INDEX

SL.NO
.

CONTENTS

I.

INTRODUCTION

II.

COMMUNICATION

PAGE NO.

Meaning
Definition
Purpose
Levels of communication
Basic elements in comunication process
Models of communucation
Forms/Types of communication
Principles of comunication
Factors influencing comunication
Barriers of communication
Elements of professional communication
Communication techniques
Therapeutic communication techniques
Non-therapeutic comunication techniques
Adapting communication techniques for
clients with special needs.
How communication skills help Nurses.

INTERPERSONAL RELATIONSHIP
III.

Meaning
Factors influencinf Nurse-Patient relationship
Principles of IPR
Characteristics of IPR
Phases of IPR
Model representing human-human relationship

CONCLUSION
IV.

BIBLIOGRAPHY

V.

COMMUNICATION
INTRODUCTION

Communication is the basic element of human interactions that allows people to

establish ,maintain and improves contacts with others.It constitutes the foundation of
interaction among humanbeings. Communication is a lifelong learning process for the
nurse.They interact with many persons in the course of their profession.Nursing is a
communicative intervention and the foundation of nursing lies in the communicative
attitude.This attitude is manifested in the striving for mutual understanding, coordination
and co-action.
Nurses communicate with people under stress: clients,families and colleagues.Nurse
function as members of interdisciplinary teams who may have different ideas about priorities
of care.Being assertive to communicate ones own needs ensures balance in a nurses life. As
nurses refine their communication skills and increase their confidence,they can progress
professionally to become experts.Competency in communication helps the nurse maintain
effective relationship within the entire sphere of professional practice and helps meet
legal,ethical and clinical standards of care.Failure to effectively communicate causes serious
difficulty,increases liability, and threatens professional credibility.
MEANING - Communication
The word communication originates from Greek word communis, meaning to
make common. It is the transmission and receiving information,feelings and or attitudes with
the overall purpose of having understood.In short, it is the process of passing messages,ideas,
facts, opinions, attitudes, information and understanding from one person to another.
DEFINITION
According to Paul Leagens, it is a process by which two or more people exchange
ideas , facts,feelings or impressions in ways that each gains a common understanding of
meaning,intent and use of a message.
According to Aristotle,communication is a means of persuation to influence the other
so that the desired effect is achieved.
Communication is the process of passing information and understanding from one
person to another.It is essentially a bridge of meaning between people.By using this bridge of
meaning a person can sefely cross the river of misunderstanding that seperates all people.
(Prof Dasguptha)
Sending,giving or exchanging ideas and information ,which is often expressed
nonverbally or verbally.(Webstar)
PURPOSES

To develop information and understanding

To foster an attitude necessary for motivation,cooperation,and job satisfaction
To discourage the spread of misinformation,rumours, gossips and to relief the
emotional tension of workers.
3

To encourage ideas and suggestions from subordinates for an improvement in the

product and working condition.
To improve relationships.
To ensure free exchange of information and ideas.
To maintain social relation among human beings.

LEVELS OF COMMUNICATION
Nurse use different levels of communication in their professional role.The nurses
communication skills need to include techniques that reflects competence in each level.
1.Intrapersonal communication:
Intrapersonal communication is a powerful form of communication that occurs with in
an individual.This level is also called self-talk, self-verbalization, and inner thought (Balzer
Rily,2000). Peoples thoughts strongly influence perceptions,feelings,behaviour and selfconcept.Intrapersonal communication creates a set of conditions through which life is
experienced.Nurses should be aware of the nature and content of their own thinking and try to
replace negative, self-defeating thoughts with positive assertions. For example, guided
imagery can be used to enhance coping and reduce stress. Nurses and clients can use
intrapersonal communication to develop self-awareness and a positive self-concept that will
enhance appropriate self expression.
2.Interpersonal Communication:
Interpersonal communication is one-to-one interaction between the nurse and another
person that often occurs face to face. It is the level most frequently used in nursing situations
and lies at the heart of nursing practice.It takesplace within a social context and includes all
the symbols and cues used to give and receive meaning.Meaningful interpersonal
communication results in echange of ideas,problem soving,expression of feelings,decision
making,goal accomplishment, team building and personal growth.
3. Transpersonal communication:
Transpersonal communication is interaction that occurs within a persons spiritual
domain. Many persons use prayer,meditation,guided reflection,religious rituals,or other
means to communicate with their higher power. Nurses who value the importance of
human spirituality often use in this form of communication with clients and for themselves.
4. Small-Group Communication:
Small-Group Communication is interaction that occurs when a small number of
persons meet together.This type of communication is usually goal directed and requires an
understanding of group dynamics.When nurses work on commities,lead client support
group,form research teams or participate in client care conferences, a small-group research
teams or participate in client care conferences, a small- group communication process is used.
5.Public Communication:
4

