bacteria acting on the body
secretions. Cleanliness is the best deodorant. Skin sensitivity to
irritation and injury varies among individuals and in accordance with
their health.
Common Skin Problem Problem and Appearance Nursing
Implication:
Abrasion Superficial layers of the skin are scraped or rubbed away.
Area is reddened and may have localized bleeding or serous weeping.
Prone to infection; therefore, wound should be kept clean and dry. Do
not wear rings or jewelry when providing care to avoid causing
abrasions to clients. Lift, do not pull, a client across a bed. Use two or
more people for assistance.
Excessive Dryness Skin can appear flaky and rough. Prone to infection
if the skin cracks; therefore, provide alcohol-free lotions to moisturize
the skin and prevent cracking. *Bathe client less frequently; use no
soap, or use nonirritating soap and limit its use. Rinse skin thoroughly
because soap can be irritating and drying. Encourage increased fluid
intake if health permits to prevent dehydration.
Ammonia Dermatitis (Diaper Rash) Caused by skin bacteria reacting
with urea in the urine. The skin becomes reddened and is sore.
Acne Inflammatory condition with papules and pustules. Keep the skin
clean to prevent secondary infection.

NURSING AS AN ART
The quality, production, expression, or realm, according to aesthetic
principles, of what is beautiful, appealing, or of more than ordinary
significance.
Why nursing is an ART?
Nursing is an art: and if it is to be made an art, it requires an exclusive
devotion as hard a preparation, as any painters or sculptors work; for what
is the having to do with dead canvas or dead marble, compared with having
to do with the living body, the temple of Gods spirit? It is one of the Fine
Arts: I had almost said the finest of Fine Arts.
Florence Nightingale (1820-1910)
Concepts related to the art of nursing
HUMAN BEINGS

Viewed as open energy fields with unique life experiences

Holistic beings that are unique, dynamic, and multidimensional,
capable of abstract reasoning, creativity, aesthetic appreciation and
self-responsibility.
Humans are viewed as valued persons, to be respected, nurtured and
understood with the right to make informed choices regarding their
health.
HEALTH
A dynamic process, is the synthesis of wellness and illness and is
defined by the perception of the client across the life span. This view
focuses on the entire nature of the client in physical, social, aesthetic,
and moral realms.
SELF AWARENESS/CONCEPTS
A collection of beliefs about oneself that includes elements such as
academic performance, gender roles and sexuality, and racial identity.
Generally, self-concept embodies the answer to "Who am I?"
SELF ENHANCEMENT
A type of motivation that works to make people feel good about
themselves and to maintain self-esteem.

Self-enhancement involves a preference for positive over negative selfviews.

It is one of the four self-evaluation motives:, along with selfassessment (the drive for an accurate self-concept), self-verification
(the drive for a self-concept congruent with one's identity) and selfimprovement (the act of bettering one's self-concept). Self-evaluation
motives drive the process of self-regulation, that is, how people control
and direct their own actions.
ENVIRONMENT
Environment is the landscape and geography of human social
experience, the setting or context of experience as everyday life and
includes variations in space, time and quality.
An energy field in mutual process with the human energy field and is
conceptualized as the arena in which the nursing client encounters
aesthetic beauty, caring relationships, threats to wellness and the lived
experiences of health.

SELF AWARENESS

Self Awareness is having a clear perception of your personality,

including strengths, weaknesses, thoughts, beliefs, motivation, and
emotions. Self Awareness allows you to understand other people, how
they perceive you, your attitude and your responses to them in the
moment.

