1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 07: Nurse–Client Relationships By: P.K. Williams, RN 01/39 Pg 055

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 46 Words to Know 02/39 Pg 055 Affective learner Affective touch Androgogy Caregiver Certified interpreter Collaborator Cognitive learner Comfort Zone Deaf Delegator Educator Empathy Expressive aphasia Fingerspelling Formal teaching Gerogogy Hard of hearing Hearing Informal teaching Intimate space Introductory space Kinesics Learning capacity Learning needs Learning needs Learning readiness Learning style Listening Motivation Paralanguage

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 46 Words to Know Cont: 03/39 Pg 055 Nonverbal communicationPersonal space Proxemics Nurse-client relationshipPsychomotor learner Public space Social space Task-oriented touch Teaching PlanTelephonic interpreting Terminating phaseTherapeutic communication Video InterpretingVerbal communication WebcamWorking phase

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 12 Objectives 04/39 Pg 055 On completion of this chapter, you will be able to:  List four roles that nurses perform within the nurse-- client relationship.  Describe three phases in a nurse-client relationship.  Differentiate between verbal, nonverbal, and therapeutic communication.  Give examples of therapeutic and nontherapeutic communication techniques.  List and explain five components of nonverbal communication.  Name and explain the four proxemic zones.

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 12 Objectives Cont: 05/39 Pg 055 On completion of this chapter, you will be able to:  Explain what is meant by a client’s “comfort zone.”  Differentiate between task-oriented and affective touch.  Explain the learning styles of cognitive, affective, and psychomotor learners.  Describe variables that affect learning.  Compare informal with formal learning.  Discuss guidelines for teaching adult clients

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse–Client Relationship*** 06/39 Pg 055 Introduction –Period of nurse–client relationship Interaction with clients: Sick or well Client’s health: Promotion; restoration Help client cope with illness or help client die with dignity Basic processes: Therapeutic communication; listening empathetically; sharing information; providing client education

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse–Client Relationship Tlb: 7-1 07/39 Pg 057 Nursing Roles Within the Nurse–Client Relationship*** –Respond to client’s needs –Four categories of client needs according to National Council of State Boards of Nursing Safe, effective care environment*** Health promotion and maintenance*** Psychosocial integrity*** Physiologic integrity*** ***[Understand Nurse role in each of the four]

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 08/39 Pg 057 Is the following statement true or false? According to the National Council of State Boards of Nursing, there are five categories of client needs.

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 09/39 Pg 057 False. According to the National Council of State Boards of Nursing, there are four categories of client needs: safe, effective care environment; health promotion and maintenance; psychosocial integrity; and physiologic integrity.

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse–Client Relationship 10/39 Pg 056 Nursing Roles Within the Nurse–Client Relationship –The nurse as caregiver Assist in health-related activities sick person cannot perform independently; restore wellness Maintain function and independence for those with chronic physical or mental health problems; emotional relationship; client’s guide, companion, and interpreter

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse–Client Relationship*** 11/39 Pg 057 Nursing Roles Within the Nurse–Client Relationship –The nurse as caregiver (cont’d) Empathy: Providing for client’s needs while remaining compassionately detached –The nurse as educator Offer health teaching: Client needs and knowledge base Explanations: Diagnostic procedures; self- administration of medications; wound care; restorative exercises

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 12/39 Pg 057 Is the following statement true or false? In their role as caregivers, the nurses’ role is to do as much as possible for all their clients so they regain wellness and perform care independently.

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 13/39 Pg 057 False. In their role as caregivers, nurses’ role is only to perform health-related activities for the client until the client can perform them independently. Nurses promote the maintenance of independent function as much as possible in all their clients.

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse–Client Relationship 14/39 Pg 056 Nursing Roles Within the Nurse–Client Relationship –The nurse as educator (cont’d) *** Treatment: Avoid giving advice; share information on potential alternatives; support client’s ultimate decision Inform client about health services; empower clients to become involved in self-help groups or emotional support

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse–Client Relationship*** 15/39 Pg 057 Nursing Roles Within the Nurse–Client Relationship –The nurse as collaborator Works with others to achieve common goal Client’s care involves many members of healthcare team Collaboration between nurse and physician

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse–Client Relationship 16/39 Pg 057

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse–Client Relationship*** 17/39 Pg 057 Nursing Roles Within the Nurse–Client Relationship –The nurse as delegator*** Knowledge and expertise of tasks appropriate for particular healthcare workers Check task performed Determine resulting outcome

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse–Client Relationship *** 18/39 Pg 058 Phases of the Nurse–Client Relationship –Introductory phase Nurse and client acquaintance; client identifies health problems Preconceived ideas: Confirmed or dismissed Value client: Courtesy; active listening; empathy; competence; appropriate communication skills Demonstrate partnership and advocacy

