INDEX
SL.NO.CONTENTSPAGE NO.
I.
II.
III.
IV.
V.
INTRODUCTION
COMMUNICATION
Meaning Definition Purpose Levels of communication Basic
elements in comunication process Models of communucation
Forms/Types of communication Principles of comunication Factors
influencing comunication Barriers of communication Elements of
professional communication Communication techniques Therapeutic
communication techniques Non-therapeutic comunication techniques
Adapting communication techniques for clients with special needs.
How communication skills help Nurses.
INTERPERSONAL RELATIONSHIP
Meaning Factors influencinf Nurse-Patient relationship
Principles of IPR Characteristics of IPR Phases of IPR Model
representing human-human relationship
CONCLUSION
BIBLIOGRAPHY
COMMUNICATIONINTRODUCTION Communication is the basic element of
human interactions that allows people to establish ,maintain and
improves contacts with others.It constitutes the foundation of
interaction among humanbeings. Communication is a lifelong learning
process for the nurse.They interact with many persons in the course
of their profession.Nursing is a communicative intervention and the
foundation of nursing lies in the communicative attitude.This
attitude is manifested in the striving for mutual understanding,
coordination and co-action. Nurses communicate with people under
stress: clients,families and colleagues.Nurse function as members
of interdisciplinary teams who may have different ideas about
priorities of care.Being assertive to communicate ones own needs
ensures balance in a nurses life. As nurses refine their
communication skills and increase their confidence,they can
progress professionally to become experts.Competency in
communication helps the nurse maintain effective relationship
within the entire sphere of professional practice and helps meet
legal,ethical and clinical standards of care.Failure to effectively
communicate causes serious difficulty,increases liability, and
threatens professional credibility.MEANING - Communication The word
communication originates from Greek word communis, meaning to make
common. It is the transmission and receiving information,feelings
and or attitudes with the overall purpose of having understood.In
short, it is the process of passing messages,ideas, facts,
opinions, attitudes, information and understanding from one person
to another.DEFINITIONAccording to Paul Leagens, it 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 a message.According to
Aristotle,communication is a means of persuation to influence the
other so that the desired effect is achieved. Communication is the
process of passing information and understanding from one person to
another.It is essentially a bridge of meaning between people.By
using this bridge of meaning a person can sefely cross the river of
misunderstanding that seperates all people. (Prof Dasguptha)
Sending,giving or exchanging ideas and information ,which is often
expressed nonverbally or verbally.(Webstar)PURPOSES To develop
information and understanding To foster an attitude necessary for
motivation,cooperation,and job satisfaction To discourage the
spread of misinformation,rumours, gossips and to relief the
emotional tension of workers. To encourage ideas and suggestions
from subordinates for an improvement in the product and working
condition. To improve relationships. To ensure free exchange of
information and ideas. To maintain social relation among human
beings.LEVELS OF COMMUNICATION Nurse use different levels of
communication in their professional role.The nurses communication
skills need to include techniques that reflects competence in each
level.1.Intrapersonal communication: Intrapersonal communication is
a powerful form of communication that occurs with in an
individual.This level is also called self-talk, self-verbalization,
and inner thought (Balzer Rily,2000). Peoples thoughts strongly
influence perceptions,feelings,behaviour and
self-concept.Intrapersonal communication creates a set of
conditions through which life is experienced.Nurses should be aware
of the nature and content of their own thinking and try to replace
negative, self-defeating thoughts with positive assertions. For
example, guided imagery can be used to enhance coping and reduce
stress. Nurses and clients can use intrapersonal communication to
develop self-awareness and a positive self-concept that will
enhance appropriate self expression.2.Interpersonal Communication:
Interpersonal communication is one-to-one interaction between the
nurse and another person that often occurs face to face. It is the
level most frequently used in nursing situations and lies at the
heart of nursing practice.It takesplace within a social context and
includes all the symbols and cues used to give and receive
meaning.Meaningful interpersonal communication results in echange
of ideas,problem soving,expression of feelings,decision making,goal
accomplishment, team building and personal growth.3. Transpersonal
communication: Transpersonal communication is interaction that
occurs within a persons spiritual domain. Many persons use
prayer,meditation,guided reflection,religious rituals,or other
means to communicate with their higher power. Nurses who value the
importance of human spirituality often use in this form of
communication with clients and for themselves.4. Small-Group
Communication: Small-Group Communication is interaction that occurs
when a small number of persons meet together.This type of
communication is usually goal directed and requires an
understanding of group dynamics.When nurses work on commities,lead
client support group,form research teams or participate in client
care conferences, a small-group research teams or participate in
client care conferences, a small- group communication process is
used. 5.Public Communication: Public communication is interaction
with an audience.Nurses have opportunities to speak with groups of
consumers about health-related topics, present scholarly work to
colleagues at conferences, or lead classroom discussions with peers
or students.Effective public communication increases audience
knowledge.Public communication requires special adaptations in eye
contact,gestures, voice inflection and use of media materials to
communicate message effectively.BASIC ELEMENTS OF THE COMMUNICATION
PROCESS. Communication is an ongoing ,dynamic, and multidimentional
process. Its basic elements are: Referent,Sender,Message, Channel,
Receiver, Feedback. This simple linear model represents a very
complex process but helps the nurse identify its essential
components.