Self awareness is the first step in creating what you want and mastering
your life. Where you focus your attention, your emotions, reactions,
personality and behavior determine where you go in life. Having self
awareness allows you to see where your thoughts and emotions are taking
you. It also allows you to take control of your emotions, behavior, and
personality so you can make changes you want. Until you are aware in the
moment of your thoughts, emotions, words, and behavior, you will have
difficulty making changes in the direction of your life.
Types of self-awareness: private and public; whether behavior is more
influenced by personal standards or social standards is partially determined
by what aspect of the self is salient (private or public)
Private being aware of ones hidden aspects of one self effects:

intensification of affect when we think about ourself in a particular

feeling state that feeling state becomes exaggerated (when college
males viewed nude photos, the ones who were made more self-aware
experienced greater positive affect than those who were not made selfaware Schierer & Carver (1977)

clarification of knowledge private events become more distinct

and the more accurate is the reporting on them. Placebo effects are
lower in self-aware people (Gibbons et al. 1979)

greater adherence to personal standards of behavior Carver

(1975) attitudes toward punishment were taken and 3 weeks later the
Ss were given the opportunity to shock someone deserving of
punishment Ss who were made more self-aware were more likely to
show attitude-behavior consistency

Public temporary state of being aware of ones public self effects;

evaluation apprehension when we realize that we are the object
of evaluation or scrutiny of others
temporary loss of self-esteem when we realize that there is a
discrepancy between our ideal and actual public self (seeing yourself on
video)
greater adherence to social standards of behavior

Why Develop Self Awareness?

As you develop self awareness you are able to make changes in the thoughts
and interpretations you make in your mind. Changing the interpretations in
your mind allows you to change your emotions. Self awareness is one of the
attributes of Emotional Intelligence and an important factor in achieving
success.
Self-awareness should not be viewed as a state that we can attain
completely it is a constant voyage of discovery that is never complete
(Burnard 1988). Rungapadiachy (1999) states that the nature of being selfaware means there is no saturation point. He proposes three layers of selfawareness. First is superficial, for example, awareness of ones age and
gender. Second is selective, which includes awareness of things that we feel
we may need to be aware of, such as our outward appearance and attitudes.
Third is deeper awareness issues known only to ourselves. This level
reflects our deepest secrets and thoughts. One way of exploring these ideas
is by thinking about the Johari Window (Luft 1969).

Knowing Myself
Realistic View
In your quest to know yourself, do not think of yourself more highly than you
should (Rom. 12:3). In other words, no superiority attitude. Rather have a
sober view of your strengths. On the other hand, do not exaggerate your
weaknesses and look down on yourself. Also, do not excuse or rationalise
your weaknesses. We need a realistic view of both our strengths and
weaknesses if we are to know our true selves.
How we see ourselves may be clouded by the feedback messages we
received about ourselves from others. But how could anyone know more
about you than you? They do not feel your emotions or think your thoughts;
they do not face the issues that you wrestled with. No one (except God, cf
Psa. 139:1-6) could know you better than you! Therefore, do not let others
look down on you (1 Tim. 4:12).
Self-awareness Questions
1 What are your strengths?
What are your weaknesses?
2 How do your friends describe you?
Do you agree with their descriptions? Why or why not?
3 List two situtations when you are most at ease.
What specific elements were present when you felt that way?
4 What types of activities did you enjoy doing when you were a child?
What about now?
5 What motivates you? Why?
6 What are your dreams for the future?
What steps are you taking to achieve your dreams?
7 What do you fear most in your life? Why?
8 What stresses you?
What is your typical response to stress?
9 What qualities do you like to see in people? Why?
Do you have many friends as you just described? Why or why not?

10 When you disagree with someone's viewpoint, what would you do?
Tips to Achieve Self-Awareness

Strive for emotional awarenessunderstand what you are feeling and

what is being triggered within so you can appropriately assess what is

occurring and how to respond in an effective way/space that voids
previously negative responses and patterns.
Recognize negative and damaging thoughts/cognitions so you can

censor them.
Recognize your behavior tendencies and possible patterns to make

appropriate adjustments prior to negative actions and/or outbursts.

Come to terms and learn about your expectations, beliefs, and

assumptions which affect the path and actions you choose.

Regardless of past events and patterns, accept responsibility for your
actions and the role you played in the outcome.