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse–Client Relationship 19/39 Pg 058 Phases of the Nurse–Client Relationship –Working phase Mutually planning client’s care; putting plan into action Participation: Nurse and client Nursing intervention: Support client’s independence –Terminating phase Client’s immediate health problems improved; nurse’s services are no longer necessary Nursing intervention: Compassion, caring attitude

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication 20/39 Pg 058 Introduction –Exchange of information –Messages: Sending, receiving, feedback Therapeutic Communication –Use words and gestures that promote person’s physical and emotional well-being

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication 21/39 Pg 059 Figure 7-3 Communication as a two-way process

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication*** 15/39 Pg 061 Therapeutic Communication –Helpful techniques –Nursing interventions: Caring for clients who are quiet and uncommunicative Avoid assuming Never probe client unwilling to communicate Wait for client to communicate Respond delicately to vocal and emotional client

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication*** 23/39 Pg 059 Verbal Communication –Communication that uses words: Speaking, reading, writing –Variables affect verbal communication –Listening: Attending to and becoming fully involved –Empathetic listening: Attempt to perceive client’s emotions and meanings –Communication with most American clients: Position at client’s level; frequent eye contact; convey interest; avoid sending messages that indicate boredom

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication*** 24/39 Pg 059/060 Nonverbal Communication –Exchange of information without using words –Kinesics Body language; collective nonverbal techniques such as facial expressions, postures, gestures, and body movements Context of communication: Clothing style and accessories –Paralanguage Vocal sounds: Communicate message Dimension to communication

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication*** 25/39 Pg 059 Nonverbal Communication –Proxemics: Use of space when communicating [ Tbl: 7-3 Pg 60] Four proxemic zones: intimate space, personal space, social space, public space Determining person’s comfort zone Explain beforehand how nursing procedure will be performed to relieve client’s anxiety

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication*** 226/39 Pg 059 Nonverbal Communication –Touch: Tactile stimulus, personal contact Contexts of nursing Task-oriented: Personal contact; performing nursing procedures Affective: Demonstrate concern or affection; caring; support; use cautiously

27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication*** 27/39 Pg 059 Nonverbal Communication –Silence Art of remaining quiet Therapeutic uses: Encourage client’s verbal communication; provide personal presence; brief period for clients to process information or respond to questions

28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Client Teaching 28/39 Pg 064 Introduction –Essential nursing activities: Sharing information; performing client teaching; meeting client needs –Formal or informal teaching: Information compatible with client’s learning style

29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Learner Assessment –To determine various components: Client’s learning status –Assess client’s learning style, needs, capacity, motivation, readiness –Learning styles: Manner in which person best comprehends new information Client Teaching 29/39 Pg 064

30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Client Teaching*** 30/39 Pg 064 Learner Assessment Three learner categories Cognitive: Processes information by listening to or reading facts and descriptions Affective: Processes information by appeals to feelings, beliefs, and values Psychomotor: Learns by doing things

31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Is the following statement true or false? In client teaching, you instruct clients in the manner with which you feel most comfortable. Question 31/39 Pg 064

32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins False. In client teaching, the most effective method is to use the style most compatible with the client’s learning style. Answer 32/39 Pg 064

33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Client Teaching 33/39 Pg 057 Learner Assessment –Learning needs Skills and concepts: Restore, maintain, or promote health Components to identify goals; tailor teaching plan for individual Evaluate outcomes –Learning capacity Person’s intellectual ability understand, remember, and apply new information

34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Learner Assessment –Learning motivation Desire to acquire new information Restore independence; prevent complications Facilitate discharge; returning to or remaining in comfort of home –Learning readiness Optimal time for learning Occurs when client is in state of physical and psychological well-being Client Teaching 34/39 Pg 057

35. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Informal and Formal Teaching –Informal teaching: Unplanned; occurs spontaneously –Formal teaching: Requires plan –Teaching plan: Organized arrangement of content with specific time frame –Importance: Reaching goals; assuming responsibility for self-care Client Teaching 35/39 Pg 057

36. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutritional –Factors interfering with client’s attention and readiness for learning Hunger, thirst Nausea, distention Constipation, diarrhea –Restoration of physical comfort: Increases client’s receptiveness Pharmacologic –Some medications dull mental ability, impair concentration General Considerations 36/39 Pg 057

37. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Gerontology –Older adults: Past experiences; lose ability to hear –Hearing-impaired adults: Stethoscope –Speaking into the bell; magic slate –Chalkboard; flash cards; writing tablets –Choose printed materials: Portray people of similar age; sufficient size; black print on white matte paper –Healthy older adults: Cognitive ability; own pace General Considerations 37/39 Pg 057

38. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Gerontology (cont’d) –Learning motor skills: Physiologic changes; more time –Foundation of positive nurse–client relationship: Appreciation –Identify hidden or unspoken message: Fear, concern –Introductory phase: Take time; listen actively; take ample time to response –Short-term memory impairment: Clarify questionable information General Considerations 38/39 Pg 057

39. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation NOW ENCLEX By: P.K. Williams, RN 39/39 pkwilliams@DNI.edu