Interpersonal variables
Channel
Referent
Referent
Message
ReceiverSender
Feedback
Communication process
Referent:The referent motivates one person to communicate with
one another .In health care setting, sights ,sounds ,odours ,time
schedules, messages, objects, emotions, sensations, perceptions,
ideas and other cues initiates communication.Sender(source): The
sender is the person who encodes and delivers the message. Ideas or
purposes must be encoded (transformed) in to the form of a message
through perceiving, thinking, reasoning, judging, speaking,
writing, drawing, gesturing, demonstrating etc. to attain the
desired response from the receiver.Messages (content):The message
is the content of the communication.It may contain verbal,
non-verbal, and symbolic language. A Message is the
information/desired behaviour in physical form which the
communicator transmit to his audience to receive, understand,
accept and act upon. Nurses can effectively send messages by
expressing themselves clearly,directly and in a manner familier to
the receiver.Components of a message:a. message code any group of
symbols that can be structured in a way that is meaningful to same
person, eg. Language.b. message content The material in the
message. i.e., selected by the source to express his purpose.c.
Message treatment decisions which the communication source makes in
selecting, arranging both codes and contents.Channels (Medium):
Channels are means of conveying and receiving messages through
visual, auditory and tactile senses. By channel is implied the
Physical bridge or the media of communication between sender and
receiver. The more channels the sender uses to convey a message,the
more clearly it is usually understood. The total communication
effort is based on the three media systems:a. Interpersonal
communication: i.e., face to face communication most common channel
of communication. The encoding function is performed and channelled
directly by the intellectual,sensory and motor skills of the
source. Eg. Vocal mechanism for Oral communication ,
posture-gesture for non-verbal communication.b. Mass media: via TV,
radio, printed media etc.c. Traditional or folk media: Every
community has its own network of traditional, or folk media such as
folk dances , singing, dramas and religious meetings.
Receiver (audience): Receiver is the person who receives
messages from the sender,decodes, interprets the meaning and gives
feedback.Feedback (effect): Feed back is the message returned by
the receiver to sender ie, the reaction of the message.It indicates
whether the meaning of the senders message was understood. Senders
need to seek verbal and non-verbal feedback to ensure that good
communication has occurred. To be effective, sender and the
receiver must be sensitive and open to each others messages,clarify
the messages and modify behaviour accordingly.Interpersonal
variables: Interpersonal variables are factors within both the
sender and receiver that influence communication. Perception is one
such variable that provides a uniquely personal view of reality
formed by ones expectations and experiences. Each person senses,
interprets, and understands events differently. Other interpersonal
variables include educational and developmental
levels,sociocultural backgrounds, Values and beliefs, emotions,
gender, physical health status, roles and relationships. Variables
associated with illness, such as pain, anxiety and medications
effects can also affect nurse-client communication.Environment: The
environment is the setting for sender-receiver interaction. For
effective communication ,the environment should meet participant
needs for physical and emotional comfort and safety. Noise,
temperature extremes, distractions, and lack of privacy or space
may create confusion ,tension and discomfort. Environmental
distractions are common in health care settings and can interfere
with messages sent between people ,so nurses must try to control
the environment to create a favourable conditions for effective
communication.MODELS OF COMUNICATION
1. Shannons model of communication process (1948)Message
ReceiverDestinationTransmitterInformation source
Noise source
Shannons model of communication process is a general model of
the process. This model breaks the process of communication into
eight descrete components. An information source. Presumably a
person who creates a message. The message , which is both sent by
the information source and received by the destination. A
transmitter :A simplest transmission system, that associates with
face-face communication, has atleast two layer of communication.
The signal which flows through a channel. A carrier or channel
which is represented by the small unlabelled box in the middle of
the model. Noise in the form of secondary signals that confuse the
signal carried. A receiver A destination,a person who consumes or
processes the message.2. Aristotle triad of communication(350 BC)
According to Aristotle, three elements that ensure effective
communication area. speakerSpeaker
b.subjectc.audience
Goal Persuation
AudienceSubject
The credibility, knowledge, skills of speaker,the topic of
conversation, and the interest of benefit to the audience, all
affect the communication process.However the audience ultimately
determines whether the communicatin takes place or not.