Self-Consciousness: A Heightened State of Self-Awareness

Sometimes, people can become overly self-aware and veer into what is
known as self-consciousness. Have you ever felt like everyone was
watching you, judging your actions, and waiting to see what you will do next?
This heightened state of self-awareness can leave you feeling awkward and
nervous in some instances. In a lot of cases, these feelings of selfconsciousness are only temporary and arise in situations when we are "in the
spotlight." For some people, however, self-consciousness can become a
chronic condition.
People who are privately self-conscious have a higher level of private selfawareness, which can be both a good and bad thing. These people tend to
be more aware of their feelings and beliefs, and are therefore more likely to
stick to their personal values. However, they are also more likely to suffer
from negative health consequences such as increased stress and anxiety.
People who are publicly self-conscious have a higher level of public selfawareness. They tend to think more about how other people view them and

are often concerned that other people might be judging them based on their
looks or their actions. As a result, these individuals tend to stick to group
norms and try to avoid situations in which they might look bad or feel
embarrassed.

SELF ENHANCEMENT
A type of motivation that works to make people feel good about
themselves and to maintain self-esteem.
Self-enhancement involves a preference for positive over negative selfviews.
It is one of the four self-evaluation motives:, along with selfassessment (the drive for an accurate self-concept), self-verification
(the drive for a self-concept congruent with one's identity) and selfimprovement (the act of bettering one's self-concept). Self-evaluation
motives drive the process of self-regulation, that is, how people control
and direct their own actions.
LEVELS OF SELF-ENHANCEMENT

Observed Effect
Self-enhancement at the level of an observed effect describes the
product of the motive. For example, self-enhancement can produce
inflated self-ratings (positive illusions). Such ratings would be selfenhancement manifested as an observed effect. It is an observable
instance of the motive.

On going Process

Self-enhancement at the level of an ongoing process describes the

actual operation of the motive. For example, self-enhancement can
result in attributing favorable outcomes to the self and unfavorable
outcomes to others (self-serving attribution bias). The actual act of
attributing such ratings would be self-enhancement manifested as an
ongoing process. It is the motive in operation.
Personality trait

Self-enhancement at the level of a personality trait describes habitual

or inadvertent self-enhancement. For example, self-enhancement can
cause situations to be created to ease the pain of failure (selfhandicapping). The fabrication of such situations or excuses frequently
and without awareness would be self-enhancement manifested as a
personality trait. It is the repetitive inclination to demonstrate the
motive.
Underlying Motive
Self-enhancement at the level of an underlying motive describes the
conscious desire to self-enhance. For example, self-enhancement can
cause the comparison of the self to a worse other, making the selfseem greater in comparison (strategic social comparisons). The act of
comparing intentionally to achieve superiority would be selfenhancement manifested as an underlying motive. It is the genuine
desire to see the self as superior.
Cultural diversity
Different between culture, norms, tradition, values and way of life of
different country Cultural competency
knowledge about different culture Cultural differences
Asians

male is dominant than female

education is the key to a success at time of death -allow
the family to stay with the body for at least 8 hrs

Buddhism
they believe in KARMA oat time of death
do not touch the body
leave the body as it is Islam/Muslim At time of death
turn the face to the right facing Mecca Judaism
feet facing towards the doorway
Orthodox/Christians
holding cross, bible or rosary

Caring: an Integral Component of Nursing

Caring is central to all heaping professions, and enables persons to

create meaning in their lives. Caring means that people, relationships,
and things matter.

CARING

Caring is a central to all heaping professions, and enables person to

create meaning in their lives. Caring means that people, relationships
and things matter.
Caring innate to an individual and that a person lives their lives
growing the capacity of caring.
Caring is living in context of relational responsibilities.
Caring is responsibility to self and others.
Caring shapes relationships.

Theory of Caring as Nursing

6 Major Assumptions
Persons are caring by virtue of humanness.
Persons are caring moment to moment.
Persons are whole or complete in the moment.
Personhood is living grounded in caring.
Personhood is enhanced through the participating in nurturing
relationships with caring others.
Nursing is both a discipline and a profession.

Nurse-Client Relationship

The nurse and the client work together to assist client to grow and
solve his problems. This relationship exists for the benefit of the client
so that it is important that at every interaction, the nurse uses self
therapeutically. This is achieved by maintaining the nurses selfawareness to prevent her unrecognized needs from influencing her
perception of and behavior towards the client.
It is the nurseclient interaction that is toward enhancing the client's
well-being, and the client may be an individual, a family, a group or a
community.

