The document discusses communication and the nurse-patient relationship. It defines communication and describes its importance in healthcare. It outlines 6 types of communication including verbal, non-verbal, written, listening, visual, and intercultural. Barriers to communication and skills needed for effective communication are also discussed. The importance of patient teaching and developing therapeutic nurse-patient relationships to promote health and wellness is emphasized. Maintaining trust, respect, confidentiality and focusing on the patient are key to developing helping relationships.

1. Communication and Nurse Patient
Relationship
Definition of communication
Communication is the process of
transmitting information from one
person, place or group to another.
It is through communication that
we share messages with each other

2. 6 Types of Communication
• Verbal Communication
• Through spoken words and the use of speech
and language to convey messages. It occurs
when we speak to others. Verbal
communication can be formal and informal.
However, when it takes place in person, verbal
communication and non-verbal
communication go together.

3. Non-Verbal Communication
• Body language, facial expressions, eye
contact, appearance, sign language. Non-
verbal communication complements
verbal communication and also helps
when words don’t help. It is an important
type of communication in interviews and
discussions as they value a lot.

4. Written Communication
• The use of written words to convey
messages. Written communication
happens through email, memos, texts,
posts, etc. While written communication
helps you share your thoughts well,
sometimes it does not fully convey the
emotion that you are trying to share.

5. Listening
• Listening is one of the most important
parts of communication as it helps you
understand the perspective of the
communicator and effectively engage
with them. The process of any
communication takes a crucial value at
listening correctly and responding
appropriately.

6. Visual Communication
• Through visual messages like pictures,
graphs, objects and other visual facets.
Visual Communication is a crucial part of
today’s methods of conveying important
information. It is used in presentations,
televisions, etc.

7. Various Cultural and Intercultural
Modes of Communication
• Several cultural modes of communication
are specific to each area and culture. It
can be symbolic usage of actions, body
language, etc. The culture of a person is
not just what they eat or wear but also
how they communicate.

8. Five Modes of Communication
• Interpretative Communication
• Presentational Communication
• Interpersonal Communication
• Verbal Communication
• Non-Verbal Communication

9. Importance of communication
• Maintains the flow of conveying information
• Helps in devising plans and strategies for reaching a goal
• Builds cordial relations and soft skills
• Decision making becomes more effective and less time-
consuming
• Problem-solving and conflict management becomes easier
• Communication makes conveying the thoughts easier and
helps to understand the perspective of another person.
Learning would stop without communication since you cannot
teach anyone without the use of text, pictures, sound, or sign
language.

10. Interpretive Communication
• One way listening and reading that does not
require a response or reaction in real time.
• It referred to as the “one-way
communication”, in this mode, the
information conveyed by the sender is
interpreted by the receiver in its original form.
The target has to understand the message in
both written and spoken form keeping various
aspects in mind

11. Advantages:
• Learners understand, interpret, and analyze
what is heard, read, or viewed on a variety of
topics.
• This mode of communication involves
interpreting the author or producer’s intent.
• There is no alternative to the active
negotiation of meaning with the writer,
speaker, or the producer.

12. Interpersonal Communication
• Interpersonal communication is the process
by which people exchange information
through verbal and nonverbal messages. It is
an unmediated mode of communication that
occurs when we interact and attempt to
mutually influence each other, simultaneously,
in order to manage relationships.

13. Presentational Communication
• Presentational Communication is another
type of one-way communication, which
facilitates interpretation by members of
another group where no direct
opportunity for the active negotiation of
meaning between members of the two
groups exists

14. Multimodal Communication
• Multimodal Communication can be
simply referred to as communication
through varied modes such as verbal,
written, gestures, etc. There are different
modes under multimodal communication
and it is popularly used in higher
education to accentuate the learning
experience for students

15. Elements of communication
• 1. Source
• The source is the creator of the message. The
source initiates the message and sends it to
the sender.
• 2. Message
• The actual context of communication is a
message. The message is the formalized
structure of communication.

16. • 3. Channel
• The method in which the messages are
communicated from one point to the other is
called a channel. Channels are essential to convey
the message from the source to the destination.
• 4. Receiver
• The receiver is the one who receives the message
from the sender. The receiver can be considered
as the termination point of the communication
process or originating source for the feedback
process of the communication.

17. • 5. Feedback
• After the receiver receives the message, the receiver
comprehends the message.
• This feedback will be based on the message which is
initially sent from the sender and will be sort of an
answer to that message.
• 6. Environment
• The atmosphere in which we receive the message is
called an environment. The environment may include
but is not limited to the surrounding equipment,
objects, climate, and other things that are present
when the process of communication happens.

18. Levels of communication:
• Physical Level of Communication
• Visual cues like eye contact, gestures,
movements, stances, breathing, posture, and
facial expressions influence how we feel and
communicate. To communicate effectively on the
physical level, it’s helpful to physically align with
others, connecting with them in form and
movement. It also helps to be mindful of your
posture, facial expressions, and hand gestures.