Public communication is interaction with an audience.Nurses have opportunities to

speak with groups of consumers about health-related topics, present scholarly work to
colleagues at conferences, or lead classroom discussions with peers or students.Effective
public communication increases audience knowledge.Public communication requires special
adaptations in eye contact,gestures, voice inflection and use of media materials to
communicate message effectively.
BASIC ELEMENTS OF THE COMMUNICATION PROCESS.
Communication is an ongoing ,dynamic, and multidimentional process. Its basic
elements are: Referent,Sender,Message, Channel, Receiver, Feedback. This simple linear
model represents a very complex process but helps the nurse identify its essential
components.

Interpersonal
variables

Channel

Referent

Referent

Message

Sender

Receiver

Feedback

Communication process

Referent:
The referent motivates one person to communicate with one another .In health care setting,
sights ,sounds ,odours ,time schedules, messages, objects, emotions, sensations, perceptions,
ideas and other cues initiates communication.
5

Sender(source):
The sender is the person who encodes and delivers the message. Ideas or purposes must be
encoded (transformed) in to the form of a message through perceiving, thinking, reasoning,
judging, speaking, writing, drawing, gesturing, demonstrating etc. to attain the desired
response from the receiver.
Messages (content):
The message is the content of the communication.It may contain verbal, non-verbal, and
symbolic language. A Message is the information/desired behaviour in physical form which
the communicator transmit to his audience to receive, understand, accept and act upon.
Nurses can effectively send messages by expressing themselves clearly,directly and in a
manner familier to the receiver.
Components of a message:
a. message code any group of symbols that can be structured in a way that is meaningful to
same person, eg. Language.
b. message content The material in the message. i.e., selected by the source to express his
purpose.
c. Message treatment decisions which the communication source makes in selecting,
arranging both codes and contents.
Channels (Medium):
Channels are means of conveying and receiving messages through visual, auditory and
tactile senses. By channel is implied the Physical bridge or the media of communication
between sender and receiver. The more channels the sender uses to convey a message,the
more clearly it is usually understood. The total communication effort is based on the three
media systems:
a. Interpersonal communication: i.e., face to face communication most common channel of
communication. The encoding function is performed and channelled directly by the
intellectual,sensory and motor skills of the source. Eg. Vocal mechanism for Oral
communication , posture-gesture for non-verbal communication.
b. Mass media: via TV, radio, printed media etc.
c. Traditional or folk media: Every community has its own network of traditional, or folk
media such as folk dances , singing, dramas and religious meetings.

Receiver (audience):

Receiver is the person who receives messages from the sender,decodes, interprets the
meaning and gives feedback.
Feedback (effect):
Feed back is the message returned by the receiver to sender ie, the reaction of the
message.It indicates whether the meaning of the senders message was understood. Senders
need to seek verbal and non-verbal feedback to ensure that good communication has
occurred. To be effective, sender and the receiver must be sensitive and open to each others
messages,clarify the messages and modify behaviour accordingly.
Interpersonal variables:
Interpersonal variables are factors within both the sender and receiver that influence
communication. Perception is one such variable that provides a uniquely personal view of
reality formed by ones expectations and experiences. Each person senses, interprets, and
understands events differently. Other interpersonal variables include educational and
developmental levels,sociocultural backgrounds, Values and beliefs, emotions, gender,
physical health status, roles and relationships. Variables associated with illness, such as pain,
anxiety and medications effects can also affect nurse-client communication.
Environment:
The environment is the setting for sender-receiver interaction. For effective
communication ,the environment should meet participant needs for physical and emotional
comfort and safety. Noise, temperature extremes, distractions, and lack of privacy or space
may create confusion ,tension and discomfort. Environmental distractions are common in
health care settings and can interfere with messages sent between people ,so nurses must try
to control the environment to create a favourable conditions for effective communication.
MODELS OF COMUNICATION
1. Shannons model of communication process (1948)
Message
Information source

Receiver

Transmitter

Destination

Noise source

Shannons model of communication process is a general model of the process. This model
breaks the process of communication into eight descrete components.
An information source. Presumably a person who creates a message.
The message , which is both sent by the information source and received by the
destination.
A transmitter :A simplest transmission system, that associates with face-face
communication, has atleast two layer of communication.
7

The signal which flows through a channel.

