1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 7 The Nurse–Client Relationship

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Within the Nurse–Client Relationship Relationship established between nurse and client

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The four basic roles performed by nurses: –The nurse as caregiver oPerforms health-related activities, contemporary caregiving role oDevelops close emotional relationships oUnderstands that illness and injury cause insecurity; uses empathy

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The nurse as educator –Educates about complex health care –Provides health teaching pertinent to each client’s needs, knowledge base –Lets the client choose his health care –Shares information and alternatives –Empowers client involvement orehabilitation, financial assistance, emotional support

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The nurse as collaborator –Works with the team toward achieving a common goal –Responsible for managing care –Shares information with other health care workers

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The nurse as delegator –One who assigns a task to someone –Necessary knowledge –Inspects completed task –Accountable for inadequate care

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The Therapeutic Nurse–Client Relationship Desired outcome: restored health Underlying principles –Treats client as a unique person and respects client’s feelings –Promotes client’s physical, emotional, social, and spiritual well-being –Encourages client participation –Individualizes client care

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Underlying principles (cont’d) –Accepts client’s potential for growth and change –Communicates using understood terms and language; incorporates client support system –Implements compatible health care techniques: client’s values and culture

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Phases of the nurse–client relationship –Introductory phase oPeriod of getting acquainted oClient initiates relationship: identifies one or more health problems oNurses to demonstrate:  empathy  Active listening and competency  Appropriate communication skills

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Working phase oMutually planning care: enact plan oParticipation from both sides oNurse promotes client independence

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Terminating phase oNurse and client mutually agree on the improved immediate health problems oCaring attitude and compassion facilitate client’s care transition

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Barriers to a therapeutic relationship oBest approach is to treat a client as you would like to be treated oBox 7-3

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication Exchange of information between two people Followed by feedback to confirm understanding Occurs simultaneously –Verbal and nonverbal communication

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Verbal communication –Using words: includes speaking, reading, and writing oTo gather facts oTo instruct, clarify, and exchange ideas

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Factors: affect ability to communicate oAttention and concentration oLanguage compatibility and verbal skills oHearing and visual acuity oMotor functions involving the throat, tongue, and teeth oSensory distractions oInterpersonal attitudes oLiteracy and cultural similarities

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Therapeutic verbal communication –"Using words and gestures to accomplish a particular objective"

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Verbal Communication Techniques

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Verbal communication (cont’d) –Listening oPay attention to what clients say oAvoid communicating signals indicating boredom, impatience, or pretense of listening

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Verbal communication (cont’d) –Silence oEncourages client participation oIntentionally withholding verbal commentary

20. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nontherapeutic Communication

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonverbal communication –Exchange of information without using words –Manner used affects meaning oKinesics (Body language) (e.g. facial expression, gestures body movements, clothing style, posture…)

22. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Paralanguage ( Vocal sounds that are not actually words) such as: –Deep breath to indicate surprise. –Whistling to get someone's attention. –Crying, laughing. –Volume, pitch. –Proxemics (Use and relationship of space to communication) oVaries according to cultural background oUnderstand client’s comfort zone

23. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Touch oTactile stimulus produced by making personal contact  Task-oriented touch  Affective touch End