Communication & Nurse Patient Relationship

COMMUNICATION & NURSE PATIENT RELATIONSHIP

Helping relationship	Social relationship
Helper takes responsibility for conduct of the relationship.	Both parties have equal responsibility for the conduct of the relationship.
Has specific purpose and health related goals.	May or may not have specific purpose and goal.
Self-disclosure is limited for the helper, encouraged for the help.	Self-disclosure for both parties in the relationship is expected.
Understanding should always put into words.	Understanding does not necessarily need to be put into words.
Terminates when the identified goal is met.	Relationship can last a lifetime or terminate without goal achievement.
Focus of relationship is on needs of the person receiving help.	Needs of both partners should receive equal attention.
Relationship is entered through necessity.	Entered spontaneously.

Helping relationship (NPR):

·         Foundation to clinical practice.

·         Created through the nurses application of scientific knowledge, understanding of human behaviour and communication to caring.

·         It exists among people who provide and receive assistance in meeting human needs.

·         Nurse client relationship is the “learning experiences whereby two people interact to face an immediate health problem, to share, if possible, in resolving it and to discover ways to adapt to the situation”.

Goals:

·         Increased independence for the person.

·         Greater feeling of worth.

·         Improved physical wellbeing.

Characteristics of helping relationship:

·         Dynamic.

·         Purposeful and time limited.

·         Person providing assistance assumes a dominant role.

Dimensions of helping relationship:

·         Professionalism.

·         Courtesy.

·         Confidentiality.

·         Trust: Travelbee (1971) defined trust as the assured belief that other individuals are capable of assisting in times of distress and will probably do so.

·         Empathy: According to Egan (1998) empathy is the intellectual correctly another person's emotional state and point of view.

·         Caring: Caring is basic to helping relationship. Caring is shown by

§  -accepting patients.

§  -respecting them as individuals.

§  -promoting trust and decreasing anxiety.

·         Autonomy and mutuality: Autonomy is an ability to be self-directed. Mutuality involves sharing with another.

§  Nurse and client work in partnership, participating in care.

§  Nurse offers opportunities to make decisions.

§  Nurse can act as an advocate to keep person informed of care alternatives and gives support in decision making.

     Phases of a helping relationship:

1.       Pre-interaction phase

2.       Orientation phase

3.       Working phase

4.       Termination phase

    Pre-interaction phase:

·         Reviews available data, including medical and nursing history.

·         Plans for the initial interaction.

·         Collects information from other health team members.

    Orientation phase:

·         Also, known as introductory phase.

·         This begins as soon as the nurse and patient meet.

·         Three stages of introductory phase are:

§  Opening the relationship

§  Clarifying the problem

§  Structuring and formulating the contract

E.g.: Nurse: ‘Good morning, Ms. X, My name is Y. I am a student nurse and I will be involved in looking after you today/ this week’.

      Opening the relationship:

·         Identify each other by name

·         Explain the role of nurse

·         Help the patient to express concerns and reasons for seeking help

·         Provide environment with minimal distractions

      Clarifying the problem:

·         Nurse begins to assess health status.

·         Through observation and interaction, the nurse make diagnostic conclusion.

·         Individual goals may be simple like moving without discomfort, choosing foods which will be easily tolerated.

·         Nurse uses communication techniques towards awareness of problem, focus on the nature of problem, explore potential solutions.

·         Sometimes the aim of interaction is mutual sharing of information, thoughts and feeling rather than identification of problem.

·         Develop plan of action.

        Structuring and formulating the contract:

·         Includes obligations to be met by both patient and nurse.

·         Elements in the agreement include:

·         Purpose of the relationship

·         Location, frequency and length of contact

·         During of the relationship

·         Maintaining trust:

·         Resistive behaviors

·         Testing behaviors

Characteristics of trusting relationship:

·         Feeling of comfort.

·         Acceptance of others.

·         Openness to new experiences.

·         Consistency between words and actions.

Working phase:

·         The relationship broadens and becomes more flexible as the nurse and patient / client are more willing to share and discuss problems.

·         Nurse encourage open expression of feelings.

·         The main aim of this phase is to achieve the set goals.

·         Nurse and patient work together to meet the physical and psychosocial needs.

·         Take actions to meet the goals.

·         Evaluate the nursing care.

·         Identify and solve the new problems.

·         Ultimately the client must make decisions and take action to become more effective.

·         The responsibility for action bc10Jygs to the client.

·         The nurse collaborates the decisions, provides support, and offer options or information.

·         Nurse requires the following skills for this phase:

§  Empathetic listening and responding

§  Respect

§  Genuineness

§  Concreteness

§  Confrontation

         Termination phase:

·         Termination occurs when the goals are achieved.

·         Patient and Nurse will verbalize feelings about the termination openly and honestly.

         How to enhance the relationship:

·         Be warm and encouraging.

·         Show strength and confidence.

·         Be consistent and dependable.

·         Restrain your own personal needs.

·         Be open to change within the relationship.

·         Stay flexible.

·         Show caring and understanding.

·         Respond therapcutically.

Elements of professional communication:

·         Courtesy

·         Use of names

·         Privacy and confidentiality

·         Trustworthiness

·         Autonomy and responsibility

·         Assertiveness

Ways of effective communication with team members:

Nurse and the patient:

·         Treat him/ her as an individual.

·         Help him to overcome his fears and anxiety.

·         Help him to adjust to the routines of the new environment and help him to co-operate and accept treatment.