A carrier or channel which is represented by the small unlabelled box in the middle of
the model.
Noise in the form of secondary signals that confuse the signal carried.
A receiver
A destination,a person who consumes or processes the message.
2. Aristotle triad of communication(350 BC)
According to Aristotle, three elements that ensure effective communication are
a. speaker
b.subject
c.audience
Speaker

Goal

Subject

Persuation

Audience

The credibility, knowledge, skills of speaker,the topic of conversation, and the interest of
benefit to the audience, all affect the communication process.However the audience
ultimately determines whether the communicatin takes place or not.
3. The linear model (Telegraph model) 1948:
In this model,communication is the transfer of information from one point to the next.

Message sent

Sender

Message sent

Channel

Receiver

Transmitter

Destination

Noise source

The goal of communication in this model is maximum line capacity with minimum
distortion noise is anything that interferes with the transfer of the message. To improve
communication, decrease interference or noise.
4. The technology model of communication
Human beings themselves have a fixed rate at which information can be transferred.
In this model,when the information sent is the same as the information
received,communication has taken place.
Eg. A nurse receives an order for Pantocid 40mg IV, and administer Pantocid 40mg IV.

Message send

Message received

Pantocid 40mg IV

Pantocid 40mg IV

5. Interactional Model (1950s)

This is a circular model of communication ,in which the message is send and received
,encoded and decoded ,and interpreted ,by both the sender and receiver. The encoding and
interpreting of message by both sender and receiver started to get recognised.In this
communication model, the cycle is not completed until sender response to the receivers
feedback.

Message

.Encoder

.Decoder
.Receiver
.
Interpren
er

.Sender
.
interpret
er

Message

6. SMCR Model (Berlo, 1960)

Encoding

Decoding

Source

Message

Channel

Receiver

Attitude

Content

Hearing

Attitude

Structure

seeing

Knowledge

Social

code

Touching

Social

culture

Symbol

Tasting

Knowledge

skills

Smelling

Culture
Skills

In this source Message-Channel-Receiver (SCMR) model by Berlo, the linear telegraph

model of communication becomes more complex.
According to Berlo,
The sender encodes the message through his speaking and writing skills.The receiver decodes
the message through his listening and reading skills. Both sending and receiving are
influenced by knowledge,attitude,experience and skills and affected by the channel through
9

which the message is sent. The sender encodes the message through the use of symbols
through a channel such as speaking,writing etc. The receiver receives the message through
the channel of listening,reading etc.Interpretation is the receivers understanding of the
message.
FORMS OF COMMUNICATION / TYPES OF COMMNICATION
1. One-way communication(Didactic Method):
The flow of communication is one-way from the communicator the receiver. Eg.
Lecture method.
Advantages:
It is considerably faster than two-way communication.
Appears neat and efficient to an outsider observer.
Sender is more psychologically comfortable.
Plan- fullness, order,systemization are associated with.
Disadvantages:
Knowledge is imposed.
Learning is authoritative.
Little audience participation.
No feedback
Little influence on human behaviour.
2. Two way communication (Socratic Method):
Both sender and receiver takepart. The process of learning is active and democratic.
It is more likely to influence behaviour than one-way communication. It is relatively noisy
and disorderly with people interrupting the sender and one-another; sender finds him/herself
psychologically under attack because his receivers pickup mistakes.
3. Verbal communication:
Verbal communication uses spoken or written words. Verbal language is a code that
conveys specific meaning as words are combined. The most important aspects of verbal
communication are:
i. Clarity and brevity: Clarity can be achieved by speaking slowly, and enunciating clearly
and using examples to make explanations easier to understand. Brevity is achieved by using
short sentences and words that express an idea simply and directly.
ii. Vocabulary: Instead of using purely technical words, use local words, synonyms to
technical words for understanding the patients. When a nurse cares for a client who speaks an
other language, an interpreter may be necessary.
iii. Denotative and connotative meaning: A single word can have several meanings. A
denotative meaning is one shared by individuals who uses common language that is used to
define a word that it means the same to everyone. A connotative meaning is the shade or
interpretation of a words meaning influenced by the thoughts, feelings, or ideas people have
about the word.
iv. Pacing: Conversation is more successful at an appropriate speed or pace. Nurses should
speak slowly enough to enunciate clearly.
10

