1st sem Bsc nursing 4th unit kuhs syllabus based

1. Communication and Nurse
Patient Relationship
1st semester BSc Nursing -Unit : IV
By
Ms. Vinni Raj M

2. Introduction
Communication is a dynamic (constant change) process that takes place around us all the time.
• The origin of the word “communication” is “communicare” or “communis” which means “to
impart”, “to participate”, “to share” or “to make common.” The sense of sharing is inherent
in the very origin and meaning of “communication.”
• It is an exchange of ideas, fact, feelings, thoughts, opinions and information which is vital in
facilitating human interaction through (written or spoken) words, symbols or actions.
Meaning
• Communication is simply the act of transferring information from one place to another/ one
person to another person.
• It is imparting or exchanging of information by speaking, writing, or using some other medium.

3. Definition
“Communication is a process by which two or more people exchange ideas, facts, feelings or
impressions in ways that each gains a ‘common understanding’ of meaning, intent and use of
message” - Paul Leagens.
“Communication is a means of persuasion to influence the other so that the desired effect is
achieved” - Aristotle
“Communication is an exchange of ideas, facts, opinions or emotions of two or more persons.” -
William Newman and Charles Summer
“Communication is a bridge of meaning. It involves a systematic and continuous process of telling,
listening and understanding. -Louis Allen

4. Levels of Communication
Intrapersonal communication
Interpersonal communication
Extra personal communication
Organizational communication
Mass communication

5. Intrapersonal Communication
• It is also known as self-talk. Like we decide what
to wear.
• similarly, nurses also do intrapersonal
communicationthrough which they enhance
and focus on positiveinteraction.
• For example, a patient is agitated and shouts on
the nurse, but the nurse never responds back in
same manner. However, she always utilizes her
intrapersonal communication and understands
that client is agitated because of medication or
anxiety related to disease. Hence, her
communication techniques will calm down the
patient and handle the situation

6. Interpersonal Communication
• It includes the communication between two or more individuals and always have a goal
to exchange messages. Interpersonal communication further can be:
• Group communication
• Public communication
• Mass communication
• Organizational communication
Group Communication
It refers to communication that occurs in between three or more individuals.
Public Communication
Communication like a large gathering Like a politician addressing citizens.
Mass Communication
It is any type of media which is used toCommunicate examination result.
Organizational Communication
It refers the flow of messages in a company or agency or an organization,
like manager sending email to subordinates and also to his higher authorities related to
his job description.

7. Extra personal communication
Extra personal communication is the way of communication in which a human
interacts with other species or non-living objects. Communication between
human beings and non-human entities is extra personal communication.
Examples:
• Communication with Animal/Birds
• Communication with Plant
• Communication with Robots/Machines
• Talking to wall
• Talking to god
• Talking to mirror

8. Organizational communication
It is the exchange of information , ideas and views within and outside the organization. It
is formal and generally objective form communication.
Forms of organizational communication Organizational communication takes three
different forms
• Internal-operational Communication
Internal-operational communication that occurs for carrying out operations of the
organization is know as the internal- operational communication.
Example :
• Worker , manager , board of director , etc…
• External-operational Communication
Communication with the external parties Or groups is known as External-operational
communication.
• It include Customer , Suppliers , government agencies , general public etc…
• Personal Communication
Personal Communication that occurs for exchanging personal information , ideas and
feeling rather than business related information is termed as personal
communication.
• Examples: Letters, Email, Memo, Report, Meeting, interview, etc…

9. Mass communication
It is the communication with the large crowd. Mass communication is a process in
which a person, group of people, or an organization sends a message through a
channel of communication to a large group of people and organizations.
The process whereby media organizations produce and transmit messages to large
publics and the process by which those messages are sought , used, understood,
and Influenced by audience. It is the high objective form of communication.
Examples:
• News paper
• Press conference
• Media
• interview
• Films
• Advertisement
• Social media

