Professional Nursing Relationships - Communication and Relational Practice Flashcards
In such relationships, the nurse assumes the role of professional helper and comes to know the patient as an individual who has unique health care needs, human responses, and patterns of living.
Helping relationships
The nurse establishes, directs, and takes responsibility for the interaction, and the patient’s needs take priority over the nurse’s needs. The relationship is also characterized by the nurse’s nonjudgemental acceptance of the patient.
Nurse-Patient Helping Relationships
___ conveys a willingness to hear a message or to acknowledge feelings. It does not mean you always agree with the patient or approve of the patient’s decisions or actions.
Acceptance
A helping relationship between nurse and patient does not just happen; you create it through care, skill, and the development of ___.
trust
Characterized by a natural progression of four goal-directed phases: preinteraction, orientation, working, and termination phases.
Nurse-patient helping relationship
Phases within this relationship often begin before the nurse meets the patient and continue until the caregiving relationship ends.
Nurse-patient helping relationship
Even a brief interaction can exhibit an abbreviated version of the four phases of this relationship. For example, the student nurse gathers patient information to prepare in advance for caregiving, meets the patient and establishes trust, accomplishes health care-related goals through use of the nursing care process, and says goodbye at the end of the shift or when the patient leaves the unit.
Nurse-patient helping relationship
Before meeting the patient, the nurse accomplishes the following tasks:
- Reviews available data, including the medical and nursing history
- Talks to other caregivers who may have information about the patient
- Anticipates health care concerns or issues that may arise
- Identifies a location and setting that will foster comfortable, private interaction with the patient
- Plans enough time for the initial interaction
Preinteraction phase
When the nurse and patient meet and get to know one another, the nurse accomplishes the following tasks:
- Sets the tone for the relationship by adopting a warm, empathetic, caring manner
- Recognizes that the initial relationship may be superficial, uncertain, and tentative
- Expects the patient to test the nurse’s competence and commitment
- Closely observes the patient and expects to be closely observed by the patient
- Begins to make inferences and form judgements about patient messages and behaviours
- Assesses the patient’s health status
- Prioritizes the patient’s problems and identifies the patient’s goals
- Clarifies the patient’s and nurse’s roles
- Negotiates a contract with the patient that specifies who will do what
- Lets the patient know when to expect the relationship to be terminated
Orientation phase
When the nurse and patient work together to solve problems and achieve goals, the nurse accomplishes the following tasks:
- Encourages and helps the patient to express feelings about his or her health
- Encourages and helps the patient to explore own feelings and thoughts
- Provides information that the patient needs to understand and to change behaviour
- Encourages and helps the patient to set goals
- Takes actions to meet the goals set with the patient
- Uses therapeutic communication skills to facilitate successful interactions
- Uses appropriate self-disclosure and confrontation
Working phase
During the ending of the relationship, the nurse accomplishes the following tasks:
- Reminds the patient that relationship termination is near
- Evaluates goal achievement with the patient
- Reminisces about the relationship with the patient
- Separates from the patient by relinquishing responsibility for his or her care
- Facilitates a smooth transition for the patient to other caregivers as needed
Termination Phase
An important initial component of interpersonal communication. It helps people get to know one another and relax. It is easy, superficial, and not deeply personal, whereas therapeutic interactions are often more difficult, intense, and uncomfortable.
Socializing
A nurse often uses ___ conversation to lay a foundation for a closer relationship, for example: “Hi, Mr. Simpson. I hear it’s your birthday today. Happy birthday!” A friendly, informal, and warm communication style helps establish trust, but nurses must get beyond ___ conversation to talk about issues or concerns affecting the patient’s health.
social x2
During social conversation, patients may ask personal questions about the nurse’s family, place of residence, and so forth. Students often wonder whether it is appropriate to reveal such information. The skillful nurse uses judgement about what to share and provides minimal information or deflects such questions with gentle ___ and refocuses conversation back to the patient.
humour
In a therapeutic relationship, nurses often encourage patients to share personal stories, which are called ___ interactions.
narrative
Through these interactions, such as reminiscing with patients, you begin to understand the context of patients’ lives and learn what is meaningful from their perspective. For example, a nurse asked a patient to tell about a time in his life when he had to make a difficult decision.
Narrative
“When I was a young man, I worked on the family farm. An uncle died and left me some money. All of a sudden, I could afford to go to university, but Dad didn’t want me to go because he needed me there. I had to decide whether to stay or go, and it was real hard because at first I just wanted to get away. I talked to our preacher, and he said it was up to me, to pray about it and do what my heart told me to. So I stayed. Oh, I’ve thought from time to time what I might have made of myself, but I never regretted it. I had a good life in farming.”
From this brief story, the nurse understood that it was important to the patient to put his family’s needs above his personal desires and that seeking ___ guidance was an important component of his decision making. This same information may not have been revealed had the nurse used a standard history that usually elicits only short answers.
spiritual
Promotes personal responsibility, enables self-expression and strengthens the patient’s problem-solving ability. In addition to patient-nurse communication, nurses also communicate collaboratively with the interprofessional team. These skills are highly consequential to patient outcomes.
Collaborative communication
Many elements of the nurse-patient helping relationship also apply to collegial relationships, which focus on accomplishing the work and goals at the point of care. Communication in such relationships may be geared toward team-building, facilitating group process, collaboration, consultation, delegation, supervision, leadership, and management. Nurses need a variety of communication skills, including presentational speaking, persuasion, group problem solving, providing performance reviews, and writing business reports.
Interprofessional Collaborative Practice (ICP) Relationships
Social and therapeutic interactions are needed between the nurse and members of the interprofessional team to build morale and strengthen relationships within the work setting. Within the interprofessional team, all members need friendship, support, guidance, and encouragement from one another to cope with the many stressors imposed by the demands of the health care context.
Interprofessional Collaborative Practice (ICP) Relationships