Three Phases of Nurse-Client Relationship:

1. Orientation Stage

Establishing therapeutic environment.

The roles, goals, rules and limitations of the relationship are

defined, nurse gains trust of the client, and the mode of
communication are acceptable for both nurse and patient is set.
o Acceptance is the foundation of all therapeutic relationship
o Acceptance of others requires acceptance of self first.

Rapport is built by demonstrating acceptance and nonjudgmental attitude.

Acceptance of patient means encouraging the patient verbally

and non-verbally to express both positive and negative feelings
even if these are divergent from accepted norms and general
viewpoint.
o The nurse can encourage the client to share his/her
feelings by making the client understand that no feeling is
wrong.

Trust of patient is gained by being consistent.

Assessment of the client is made by obtaining data from primary

and secondary sources.

The patient set the pace of the relationship.

During this phase, the problems are not yet been resolved but
the clients feelings especially anxiety is reduced, by using
palliative measures, to enable the client to relax enough to talk
about his distressing feelings and thoughts.

This stage progresses well when the nurses show empathy

provide support to client and temporary structure until the client
can control his own feelings and behavior.
o Reality testing is accepting the patients perceptions,
feelings and thoughts as neither right nor wrong, but at the
same time offering other options or points of view to the
client in a non-argumentative manner for the purpose of
helping the client arrive at more realistic conclusions.

o To provide structure is to intervene when the client loses

control of his own feelings and behaviors by medications,
offering self, restrain, seclusion and by assisting client to
observe a consistent daily schedule.
2. Working/ Exploration/ Identification Stage at this point, the clients
problems are identified and solutions are explored, applied and evaluated.

The focus of the assessment and of the relationship is the clients

behavior and the focus of the interaction is the clients feelings.

The nurse should realize that the clients feelings of security are
developed by being consistent at all times.

Perception of reality, coping mechanisms and support systems

are identified.

The nurse assists the patient to develop coping skills, positive

self concept and independence in order to change the behavior
of the client to one that is adaptive and appropriate.
o The nurse uses the techniques of communication and
assumes different roles to help the client.

3. Termination/ Resolution stage

the nurse terminates the relationship when the mutually agreed

goals are met, the patient is discharged or transferred or the
rotation is finished. The focus of this stage is the growth that has
occurred in the client and the nurse helps the patient to become
independent and responsible in making his own decisions. The
relationship and the growth or change that has occurred in both
the nurse and the patient is summarized.

Client may become anxious and react with increased

dependence, hostility and withdrawal, these are normal reactions
and are signs of separation anxiety, these feelings and behavior
should be discussed with the client.

The nurse should be firm in maintaining professionalism until the

end of the relationship. She should not promise the client that
the relationship will be continued.

The time parameters should be made early in the relationship

and meetings are set further and further apart near the end to

foster independence of the patient and prepare the latter

gradually for the separation.

The nurse should not give her address or telephone numbers to

the patient.

Referral for continuing health care and support after discharge

provides additional resources for the client and the family.

The goal of the therapeutic relationship have been met when the
patient has developed emotional stability, cope positively,
recognized sources or causes of anxiety, demonstrates ability to
handle anxiety and independence, and is able to perform selfcare.
o Preparation of the termination phase begins at the
orientation phase, when the duration and length of the
nurse-client relationship was established.
o It is normal for the client to experience separation anxiety
such as sleeplessness, anorexia, physical symptoms,
withdrawal and hostility.
Therapeutic use of Self

Therapeutic reciprocity poses significant practical difficulties and

ethical hazards. For the use of this technique of self-disclosure to be
considered ethical, the nurse must justify having a special relationship
with the patient. To be considered practical, the interaction must help
and not harm the patient or the patient's family members.
Both nurses and patients place high value on the "therapeutic
use of self," which involves the nurse's positive regard for patients.
Taking relationships with patients seriously means nurses must
examine their own feelings and motives and how they affect their
ability to practice ethically. Interactions with patients must be
conducted in a way that's fair to all patients. For example, when nurses
see similarities between patients' lives and their own, they aren't
justified in giving those patients preferential treatment (as in the
distribution of health care resources).
Such a similarity does not provide an ethical basis for a special
relationship with the nurse. If it did, all patients would be entitled to be
cared for by nurses who resemble them.