10. Elements of Communication
There are seven elements of Communication which includes:
• Sender/encoder
• Medium
• Channel
• Receiver/decoder
• Feedback
• Context
• Noise

11. Sender/Encoder
The sender also known as the encoder decides on the message to be sent, the best/most
effective way that it can be sent. All of this is done bearing the receiver in mind. It is
his/her job to conceptualize.
Medium
The medium is the immediate form which a message takes. For example, a message may
be communicated in the form of a letter, in the form of an email or face to face in the form
of a speech.
Channel
The channel is that which is responsible for the delivery of the chosen message form.
For example:- post office, internet, radio.
While selecting channels of communication, several factors must be considered:
•availability of channel, cost
•purpose, suitability
•types of receivers, preference of sender & receivers
•types of message communication skills of the sender, etc...

12. Receiver/ Decoder
The receiver or the decoder is responsible for extracting/decoding meaning from the
message. The receiver is also responsible for providing feedback to the sender. In a word, it
is his/her job to interpret
Feedback
It is a return message sent by the receiver to the sender.
• It is most essential element of the communication process as it shows that the receiver
has understood the primary message sent by the sender & the communication process is
now consider complete.
• A successful communication must be a two-way process where the sender sends the
message & receives feedback from the receiver.
• These feedback could be verbal & nonverbal
Context
Communication does not take place in a vacuum. The context of any communication act is
the environment surrounding it. This includes, among other things, place, time, event, and
attitudes of sender and receiver.

13. Noise
This is any factor that inhibits the conveyance of a message. That is, anything that gets in
the way of the message being accurately received, interpreted and responded to. Noise
may be internal or external.
A student worrying about an incomplete assignment may not be attentive in class
(internal noise) or the sounds of heavy rain on a galvanized roof may inhibit the
reading of a storybook to second graders (external noise).
Confounding elements
These elements are not a direct part of the flow of the communication process but
influence the communication process significantly indirected.
• These elements are interpersonal variables of the sender & the receiver & the
environment where the communication process take place.
• Interpersonal variables such as perception, beliefs, values, socio-cultural background,
educational & developmental levels, emotion, gender, physical & mental health, etc.
• may significantly affect the communication process.

14. Communication Process

15. Types of Communication
Based on the means of delivering the message
Based on the purpose of communication
Based on the levels of communication
Based on the pattern of communication

16. I. Based on the means of delivering the message
a) Verbal communication:
• It occurs through the medium of spoken or written.
• A combination of several words is used & each words conveys a specific
meaning.
• Some important elements of verbal communication are
> language, vocabulary
> denotative & connotative meaning
> pacing
> intonation
> clarity, consciousness
> preciseness
> comprehension
> brevity,
> timing & relevance.

17. Subtypes of verbal communication:
• Spoken communication
• Written communication
• Telecommunication
• Electronic communication
b) Nonverbal communication
This communication occurs without words; where the five senses & whole range of body
movements, posture, gesture, facial expressions & silence are used for sending & receiving
the message.
• Nonverbal communication is a more accurate way of communication because it
convey the true & intended meaning of the message.
Nonverbal communication may be accomplished by the following means:
Touch  Eye contact  Facial expression  Posture  Gait
 gesture  Physical appearance  Sound  Silence

18. II. Based on the purpose of communication
a) Formal communication
Formal communication follows line of authority & is generally used in organization to
achieve organizational objectives.
• For example, the nursing superintendent of a hospital will communicate
with staff nurse through assistant nursing superintendents, supervisors & ward-in-
charge nurses.
b) Informal communication
Informal communication does not follow line of authority.
• Examples of informal communication are gossip, chitchat & kitty parties.
• It is very fast & usually takes place in social groups like friends, family, peer groups,
etc...
c) Therapeutic communication
Therapeutic communication takes place between a health care personnel & a patient,
with the purpose of modifying the patient behaviour.
• This is accomplished with repeated interaction using certain essential
attribute such as trust, empathy, tenderness, concern &non-judgemental attitude.

