Communication

refers to the reciprocal exchange of ideas, belief, attitude or

feelings between or among persons
• Modes of Communication
– Verbal
– Non-verbal
– Meta communication
 Elements of Communication
• SENDER – originator of information
• MESSAGE – information being transmitted
• RECEIVER – recipient of information
• CHANNEL – mode of communication
• FEEDBACK – return response
• CONTEXT – the setting of communication
 Criteria of Successful Communication

• Feedback
• Appropriateness
• Flexibility
• Efficiency
Common Problems in Communication

• dysfunctional communication
• double bind communication
• differences between the denotative and
connotative meaning
• incongruent communication
  
Privacy and Respecting Boundaries

• Proxemics - is the study of distance zones between

people during communication
• Intimate zone
• Personal zone
• Social zone
• Public zone

• The therapeutic communication interaction is most

comfortable when the nurse and client are 3 to 6
feet apart
• • Intimate zone (0 to 18 inches between people): This amount of
space is comfortable for parents with young children, people who
mutually desire personal contact, or people whispering. Invasion
of this intimate zone by anyone else is threatening and produces
anxiety.
• • Personal zone (18 to 36 inches): This distance is comfortable
between family and friends who are talking.
• • Social zone (4 to 12 feet): This distance is acceptable for
communication in social, work, and business settings.
• • Public zone (12 to 25 feet): This is an acceptable distance
between a speaker and an audience, small groups, and other
informal functions
 5 types of touch:
• Functional-professional touch is used in
examinations or procedures such as when the
nurse touches a client to assess skin turgor or a
masseuse performs a massage.

• • Social-polite touch is used in greeting, such as

a handshake and the “air kisses” some women
use to greet acquaintances, or when a gentle
hand guides someone in the correct direction.
 5 types of touch:
• • Friendship-warmth touch involves a hug in
greeting, an arm thrown around the shoulder of a
good friend, or the back slapping some men use
to greet friends and relatives.

• • Love-intimacy touch involves tight hugs and

kisses between lovers or close relatives.

• • Sexual-arousal touch is used by lovers.

• Active listening means refraining from other
internal mental activities and concentrating
exclusively on what the client says.

• Active observation means watching the

speaker’s nonverbal actions as he or she
communicates.
 Nurse Patient Relationship
• Elements
– Trust
– Rapport
– Unconditional positive regard
– Setting limits
– Therapeutic communication
 TRUSTING BEHAVIORS
• Friendliness
• Caring
• Interest
• Understanding
• Consistency
• Treating the client as a human being
• Suggesting without telling
• Approachability
• Listening
• Keeping promises
• Providing schedules of activities
• Honesty
• Phases
– Pre-interaction Phase
– Orientation Phase
– Working Phase
– Termination Phase
 When to terminate NPR
• When the goals have been accomplished
• When the patient is emotionally stable
• When the patient exhibits greater
independence
• When the patient able to cope with anxiety
separation, fear and loss
How to terminate
1.gradually decrease interaction
2.focus on future oriented topics
3.encourage expression of feelings
4.make the necessary referral
Principles of Care in Psychiatric Settings

• the nurse views the patient as a holistic

human being with interdependent and
interrelated needs
• the nurse accepts the patient as a unique
human being with inherent value and worth
exactly as he is
Principles of Care in Psychiatric Settings

• the nurse should focus on the patients

strengths and assets and not on his weakness
and liabilities
• the nurse views the patient’s behavior non-
judgmentally, while assisting the patient to
learn more adaptive ways of coping
Principles of Care in Psychiatric Settings

• the nurse should explore the patient’s

behavior for the need it is designed to meet
and the message it is communicating
• The nurse has the potential for establishing
nurse-patient relationship with most if not all
patients.
Principles of Care in Psychiatric Settings

• the quality of the nurse patient relationship

determines the degree of change that can
occur in the patient’s behavior
 Levels of Interventions in Psychiatric
Nursing
1. PRIMARY – interventions aimed at the promotion of mental health and
lowering the rate of cases by altering the stressors
 Examples: health education, information dissemination, counseling

2. SECONDARY – interventions that limit the severity of a disorder

 2 Components: case finding, prompt treatment
 Examples: crisis intervention, administration of medications

3. TERTIARY – interventions aimed at reducing the disability after a disorder

 2 Components: prevention of complication, active program of rehabilitation
 Examples: alcoholics anonymous, occupational therapy
 CARPER’S PATTERNS OF NURSING
KNOWLEDGE
• Empirical knowing (obtained from the science of nursing)
• Client with panic disorder begins to have an attack. Panic attack will raise pulse
rate.

• Personal knowing (obtained from life experience)

• Client’s face shows the panic.

• Ethical knowing (obtained from the moral knowledge of nursing)

• Although the nurse’s shift has ended, she remains with the client.

• Aesthetic knowing (obtained from the art of nursing)

• Although the client shows outward signals now, the nurse has sensed previously
the client’s jumpiness and subtle differences in the client’s demeanor and
behavior.
POSSIBLEWARNINGS OR SIGNALS OF ABUSE
OF THE NURSE–CLIENT RELATIONSHIP
• Secrets, reluctance to talk about the work being
done with clients
• Sudden increase in phone calls between nurse
and client or calls outside clinical hours
• Nurse making more exceptions for client than
normal
• Inappropriate gift-giving between client and nurse
• Loaning, trading, or selling goods or possessions
POSSIBLEWARNINGS OR SIGNALS OF ABUSE
OF THE NURSE–CLIENT RELATIONSHIP
• Nurse disclosure of personal issues or information
• Inappropriate touching, comforting, or physical
contact
• Overdoing, overprotecting, or over-identifying
with client
• Change in nurse’s body language, dress, or
appearance (with no other satisfactory
explanation)
• Extended one-on-one sessions or home visits
 METHODS TO AVOID INAPPROPRIATE
RELATIONSHIPS BETWEEN NURSES AND CLIENTS
• Realize that all staff members, whether male or
female, junior or senior, or from any discipline,
are at risk of over-involvement and loss of
boundaries.
• Assume that boundary violations will occur.
Supervisors should recognize potential
“problem” clients and regularly raise the issue
of sexual feelings or boundary loss with staff
members.
 METHODS TO AVOID INAPPROPRIATE
RELATIONSHIPS BETWEEN NURSES AND CLIENTS
• Provide opportunities for staff members to discuss
their dilemmas and effective ways of dealing with
them.
• Develop orientation programs to include how to set
limits, how to recognize clues that the relationship is
losing boundaries, what the institution expects of
the professional, a clear understanding of
consequences, case studies, developing skills for
maintaining boundaries, and recommended reading.
 METHODS TO AVOID INAPPROPRIATE
RELATIONSHIPS BETWEEN NURSES AND CLIENTS
• Provide resources for confidential and
nonjudgmental assistance.
• Hold regular meetings to discuss inappropriate
relationships and feelings toward clients.
• Provide senior staff to lead groups and model
effective therapeutic interventions with
difficult clients.
 METHODS TO AVOID INAPPROPRIATE
RELATIONSHIPS BETWEEN NURSES AND CLIENTS

• Use clinical vignettes for training.

• Use situations that reflect not only sexual
dilemmas but also other boundary violations
including problems with abuse of authority
and power.