19. • Auditory Level of Communication
• The sound of our voice, including the tone,
range, volume, and speed affects how our
messages are received and interpreted by
others.
• To communicate effectively on the auditory
level, become aware of various auditory cues,
speaking to others in a manner more akin to
their own ways

20. • Emotional Level of Communication
• our emotional states affect what we
communicate and how the message is
interpreted by the recipient. To communicate
effectively on the emotional level, become aware
of your emotional status learning to pause and
release negative emotions before attempting to
connect with others. Words delivered with pride,
anger or fear are rarely well-received.

21. • Energetic Level of Communication
• This level of communication encompasses a
vast range of unseen factors including a
person’s level of consciousness, the frequency
or harmonics of the message, and other subtle
energies.

22. Factors influencing communication
process
• Development/Age of the client influence the
communication: As per the
• developmental stage of life, needs of client vary.
• Gender : One same message can be interpreted
differently by the male and the females. Girls
used to communicate for confirming message,
establishing intimacy, whereas boys communicate
to establish independence and status within a
group

23. • Values and Perceptions : Values are the
standards that influence behaviour and
perceptions are the mental image of an event.
Every human being perceives and interprets
message according to his personality trait, values,
experience.
• Personal space : Personal space is the distance
maintained by persons in interaction with others.
Professional nurse maintains good interpersonal
relations and by observing client's health status,
also maintains personal space.

24. • Territoriality Is a concept of the space and
things that an individual considers as
belonging to the self.
• Roles and Relationships : The role and
relationship between sender and receiver
affect significantly the communication
process. A girl will interact differently with her
father, teacher, friend, sister, nurse, strange
person.

25. • Environment : A conducive and therapeutic
environment is the necessity for the effective
communication. So, the environment should be
noise free, well- ventilated and have temperature
within normal range. Lack of privacy, light also
affect the communication
• Congruence: Is to what extent verbal and non
verbal expressions are similar or match to each
other. Perception of congruence in
communication is very important for effective
communication.

26. • Interpersonal Attitudes : Attitude reflects the
beliefs, thoughts and feelings about people
and events. Attitude such as caring, warmth,
respect and acceptance facilitates
communication. Thus nurse having such
attitude will develop good interpersonal
relations with client and colleagues whereas
the lack of interest, coldness inhibit the
communication and ultimately relationship

27. Skill for effective communication
• In order to communicate effectively, one should have
following skills :
• I. Confidence : Confidence is very important for
developing and maintaining a trust with others. Nurse
will be confident if she has up to date knowledge,
skilful and as well as having the self concept.
• II. Critical thinker : Nurse must have this quality for the
effective communication. She must collect the
information, analyze it, then interpret it. Nurse must
think critically about the message she wants to
communicate.

28. • III. Analytical : Means ability to examine the impact of
message on listener/recipients. For effective
communication, nurse must be able to examine the
verbal, non verbal response of client.
• IV. Open mindness : An open minded communication
will explore the information by entering in the
situation.
• V. Active listener is the best quality of a good
communicator. This can be done by the head,
maintaining eye contact, saying "Yes" "No" in between
the conversation.

29. • VI. Empathetic : Empathy means perceiving the
client's feelings being empathetic , enablethe
nurse to help the client.
• VII. Honesty is very important in any of
communication whether it is formal, informal,
interpersonal or intrapersonal.
• VIII. To keep the information secret and use it for
the particular purpose confidentiality is
important skill. She must maintain client's right of
privacy and share the information professionally
for providing best care and treatment

30. • IX. Having a professional knowledge, is
important skill in effective
communication.Knowledge regarding what to
ask and how to ask is also essential. Along
with this, knowledge about the client's values,
perception, beliefs, feelings, developmental
age, culture, ethnic group is very important to
initiate communication.

31. • X. Being systematic is important because good
communicators tend to seek and provide
information in an organised and focused way.
Communication must be proceeded from
simple to complex manner.
• XI. Is the pivotal quality for effective
communication. How to convey message and
get response is the essential quality of a good
communicator

32. Barriers of communication
• 1. physiological barriers:
• Difficulty in hearing
• Difficulty in vision
• Difficulty in perception
• Difficulty in expression

33. • 2. psychological barriers
• Emotional disturbance (Crisis, Anxiety, Severe
stress Neurosis.
• Levl of understanding
• Fear.
• Ego centricity, superior or inferior complex

34. • 3. Environmental Barriers:
• Lack of ventilation
• Lack of light
• Extreme temperature
• Extreme noise
• Lack of privacy

35. • 4. Cultural Barriers:
• Level of knowledge andunderstanding.
• Personality traits.
• Custom
• Belief
• Religion
• Attitude
• Language

36. Importance of Health system:
• 1. Information: Primary function of
communication is to provide information to
public about prevention of Diseases and
promotion of health.
• 2. Education: It is very important to educate the
client regarding discharge planning, precautions
to be taken, dietary management, life style
modification. Education on these points is
conveyed by direct conversation/communication
with client.

