Communication

2. NursingCare Plan
 A written summary of the care that a client is
to receive.
 ▪ It is the “blueprint” of the nursing process. ▪
It is nursing centered in that the nurse
remains in the scope of nursing practice
domain in treating human responses to
actual or potential health problems.

3.  It is a step-by-step process as evidence by:
 ▫ Sufficient data are collected to substantiate
nursing diagnosis.
 ▫ At least one goal must be stated for each nursing
diagnosis.
 ▫ Outcome criteria must be identified for each goal.
 ▫ Nursing interventions must be specifically
designed to meet the identified goal.
 ▫ Each intervention should be supported by a
scientific rationale, which is the justification or
reason for carrying out the intervention.
 ▫ Evaluation must address whether each goal was
completely met, partially met or completely unmet

4. 1. Sample Case Study (Example)
2. ▪ Nursing Diagnosis : Impaired skin integrity related to
physical mobility ▪ Expected Outcomes :The patient will be
able to get recovery of pressure sore.
3. ▪ Planning: ▪ Pressure sore dressing ▫ Rationale: Cleansing
the area will prevent further infection ▪ Back care ▫
Rationale: It will promote blood circulation ▪ Change the
position frequently ▫ Rationale: It will relieve pressure on
the sore site ▪ Encourage the patient to ambulate ▫
Rationale: It will relieve pressure on the sore site ▪Take
protein rich diet ▫ Rationale: Protein helps in repair of
tissues
4. ▪ Evaluation:Wound healing was observed (tissues were
red, healthy)

5. COMMUNICATION

6. DEFINITION
Webster’s new collegiate dictionary defines
communication as a process by which
information is exchanged between indvidual
through a common system of symbols, signs or
behaviour.
Millet defined communication as “shared
understanding of a shared purpose.”
Peter g. Northouse (1992) defined
communication as the process of sharing
information using a set of common rules.

7. TYPES
 Based upon relationship
1. Formal
2. Informal
 Based upon flow
1. Downward
2. Upward
3. Horizontal
 One way
 Two way
 Others
 Visual
 Telecommunication
 Meta communication

8.  Based on relationship
i. Formal communication: It is the communication
between officials on various position in any
organisation or institution, e.g. between nursing
superintendent and staff nurse.
o it occurs officially
o It occurs in formal way
o It involves transmitting official message within or
outside the organization.
o Line of authority and unity of command are
maintained.
o It involves also communication between the
departments.

9. ii. Informal communication: It is the communication
between two people , may be in social system or In
organization. E.g. interaction between the two
close friends.
o it is very simple.
o This is very informal talk with the people. E.g.
gossiping, back biting etc.
o There is no formality in delivering the message
among people.
o The message is enalic and no one can held
responsible.

10.  Based upon flow
I. Upward communication: communication occurs
from bottom to the top. It may be in the form of
suggestions, complaints, report etc.
-it can be verbal or in written form.
e.g.1. Application for leave
2. Suggestions from staff nurses to NS for improving
the quality care in the hospital.

11. II. Downward communication: It is the
communication which occurs from top to
bottom such as communication from
superior to subordinate. E.g. from nursing
superintendent to staff nurses.
 Downward communication is done to:
-convey information
-instructions
-orders etc which are related to organizational
activities and policies.

14. III. Horizontal communication:The communication flows
horizontally among same hierarchial levels.
e.g.- communication among collegues.
-communication among lecturers.
a) One way communication: it is the flow of
communication from sender to receiver only.
 It always flows in one direction.
 There is no feedback.
 E.g. lecture receive by teacher in class room.
b)Two way communication:
-it is the flow of communication from sender to receiver
and again from receiver to sender.
-there is participation of the receiver or learner/listener.

15.  OTHERS
1. Visual communication: In this communication
message is conveyed using symbols in the form of
charts, maps, posters, painting etc. Also known as
symbolic communication.
Eg. Displayed models in exhibition.
2.Telecommunication: It is the process of
communicating in distant places with help of
electromagnetic appliances.
Eg.Television, radio, internet
3. Meta communication:This communication occurs in
deeper sense. It conveys message within a message.
Eg. One lady is doing praise of her daughter-in-law. Here
actual feeling of mother need to be explored.