19. III. Based on the levels of communication
Intrapersonal communication
It take place within an individual; we may also say it is self-talk.
• It is crucial because it provides a person with an opportunity to assess self or a
situation, before acting on it, ultimately affecting the person behaviour.
Interpersonal communication
It takes place whenever two or more people interact & exchange messages or ideas.
• This is also one of the most common forms of communication in our daily lives.
• Interpersonal communication may further categories into assertive, non-assertive&
aggressive communication.
Transpersonal communication
It takes place within a person’s spiritual domain.
• The purpose of transpersonal communication is to realize selfhood, enhance spirituality
& answer questions that are spiritual in nature.

20. Small-group communication
An example of a small-group communication is when nurse interact with two or more
individuals face-to-face or use a medium (like a conference call).
• Patient care conferences, staff meetings & reports are good examples of small-
group communication.
Public communication
Public is generally defined as a large group of people.
• Communication with such a large group of people is known as public
communication.
• Public communication requires essential skills to influence people at large & media
material to reach member of the public clearly & loudly.
Organizational communication
It takes place when individuals & groups within an organization communicate with
each other to achieve established organizational goals.

21. IV. Based on the pattern of communication
One-way communication
It take place when message are delivered to the audience from the communicator only
without constant feedback.
• A common example of one-way communication is lecture delivered in a classroom.
Two-way communication
It takes place when both the communicator & audience take part in the process.
• The audience may raise questions & add information, ideas & opinions on the
subject.
One-to-one communication
Communication between one sender & one recipient at one time is termed as one-to-
one communication.
• A nurse providing information to a patient is an example of one-to-one
communication

22. One-to-many communication
Where one person communicates with may people at the same time, it is
termed as one- to-many communication.
• A nurse providing health education to a community is an example of one-to-
many communication.
Many-to-one communication
Many-to-one communication takes place when several people communicate
with one person at the same time.
• A panel of expert taking an interview is an example of many-to-one
communication

23. Three modes of Communication
Interpersonal Mode:
Students engage in conversation, provide and obtain information, express feeling and
emotion and exchange opinions.
Interpretive Mode:
Students understand and interpret written and spoken language on a variety of topics.
Presentational Mode:
Students present information, concepts and ideas to an audience of listeners or readers
on a variety or topics.

24. Factors Affecting Communication
 Status/Role
 Cultural Differences
 Choice of communication channels
 Length of Communication
 Use of Language
 Disabilities
 Known or Unknown Receiver
 Individual Perceptions
 Atmosphere/Noise
 Clarity of Message
 Lack of Feedback

25. Status/Role
The Sender and receiver of a message may be of equal status within a hierarchy or they
may be at different levels, This difference in status sometimes affects the effectiveness of
the communication process
Cultural Differences
Cultural differences, both within or outside the organization may impede the
communication process
Choice of Communication channels
Before you choose your communication channel you should ask yourself whether the
channel is appropriate for particular purpose and the person/receiver you have in mind
Length of Communication
The Length of the message also affects communication process. You need to be sure that it
serves the purpose and appropriate for the receiver
Use of Language
Poor choice of words or weak sentence structure also pampers communication. The same
goes for inappropriate punctuation For Example : Women, without her, man is nothing
Women, without her man, is nothing

26. Disabilities
You may need to use hearing aids, sign languages, minifying systems and symbols to
alleviate problems caused by disabilities
Known or Unknown Receiver
Whether the receiver is known or unknown to you also plays a major role in
determining the effectiveness of your communication  A known receiver may be
better able to understand your message
Individual perceptions
Sometime the method of communication needs to take into consideration the
receivers personality traits, age and preferred style
Atmosphere/Noise/Distraction
Our surroundings can sometimes pose as barriers to effective communication – A noisy
place usually puts strain on oral communication as both the sender and receiver need
to put extra effort to communicate
Clarity of message
It is the message conveyed in a clear or ambiguous manner
Lack of Feedback
Feedback is important as it enables confirmation of understanding to be made by both
parties.