3. The linear model (Telegraph model) 1948: In this
model,communication is the transfer of information from one point
to the next.ChannelMessage sentMessage sent
ReceiverDestinationTransmitterSender
Noise source
The goal of communication in this model is maximum line capacity
with minimum distortion noise is anything that interferes with the
transfer of the message. To improve communication, decrease
interference or noise.4. The technology model of communication
Human beings themselves have a fixed rate at which information can
be transferred.In this model,when the information sent is the same
as the information received,communication has taken place.Eg. A
nurse receives an order for Pantocid 40mg IV, and administer
Pantocid 40mg IV.Message send Message receivedPantocid 40mg IV
Pantocid 40mg IV
5. Interactional Model (1950s) This is a circular model of
communication ,in which the message is send and received ,encoded
and decoded ,and interpreted ,by both the sender and receiver. The
encoding and interpreting of message by both sender and receiver
started to get recognised.In this communication model, the cycle is
not completed until sender response to the receivers feedback.
6. SMCR Model (Berlo, 1960)
DecodingEncoding
ChannelReceiverMessageSource
AttitudeHearingContentAttitude
KnowledgeseeingStructureKnowledgee
SocialTouchingcodeSocial
Culture
TastingSymbolculture
Skills
Smellingskills
In this source Message-Channel-Receiver (SCMR) model by Berlo,
the linear telegraph model of communication becomes more
complex.According to Berlo, The sender encodes the message through
his speaking and writing skills.The receiver decodes the message
through his listening and reading skills. Both sending and
receiving are influenced by knowledge,attitude,experience and
skills and affected by the channel through which the message is
sent. The sender encodes the message through the use of symbols
through a channel such as speaking,writing etc. The receiver
receives the message through the channel of listening,reading
etc.Interpretation is the receivers understanding of the
message.FORMS OF COMMUNICATION / TYPES OF COMMNICATION1. One-way
communication(Didactic Method): The flow of communication is
one-way from the communicator the receiver. Eg. Lecture method.
Advantages: It is considerably faster than two-way communication.
Appears neat and efficient to an outsider observer. Sender is more
psychologically comfortable. Plan- fullness, order,systemization
are associated with.Disadvantages: Knowledge is imposed. Learning
is authoritative. Little audience participation. No feedback Little
influence on human behaviour.
2. Two way communication (Socratic Method): Both sender and
receiver takepart. The process of learning is active and
democratic. It is more likely to influence behaviour than one-way
communication. It is relatively noisy and disorderly with people
interrupting the sender and one-another; sender finds him/herself
psychologically under attack because his receivers pickup
mistakes.3. Verbal communication: Verbal communication uses spoken
or written words. Verbal language is a code that conveys specific
meaning as words are combined. The most important aspects of verbal
communication are:i. Clarity and brevity: Clarity can be achieved
by speaking slowly, and enunciating clearly and using examples to
make explanations easier to understand. Brevity is achieved by
using short sentences and words that express an idea simply and
directly.ii. Vocabulary: Instead of using purely technical words,
use local words, synonyms to technical words for understanding the
patients. When a nurse cares for a client who speaks an other
language, an interpreter may be necessary.iii. Denotative and
connotative meaning: A single word can have several meanings. A
denotative meaning is one shared by individuals who uses common
language that is used to define a word that it means the same to
everyone. A connotative meaning is the shade or interpretation of a
words meaning influenced by the thoughts, feelings, or ideas people
have about the word.iv. Pacing: Conversation is more successful at
an appropriate speed or pace. Nurses should speak slowly enough to
enunciate clearly.v. Intonation: Tone of the voice dramatically
affects a messages meaning. Depending on intonation, even a simple
question or statement can express enthusiasm, anger, concern or
indifference .The nurse must be aware of voice tone to avoid
sending unintended messages.vi. Timing and relevance: Timing is
critical in communication. Even though a message is clear ,poor
timing can prevent it from being effective. For example, the nurse
should not begin routine teaching when a client is in severe pain.
If messages are relevant or important to the situation at hand,
they are more effective.
4. Non - verbal Communication: Non-verbal communication includes
all of the five senses and everything that doesnot involve the
spoken or written word. It is common that non-verbal communication
is consciously motivated and may more accurately indicate a persons
intended meaning than the spoken words(Stuart and Laraia,2001).
Personal appearance, facial expression, posture and gait, eye
contact, gestures, sounds, touch and vocal tone are the powerful
ways people convey messages to others. Territoriality and personal
space is important . During interpersonal interaction, people
maintain varying distances between each other.
ZONES OF PERSONAL SPACE Intimate zone (0- 18 inches): Holding a
crying infant, Performing physical assessment , Bathing,grooming,
dressing,feeding and toileting a client. Personal zone (18 inches
to 4 feet Sitting a clients bedside, Taking clients
history,Teaching an individual client. Social zone (4 to 12 feet)
Making rounds with a physician, sitting at the head of a conference
table, conducting a family support group. Public zone (12 feet and
greater) Speaking at a community forum, Lecturing to a class of
students.ZONES OF TOUCH Social zone (Permission not needed)
Hands,arms, shoulders,back Consent zone (permission needed)
Mouth,wrist,feet Vulnerable zone (special care needed)
Face,neck,front of body Intimate zone (great sensitivity needed)
Genitalia, rectum.5. Symbolic communication: Good communication
requires awareness of symbolic communication,the verbal and
non-verbal symbolism used by others to convey the meaning.Art and
music are forms of symbolic communication that may be used by the
nurse to enhance understanding and promote healing.Dreams,
drawings, a childs play and even the symptoms of illness are all
symbolic forms of self-expression that have rich messages for
health care providers.