Empathy tends to occur between like people and with likable

people. Nurses, like all people, are prone to having special feelings for
others who are like them or who are endearing-or for patients who're
"easy." It seems that the real ethical problem is not how to refine
relations with patients whom nurses see as similar, but rather how to
connect with patients whom they see as different or "difficult."
A nurse who perceives a special connection with a patient might
be justified, even obligated, to use that connection for the patient's
benefit as long as it doesn't interfere with other patients' care. A more
potent danger occurs when a nurse's need to see similarities interferes
with her or his ability to have a therapeutic nurse-patient relationship,
such as if the nurse distorts understanding of a patient and the
patient's problems in an effort to see the patient as more like herself or
himself. Therapeutic connection is better served by developing the
ability to understand, appreciate, and empathize with patients who
differ significantly from the nurse, and to perceive the connection as
broadly as possible, such as "I'm like you because of the experience of
sadness" rather than "I'm like you because I lost my father, too."
There are also significant practical problems inherent to
disclosing personal information therapeutically. For one, it's a difficult
technique to master. Psychiatric nursing students, even those in
master's programs, typically mistake disclosing personal information
(such as "I cried like you when my father died"), which tends not to be
therapeutic because the focus is on the nurse, for here-and-now
personal feelings (such as "It makes me sad to see you watch your
father die"), which are most likely to be therapeutic. The reciprocity
that occurs in friendship is not the same as that which occurs between
nurse and patient. In friendship, there is, appropriately, an expectation
of reciprocity. In therapeutic relations, the clinician's positive regard of
the patient must be unconditional. Also, friends may work toward
equality in their relations, but in the clinical relationship power is not,
cannot be, and should not be equal.
Countertransference-when the nurse's feelings toward the
patient are in part based on personal experience and not directly
related to the current situation-presents daunting practical challenges,
especially when a nurse is attempting to judge whether disclosing
personal information has therapeutic value. Nurses want to believe
they're taking the right action, and they may want patients to tell them
that they've done the right thing. And the patient may want to respond
positively to the nurse-an ethically more concerning bias over which

the nurse has no control. These sources of bias make it difficult for
nurses to judge the therapeutic value of their own disclosures. A
nurse's disclosure of personal information to a patient can be
beneficial, but as a technique therapeutic reciprocity is difficult to
perform and teach, requiring more than compassion. It should not be
taught to novice nurses, nor should it be widely promoted as part of
standard practice. The gratification nurses get from patients is what
makes nursing a great vocation-contact with patients is fulfilling
because nurses don't demand or expect anything in return. The ethical
struggle is not in having compassion for patients who give back
willingly and knowingly; it's in learning to feel that one has received
something in return from the patient who rebuffs or is different from
the nurse.
Characteristics of Therapeutic Relationship
The therapeutic relationship (also therapeutic alliance, the helping
alliance, or the working alliance) refers to the relationship between a
healthcare professional and a client (or patient). It is the means by
which a therapist and a client hope to engage with each other, and
effect beneficial change in the client.