27. Completeness
Clarity
Courtesy
Consideration
Concreteness
Correctness
coherent
FACILITATORS OF COMMUNICATION
Seven Cs of effective communication

28. BARRIERS OF COMMUNICATION
I. Physiological barriers
• Poor retention due to memory problem
• Lack of attention
• Discomfort due to illness
• Poor sensory perception
• Hearing problems
• Poor listening skills
• Information overload
• Gender physiological differences

29. II. Environmental barriers
•Loud background noise
• Poor lighting
• Uncomfortable setting
• Unhygienic surrounding & bad odour
• Very hot or cold room
• Distance
III. Cultural barriers
• Ethnic, religious & cultural differences
• Cultural tradition
• values &behaviour

30. IV. Psychological barriers
•Misperception & misunderstanding
• Distrust & unhappy emotions
• Emotional disturbances
• Psychotic or neurotic illness
• Worry & emotional disturbances
• Fear, anxiety & confused thinking
V. Social barriers
• Diffidence in social norms, values & behaviour
• Social taboos
• Different social strata

31. VI. Semantic barriers
• Language barriers
• Faulty language translation
• Individual differences in expression & perception
• Past experiences of an individual failure to listen
VII. Organizational barriers
• Organizational policy, rules & regulation
• Technical failure
• Time pressure
• Complexity of organization structure due to hierarchy
• Size of the organization

32. VIII. Communication process-related barriers
• Unclear & conflicting message
• Stereotypical approach
• Inappropriate channels
• Lack of or poor feedback

33. METHODS TO OVERCOME BARRIERS OF COMMUNICATION
I. Methods to overcome physiological barriers
• Keep in each other’s retention & recollection abilities.
• Pay attention during the sharing of information
• Ensure each other comfort.
• Ensure the intactness of sensory perception.
• The limitation of hearing abilities must keep in mind.
• Active listening.
• Information overload must avoid
II. Methods to overcome environmental barriers
• Good lighting must be ensured to facilitate nonverbal communication.
• A comfortable seating arrangement.
• A hygienic & odour-free environment.

34. III. Methods to overcome psychological barriers
• Happy & trustworthy manner
• Should not harbour negative emotions
• Avoid feeling of prejudice, resentment & antagonism.
• Free from fear, anxiety & confusion
IV. Methods to overcome social barriers
• The difference in social norms, values & behaviour must be give consideration.
• Social beliefs must be kept in mind.
V. Methods to overcome cultural barriers
• Consider cultural differences
• Consider cultural traditions, values &behavior.

35. VI. Methods to overcome semantic barriers
• Use the same language
• Considered difference in the expression & perception of message
VII. Methods to overcome organizational barriers
• Considered Organizational policy, rules & regulation.
• Organization structure must be simple & noncomplex
• Large organization must divided into smaller subset
VIII. Methods to overcome communication process-related barriers
• An appropriate channel must be used.
• A stereotypical approach must be avoided in communication.
• The message must be clear & non-conflicting
• Proper feedback must be ensured by the recipient.

36. TECHNIQUES OF EFFECTIVE COMMUNICATION
I. Conversational skills
• Focusing
• Paraphrasing
• Sharing information
• Providing information
• Asking relevant question
• Clarifying & summarizing
• Sharing humour
II. Listening skills
• Active listening
• Using silence
• Listening with purpose
• Acknowledgement of message
• Giving feedback

37. III. Technical skills
• Using touch
• Using nonverbal cues
• Sharing feeling
• Sharing observations
• Sharing hope
• Presenting reality
• Sharing empathy

38. LANGUAGE
Different languages in the world
•As a bridge
•As a barrier
•Jargons
•Technical language
•A medium through which a message is transmitted to its intended audience, such as print
media or broadcast (electronic) media.
•Before you choose your communication channel you should ask yourself whether the
channel is appropriate for particular purpose and the person ( receiver) have in mind.
•Telephone, Radio, Electronic Mail, Television etc.