37. • 3.Motivation: Motivation is the power which
drives person to do from within / inside. Client
can never recover from illness, until he is
motivated internally. Motivation to modify life
style is given only through communication
• 1) Motivating obese client to reduce body weight.
• 2) Motivating Hypertensive client to modify
dietary pattern and sedentary life style.

38. • 4. Persuasion: Persuasion means convincing,
influencing the person. One of the important
purpose of communication is to influence others.
Communication helps the person to understand
values, behaviour of another individual.
• 5. Counselling: Counselling brings change in the
behaviour of person. Therapeutic Nurse client
interaction helps him to better understand and
deal with problem. Counselling provides support
at time of crisis and helps in changing the
behaviour.

39. • 6. Brings Peace: Communication/interaction
between two person helps in ventilating the
feelings. Many times we want somebody should
listen to our feelings. Once these feelings are
shared or expressed, we get satisfied
• 7. Reduces Stress/ Tension: Ventilating the
feelings through verbal and non verbal modes of
communication helps the client to get relief from
stress.

40. • 8. Health Promotion: Above all mentioned
functions of communication leads to promote
the health.

41. Importance of non verbal
communication:
• Non verbal communication fulfills several
purposes of communication process such as
• To express feelings.
• To regulate interaction.
• To validate verbal messages.
• To maintain self image.
To maintain relationship

42. PatientTeaching
• Teaching is a system of activities intended to produce
learning. Teaching is given to enhance specific learning
of patient. Teaching is a system of activities performed
to produce learning in client related to health. Health
teaching is defined as a flexible, person-oriented
process in which the helping person provides
information and support to client with a variety of
health related learning needs
• Patient teaching involves teaching about reducing the
health risk factors, increasing client's level of wellness
and taking specific protective health measures.

43. Purposes of patient teaching:
• To promote health
To protect health
To maintain health
• To identify relevant health care needs of client
• To provide emotional and cognitive support
during teaching learning process. To keep
nurse knowledgeable
• To raise self-confidence of Nurse in teaching.

44. 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 client's health status is
mandatory now a days

45. • Patient teaching involves dynamic interaction
between client and nurse. Patient teaching is
important to communicate information,
emotions, perceptions and attitude towards
health or disease condition.
• Patient teaching ensures the patient's safe
transition from one level of care to another. It
also helps in making appropriate plans for
follow-up education in the client's home.

46. Nurse Patient Relationship
• Nurse patient relationship is a basic
requirement of nursing practice. A nurse who
is efficient and skillful uses the holistic
approach in caring for a patient with any type
of problem. These relationships find
encouragement when we are feeling down
and comfort when we are hurting. The
relationships also provide nurture for the self-
concept and sense of well-being.

47. • Defenition of Nurse Patient relationship
• It is an interaction process in which the nurse
fulfills her role by using her professional
knowledge and skill in such a way that she is
able to help the patient physically, socially and
emotionally.

48. Types of relationship
• 1. Social relationship: These relationships are
primarily initiated for the purpose of
• friendship, socalization enjoyment and for
accomplishing a task. Mutual needs are met
during social interactions
• 2. Intimate relationship: These relationships are
formed between the individuals who
• have emotional commitment to each other. Short
term and long term goals are set, the information
shared between the individuals may be personal
and intimate.

49. • 3. Therapeutic relationship: It is between the
nurse and client. It differs from both a social
and intimate relationship, in which a nurse
develops communication skills, understanding
personal strengths in order to enhance the
client growth.

50. Difference between therapeutic
relationship and social relationship:
• Therapeutic relationship
• It is a planned relationship
• * The objective of the relationship is to help
the client for recovering from disease.
• * It is for specific time and planned for specific
place.
• * The length of the relationship depends upon
the purpose. Time period is limited.

51. • * The nurse is fully accountable for any type of
actions and activity.
• * The nurse accepting the patient as"here and
now" without any
discrimination and judgement.
• * Termination of the relationship is an
important part. It is planned and discussed
with the patient at the time of starting
relationship.

52. • Social relationship:
• It just happens with mutual interest. There is no set
objective use for fun or satisfying needs of each other.
It may be planned for time and place or by chance
when two people meet.
Length of relationship varies and may last for years.
• Accountability is shared between both the parties.
• The shared values and beliefs affect the acceptance of
the social relationships.
• Relationship exists for long time. May terminate
gradually/suddenly depends upon the various factors.