Components: In psychoanalysis, the therapeutic relationship has been

theorized
to
consist
of
three
parts:
the
working
alliance,
transference/countertransference, and the real relationship.[2][3][4]
Evidence on each component's unique contribution to outcome has been
gathered, as well as evidence on the interaction between components.[5]
Transference The concept of therapeutic relationship was described by Freud
(1912) as "friendly affectionate feeling" in the form of positive transference.
Working alliance Also known as the therapeutic alliance, working alliance is
not to be confused with the therapeutic relationship, of which it is theorized
to be a component.[citation needed]
The working alliance may be defined as the joining of a client's reasonable
side with a therapist's working or analyzing side.[6] Bordin[7] conceptualized
the working alliance as consisting of three parts: tasks, goals, and bond.
Tasks are what the therapist and client agree need to be done to reach the
client's goals. Goals are what the client hopes to gain from therapy, based on
his or her presenting concerns. The bond forms from trust and confidence
that the tasks will bring the client closer to his or her goals.
Research on the working alliance suggests that it is a strong predictor of
psychotherapy or counseling client outcome. Also, the way in which the
working alliance unfolds has been found to be related to client outcomes.
Generally, an alliance that experiences a rupture that is repaired is related to
better outcomes than an alliance with no ruptures, or an alliance with a

rupture that is not repaired. Also, in successful cases of brief therapy, the
working alliance has been found to follow a high-low-high pattern over the
course
of
the
therapy.
Characteristic of the Therapeutic Relationship
The therapeutic relationship has several characteristics; however the most
vital will be presented in this article. The characteristics may appear to be
simple and basic knowledge, although the constant practice and integration
of these characteristic need to be the focus of every client that enters
therapy. The therapeutic relationship forms the foundation for treatment as
well as large part of successful outcome. Without the helping relationship
being the number one priority in the treatment process, clinicians are doing a
great disservice to clients as well as to the field of therapy as a whole.
The following discussion will be based on the incredible work of Carl Rogers
concerning the helping relationship. There is no other psychologist to turn to
when discussing this subject, than Dr. Rogers himself. His extensive work
gave us a foundation for successful therapy, no matter what theory or
theories a clinician practices. Without Dr. Rogers outstanding work,
successful therapy would not be possible.
Rogers defines a helping relationship as , a relationship in which one of the
participants intends that there should come about , in one or both parties,
more appreciation of, more expression of, more functional use of the latent
inner resources of the individual ( 1961).
There are three characteristics that will be presented that Rogers states are
essential and sufficient for therapeutic change as well as being vital aspects
of the therapeutic relationship (1957). In addition to these three
characteristics, this author has added two final characteristic that appear to
be effective in a helping relationship.
1. Therapists genuineness within the helping relationship. Rogers
discussed the vital importance of the clinician to freely and deeply be
himself. The clinician needs to be a real human being. Not an all knowing,
all powerful, rigid, and controlling figure. A real human being with real
thoughts, real feelings, and real problems (1957). All facades should be left
out of the therapeutic environment. The clinician must be aware and have
insight into him or herself. It is important to seek out help from colleagues
and appropriate supervision to develop this awareness and insight. This
specific characteristic fosters trust in the helping relationship. One of the
easiest ways to develop conflict in the relationship is to have a better than
attitude when working with a particular client.
2. Unconditional positive regard. This aspect of the relationship
involves experiencing a warm acceptance of each aspect of the clients
experience as being a part of the client. There are no conditions put on

accepting the client as who they are. The clinician needs to care for the
client as who they are as a unique individual. One thing often seen in therapy
is the treatment of the diagnosis or a specific problem. Clinicians need to
treat the individual not a diagnostic label. It is imperative to accept the client
for who they are and where they are at in their life. Remember diagnoses are
not real entities, however individual human beings are.
3. Empathy. This is a basic therapeutic aspect that has been taught to
clinicians over and over again, however it is vital to be able to practice and
understand this concept. An accurate empathetic understanding of the
clients awareness of his own experience is crucial to the helping
relationship. It is essential to have the ability to enter the clients private
world and understand their thoughts and feelings without judging these
(Rogers, 1957).
4. Shared agreement on goals in therapy. Galileo once stated, You
cannot teach a man anything, you can just help him to find it within himself.
In therapy clinicians must develop goals that the client would like to work on
rather than dictate or impose goals on the client. When clinicians have their
own agenda and do not cooperate with the client, this can cause resistance
and a separation in the helping relationship (Roes, 2002). The fact is that a
client that is forced or mandated to work on something he has no interest in
changing, may be compliant for the present time; however these changes
will not be internalized. Just think of yourself in your personal life. If you are
forced or coerced to work on something you have no interest in, how much
passion or energy will you put into it and how much respect will you have for
the person doing the coercing. You may complete the goal; however you will
not remember or internalize much involved in the process.
5. Integrate humor in the relationship. In this authors own clinical
experience throughout the years, one thing that has helped to establish a
strong therapeutic relationship with clients is the integration of humor in the
therapy process. It appears to teach clients to laugh at themselves without
taking life and themselves too serious. It also allows them to see the
therapist as a down to earth human being with a sense of humor. Humor is
an excellent coping skill and is extremely healthy to the mind, body, and
spirit. Try laughing with your clients. It will have a profound effect on the
relationship as well as in your own personal life.
Before delving into the empirical literature concerning this topic, it is
important to present some questions that Rogers recommends (1961) asking
yourself as a clinician concerning the development of a helping relationship.
These questions should be explored often and reflected upon as a normal
routine in your clinical practice. They will help the clinician grow and
continue to work at developing the expertise needed to create a strong
therapeutic relationship and in turn the successful practice of therapy.