6. Metacomunication: Metacommunication is important to effective
interpersonal interaction. It is communication about communication
so that the deeper message within a message can be uncovered and
understood (Wood, 1999).It is the comment on the content and nature
of the relationship between persons involved.It is the message that
conveys senders attitudes, feelings, and intentions to the
listener; may be verbal or non-verbal. Eg., smiling when angryOTHER
FORMS OF COMMUNICATION
1. Formal communication: It follows lines of authority. ie, it
is an officially organised channel of communication.2. Informal
Communication: Friends,interest groups,like-minded group, casual
groups etc. communication is very faster here than the formal
group.3. Serial communication: Person to person the message will be
passed like a chain. Sender passes the message to one person, then
the receiver passes information to other and so on.4. Physiological
communication: If a stimuli received by the body,immediately the
brain receives the information and transmits to the respective
organs through the neurons where it has to be passed.5. Psychic
communication: In this extra sensory perception occurs. i.e,
something which will occur in future.The person perceives and
predicts that in advance is called psychic communication.6.
Interpersonal communication: It is the exchange of ideas between
two persons.7. Visual communication: It comprises charts, graphs,
tables, maps, posters, etc.8. Telecommunication and internet/
mechanical communication: It is the process of communication over
distance using electromagnetic instruments designed for this
purpose. Radio, TV, internet etc.
PRINCIPLES OF COMMUNICATION There are few basic principles of
communication. Communication should have objective and purpose.
Should be appropriate to situation. Systematic analysis of the
message, i.e, the idea, the thought to be communicated , so that
one is clear about it. Selection and determination of appropriate
language and medium of communication according to its purpose.
Organizational climate , including appropriate timing and physical
setting to convey the desired meaning of the communication.
Consultation for planning of communication; involves special
preparation. Message should convey something of value to the
receiver in the light of his needs and interest. The communication
action following a communication is effective communication as it
speaks more than his/her words. The sender has to understand
receivers attitude and reaction by careful, alert and proper
listening to ensure that the desired meaning of the message has
been comprehended by the receiver. Credibility is very important.
Communication programme should make use of existing facilities to
the great extent possible and should avoid challenging them
unnecessarily.
FACTORS INFLUENCING COMMUNICATION
1. Perceptions: It is the personal view of events, ie. Each
person senses, interprets and understands the events differently;
it is formed by experience and expectations.2. Values: These are
standards that influence behaviour; what person considers important
in life and thus influence expression of thoughts and ideas.3.
Emotions: Subjective feelings about events.The way a person
communicates with others is influenced by emotions.4.
Socio-subjective feelings about events: Culture is the sum total of
the learned way doing,feeling and thinking.5. Knowledge: Knowledge
of handling different level persons is essential for
communication.6. Role and relationships: Communication is more
effective when the participants remain aware of their role in a
relationship.7. Environment: Warm and comfortable environment
facilitates good communication.8. Space and territoriality:
Territoriality is the drive to gain, maintain and defend an
exclusive right to an area of space. It provides people with a
sense of identity, security and control.
BARRIERS OF COMMUNICATION It denotes the factors which causes
communication as a failure; can be classified as;1.
Physical/environmental barriers Noise, invisibility, environmental
and physical discomfort, distraction and ill
health,climate,time,place,medium etc.2. Personal barriers Language,
mental status, personality complexes,bias and prejudice,
impatience, inhibition attitude etc.3. Physiological barriers
Difficuties in health , expression ,moods attitudes,relationships,
disease conditions etc.4. Psychological barriers Prejudices,
inattention, disinterest, feeling of anxiety and unfulfilled
curiosity, level of intelligence, comprehension difficulties.5.
Cultural barriers Language variation, customs, believes, religion,
attitude etc. (differences between urban education and education)6.
Background barriers previous learning , cultural background ,
previous environment of working etc.
ELEMENTS OF PROFESSIONAL COMMUNICATION Professional appearance
,demeanor ,and behaviour are important in establishing the nurses,
trustworthiness and competence. Courtesy : Common courtesy is part
of professional communication. To practice courtesy , the nurse
says hello and goodbye, knocks on doors before entering and uses
self-introduction. The nurse also states his or her purpose ,
addresses people by name, says please and thank you to team
members, and apologizes for advertently making an error or causing
someone distress. Use of Names : Self-introduction is important.