39. TECHNIQUES OF THERAPEUTIC COMMUNICATION
LISTENING
• It is an active process of receiving information.
• Responses includes maintaining eye contact, nodding ,gesturing and other non-verbal
communication convey to the patient that he is being listened to and understood.
BROAD OPENINGS
• Encouraging the patient to select topics for discussion
• Example: “What are you thinking about?”
RESTATING
• Repeating the main thought expressed by the patient
• Example: “you say that your mother left you when you were 5 years old.”
SEEKING CLARIFICATION
• Asking patient to elaborate or give examples of ideas or feelings to seek clarification of what is
unclear.
• Example: “ I am not familiar with your work, can you describe it further for me.”

40. REFLECTING
•Throwing back the patients statement in a form of question that helps patient to identify feelings.
•Example: Patient: I think I should leave now.
Nurse: Do you think you should leave now.
FOCUSING
•Pursuing a topic until its meaning or importance is clear.
•Example: You were saying…..”
IDENTIFYING THEMES
•Asking to identify recurring thoughts, feelings, behaviours.
•Example: when do you always feel the need to check the locks and doors.
INFORMING
•The skill of information giving.
•Example: “ I think you need to know more about your medications.”

41. HUMOUR AND SILENCE
• HUMOUR : Discharge of energy through cosmic enjoyment of imperfection.
•SILENCE: Lack of verbal communication for a therapeutic reason.
SUGGESTING
•Presenting of alternative ideas for the patient to problem solving.
•Example: “ Have you thought about responding to your boss in a different way when he raises that
issues with you?
SHARING PERCEPTION
•Asking the patient to verify the nurses understanding of what the patient is thinking or feeling.
•Example: “ You are smiling but I sense that you are angry with me.”

42. IMPORTANCE OF COMMUNICATION
 Information
 Education
 Motivation
 Counselling
 Reduce stress
 Health promotion

43. NURSE PATIENT RELATIONSHIP
Introduction:-
NPR is a basic requirements of nursing practice.
These relationship find encouragement when we are feeling down & comfort
when we are hurting.
Definition:-
It is an interaction between two persons in which the nurse offers a series of
purposeful activities & practice that are useful to particular patient.
Types of relationships:-
 Social relationship
 Intimate relationship
 Therapeutic relationship

44. characteristics
• It is an intellectual and emotional bond between the nurse and mainly focused on the
client.
• It respects the client as an individual.
• Considering family relationship and values.
• Maximizing the clients abilities to participating in decision making.
• It respects client confidentiality.
• It is based on the mutual trust, respect and acceptance.
Developing Helping Relationship
The following points are important, to develop a nurse- client relationship or helping
relationship.
• listen actively • Be honest.
• Be aware of cultural differences. • Maintain client confidentiality.
• Know your rolls and your limitations

45. PHASES OF
NURSE-PATIENT
RELATIONSHIP
Pre-
interaction phase
Introductory
phase
Working phase
Termination
phase

46. Pre-interaction Phase
This phase begins when the nurse is assigned to initiate a therapeutic relationship & included all
that the nurse thinks, feels or does immediately prior to the first interaction with the patient.
Nurse’s tasks in the pre-interaction phase:
Explore own feelings, fantasies & fears
Analyze own professional strengths & limitations.
Gather data about patient whenever possible.
Plan for first meeting with patient.
Problems encoutered:
• Difficulty in self analysis & self acceptance.
• Anxiety • Boredom • Depression • Indifference • Anger
Ways to overcome:
 Help from peers and supervisor in self analysis & facing reality.
Analyze herself & recognize her asset & limitation.