53. • Characteristics of Nurse client relationship:
• It is an intellectual and emotional bond between the
nurse and client and mainly focussed on the client.
• It respects the client as an individual by maximizing the
client's abilities to participate in decision making.
Considering ethnic and cultural aspects.
• Considering family relationships and values. It respects
client's confidentiality.
• It emphasis on the client's well being.
• It is based on the mutual trust, respect and acceptance.
•

54. Developing helping relationship:
• 1. Listen actively:
• When you are listening a patient, you must concentrate. Do
not show that you do not have much time and you are busy
in any other assignment.
• Help to identify what the person is feeling. Most of the
time, the patients who are suffering from any type of
problem, are unable to identify or to label their feelings. It
is very hard time to talk with the patients because they do
not be able to explain what they are feeling.
• 2. Be Honest: While making relationship with the client, the
nurse's approach must be honest. Do not give any type of
facts.Be genuine and credible.

55. • 3. Be aware of cultural differences: that may affect
meaning and understanding. In order to develop
communication effectively, the nurse must recognize
what language the patient can understand. Provide a
bilingual interpreter if needed for clients limited in any
language.
• 4. Maintain clients confidentiality: The professional
attitude of the nurse, that she should not share any
information related to client with any other person
rather only with the health care professionals is
needed for effective care and treatment.

56. • 5. Know your roles and limitations: Every
person has unique strengths and limitations.
When you feel unable to handle any problem
or situation, you must inform the client and
refer the client to the appropriate health
professional.

57. Phases of helping relationship:
• The nurse client relationship is a process that can be
explained in terms of four sequential phases.
• 1. Preinteraction 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
includes i.e. patient's name, age, sex, address, medical
history, surgical history if any' and/or social history. The
nurse may feel anxious regarding the relationship and
the anxiety can be relieved by organizing the feelings
and materials before face-to-face meeting.

58. • 2. Introductory phase: It is also referred as
orientation phase or pre-helping phase. It
is important because it provides base for
whole of the relationship. During this phase,
the nurse and client closely observe each
other and make judgements about each
other's behaviour.

59. • There are three stages of the introductory
phase.
• Opening relationship
• Clarifying the problem
• Structuring and formulating the contract.

60. • In the initial parts of this phase, the client may
exhibit resistivebehaviour. Resistive
behaviours are those behaviours that avoid
the involvement and cooperation. This may be
due to the client's anxiety to share the
information with the other unknown person.

61. • 3. Working phase:
• Here, the nurse and the client view each other as
unique individuals. This is the phase where the
nurse makes full use of the services to reduce the
problem of the patient and to restore the health
of the patient.
• 4. Termination phase:
• This phase is expected to be difficult and filled
with the ambivalence. The client becomes
confident independent and evaluates preventive
measures. He/She will be ready for the follow-up.

62. Therapeutic communication:
• Therapeutic communication facilitates the
establishment of the nurse client relationship and
fulfills the purpose of nursing.
• Principles of therapeutic communication:
• Plan to interview at an appropriate time.
• Ensure privacy.
• Establish guidelines for the therapeutic
interactions.
• Provide for comfort during the interaction.

63. • Accept the client exactly as he is.
• Encourage spontaneity.
• Focus on the client and on the leads and clues
presented.
Encourage the expression of feelings.
• Be aware of your own feelings during the
interaction.

64. Therapeutic communication
techniques:
• Offering self
• Nurse is available physically and emotionally.
• Nurses show willingness and ready to help.
• Shows nurse's attention and interest.
• Broad openings
• Encourage client to choose topic for discussion.
• Exhibit respect for client's thoughts and feelings.
• Emphasize importance of client's needs.

65. • Silence
• Gives time to client to reflect
• Helps the client to express herself / himself.
• Convey respect and acceptance.
• Tries to understand the client's message.
• Open ended comments
• Allow the client to think and decide what content
is relevant.
• Questions that cannot be answered with one or
two words answer.

66. • Reflection
• Repeating the client's last words.
• Make him/her think that nurse is listening
actively.
• Focus on client's content, message and feelings
• Restating
• Repeating or paraphrasing client's main idea.
• Indicates nurse is listening actively.
• Give an opportunity to client for explaining the
matter.

67. • Exploring
• Identifies patterns
• Attempts to develop in more detail.
• Recognition
• Nurse points out observed clues to client.
• Focusing
• Question or statements that help client to expand
an idea.
• Directs conversation towards main topics.

68. • Directing
• Used to collect assessment data, but not to satisfy
nurse's curiosity.
• Making observation
• Nurse calls attention of client to behavior
indicative of feelings.
• Clarifying
• Makes the meaning of client's message clear.
• Helps the nurse not to make assumptions about
client's message.

69. • Confronting
• Encourages client to recognize different areas
for change.
• Nurse's verbal response to incongruence
between client's words and actions.
• Limit setting
• Establishing behaviours parameters.
• Stating expectations for appropriate behavior.