The nurses failure to give a name ,indicate status(e.g., registered
nurse or licenced practical nurse) or acknowledge the client can
create uncertainity about the interaction and convey an impersonal
lack of commitment or caring.Addressing others by name conveys
respect for human dignity and uniqueness.Avoid terms of endearment
such as honey, dear, grandma or sweetheart. Avoid referring to
clients by diagnosis, room number, or other attribute , which is
demeaning and sends the message that the message that the nurse
doesnot care enough to know the person as an individual. Privacy
and confidentiality: Maintaining confidentiality is an important
aspect of professional behaviour. It is essential that the nurse
safeguard the clients right to privacy.Gossiping about others
violates nursing ethical codes and practice standards. Respect for
clients is demonstrated when the nurse treats others with dignity
and maintains their physical emotional privacy. Trustworthiness
Trust is relying on someone without doubts or question.Being
trustworthy means helping others without hesitation when help is
needed.To foster trust, the nurse communicates warmth and
demonstrates consistency,reliability ,honesty and competence.
Autonomy and Resposibility Autonomy is the ability to be
self-directed and independent in accomplishing goals and advocating
for others.Professional nurse make choices and accept
responsibilities for the outcomes of their actions(Townsend,2003).
They take initiative in problem solving and communicate in a manner
that reflect what they really need and want(Burden,1997).
Assertiveness According to Darley (2002) assertiveness comprises
respect for others,respect for yourself,self awareness and
effective,clear and consistent communication. Assertiveness conveys
a sense of self assurance while also communicating respect for the
other person (Stuart and Laraia,2001). The advantages of assertive
behaviour include the following (Balzer Riley,2000) It is more
likely you will get what you want when you ask for it. People
respect clear,open,honest communication. You stand up for your own
rights and experience self-respect. You avoid the invitation of
aggression when the rights of others are violated. You are more
independent. You become a decision maker. You feel more peaceful
and comfortable with yourself.Nurses can teach assertiveness skills
to others as a means for promoting personal health.COMMUNICATION
TECHNIQUES In carrying out any plan of care, nurses need to use
communication techniques that are appropriate for clients
individual needs. It is necessary to learn the communication
techniques that serve as a foundation for professional
communication. 1. Therapeutic communication techniques2.
Non-therapeutic communication techniques
1. Therapeutic communication techniques Therapeutic
communication techniques are specific responses that encourages the
expression of feelings and ideas and convey the nurses acceptance
and respect. Learning these techniques helps the student develop
awareness of the variety of nursing responses available for use in
different situations. Tremendous satisfaction will result as
therapeutic relationships and outcomes are achieved.a) Active
listening: Active listening means to be attentive to what the
client is saying both verbally and non-verbally. Active listening
facilitates client communication. Several non-verbal skills have
been identified as facilitative skills for attentive listening.
They can be identified by the acronym SOLER (Townsend,2003):S sit
facing the client. This posture gives the message that the nurse is
there to listen and is interested in what the client is saying.O
observe an open posture (ie. Keep arms and legs crossed).This
posture suggests that the nurse is open to what the client says.L
Lean toward the client. This posture conveys that the nurse is
involved and interested in the interaction.E Establish and maintain
intermittent eye contact. This behaviour coveys the nurses
involvement in and willingness to listen to what the client is
saying. Absence of eye contact or shifting of the eyes gives the
message that the nurse is not interested in what is being said.R
Relax. It is important to communicate a sense of being relaxed and
comfortable with the client. Restlessness communicates a lack of
interest and may also convey a feeling of discomfort that may be
transferred to the client. b) Sharing observations : Nurses makes
many observations by commending on how the other people looks,
sounds or acts. Stating observations often helps the client
communicate without the need for extensive questionning,focusing or
clarification.This technique help start a conversation with quit or
withdrawn persons. Eg: The nurse interpreting fatigue as depression
or assuming that untouched food indicates lack of interest in
meeting nutritional goals. You look tired, You seem different today
or I see you havent eaten anything. c) Sharing empathy: Empathy is
the ability to understand and accept another persons reality,to
accurately perceive feelings and to communicate this understanding
to the other. Eg: the nurse might say to an angry client who has
low mobility after stroke: It must be very frustrating to know what
you want and not be able to do it.d) Sharing hope: Nurses recognise
that hope is essential for healing and learn to communicate a sense
of possibility to others.Appropriate encouragement and positive
feedback are important in fostering hope and self-confidence and
for helping people achieve their potential and reach their goals.