47. Introductory Phase/Orientation phase
 During the introductory phase that the nurse & patient meet for the first time.
 One of the nurse’s primary concerns is to find out why the patient sought help.
Nurses tasks:
 Establish rapport, trust & acceptance
 Establish communication
 Gather data, including the client’s feelings, strengths & weaknesses
 Define client’s problems; set priorities for nursing intervention
 Mutually set goals
Problems encountered:
• Perception of each other as unique individual may not take place.
• Problems related to establishing an agreement or pact between the & patient.

48. Ways to overcome:
• Nurse must be willing to relate honestly to her feeling & share it with supervisor.
• Nurse must feel free to reveal self without fear of criticism.
• Difficulty may be faced in assisting a nurse with counter transference since most of this behaviour is
unconsciously determined.
• A alert supervisor can detect this & guide the nurse appropriately.
Working Phase
 Most of the therapeutic work is carried out during the working phase.
 The nurse & the patient explore relevant stressors & promote the development of insight in the
patient.
Nurse’s tasks in the working phase:
• Gather further data; explore relevant stressors
• Promote patient’s development of insight & use of constructive coping mechanism.
• Facilitate behavioural change; encourage him to evaluate the results of his behaviour
• Provide him with opportunities for independent functioning.
• Evaluate problems , goals & redefine

49. Problems encountered:
• Testing of nurse by the patient.
• Unrealistic assumption about progress of patient.
• The nurse’s fear of closeness.
• Life stressors of nurse.
• Resistance behaviour.
• Transference
• Counter transference
Ways to overcome:
• Conferences with the supervisors & group discussions with other members of the staff .
• There will be times when the nurse believes she is making little or no progress.
• Handling resistances.

50. Termination Phase
 This is the most difficult, but most important phase of the therapeutic nurse- patient relationship.
 The goal of this phase is to bring a therapeutic end to the relationship.
Nurse’s tasks in the Termination Phase:
 Establish reality of separation
 Mutually explore feelings of rejection, loss, sadness, anger & related behaviour.
 Review progress of therapy & attainment of goals
 Formulate plans for meeting future therapy needs.
Problems Encountered:
• Anger
• Punitive behaviour
• Depression or assuming non caring attitude
• Flight to health
• Flight to illness.
• Nurse’s inability or unwillingness to make specific plans & implement them.

51. Ways to overcome:
 Nurse should be aware of patients feeling & be able to deal with them appropriately.
 Assist the patient by openly eliciting his thoughts & feelings about termination.
 Supervisor can assist the nurse in preparing patient for discharge.
THERAPEUTIC IMPASSES
Resistance Transference
Counter
transference
Gift giving
Boundary
violation

52. RESISTANCE
• Resistance is the patient’s attempt to remain unaware of anxiety producing aspects within himself.
• It’s a natural learned reluctance to avoidance of verbalizing or even experiencing troubled aspects of
self.
Ways to overcome:
 Active listening
 Clarification – Give for focused idea of what is happening.
 Reflexion – Helps the patient to become aware of what has been going in his mind.
 Explore behaviour to find possible reason.
 Maintain open communication with supervisor
TRANSFERENCE
• It is an unconscious response of the patient in which he experiences feeling & attitudes towards
the nurse that were originally associated with significant figures in his early life.
• Such response utilize the defence mechanism of displacement.
• Transference reactions are harmful to the therapeutic process only if they remain ignored &
unexamined.

53. Ways to overcome:
• No need to terminate relationship unless poses a serious barrier to therapy or safety.
• Nurse should work with patient in sorting out past from the present
• Assist patient in identifying the transference & reassign a new & more appropriate meaning to the
current nurse patient relationship.
• The goal is to guide the patient to independence by teaching them assume responsibility for their
own behaviours, feeling & thoughts & to assign the correct meaning to the relationship based on
the present circumstances instead of past.
COUNTER TRANSFERENCE
• It’s a therapeutic impasse created by the nurse.
• It refers to nurse’s specific emotional response generated by the qualities of the patient.
• In this case the nurse identifies the patient with individuals from her past & personal needs will
interfere with therapeutic effectiveness.
• The nurse’s unresolved conflicts about authority, sex, assertiveness & independence ten to create
problems rather than solve them.

