Fundamentals of nursing interactive process

INTERACTIVE PROCESS
2/23/2021
JONES H.M- MBA/DMS 1

 The nurse is always in an interaction process
in her/his practice. The nurse interacts with
the clients, clients’ relatives and other health
care team members. Creating caring
relationships is the core business of nursing.
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 Communication is therefore essential in
creating any relationship within the health
care system. Competency in communication
helps maintain effective relationships within
the spheres of the professional practice.
 Through out the nursing process, the nurse
uses her communication skills as she
collaborates with clients and the health care
team members to achieve health goals.
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Communication
 Communication is the interchange of
information between two or more people.
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 Communications is at different levels and the
nurses are found to use all the levels because
of the profession. The following are the
levels;
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Intrapersonal communication
 This is also called self talk. It involves self
verbalisation and inner thought. Both the
nurse and clients use intrapersonal
communication to develop self awareness.
 It is the most powerful level of
communication because it helps the
individual prepare for the situation through
self instruction and mental rehearsal for
difficult tasks.
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 Interpersonal communication
 This is a one to one interaction between the
nurse and another person (client, team
member etc). Meaningful intrapersonal
communication results in exchange of ideas,
information and also team building.
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 Small group communication
 This is interaction that occurs when a small
number of people meet together to discuss a
common topic. This type of communication is
mostly used in the health care setting during
clinical meetings, case review, etc
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Public communication
 This is interaction with an audience. The
nurse uses this kind of communication during
health talks.
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Communication process involves four major
elements: sender, message, receiver and
feedback.
 Sender: this is the person or group who
wishes to convey a message to the other.
The sender does the encoding, that is
selecting specific signs and symbols to
transmit the message (which language,
words to use tone of voice and gestures to
use).
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 Message: This is what is actually transmitted
which could be written or said or through
body language. The medium through which
the message is conveyed is called the
channel.
 Receiver: This is the person the message is
intended for, the listener, who must listen,
and observe. This person is the decoder who
must interpret the message and perceive
what the sender intended.
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 Feed back/Response: this is the message that
the receiver sends to the sender. It indicates
whether the meaning of the sender’s
message was understood. Feedback may
either be verbal or non-verbal e.g. head nod.
Both the sender and the receiver must be
sensitive to each others messages.
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 Generally communication involves two
different modes; verbal and non-verbal
Verbal communication
 This mode uses the spoken or written word. It
is largely conscious because people choose
which words to use. When using this mode of
communication, the nurse should bear in
mind the following:
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Pace and intonation
The speed and tone of the voice of the nurse
communicating can affect the message. A slow
pace may help calm a client.
Simplicity
 This is the use of commonly used and
understood words. Nurses need to realise that
they are dealing with lay people who may not
understand the medical terms. It is therefore
important for the nurse to explain in simple
terms based on the age, knowledge/education
and culture of the client.
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Clarity
 This is communicating in simple, brief way.
The nurse should learn to use few words to
avoid confusing the clients as they are
communicating and avoid using terms like
“you know” at the end of every sentence as
this would distract the clarity of the
statement.
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Timing and Relevance
 It is important to note the mood and
condition of the client before
communicating to the client. When the
client is in severe pain, you can not start
teaching about hygiene or diet. The nurse
should communicate relevant message to
the client at that time.
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 This involves everything except what is said
or written.
 Most of the messages are transmitted
through body language.
 During the communication process with
clients, relatives and other health care team
members, the nurse should mind her/his
own non verbal actions and also that of the
receiver.
 In assessing non verbal cues, the health
care provider should consider the following;
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Personal appearance
 This includes physical appearance, facial
expression and manner of dress and
grooming.
 These communicate the wellbeing of an
individual, social status, religious affiliation.
 From the appearance the nurse will be able
to get the general status of the client and the
client will also get the professionalism of the
nurse from his or her appearance.
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Posture and gait
 The way an individual walks, stands, sits
communicates some emotions, attitude, self
concept and health status.