·         Create confidence in the patient.

         The nurse and the nusing superintendent:

·         Respect her and give the full co-operation.

·         Orders of the ward supplies and equipment should be placed to her.

          Head nurse and the departmental sister:

·         Head nurse is the in charge of a particular ward of department.

·         Attitude of the nurse to her supervisor should be of respect, enthusiastic support and intelligent co-operation.

       Nurse and other hospital personnel:

·         Good relationship between the personnel of different departments must be maintained.

·         Co-ordinate with other departments.

Nurse and other non-professional workers:

Give them necessary guidance to carry out their function.

      Patient teaching:

·         T: tune into the patient

·         E: edit patient information

·         A: act on every teaching moment

·         C: clarify often

·         H: honor the patient as a partner in the education process

Teaching & Learning:

·         Teaching is a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors or perform new skills.

·         Learning is the purposeful acquisition of  new knowledge, attitudes, behaviour and skills.

Patient teaching:

Patient teaching is any set of planned, educational activities designed to improve patients health behaviors, health status or both. Activities designed to aimed at improving knowledge of the patients.

Importance of patient teaching:

·         Shorter hospital stay

·         Consumer awareness

·         Ensure continuity of care

·         Clients right to know the care

·         Improve quality care

·         Decrease patient anxiety

·         Promote adherence to health care treatment plan

·         Reduce the complications of illness

·         Maximize independence in the perfomance of ADL

    Purposes of patient teaching:

·         Maintenance and promotion of health and illness prevention.

·         Restoration of health.

·         Coping with impaired functioning.

    Teaching and Nursing Process:

Teaching	Nursing Process
Collect data; analyze client’s learning strengths and deficits.	Collect data; analyze client’s strengths and deficits.
Make educational diagnosis	Make nursing diagnosis
Prepare teaching plan ·         Write learning outcomes ·         Select content and time frame ·         Select teaching strategies	Plan nursing goals and select interventions
Implement teaching plan	Implement nursing strategies
Evaluate client learning based on achievement of learning outcomes	Evaluate client outcomes based on achievement of goals

Integrating Patient Teaching and Nursing process:

Assessment:

·         Learning needs determine information that is critical for patients to learn.

·         Learning needs change, depending on patient's current health status.

a)       Assess the following to identify the learning needs:

·         Information or skills needed by the patient to perform self-care and to understand the implications of a health problem.

·         Patient experiences

·         Information that family caregivers require to support the patient's needs.

b)      Assess the following motivational factors:

·         Behavior (attention span, memory, ability to concentrate)

·         Health beliefs and socio cultural background influence a patient's beliefs and values about health and various therapies, communication pattern etc.

·         Desire to learn

·         Attitudes about health care providers

·         Learning style preference

c)       Ability to learn:

Assess the following factors:

·         Physical strength is the extent to which one can perform skills.

·         Sensory deficits

·         Patient's reading level

·         Patient's developmental level

·         Pain, fatigue, anxiety or other physical symptoms that interfere with the ability to maintain attention.

d)      Learning environment:

Assess the following factors:

·         Distractions or persistent noise

·         Comfort of the room including ventilation, temperature, lighting, furniture

·         Room facilities and available equipment.

e)   Resources for learning:

Assess the following:

·         Patient's willingness to have family caregivers involved in the teaching plan and provide health care.

·         Family caregiver's perceptions and understanding of the patient's Illness.

·         Family caregiver's willingness and ability to participate in patient care.

·         Resources (financial and material)

·         Teaching tools including audiovisual materials or posters.

2.      Nursing diagnosis:

·         Deficient knowledge related to ……………….

·         Noncompliance………..

·         Ineffective therapeutic regimen management

·         Ineffective self-health management

3.      Planning:

^·          Developing learning objectives

·         Setting priorities

·         Timing

·         Organizing teaching material

·         Selection of teaching methods

Implementation:

Maintaining learning attention & participation

Building on existing knowledge

Approaches: telling, selling, participating, entrusting, reinforcing.

1.       Telling:

· It is useful when limited information must be taught (eg: preparing a client for emergency procedure)

· When using telling, the nurse outlines the task to be done by the client.

· There is no opportunity for feedback.

2.       Selling:

·         This approach uses two-way communication.

·         Nurse paces instruction based on the client’s response.

·         Specific feedback is given to the client who in learning (Learns procedure step by step).

3.       Participating:

·         Participating involves the nurse and client setting objectives and becoming involved in the learning process together.

·         There is opportunity for discussion, feedback, mutual goal setting and revision of the teaching plan.

4.       Entrusting:

·         It provides the client opportunity to manage self-care.

·         Responsibilities are accepted, and the client performs tasks correctly and consistently.

·         The nurse observes the client's progress and remain available to assist without intro using more new information.

5.       Reinforcing:

·         It is the use of a stimulus that increases the probability for a response.

·         A learner who receives reinforcement before or after a desired learning behavior is likely to repeat the behavior.

·         Reinforces are positive or negative. Positive reinforcement like smile or spoken approval. Negative reinforcement like frowning, critizing.

·         Three types of reinforces:

o   Social – smile, compliments, words of encouragement

o   Material – food, toys etc.

o   Activity – chance to go outside

Instructional methods:

·         One to one discussion

·         Group discussion

·         Demonstrations

·         Role play.

Teaching tools for instruction:

·         Printed materials

·         Non-print materials

Evaluation

Repeat teaching if necessary