54. Ways to overcome
• Need not terminate relationship.
• Support the nurse.
• Assist her identifying counter transference.
• Discuss with superiors.
• Self examination.
• Pursue to find out source of problem.
• Exercise control counter transference.
• Peer consultation & professional meetings.
GIFT GIVING
 Receiving a gift from patient make the nurse to inhibit independent decision making & create a
feeling of anxiety or guilt.
 Gift is something of value is voluntarily offered to another person, usually to convey a gratitude.

55. Things to observe:
 The timing of a particular situation,
 The intent of giving.
 The contextual meaning of giving of the gift.
BOUNDARY VIOLATION
It occurs when nurse goes outside the boundaries of therapeutic relationship & establishes a
social, economic or personal relationship with the patient.
Ways to identify:
• Receives feedback that her behaviour is intrusive with patient or their families.
• Has difficulty in setting limit with patient.
• Relates the patient to a friend or family member.
• Has sexual feeling towards a patient.
• Feels that she is the only one who understands the patient.
• Receives feedback that she is too involved with a patient or family.
• Feels that other staffs are too critical or jealous of her relationship with the patient.

56. PATIENT TEACHING
Teaching is given to enhance specific learning of patient. Patient teaching is a creative
interpersonal experience, differs from other forms of teaching by its client oriented relationship.
Definition:
Patient teaching is a process involves teaching the patient about reducing the health risk factors,
increasing clients level of wellness and taking specific protective health measures.
Role of nurse in patient teaching
 Nurse is to identify clients learning needs.
 Motivate the client.
 Involving client actively.
 Topic of the client teaching should match with clients need.
 The teaching should be simple to complex.
 She should provide peaceful environment while teaching.
 She should observe the emotional and physiological needs.
 The nurse should be knowledgeable and confidence

57. Purposes of patient teaching
 To promote health
 to protect health
 to maintain health
 to identify relevant health care needs of the clients
 to provide psychological support during teaching learning process
 to keep nurse knowledgeable
 to raise self confidence of nurse in teaching
Importance of patient teaching
 Providing patient teaching is an important independent function of nurse. As client has a “right to
know”, “right to information”, giving information regarding clients health status is mandatory now
a days.
 Patient teaching improves nurse client relationship.
 It helps in patients safe transition from one level to another
 It helps client to make decision about his health condition.

58. Guidelines for effective patient teaching
 Development and maintenance of rapport between nurse and client is important.
 Time for delivering teaching should be as clients convenience.
 Nurse should have all communication skills.
 Local language should be perfectly used.
 Use of A.V Aids faster learning and grasp the client attention.
 Teaching with demonstration is effective.
 Repetition is necessary in teaching process.
 Active involvement of nurse and client is important

59. PROFESSIONAL COMMUNICATION IN NURSING
Communication in a clinical setting plays an important role in improving health status of the patients.
Depending on the way one communicates can have positive/negative impact on client’s health either
directly or indirectly.
SCENARIO:-
The patient is 30 year old women who had a baby girl yesterday. Patient had not slept very much
during the night, as she was nursing the baby and is now very irritable. She is finding the breastfeeding
quite a challenging ,as she did not expect baby to nurse so often .she is also not sure that she is doing a
good job. The baby is doing well and is able to latch on. You are giving the handover report in patient’s
room.
NON THERAPEUTIC TECHNIQUES
• Offering false reassurance: Indicating to the client that there is no cause for anxiety, thereby devaluing
the client's feelings
• Expressing unnecessary approval or disapproval: Sanction or denouncing the client's idea or behaviour.
• Changing subject: Changing the topic is as similar to ignoring the client or rejecting to answer
• Rejecting: Refusing to consider or showing contempt for the client's ideas or behaviour.
• Probing: Persistent questioning of the client; pushing for answers to issues the client does not
wish to discuss.
• Requesting an explanation: using ‘why’ words which client may not be able to answer.