 In the same manner, the posture and gait of
the patient towards communicates a lot, for
example, leaning forward as the client is
speaking indicates that the health care
provider is attentive.
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 Facial expression
 Facial expression is the most commonly
used non-verbal communication.
 These express emotions such as fear, anger,
happiness and sadness. The Facial
expressions should be matching with the
words that are spoken.
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 Any inappropriate facial expression will
distort the message, for example a nurse
delivering sad news to the client but smiling.
 Clients are always observing the expressions
of the health care provider.
 Although some expression may be made
unconsciously, the health care provider
should always be conscious of her
expressions.
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Eye contact
 Eye contact signals readiness to
communicate and willingness to listen.
Maintaining eye contact allows people to
observe one another.
 If the client is not maintaining eye contact,
he/she may be uncomfortable, anxious, or
has no confidence in the person
communicating. It is however important
moderate the eye contact especially when
dealing with the opposite sex.
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Other non verbal cues include
 gestures,
 sounds, etc
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 Nurse-patient interaction is a professional
relationship between the nurse and the patient.
 The nurse interacts with the client for the purpose
of helping the client recover and become
independent.
 A meaningful nurse-patient interaction results in
the exchange of ideas, expression of feelings and
problem solving.
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 Therapeutic communication between the client and
the nurse allows the attainment of health related
goals.
 Open communication between the nurse and
the patient ensures the ongoing identification
of the patient’s health problems.
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 There are five elements cardinal to the nurse-
client relationship: trust, respect,
confidentiality, empathy and power.
Regardless of the context, length of
interaction and whether a nurse is the
primary or secondary care provider, these
elements should always be ensured.
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 Trust.
 Trust is critical in the nurse/ health care
provider -client relationship because the
client is in a vulnerable position. Initially,
trust in a relationship is fragile, so it’s
especially important that a health care
provider keep promises to a client. If trust is
breached, it becomes difficult to re-establish.
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 Respect.
 Respect is the recognition of the inherent
dignity, worth and uniqueness of every
individual, regardless of socio-economic
status, personal attributes and the nature of
the health problem.
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 Confidentiality
 Keep information entrusted to you by the
client confidential.
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Empathy.
 Empathy is the expression of understanding
of the client’s situation.
 It involves putting oneself in the position of
the other.
 In nursing, empathy includes appropriate
emotional distance from the client to ensure
objectivity and an appropriate professional
response.
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Power.
 The nurse-client relationship is one of
unequal power.
 The nurse has more authority and influence
in the health care system, specialized
knowledge, access to privileged
information, and the ability to advocate for
the client and the client’s significant others.
 The appropriate use of power, in a caring
manner, enables the nurse to partner with
the client to meet the client’s needs.
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Rapport
 Connect on a social level.
 See the patient’s point of view.
 Consciously suspend judgment.
 Recognize and avoid making assumptions.
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Empathy
 Remember that the patient has come to you
for help.
 Seek out and understand the patient’s
rational for his/her behaviors or illness.
 Verbally acknowledge and legitimize the
patient’s feelings
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Support
 Ask about and understand the barriers to
care and compliance.
 Help the patient overcome barriers.
 Involve family members if appropriate.
 Reassure the patient you are and will be
available to help.
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Partnership
 Be flexible with regard to control issues.
 Negotiate roles when necessary.
 Stress that you are working together to
address health problems
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Explanations
 Check often for understanding.
 Use verbal clarification techniques.
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Cultural competence
 Respect the patient’s cultural beliefs.
 Understand that the patient’s view of you
may be defined by ethnic or cultural
stereotypes.
 Be aware of your own cultural biases and
preconceptions.
 Know your limitations in addressing medical
issues across cultures.
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Trust
 Recognize that self-disclosure may be
difficult for some patients.
 Consciously work to establish trust.
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1. Client oriented eye-gaze
 Allows the client/nurse to check whether the
information is understood.
