NUR142Lecture#3

• Establish therapeutic relationships –
• Essential element of nurse-patient relationship –
• Critical skill –
• Dynamic Process- constantly changing

• 1. Gather information
• 2. Teach, support, encourage-we do the teaching
• 3. Express caring and comfort

• Verbal
• Nonverbal
• Verbal Communication

• Language
• o Words
• o Written
• –Spoken
• –Expressing and Receiving

• Body language
• –Posture, gait, personal appearance
• –Touch
• –Facial expressions
• –Gestures
• Not always under our conscious control.

• – Assessing
• – Diagnosing
• – Planning
• – Implementing
• – Evaluating
• "ADPIE"
• Therapeutic (helping) communication

• Therapeutic-only reason why we are in a relationship with a patient
• –Helping
• –Interpersonal
• –Professional
• In the trenches! The nurse is constantly with the patient.

• Does not occur spontaneously
• –Unequal sharing
• –Based upon patient’s needs, not ours.
• –PROFESSIONALISM
• –Must permeate the relationship
• –Be careful what you share personally. Stop and think.
• –We are there for the patient and family
• –What would a reasonable and prudent nurse do?

• Dynamic-nonlinear
• –Purposeful-what would be the best thing for this patient?
• –Respects patient as individual-always try! A human being.
• –Based upon trust-implicit trust in the nurse

• –Professional Accountability
• – Person providing assistance presents his/her helping abilities honestly and completely

• Improved health and well-being
• –Helps patients/families manage problems
• –Help patients/families develop better ways to help themselves

• Orientation Phase
• Working Phase
• Termination Phase

• –Tone of relationship is established-when you first meet, could be a lot of different places
• –Roles identified-introduce yourself, tell your role
• –Agreement
• o Goals-how are they feeling, what are their goals
• o Duration, frequency, location
• –Orientation
• –TRUST BEGINS (Rapport)

• Longest phase
• –Nurse provides nursing assistance
• –Nursing roles are performed:
• – Teacher
• – Counselor
• – Advocate
• – Leader
• – Communicator!

• Conclusion
• –Can occur at various times
• –Emotions associated-someone may be leaving to die, don’t make promises you can’t keep, don’t be offhand
• –Honesty is critical
• –Trust

• Warmth and friendliness-speak to person, introduce yourself
• Openness/respect-do not judge, do not react to bad behavior
• Empathy-some level of understanding of what a person may be going through, deeper level than sympathy
• Competence-technical, interpersonal,
• Caring-constant polishing of this skill

• Examples:
• – Comfortable environment
• – Privacy
• – Confidentiality-what patient’s say to you stays within the appropriate realm. Do not say: I won’t tell anyone. Adult patients have a right to speak with you alone. Use intuition and observation skills.
• –Patient focus
• – Focus not on nurse or her activity
• Observations
• – Seeing and interpreting/communicates caring, “I noticed you aren’t very happy today……I noticed…” Be careful of cultural differences.
• –Providing Personal space
• – Be sensitive
• – Nursing is an intimate profession!

• Must permeate the nurse patient relationship
• – Recognize patient’s flaws as part of total picture
• – Respect not dependent upon patient’s behavior
• – Non-judgmental
• – Accepting their humanness without ridicule…remove self if situation gets out of hand, explain to quit talking like that and that you are going to leave.

• Focuses on the patients concerns
• 1. Takes time and practice to acquire!
• 2. Does not occur quickly
• 3. Mark of a competent professional

• 1. Pacing-keep it steady
• 2. Tone of voice-neutral demeanor, calming
• 3. Clarity-try to be clear
• 4. Brevity-to the point, simplicity, no jargon, use lay terms when necessary, do not assume a casual relationship with patient

• 1. It is a SKILL
• 2. Most important technique
• 3. Basic to all other techniques
• 4. Active process
• 5. Requires concentration and energy
• a. Silence
• 6. Silence-it is GOLDEN!
• 7. Different from social communication
• 8. Its OK! Communicates acceptance.
• – Do not have to fill as in a social dialogue
• – Prevents too much talking on part of nurse
• – Prevents filling in with social conversation

• Open ended question/comment
• – Allows patient a range of possible responses
• – Prevents a simple yes/no when trying to encourage verbalization
• – “Tell me about….”
• – “What do you think about…”

• – Mirroring a statement or statement fragment with a questioning tone
• – “Upset?”
• – “Won’t be easy?” Using the patient’s own words

• – Ensuring what was “heard” was correct
• – What was the meaning of the words used
• – “So, what I am hearing you say is….”
• – “You are saying that you are worried about the test results?”

• Make clear, more specific than validating
• – Helps nurse to understand what was said
• – “Are you taking your medicine every night, or just when you have trouble sleeping”

• Places events, incidents in order
• – “You had the argument with you son after you saw the social worker?”

• Focusing on a topic
• – “You were talking earlier about moving to assisted living”

• Touch-for comfort and out of necessity
• Humor-no sarcasm, or difficult to understand

• Happen when a nurse fails to view the patient as a human being
• – Not a diagnosis
• – Not a problem
• – Not “work”
• – Not the recipient of task
• – Nurse focuses on the WHOLE PERSON -distinguishes nursing from other professions!

Blocks-usually happens when we fail to look at the whole person

LISTENING must occur throughout all interactions! Failure to do so may result in a communication block.

• Clichés
• – Trite response- “Boys will be boys” Conversation killers
• Closed questions
• – Can be answered with yes/no
• Can be appropriate in certain situations when you need to glean information quickly
• – Asking why
• Can be intimidating or challenging, may put patient on defensive- “Why didn’t you discuss this with your doctor?”
• Probing for information
• –

• Aggressive approach vs assertive –
• “What do you mean you don’t keep your appointments?” –
• Using leading questions –
• “You like the care you get here, don’t you?” –
• Giving advice –
• Nurse is an authority! –
• Must be very aware of own influence –
• People must be assisted and supported to make own decisions

• – Imposing own standards upon others
• – Does not convey acceptance
• – “You know you are not going to get well until you grow up and face this”

• Conveys unacceptance
• Shifts focus from patient centered dialogue to nurse controlled dialogue

• Minimizes patients feelings/fears
• – Belittling
• – Conveys non interest on part of nurse
• – Nurse may be the only one to whom patient can voice true fears and feelings
• – “I am sure everything will turn out OK”

• Individualize for the patient with whom you are communicating
• Vary the techniques used
• Overuse of one technique will communicate that you are not listening
• Use non verbal communication appropriately- body language, tone of voice etc
• Hints
• – Patient should be talking more than the nurse
• – You will make mistakes, if genuine interest is expressed and the nurse is attempting to be therapeutic the relationship will be able to withstand an error or two!
• – As a novice, RELAX, realize that most patients want very much to talk with you