60. OTHERS:-
MAKING STEREOTYPICAL COMMENTS
 Clichés & trite expressions are meaningless in a nurse-client relationship.
 Using denial Denying that a problem exists blocks discussion with the client & avoids helping the
client identify & explore areas of difficulty
 Incomplete handover
 Lack of eye contact
THERAPEUTIC COMMUNICATION
ACTIVE LISTENING
 Maintaining eye contact
 giving attention
 avoiding interruption
 conveying evidence of listening
ASSERTIVENESS
 Confidently and honestly expressing our opinions
 thoughts and ideas.

61. CLARIFICATION
 Appropriate questioning techniques to clarify the information.
QUESTIONING
 Open ended questions Reflection Most difficult Elicit to enable important information Restating
Allows patient to explore the views /problems.
REFLECTION
 Most difficult. Elicit to enable important information.
RESTATING
 Allows patient to explore the views/problems.
OTHER THERAPEUTIC TECHNIQUES
• Silence
• Summarizing
• Focusing
• Giving information
• Humour
• Self disclosure
• Making observations
• Good tone of voice

62. COMMUNICATION WITH VULNERABLE GROUPS
There are five categories of vulnerable people.
Children
Women
Physically challenged
Mentally challenged
Elderly
Children
 Introduce yourself and your role to the child/young person and their parents.
 Work in such a way as to ensure that children’s and young people’s rights are protected and
asserted.
 communicate directly with children and young people; listen and respond appropriately to what
they say themselves.
 Be attentive to the needs of children and young people and make time for interventions don’t rush.
 Work positively with siblings and friends for the benefit of the child/young person.
 Act in ways that recognize and acknowledge the expressed beliefs or choices of children, young
people and their parents – don’t be judgmental

63. WOMEN
 Introduce yourself to the women
 Build respect & trust between you and the women
 Maintain a humanized and individualized care
 Develop the social network to talk with the women
 Understand the need of the women and empathize with her
PHYSICALLY CHALLENGED
 Introduce yourself to the person.
 Look at the person as a person, the same way you look at nondisabled people.
 Speech intelligibility of a person with a speech impairment will often improve after you've spent
some time and grown accustomed to their speech patterns.
 Allow extra response time from someone who has a speech impairment
 Don't be offended if a person with speech difficulties is reluctant to participate in conversation.
 If the person with a disability must be seated, you should try to sit also to maintain the same eye
level

64. MENTALLY CHALLENGED
 To help hold the attention of a distractible or hyperactive person when you're trying to
communicate, call the person's name frequently or touch their arm or shoulder.
 If you notice signs of fatigue, anxiety, irritability, or disinterest, take a break. Don't press on, change
activities.
 Focus on the person's individual and unique abilities rather than their disabilities
 Maintain calm and low volume
 Know your patient mental age
 Do not cover or hide your mouth because listeners will want to watch you as you pronounce your
words.
 Do not mimic how the mentally challenged speaker pronounces words.
 Avoid running words together.
 When possible, opt for simple words instead of ones that are complex.
 Avoid speech complexity which is beyond your mentally challenged listener's comprehension level.
 Look them in the eye

65. ELDERLY
 Allow extra time for older patients.
 Avoid distractions.
 Sit face to face.
 Maintain eye contact.
 Listen.
 Speak slowly, clearly and loudly.
 Use short, simple words and sentences.
 Stick to one topic at a time.
 Simplify and write down your instructions.
 Use charts, models and pictures.
 Frequently summarize the most important points.
 Give patients an opportunity to ask questions and express themselves.

66. THANK
YO U