Eg: The nurse might say to a client discouraged about a poor
prognosis. I believe you will find a way to face your situation,
because I have seen your courage and creativity in the past.e)
Sharing humour: Humour is an important but underused resource in
nursing interactions.Humour has positive effects on both a persons
psyche and physiology. Laughter signifies positive events to
people; it may contribute to feelings of togetherness, closeness
and friendliness.Further more, humour tends to minimise the effect
of negative factors and protects from difficulties.f) Sharing
feelings : Emotions are subjective feelings that result from ones
thought and perceptions.Feelings are not right,wrong, good or bad
,although they may be pleasant or unpleasant.If feelings are not
expressed, stress and illness can occur.Nurses can help clients
express emotions by making observations, acknowledging feelings,
encouraging communication,giving permission to express negative
feelings and modelling healthy emotional self-expression.g) Using
touch: Touch is one of the nursess most potent forms of
communication. Nurses are previlaged to experience more of this
intimate form of personal contact than almost any other
professional. Many messages such as affection, emotional
support,encouragement,tenderness and personal attention are
conveyed through touch.h) Using silence: Silence can prompt people
to talk.Silence allows clients to think and gain insight,its the
time sort out feelings,think how to say things,and consider what
has been communicated. The nurse should allow the client to break
the silence,particularly when the client has initiated it. It
become therapeutic during times of profound sadness or grief.i)
Providing information: Providing relevant information tells other
persons what they need or want to know so they can make
decisions,experience less anxiety, and feel safe and secure.Clients
have a right to know about their health status and what is
happening in their environment.j) Clarifying: To check whether
understanding is accurate, the nurse can restate an unclear or
ambiguous message to clarify the senders meaning.k) Focussing:
Focusing is used to centre on key elements or concepts of a
message. If conversation is vague or rambling or clients begin to
repeat themselves,focussing is a useful technique.l) Paraphrasing:
Paraphrasing is restating anothers message more briefly using ones
words. Through paraphrasing, nurse sends feedback that lets the
client know that the client is actively involved in the search for
understanding.m) Asking relevant questions : Nurse ask relevant
questions to seek information needed for decision making.Ask only
one question at a time and fully explore one topic before moving to
another area.Open-ended questions allows the client to take the
conversational lead and introduce pertinent information about a
topic.n) Summarizing: summarising is a concise view of key aspects
of an interaction.It brings a sense of satisfaction and closure to
an individual conversation and is helpful in termination of
nurse-client relationship.o) Self-disclosure: Self disclosures are
subjectively true, personal experiences about the self and are
intentionally revealed to another person.The nurse may choose to
share experiences or feelings that are similar to those of the
client and may emphasize both the similarities and differences.p)
Confrontation: To confront someone in a therapeutic way, the nurse
helps the other person become more aware of inconsistencies in
his/her feelings,attitudes,beliefs and behavious. This technique
improves clients self-awareness and helps the client recognise
growth and deal with important issues. This should be use only
after trust has been established. Eg: You say youve already decided
what to do,yet youre still talking a lot about your options.2.
Non-Therapeutic communication techniques Certain communication
techniques can hinder or damage professional relationships.
Nontherapeutic techniques tends to discourage further expression of
feelings and ideas and may discourage further expression of
feelings and ideas and may engender negative responses or
behaviours in others.a) Asking personal questions : Asking personal
questions that are not relevant to the situation, simply to satisfy
the nurses curiosity , is not appropriate professional
communication. Eg. Why dont you and John get married?b) Giving
personal opinions: If I were you, Id put your mother in a nursing
home. When the nurse gives a personal opinions it taking decision
making away from the client .Personal opinions differ from
professional advice.At times client needs suggestions and help to
make choices.c) Changing the subject: Lets not talk about your
problems with the insurance company.Its time for your walk.
Changing the subject when another person is trying to communicate
something important is rude and shows a lack of empathy.It blocks
the further communication and the communication is interrupted and
the client may fail to openly express feelings..d) False
reassurance: Dont worry,everything will be allright. When a client
is seriously ill or distressed,the nurse may be tempted to offer
hope to the client with statements such as You will be fine.
Offering reassurance not supported by facts or based in reality can
do more harm than good.e) Sympathy: Sympathy is concern,sorrow, or
pity felt for the client generated by the nurses personal
identification with the clients needs.f) Asking for explanation:
Why are you so anxious? A nurse may be tempted to ask the other
person to explain why the person believes, feels or has acted in a
certain way.g) Approval or disapproval: Judgemental responses by
the nurse often contains terms such as should,ought,good,bad, right
or wrong. Approving implies thet the behaviour being praised is the
only acceptable one. Disapproving implies that the clients must
meet the nurses expectations or standards. Eg. You shouldnt even
think about assisted suicide,its not right .h) Defensive response:
No one here would intentionally lie to you. Becoming defensive in
the face of criticism implies the other person has no right to an
opinion. To discover reasons for the clients anger or
dissatisfaction, the nurse must listen uncritically.By avoiding
defensiveness the nurse can defuse anger and uncover deeper
concerns.i) Passive or aggressive responses: Things are bad,and
theres nothing I can do about it. Passive responses serve to avoid
conflict or sidestep issues.They reflect feelings of
sadness,depression, anxiety, powerlessness and hopelessness.
Aggressive response provoke confrontation at the other persons
expense.They reflect feeling of anger, frustration, resentment, and
stress.j) Arguing: How can you say you didt sleep a wink, when I
heard you snoring all night long? Challenging or arguing against
perceptions denies that they are real and valid to the other
person.They imply that the other person is lying, misinformed or
uneducated.The skilful nurse can give information in a way to avoid
argument.Adapting communication techniques for the clients with
special Needs Communicating with older adults who have
communication Needs/Barriers Always start the communication process
by checking for a hearing aid. Amplify your voice if necessary. Get
the clients attention before speaking.Face them so that they can
see your mouth. Structure the environment so it is conducive to
good communication. Minimise visual and auditory distractions.Make
sure there is adequate lighting. When caring for elderly clients
with communication disorders,remember their deficit. Dont expect to
communicate in the same way as you would with a nonimpaired
person.Instead,act as a communication partner whose job is to
facilitate the clients self-expression and comprehension. Speak
slowly and clearly while maintaining eye contact.Use short
sentences with simple words. Supplement your words with simple
gestures. Summarise the most important points of the conversation.
