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  • 1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 7 The Nurse–Client Relationship
  • 2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship • Relationship established between nurse and client • Four categories of client needs designated by The National Council of State Boards of Nursing – Safe, effective care environment – Health promotion and maintenance
  • 3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) • Four categories of client needs designated by The National Council of State Boards of Nursing (cont’d) – Psychosocial integrity – Physiologic integrity
  • 4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) • The four basic roles performed by nurses: – The nurse as caregiver o Performs health-related activities, contemporary caregiving role o Develops close emotional relationships o Understands that illness and injury cause insecurity; uses empathy
  • 5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) • The nurse as educator – Educates client about complex health care arena – Provides health teaching pertinent to each client’s needs, knowledge base – Avoids giving advice – Lets the client choose his health care
  • 6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) • The nurse as educator (cont’d) – Shares information and potential alternatives – Empowers client involvement o Self-help groups, rehabilitation, financial assistance, emotional support
  • 7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) • The nurse as collaborator – Works with the team toward achieving a common goal – Responsible for managing care – Shares information with other health care workers
  • 8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship (cont’d) • The nurse as delegator – One who assigns a task to someone – Legal, appropriate delegation – Inspects completed, delegated task – Accountable for inadequate care
  • 9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship • Desired outcome: moving toward improved health – Client-centered: time-bound goals – Encourage active client involvement o For communicating and questioning o For planning care and retaining maximum independence
  • 10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) • Underlying principles – Treats client as a unique person and respects client’s feelings – Promotes client’s physical, emotional, social, and spiritual well-being – Encourages client participation – Individualizes client care
  • 11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) • Underlying principles (cont’d) – Accepts client’s potential for growth and change – Communicates using understood terms and language; incorporates client support system – Implements compatible health care techniques: client’s values and culture
  • 12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) • Phases of the nurse–client relationship – Introductory phase o Period of getting acquainted o Initial interaction o Client initiates relationship: identifies one or more health problems
  • 13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) • Phases of the nurse–client relationship (cont’d) – Introductory phase (cont’d) o Nurses to demonstrate:  Courtesy and empathy  Active listening and competency  Appropriate communication skills
  • 14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) • Phases of the nurse–client relationship (cont’d) – Working phase o Mutually planning care: enact plan o Participation from both sides o Nurse promotes client independence
  • 15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) • Phases of the nurse–client relationship (cont’d) – Terminating phase o Nurse and client agree immediate health problems improved o Caring attitude and compassion facilitate client’s care transition
  • 16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship (cont’d) • Barriers to a therapeutic relationship – Positive relationship with every client not possible o Best approach is to treat a client as you would like to be treated
  • 17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication • Exchange of information • Following feedback confirms understanding • Occurs simultaneously – Verbal; Nonverbal • Nurses develop skills for therapeutic interactions
  • 18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) • Verbal communication – Using words: includes speaking, reading, and writing o To gather facts o To instruct, clarify, and exchange ideas – Factors: affect ability to communicate o Attention and concentration
  • 19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) • Verbal communication (cont’d) – Factors: affect ability to communicate (cont’d) o Language compatibility and verbal skills o Hearing and visual acuity o Motor functions involving the throat, tongue, and teeth
  • 20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) • Verbal communication (cont’d) – Factors: affect ability to communicate (cont’d) o Sensory distractions o Interpersonal attitudes o Literacy and cultural similarities
  • 21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) • Verbal communication (cont’d) – Nurse promotes factors enhancing communication; eliminates those interfering with expressed idea clarity • Therapeutic verbal communication o Social: superficial o Therapeutic: accomplish objective o Avoid non-therapeutic communication
  • 22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Verbal Communication Techniques
  • 23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nontherapeutic Communication
  • 24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) • Verbal communication (cont’d) – Active listening: attending to/becoming fully involved in client reporting o Pay attention to what clients say o Avoid communicating signals indicating boredom, impatience, or pretense of listening
  • 25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) • Verbal communication (cont’d) – Silence: intentionally withholding verbal commentary o Encourages client participation o Can relieve client anxiety by providing personal presence
  • 26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question •Is the following statement true or false? Silence is a form of verbal communication.
  • 27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Silence is a form of verbal communication.
  • 28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) • Nonverbal communication: exchange of information without using words – Kinesics: Body language •Knowledge of kinesics important – Paralanguage: communicating through vocal sounds
  • 29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) • Nonverbal communication (cont’d) – Proxemics: use/relationship of space in communication o Varies according to cultural background o Understand client’s comfort zone
  • 30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question •Which of the following defines personal space in proxemics? a. 4 to 12 feet b. 6 inches to 4 feet c. Within 6 inches d. More than 12 feet
  • 31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer b. 6 inches to 4 feet According to the four zones in proxemics, personal space is defined as 6 inches to 4 feet. Social space is indicated by 4 to 12 feet. Intimate space is within 6 inches, and public space is more than 12 feet.
  • 32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication (cont’d) • Nonverbal communication (cont’d) – Touch: tactile stimulus produced by making personal contact • Task-oriented touch • Affective touch • Must be used cautiously
  • 33. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question •Is the following statement true or false? Affective touch involves the personal contact required when performing nursing procedures.
  • 34. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Affective touch is used to demonstrate concern or affection. Task-oriented touch involves the personal contact required when performing nursing procedures.
  • 35. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations • Demonstrate respect for older clients to establish a trusting relationship • Avoid quick and presumptuous approach • Initially greet the client by giving your name and title • Appropriate use of touch
  • 36. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations (cont’d) • Address the client using formal titles of respect • Never treat older adults as children, uneducated • Promote control over decisions • Encourage reminiscing