16. BARRIER
1. Physilogical barrier:
 Difficulty in hearing
 Difficulty in vision
 Difficulty in expression
 Difficulty in palpitations
2. Psychological barriers:
 Emotional disturbance
 Neurosis (a relatively mild mental illness that is not
caused by organic disease, involving symptoms of
stress (depression, anxiety, obsessive behaviour,
hypochondria) but not a radical loss of touch with
reality.)s
 Level of intelligence
 Fear
 Ego centricity

17. 3. Environmental barriers:
• Lack of ventillation
• Lack of light.
• Extreme temperature
• Extreme noise.
• Lack of privacy.

18. 5. Cultural barriers:
 Level of knowledge and understanding
 Personality traits
 Customs
 Beliefs
 Religion
 Attitude
 Language
6. Others
• Language
• Low attention
• Unspecific message
• Low listening habbit

19.  Education level
 Lack 0f communication skills
 One way communication
 Interest
 Time
 Gender differences
 Non-verbal communication

20.  Measures of overcoming barrier of
communication
1. Clarify ideas before communication
2. Communicate according to the need of the
receiver.
3. Consult others before communication.
4. Be aware of the language, tone and content of
the message
5. Ensure proper feedback
6. Consistency of message
7. Follow up communication
8. Be a good listener.-

21. Interpersonal Relationship
 DEFINITION:Interpersonal relationship refers
to social and emotional interaction between
two or more individuals in an environment.
~Interpersonal relationship is also defined as
the close association between the individuals
who share common interest and goals .

22. Importance of Interpersonal
relationship
 I. Interpersonal relationship for an Individual
Personal growth & development
• Source of enjoyment
• Sense of security
• Context of understanding
• Interpersonal needs
• Establishing personal identity

23. II. Interpersonal relationship for Nurses
 Building a positive functional
multidisciplinary team
 Improving intra-and/or inter-team
communication, coordination & cooperation
 Building mutual understanding & cooperation
 Understanding self
 Improved decision making & problem solving

25. 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.

26. Nurse patient relationship
Definition :It is an interaction process in which the
nurse fulfills her role by using her professional
knowledge and shill in such a way that she is able
to help the patient physically, socially and
emotionally.
OR
It is an interaction process between two persons in
which the nurse offers a series of purposeful
activities and practices that are useful to
particular patient.

27. Types of relationship
1. Social relationship:This relationship are
primarily initiated for the purpose of friendship,
socialization enjoyment and for accomplishing
a task. E.g. participating in other’s parties,
functions, sharing ideas, giving advice etc.
2. Intimate relationship:These relationships are
formed between the individuals who have
emotional commitment to each other. People
may want to intimate relationships for many
reasons i.e. procreation, sexual or emotional
satisfaction, to reduce loneliness.

28. 3.Therapeutic relationship: It is between the nurse and
client. It differs from both a social and intimate
relationship.
PHASE OF RELATIONSHIP
1.PRE-INTERACTION PHASE:This phase is similar to
planning stage before an interview. She may have
some information regarding the patient before the
first face to face meeting.The information include i.e.
patient’s name, age, sex, address, medical history,
surgical history, social history.
2.INTRODUCTORY PHASE: It is also referred as
orientation phase or pre-helping phase. During this
phase, the nurse and client observes each other and
makes judgements about each other’s behaviour.

29. There are 3 stages of the introductory phase
-opening relationship
-clarifying the problem
-structuring and formulating the contract.
3.Working phase: Here the nurse and the client
view each other as unique individuals.This is the
phase where the nurse makes full us eif the
services to reduce the problem of the patient and
to restore the health of the patient.
Stage
a.Exploring and understanding thoughts and
feelings
b. Facilitating and taking action

30. a. Exploring and understanding thoughts and
feelings:
o Emphathetic listening and responding
o The nurse must respect the feelings of the
patient.
o Genuineness
o Confrontation
b.Taking action: during this stage of the working
phase the feeling i.e. anger, shame, or self
consciousness can be expressed.The nurse
should be skillfull to explore the internal feelings
and problem of the patient.The further action
may be planned for the welfare of the patient.

31. 4.Termination phase:This phase is expected to be
difficult and filled with the ambivalence.The
client become confidient independent and
evaluates preventive measures. He /she will be
ready for follow-up.