Give clients plenty of time to ask and answer questions. Be a good
listener despite time constraints that makes listening difficult.
Strict to one topic at a tie. Whenever possible, have a family
member or caregiver in the room with you.This person will usually
be most familiar with the clients communication patterns and can
assist in the communication process. Communicating with clients who
cannot speak clearly(Aphasia, dysarthria, muteness) Listen
attentively, be patient and dont interrupt. Ask simple questions
that require yes or no answers. Allow time for understanding and
response. Use visual cues (e.g., words,pictures and objects) when
possible. Allow only one person to speak at a time. Donot shout or
speak too loudly. Encourage the client to converse. Collaborate
with speech therapist as needed. Use communication aids: Pad and
felt-tipped pen or Magic slate Communication board with commonly
used words,letters,or pictures denoting basic needs. Cal bells or
alarms Sign language Use eye blinks or movements of fingers for
simple responses (yes or no) Communicating with clients who are
cognitively impaired Reduce environmental distractions while
conversing Gets clients attention prior to speaking Use simple
sentences and avoid long explanations Ask one questions at a time
Allow time for client to respond Be an attentive listener Include
family and friends in conversations,especially in subjects known to
client. Communicating with clients who are unresponsive Call client
by name. Communicate both verbally and by touch Speak to client as
though he/she could hear. Explain all procedures and sensations.
Provide orientation to person,place and time. Avoid talking about
client to others in his or her presence. Communicating with clients
who donot speak English Speak to client in normal tone of voice
(shouting may be interpreted as anger) Establish method for client
to signal desire to communicate (call light or bell) Provide an
interpreter(translator) as needed Avoid using family
members,especially children as interpreters. Develop communication
board,pictures or cards. Translate words from native language into
English list for client to make basic requests. Have dictionary
(English/Spanish and so forth) available if client can read.HOW
COMMUNICATION SKILLS HELP NURSES?A critical component of nursing
practice is the ability to communicates effectively. It helps
nurses in many ways: General trust between nurse and clients.
Provides professional satisfaction. Is a means for bringing about
change , ie, nurse listens,speaks and acts to negotiate changes
that promotes clients well-being. Is the foundation of the
relationship between the nurse and other members of the health
team. Helps to promote managerial efficiency. Provides basis for
leadership action. Provides means of co-ordination.
INTERPERSONAL RELATIONSHIPThe nurse is an important member of
the health care team that must work in co-operation and harmony for
the care of the patient.This co-operation and harmony depends upon
the interpersonal relationship that is maintained among the members
of the health care team.Meaning: The interpersonal relationship is
Any of all behaviour which a person undertake in the presence of
others.(Jerald) It is the learning experience where by two people
interact to face an immediate health problem to share if possible
in reserving it into adopt a situation.Factors influencing
Nurse-Patient Relationship Personal experience Specific health
oriented experience General life experienceEssentials if
IPR1.Effective and efficient communication2.Non-verbal
communication which is appropriate to the situation
Principles of IPR1) Learn everyones name and never address
anyone by nickname.2) Respect everyones individuality.Each member
of a team is important as the other.3) Do not impose anything on
anybody.4) Keep emotion under control.5) Dont be afraid to admit
ignorance.6) Do not give and take personal favour.7) The team
leader should not make any excuse regarding his or her
responsibility.8) Develop habit on listening and focus attention on
the problem.9) Do not say or do anything that will disturb others
faith.10) Give importance to others and practice justice.11) The
members of team should be loyal,honest,dependable and willing to
carry out the directions of the team leader.12) There should be
team spirit or team feeling among the members. Each member should
work for the interest of the group.13) There should be mutual
understanding between the members.There should be willing to give
and take corrections.14) There should be delegation or
responsibility in a group and every member should carry out his/her
responsibility to the satisfaction of the group.15) The
relationship between the members of a group should be decent and
considerate.16) Teach the newcomer about the job.Make sure that all
the assignments are understood.17) The newcomer of the group should
feel at home where he joins the group.18) Establish a good rapport
among the members in order to achieve the aim.19) Every member
should be familiar with the organisations plan and policies of the
group.20) Be upto date with the information that is going
around.21) Avoid arguments in the group.22) Talk in terms of other
mans interest.23) Praise the slightest improvement made by
others.Use words of encouragement.24) Have a smile face always.25)
Prepare yourself mentally to accept the worst if necessary.
