The Nurse-Client Relationship

Communication
Communication is the exchange of thoughts, feelings, and other information. The nurse-client relationship depends on effective communication.

Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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The Communication Process

Five Major Components
Sender Message Channel Receiver Feedback

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A Communication Model

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The Communication Process

The sender initiates the process of communication by generating a message. The message is communicated via a channel, verbally, non-verbally, or in another symbolic form.

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The Communication Process

Channels
The visual channel allows for visual observation and perception. The auditory channel consists of spoken words and other verbal cues. The kinesthetic channel refers to physical sensations mediated by touch.

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The Communication Process

The receiver infuses the message with meaning specific to her personal experience. Physiological, psychological, and cognitive processes influence the receivers interpretation.

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The Communication Process

Feedback is information about the receivers perception of the message. Feedback can either facilitate or impede effective communication.

Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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Characteristics of Effective Feedback

Descriptive, clear Provided in a supportive, non-threatening manner Practical and appropriate for the individual client Direct and honest

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Factors Influencing Communication

Perception Cultural Context Space and Distance Time

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Perception
Each persons perceptions of the world are unique. Perceptions are a function of social, cultural, and family experiences. Misunderstandings occur when two people do not perceive the same meaning about a message.

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Space and Distance

The nurse demonstrates respect for each clients culturally determined right to personal space and distance.

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Time
Quality time spent with the client allows her to feel cared for and valued. The nurse should avoid appearing rushed while gathering important data and providing client education.

Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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Levels of Communication
Intrapersonal communication (self-talk), consists of ideas and information inside ones own mind. Interpersonal communication occurs between two people. Group communication occurs with three or more individuals.

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Self-Talk

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Interdisciplinary Group Communication

The Health Care Team collaborates to assess client status and plan for effective client outcomes. Breakdown of communication between different team members can interfere with the clients treatment.

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The Health Care Team

Client Family Nurses Social Workers Physical Therapists Occupational Therapists

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Modes of Communication
Verbal Messages Nonverbal Messages Facial Expression Posture Gestures Touch Physical Appearance and Artifacts
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Therapeutic Communication
Is a vehicle for establishing a partnership between the nurse and the client. Conveys to the client that he is cared for and understood.

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

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Principles of Therapeutic Communication

Time the interaction to avoid distraction or fatigue. Provide a comfortable and private environment. Clarify the purpose of the interaction. Establish guidelines.

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Principles of Therapeutic Communication

Accept the client as is. Let the client take the lead through active listening. Seek clarification by reflection and restating.

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Barriers to Therapeutic Communication

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

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Barriers to Therapeutic Communication

Language Barriers
Discrepancies in vocabulary usage and expressions Use of health care jargon

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Nontherapeutic Communication Blocks

Intrusive self-talk or inappropriate responses
Certain responses that would be acceptable during social conversation are not useful during therapeutic interaction. An inappropriate response may result in the client experiencing feelings of inadequacy, intimidation, or confusion.

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Communication, Critical Thinking, and the Nursing Process

Interpersonal skills and critical thinking are competencies that form the basis for successful application of the nursing process.

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Communication, Critical Thinking, and the Nursing Process

Critical Thinking and Assessment
The clients sense of control is enhanced when the nurse asks open-ended questions and pays attention to verbal and nonverbal messages.

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Communication, Critical Thinking, and the Nursing Process

Critical Thinking and Nursing Diagnosis
Careful attention to assessment data provides a deeper understanding of the clients experience and needs. Accurate analysis of assessment data leads to accuracy in diagnostic judgment.

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Communication, Critical Thinking, and the Nursing Process

Nursing diagnoses related to communication difficulties
Social Isolation related to impaired verbal communication Anxiety related to impaired verbal communication Self-Esteem Disturbance related to impaired verbal communication

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Communication, Critical Thinking, and the Nursing Process

Planning and Outcome Identification
Effective therapeutic communication allows the nurse and the client to work together to develop goals and identify appropriate outcomes.

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Communication, Critical Thinking, and the Nursing Process

Implementation
Alternative modes of communication can be used in implementing a teaching plan.
Sign language Gestures Alphabet boards Electronic communication devices

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Communication, Critical Thinking, and the Nursing Process

Evaluation
It is important to determine if communication is a factor that impedes the clients healing process.
- Verbal and nonverbal cues may indicate to the nurse the need for further client teaching. - Interventions that might resolve this problem require consideration.

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