Hospital….

• A part of social system

• Dealings with Professionals – Nurses, doctors, technicians,

paramedics Other personnel – housekeeping, dietary, laundry,

supplies, accounts… Clients, relatives, friends visitors, other customers

• All lead to public relations within the hospital

Public relations spring from human relations

• Client – a bundle of expectations, anxieties, hopes and fears

- Wants effective & satisfactory services - Forms impressions of the hospital set up

• Health workers – Have personal and professional needs

- Want job satisfaction & recognition of their efforts

• Hospital administration – Wants efficiency and maximum satisfaction of staff and patients

The ultimate outcome depends on ‘Human Relations’

HUMAN RELATIONS IN NURSING

PROFESSIONALS IN HEALTH TEAM

Nursing teamPhysicians

Physical therapist

Pharmacist Lab technologist

Nutritionist

Occupational therapist

Radiologist

DieticianImmunologist

Respiratory therapist

Spiritual advisorsSocial workers

The nurse in the health team

• Health team - A group of people who coordinate their particular skills in order to assist a client or his family, to achieve optimum health

• The quality and quantity of personnel in the health team will depend upon the needs of the client

The nurse is an important member of the health team

Relationship of nurse with the members of health team

Nurse and the Physician

• Have team spirit & co-worker relationship

• Be loyal, honest and dependable

• Carry out instructions intelligently

• DO NOT take verbal orders.

Nurse & Nursing superintendent

• Respect & cooperate

• Reporting punctually

• Maintain courtesy when taking ward rounds

• Take assistance for problem solving

Nurse and the Head nurse

• Head Nurse is the team leader

• Respect & support her

• Cooperate intelligently

• Reporting on duty and leaving off duty

• Hand over & take over important issues

Nurse and fellow nurses

• Treat seniors with respect

• Maintain good team work/ spirit

• Share information to achieve best care of the sick

• Correctly hand over and take over patient concerning information

Nurse and other hospital personnel

• Maintain good relationship with all departments

• Maintain smooth coordination between patient unit and the departments

Nurse and the non professional workers

• Be decent & considerate

• Maintain good relationship

• Provide guidance and teaching

Nurse and the Client

• Treat as an individual• Understand and help• No discrimination. • Do not accept any gifts/ favours.• Help to adjust, cooperate and accept treatments• Create confidence. Establish good N-Pt relationship.

Call by name.. Be pleasant, cheerful and courteous• Do not get too familiar. Do not discuss personal

affairs.

Therapeutic nurse-client relationship (TNCR)

• The core of nursing• Nurses use their knowledge, skill and

judgment• Applies to all nurses in all roles and practice

settings Therapeutic communication Client-centered care Maintaining boundaries Protecting the client from abuse

Complaints by clients and community

Complaints Situations

Indifferent care

Unfriendly behaviour of staff

Lack of ‘human touch’

Poor quality care Quality of linen, diet, equipment, facilities, cleanliness etc

Lack of information & guidance About facilities & staff Oral information, sign posting, boards

Lack of comforts Chairs, benches, drinking water, toilets….

Delays at almost every step

Overcrowding

Noise pollution

Poor sanitation

The ‘Human touch’..or ‘No touch’?

Types of the Relationship

Social

Friendship

Companion

Use small talk

superficial

Intimate

Emotional commitment

May be sexual/

emotional

Intimacy

Therapeutic

Focus on client needs

Experiences,

Feelings, ideas

Goal oriented

Traits of Therapeutic Communication

• GenuinenessGenuineness

• Positive Regard (acceptance)Positive Regard (acceptance)

• EmpathyEmpathy

• TrustworthinessTrustworthiness

• ClarityClarity

• ResponsibilityResponsibility

• AssertivenessAssertiveness

Indicators of Therapeutic Communication

• Introduce self to client (by name and category)• Provide for expression of feelings by the client• Ensure privacy of information• Be aware of verbal and non-verbal communication• Modify communication style• Anticipate and provide care

• Recognize that all behaviour has meaning and seek to understand the cause

• Understand and respect the client

• Involve client in planning of care

• Provide information to promote client choice

• Enable the client to make informed decisions

Maintaining Boundaries

Boundary

Nurse Client

Maintain Boundaries in the therapeutic nurse patient relationship

• Develop and follow plan of care with the client• Recognize when boundaries are being crossed• Set and maintain the appropriate boundaries within

the relationship• Abstain from disclosing personal information unless

it meets the therapeutic need of the client• Ensure that nursing strategies promote health and

well being of the client

Obstacles to the Therapeutic Relationship:

• Inappropriate Boundaries • Encouraging dependence• Non acceptance/Avoidance• Resistance

Role of nurse – Teacher, Caregiver, Advocate, counselor

Crossing Boundaries

Boundary

Nurse Client

Principles of IPR in Nursing

• Learn everyone’s name• Respect everyone’s individuality• Do not impose anything on anybody• Keep emotions under control• Do not fear to admit ignorance• Do not give and take personal favour• Team leader should be responsible• Develops habits of listening• Do not say hurtful things• Be loyal, honest, dependable and willing • Maintain a ‘team spirit’ • Have mutual understanding among members

Phases of the Nurse-Client Relationship

• Self assessment - examine own feelings, fears, anxieties.

Pre-Orientation

Orientation

• Introductory Phase

- establish trust, share information with client, discrete self-disclosure.

convey support, facilitate healing,

educate

The Working Phase

• Problems identifiedExploration- guide client to examine

feelings/responses, develop new coping skills

Termination Phase

• Resolution phase- Examine goals achieved

- Explore feelings regarding termination

- Establish plan for continuing assistance

Communicating with the client is important!