 It signals readiness to initiate interaction
with a client.
 Eye contact shows you are interested in what
the other person saying.
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2. Affirmative Head Nodding
 It supports spoken language
 Indicates to the client that you are with
him/her in the conversation.
3. Smiling
 Its considered a sign of good humour,
warmth and immediacy.
 Its most important when a nurses wishes to
establish good rapport with the client
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4. Forward leaning
 It shows awareness, attention and immediacy.
 It clearly suggests interest in the client
5. Touch
 Its important in building rapport and a
relationship between the nurse and the client.
 It conveys affection, care and comfort
6. Others
Empathy, kindness, confidentiality, privacy, hope
etc
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 There are four phases of the nurse-client
relationship.
1. Pre-interactive phase
 This is the period before the nurse and client
meets. At this stage, the nurse has
information about the client. The nurse
reviews the data concerning the client
including the medical records.
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 The nurse also gathers information from the
other health professional and prepares for
the interaction with the client. The nurse
prepares the environment which is
comfortable for the first interaction with the
client.
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2. Orientation Phase
 The orientation phase begins with the nurse’s
introduction to the client, which include, the
name, position and explanation of the
purpose for the interaction .
 Phase is important in establishing trust and
confidence in the client.
 Reassure the client that any information
shared will be kept confidential and shared
only with client’s consent
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 During this stage, the roles of the client and
the nurse are clarified. The nurse assesses
the client’s health status so that she is able to
identify the problems.
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3. Working Phase
 Phase when the nurse and client work together
to solve problems and accomplish goals.
 If it is during an interview it involves gathering
information.
 Identify behaviours that are resistant to change
and so facilitate shifts in these behaviours.
 During this phase, the nurse should
 Encourage client to express feelings
 Encourage client to set goals and take action to
meet them
 Assist client to regain independence
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 Good communication skills are important to
facilitate a successful interaction.
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4. Termination phase
 With a clear understanding of goals
identified and resolved through negotiation
in the working stage termination of the
relationship is necessary .
 Termination phase is the Stage of ending the
relationship with the client.
 Inform the client that you are about to end
the relationship.
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 Evaluated the goals and see if they have been
met.
 Slowly wean off the client.
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 When providing nursing care for a client,
family member, friend or acquaintance: be
aware of the boundary between your
professional and personal roles;
 clarify that boundary for the client;
 meet personal needs outside of the
relationship;
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 There are times when a nurse may be
crossing the boundaries of the nurse-client
relationship. Nurses should avoid finding
themselves in such situations. Some of the
signs that indicate that the nurse is crossing
the boundaries of the relationship include the
following;
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 spending extra time with one client beyond
his/ her therapeutic needs;
 changing client assignments to give care to
one client beyond the purpose of the primary
nursing care delivery model;
 feeling other members of the team do not
understand a specific client as well as you do;
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 disclosing personal information to a specific
client;
 frequently thinking about a client when away
from work;
 feeling guarded or defensive when someone
questions your interactions with a client;
 spending off-duty time with a client;
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 keeping secrets with the client and apart from
the health care team for example, not
documenting relevant discussions with the
client in the health record
 giving a client personal contact information
unless it’s required as part of the nursing
role; and
 a client is willing to speak only with you and
refuses to speak with other nurses
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 The nurse has to understand that the client
has relations and it is important to involve
the relations in the therapeutic relationship.
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 Building relationships is very important in the
health care setting. The nurse does not work
alone because the client’s needs are varied.
This therefore means that the whole health
care team has to work together for the
common good of the client.
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 Good communication is very important in this
team building relationship for good
collaboration, consultation delegation,
supervision and management. A good health
team relationship builds confidence in the
clients.
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 To avoid duplication of work
 For sharing of information
 To coordinate and provide quality care
 Helps in the utilisation of resources.
 Reduces the risks of errors and mishaps.
 For continuity of care e.g. in cases of
handovers
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Fundamentals of nursing interactive process

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