1. Can I be in some way which will be perceived by the client as

trustworthy, dependable, or consistent in some deep sense?
2. Can I be real? This involves being aware of thoughts and feelings
and being honest with yourself concerning these thoughts and feelings. Can I
be who I am? Clinicians must accept themselves before they can be real and
accepted by clients.
3. Can I let myself experience positive attitudes toward my client for
example warmth, caring, respect) without fearing these? Often times
clinicians distance themselves and write it off as a professional attitude;
however this creates an impersonal relationship. Can I remember that I am
treating a human being, just like myself?
4. Can I give the client the freedom to be who they are?
5. Can I be separate from the client and not foster a dependent
relationship?
6. Can I step into the clients private world so deeply that I lose all
desire to evaluate or judge it?
7. Can I receive this client as he is? Can I accept him or her completely
and communicate this acceptance?
8. Can I possess a non-judgmental attitude when dealing with this
client?
9. Can I meet this individual as a person who is becoming, or will I be
bound by his past or my past?
Empirical Literature There are obviously too many empirical studies in
this area to discuss in this or any brief article, however this author would like
to present a summary of the studies throughout the years and what has
been concluded.
Horvath and Symonds (1991) conducted a Meta analysis of 24 studies
which maintained high design standards, experienced therapists, and
clinically valid settings. They found an effect size of .26 and concluded that
the working alliance was a relatively robust variable linking therapy process
to outcomes. The relationship and outcomes did not appear to be a function
of type of therapy practiced or length of treatment.
Another review conducted by Lambert and Barley (2001), from Brigham
Young University summarized over one hundred studies concerning the
therapeutic relationship and psychotherapy outcome. They focused on four
areas that influenced client outcome; these were extra therapeutic factors,
expectancy
effects,
specific
therapy
techniques,
and
common
factors/therapeutic relationship factors. Within these 100 studies they
averaged the size of contribution that each predictor made to outcome. They
found that 40% of the variance was due to outside factors, 15% to