We’re moving you from intensive

care to intensive billing

Non Verbal Communication

• Eye Contact, body Language, facial Expressions, Eye Contact, body Language, facial Expressions, silence, vocal cuessilence, vocal cues

• Space (comfort zone)Space (comfort zone)• Touch ( action/personal space – used cautiously)Touch ( action/personal space – used cautiously)• Appearance – communicates a particular image/one’s Appearance – communicates a particular image/one’s

mental status ( use of clothing, make-up etc.)mental status ( use of clothing, make-up etc.)

Be aware of own non-verbal cues!!Be aware of own non-verbal cues!!

Active Listening!!

• S – Sit facing the clientS – Sit facing the client

• O – Open PostureO – Open Posture

• L – Lean forward towards clientL – Lean forward towards client

• E – Establish eye contactE – Establish eye contact

• R- Relax!!R- Relax!!

Conditions Affecting Communication

• Values• Attitudes• Beliefs• Perceptions• Culture or Religion• Social Status• Gender• Age or developmental level• Environment

Enhancing Communication

• SilenceSilence• Support/reassuranceSupport/reassurance• Sharing Sharing

ObservationsObservations• Acknowledge Acknowledge

feelingsfeelings• Broad – open ended Broad – open ended

statementsstatements• Information givingInformation giving• InterpretationInterpretation

• Restating• Reflecting• Clarification• Confrontation• Offering Alternatives• Voicing doubt• Role-playing• Use of Humor – use

cautiously/discretely

Non-therapeutic communication

• Advising• Agreeing• Belittling feelings• Challenging• Defending• Disagreeing• Disapproving • Probing

Caring for clients from different socio-cultural backgrounds

• Important !! – Analyze self! – know your own beliefs/values/customs/behaviors

• Avoid being judgmental

• Rules for communication vary since they arise from cultural norms!

• Understand differences in communication among various cultures

• Ask families for assistance regarding their culture

• Reflect on your emotions/journal write feelings

Therapeutic communications ?

1. The nurse is meeting a new client on the unit.Which action, by the nurse, is most effective in initiating the nurse-client relationship?

A. Introduce self and explain the purpose and the plan for the relationship.

B. Describe the nurse’s family and ask the client to describe his/her family.

C. Wait until the client indicates a readiness to establish a relationship.

D. Ask the client why he/she was brought to the hospital.

2. Mrs. F. has remained close to the nurse all day. When the nurse talked with other clients during dinner, Mrs. F. tried to regain the nurse’s attention and began to shout, “You’re just like my mother. You pay attention to everyone but me!” The best interpretation of this behavior is that

A. Mrs. F. is exhibiting resistance.

B. Mrs. F. has been spoiled by her family.

C. The nurse has failed to meet Mrs. F’s needs.

D. Mrs. F. is demonstrating transference.

3. The nurse is caring for a rural client who says, “I don’t want you to touch me.I’ll take care of myself.” Which nursing response is most therapeutic?

A. “Okay, if that’s what you want.I’ll just leave this cup for you to collect your urine.”

B. “If you don’t want our care, why did you come here?”C. “Why are you being so difficult? I only want to help you.”D. “It sounds as though you want to take care of yourself.

Let’s work together so you can do things for yourself.”

4. The client says to the nurse “I am going to die, I wish my family would stop hoping for a cure! I get so angry when they carry on like this! After all, I’m the one who’s dying.” The most therapeutic response is:

A. “You’re feeling angry that your family continues to hope for you to be cured.”

B. “I think we should talk more about your anger with your family.”

C. “Well, it sounds like you’re being pessimistic. After all, years ago people died of pneumonia.”

D. “Have you shared your feelings with your family?”

5. The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbor says to the nurse, “How is Carol doing? She is my best friend and is seen at your clinic every week.” The most appropriate nursing response is which of the following?

A. “I’m not supposed to discuss this, but because you are my neighbor, I can tell you that she is doing great!”

B. I’m not supposed to discuss this, but because you are my neighbor, I can tell you that she really has some problems!”

C. “If you want to know about Carol, you need to ask her yourself.”

D. “I cannot discuss any client situation with you.”

6. The nurse is preparing the client for the termination phase of the nurse-client relationship. Which nursing task is most appropriate for this phase?

A. Identifying expected outcomes

B. Planning short term goals

C. Making appropriate referrals

D. Developing realistic solutions

8. A client looks at a mirror and cries out, “I look like a bird. This is not my face.” The nurse responds therapeutically by saying:

A. “What kind of a bird do you think you are?”

B. “That must be very distressing to you, your face does not look different to me.”

C. “Maybe the light is playing tricks on you.”

D. “Why do you think that you look like a bird?”

9. A 32 year old mother of 2 young children diagnosed with cervical cancer with metastasis, tells her nurse “I’m going to die, aren’t I ?” The nurse’s most appropriate response would be:

A. “No, you are not . After all you are receiving the latest treatment available, and your doctor is one of the best in this area.”

B. “We are all going to die sometime.”C. “What did your doctor tell you?”D. “I don’t know. You have a serious illness. Do you have

feelings that you would like to talk about?”

10. A client relates angrily to the nurse that his wife says he is selfish. Which response by the nurse would be most helpful?

A. “That’s just her opinion.”B. “I don’t think that you are selfish.”C. “Everyone is a little bit selfish.”D. “You sound angry – tell me more about what

happened.”

11. The most therapeutic response a nurse could make to a student who begins to cry upon learning that a failing grade was received on a final exam is:

A. “You’ll make it next time.”

B. “Failing an exam is an upsetting thing to happen.”

C. “How close were you to passing?”

D. “It won’t seem so important 5 years from now.”

ThanQ