Characteristics of IPR Helping relationship is a therapeutic
relationship in nursing which promotes a psychological climate that
brings a positive change in the client and promote his group.i.
Facilitative characteristics ii. Action orientation
i. Facilitative characteristics They are essential messages for
the nurses to establish positive and supportive relationship with
the client.These are conditions that create an emotional
environment in which a patient feel comfortable and safe. Trust
Empathy Caring Autonomy and mutuality Geniuses Non-possesssive
warmthii. Action orientation These are conditions that assist a
person to move towards his goals.Action oriented characteristics
are used on the nurse patient relationship to progress beyond the
initiation process. Concreteness in communication Immediacy
Sensitive confrontation
Phases of IPR The nurse client relationship is therapeutic, not
social in nature.It is always client centered and goal directed. It
is objective rather than subjective. The indent of a professional
relationship is for client behaviour to change.The phases of a
helping relationship includes:1. Pre-interaction phase2.
Orientation phase3. Working phase 4. Termination phase1.
Pre-interaction phase/pre-orientation phase: Before meeting the
client,the nurse : Gathers data about the client, reviewing
available data including the clients condition, medical and nursing
history. Talks to other caregivers who may have information about
the client. The nurse also utilizes the process of autodiagnosis to
determine his/her own perceptions , a commitment to
non-judgementalism and the avoidance of stereotyping are
imperative. Anticipates health concerns or issues that may arise.
Identifies a location and setting that will foster comfortable
,private interaction. Plan enough time for the initial
interaction.
2. Orientation phase: The nurse and client meet and get to know
one another. The nurse Sets the tone for the relationship by
adopting a warm,empathetic,caring manner. The purpose of
orientation phase is to become acquainted with the client, gain
rapport, demonstrate genuine caring and understanding and establish
trust. This phase usually lasts 2 to 10 sessions but with some
clients can take many months. The nurse closely observes the client
and expects to be closely observed by the client. Begins to make
inferences and form judgements about client messages and behaviour.
Assess the clients health status, prioritise the clients problems
and identifies the clients goals. Clarifies the clients and nurses
roles. Lets the client know when to expect the relationship to be
terminated.
3. Working phase The nurse and the client work together to solve
problems and accomplish goals. The purpose of this phase is to
bring about positive changes in the clients behaviour ,with focus
on the here and now. Working phase ideally begins when the client
assumes responsibility to uphold the limits of the relationship.
Adjustments may have to be made ,depending on the clients length of
stay. In this phase, the nurse: Encourages and helps the client to
express feelings about his or her health. Provide information
needed to understand and change behaviour. Encourages and helps the
client to set goals. Uses therapeutic communication skills to
facilitate successful interactions. Uses appropriate
self-disclosure and confrontation.
4. Termination phase The ending of the relationship. The purpose
of this phase is to dissolve the relationship and assure the client
that she/he can be independent in some or all of his/her
functioning. Ideally, termination phase begins during the
orientation phase. The nurse reminds the client that termination is
near. Termination normally occurs when the client has improved
sufficiently for the relationship to end, but it may also occur if
a client is transferred or you as a nurse leave the facility. The
nurse evaluate the goal achievement with the client. The nurse
achieves a smooth transition for the client to other caregivers as
needed.
Model representing human-human relationship The model represents
the interaction between the nurse and patient or recipient of her
care.The major characteristics of this experience is that the
nursing needs of the individual is met.The half circle at the point
of original encounter indicates the possibility of and need for
developing encounter in to therapeutic relationships. As the
interaction process progresses towards rapport, the circle joints
in to one full circle, representing that the potential for a
therapeutic relationship has been attained. The human to human
relationship in nursing situation is the means through which the
purpose of nursing is accomplished.The human to human relationship
is established when the nurse and the recipient of her care attain
a rapport after having progressed through the stage of the original
encounter,emerging identities,empathy and sympathy.Nurse and
patient
Rapport
\NursesympathyPatient
Patient
Nurse
Empathy
Patient
Nurse
Emerging identities
Patient
Nurse
Original encounter
Human Human
CONCLUSION Considerable thought and attention have been given to
the subject to interpersonal relationship. It has become a fad
lately for almost everyone to consider himself an expert on that
subject.Only a responsible and highly motivated individual can help
in meeting the fundamental needs and healing processes of others.
There are other motivating influences in selecting a helping or
healing profession.This interpersonal relationship is primarily an
experiences or series of experience between nurse and patient. The
major characteristics of these experiences is that the nursing
needs of the individual are met.
BIBLIOGRAPHY1. Potter Patricia A., Perry Anne Griffin,
Fundamentals of Nursing, 6th edition, Elsevier Publications, Page
no.425-444.2. Park.K, Preventive and social Medicine, 19th
edition,Bhanot publications, page no.707-709.3.Basheer S.P , A
concise textbook of Advanced Nursing Practice(2013), Emmes medical
Publishers, Page no.551-560.4. Samta Soni, Text book of Advanced
Nursing Practice(2013), Jaypee Publications, page no.134-149.
1