expectancy effects, 15% to specific therapy techniques, and 30% of variance

was predicted by the therapeutic relationship/common factors. Lambert and
Barley (2001) concluded that, Improvement in psychotherapy may best be
accomplished by learning to improve ones ability to relate to clients and
tailoring that relationship to individual clients.
One more important addition to these studies is a review of over 2000
process-outcomes studies conducted by Orlinsky, Grave, and Parks (1994),
which identified several therapist variables and behaviors that consistently
demonstrated to have a positive impact on treatment outcome. These
variables included therapist credibility, skill, empathic understanding,
affirmation of the client, as well as the ability to engage the client and focus
on the clients issues and emotions.
Finally, this author would like to mention an interesting statement made by
Schore (1996). Schore suggests that experiences in the therapeutic
relationship are encoded as implicit memory, often effecting change with the
synaptic connections of that memory system with regard to bonding and
attachment. Attention to this relationship with some clients will help
transform negative implicit memories of relationships by creating a new
encoding of a positive experience of attachment. This suggestion is a topic
for a whole other article, however what this suggests is that the therapeutic
relationship may create or recreate the ability for clients to bond or develop
attachments in future relationships. To this author, this is profound and
thought provoking. Much more discussion and research is needed in this
area, however briefly mentioning it sheds some light on another important
reason that the therapeutic relationship is vital to therapy.
Throughout this article the therapeutic relationship has been discussed in
detail, questions to explore as a clinician have been articulated, and
empirical support for the importance of the therapeutic relationship have
been summarized. You may question the validity of this article or research,
however please take an honest look at this area of the therapy process and
begin to practice and develop strong therapeutic relationships. You will see
the difference in the therapy process as well as client outcome. This author
experiences the gift of the therapeutic relationship each and every day I
work with clients. In fact, a client recently told me that I was the first
therapist he has seen since 9-11 that he trusted and acted like a real person.
He continued on to say, thats why I have the hope that I can get better and
actually trust another human being. Thats quite a reward of the therapeutic
relationship and process. What a gift! Ask yourself, how you would like to be
treated if you were a client? Always remember we are all part of the human
race and each human being is unique and important, thus they should be
treated that way in therapy. Our purpose as clinicians is to help other human
beings enjoy this journey of life and if this field isnt the most important field
on earth I dont know what is. We help determine and create the future of
human beings. To conclude, Constaquay, Goldfried, Wiser, Raue, and Hayes

(1996) stated, It is imperative that clinicians remember that decades of

research consistently demonstrates that relationship factors correlate more
highly with client outcome than do specialized treatment techniques.
Focus of Nursing
Nursing

is a profession focused on assisting individuals, families,

and communities in attaining, maintaining, and recovering
optimal health and functioning. Modern definitions of nursing define it
as a science and an art that focuses on promoting quality of life as
defined by persons and families, throughout their life experiences
from birth to care at the end of life.

Professional Development
Nursing Research
At Trinity Health, nurses are encouraged to practice using the full extent of
their education and experience. They are also encouraged to expand that
education and experience and to employ the many great learnings made
available to them through research initiatives.
Most Trinity Health Regional Health Ministries participate in nursing
research, whether on a multi-site or single-site level, seeking to impact a
wide variety of quality and patient safety initiatives in critical areas,
including:

Falls prevention

Dementia issues and care of the elderly

Early sepsis identification

Public health issues (diabetes, obesity, smoking cessation, etc.)

Additionally, Trinity Health participates in federally funded nursing research

initiatives, like those made possible by the Robert Wood Johnson Foundation,
the Agency for Healthcare Research and Quality, and the Centers for
Medicare and Medicaid Services. This research and the positive practice
changes it inspires is used by nurses throughout the Trinity Health enterprise,
helping improve outcomes in all Trinity Health communities.

Academic Progression
Trinity Health actively promotes academic progression and advanced
education for nurses. With three strong academic institutions in its system
the Loyola University Marcella Niehoff School of Nursing in Chicago, Ill.,
Mount Carmel College of Nursing in Columbus, Ohio, and Our Lady of Lourdes
School of Nursing in Camden, N.J. Trinity Health is able to offer program
opportunities and collaborate with other academic institutions, as well. These
affiliations support a culture of inquiry and professional excellence.
Leadership Development
Committed to developing and supporting its nurse leaders, Trinity
Health recognizes that an investment in nursing leadership can optimally
influence every patient outcome. To that end, Trinity Health regularly
develops programs to support both those seeking leadership roles and those
who have achieved them. For instance, a new program, created especially
for Chief Nursing Officers, helps those from the clinical ranks expand their
leadership capabilities through the development of core business and
corporate skills. The program, which includes coaching and mentoring
aspects, helps new nurse leaders expand their areas of expertise as they
expand their areas of responsibility from patient care only to patient care
and operations.
Other programs help aspiring nurse leaders develop essential foundational
skills.
These programs are part of our commitment both to our nurses who wish to
grow in their careers and to our patients and communities who, ultimately,
benefit.
Search for a Trinity Health nursing career.