v. Intonation: Tone of the voice dramatically affects a messages meaning. Depending on

intonation, even a simple question or statement can express enthusiasm, anger, concern or
indifference .The nurse must be aware of voice tone to avoid sending unintended messages.
vi. Timing and relevance: Timing is critical in communication. Even though a message is
clear ,poor timing can prevent it from being effective. For example, the nurse should not
begin routine teaching when a client is in severe pain. If messages are relevant or important
to the situation at hand, they are more effective.
4. Non - verbal Communication:
Non-verbal communication includes all of the five senses and everything that doesnot
involve the spoken or written word. It is common that non-verbal communication is
consciously motivated and may more accurately indicate a persons intended meaning than the
spoken words(Stuart and Laraia,2001). Personal appearance, facial expression, posture and
gait, eye contact, gestures, sounds, touch and vocal tone are the powerful ways people convey
messages to others. Territoriality and personal space is important . During interpersonal
interaction, people maintain varying distances between each other.
ZONES OF PERSONAL SPACE
Intimate zone (0- 18 inches):
Holding a crying infant, Performing physical assessment ,
Bathing,grooming, dressing,feeding and toileting a client.
Personal zone (18 inches to 4 feet
Sitting a clients bedside, Taking clients history,Teaching an individual client.
Social zone (4 to 12 feet)
Making rounds with a physician, sitting at the head of a conference table,
conducting a family support group.
Public zone (12 feet and greater)
Speaking at a community forum, Lecturing to a class of students.
ZONES OF TOUCH
Social zone (Permission not needed)
Hands,arms, shoulders,back
Consent zone (permission needed)
Mouth,wrist,feet
Vulnerable zone (special care needed)
Face,neck,front of body
Intimate zone (great sensitivity needed)
Genitalia, rectum.
5. Symbolic communication:
Good communication requires awareness of symbolic communication,the verbal and
non-verbal symbolism used by others to convey the meaning.Art and music are forms of
symbolic communication that may be used by the nurse to enhance understanding and
promote healing.Dreams, drawings, a childs play and even the symptoms of illness are all
symbolic forms of self-expression that have rich messages for health care providers.
6. Metacomunication:

11

Metacommunication is important to effective interpersonal interaction. It is

communication about communication so that the deeper message within a message can
be uncovered and understood (Wood, 1999).It is the comment on the content and nature of
the relationship between persons involved.It is the message that conveys senders attitudes,
feelings, and intentions to the listener; may be verbal or non-verbal. Eg., smiling when angry
OTHER FORMS OF COMMUNICATION
1. Formal communication: It follows lines of authority. ie, it is an officially organised
channel of communication.
2. Informal Communication: Friends,interest groups,like-minded group, casual groups etc.
communication is very faster here than the formal group.
3. Serial communication: Person to person the message will be passed like a chain. Sender
passes the message to one person, then the receiver passes information to other and so on.
4. Physiological communication: If a stimuli received by the body,immediately the brain
receives the information and transmits to the respective organs through the neurons where it
has to be passed.
5. Psychic communication: In this extra sensory perception occurs. i.e, something which
will occur in future.The person perceives and predicts that in advance is called psychic
communication.
6. Interpersonal communication: It is the exchange of ideas between two persons.
7. Visual communication: It comprises charts, graphs, tables, maps, posters, etc.
8. Telecommunication and internet/ mechanical communication: It is the process of
communication over distance using electromagnetic instruments designed for this purpose.
Radio, TV, internet etc.
PRINCIPLES OF COMMUNICATION
There are few basic principles of communication.
Communication should have objective and purpose.
Should be appropriate to situation.
Systematic analysis of the message, i.e, the idea, the thought to be communicated ,
so that one is clear about it.
Selection and determination of appropriate language and medium of communication
according to its purpose.
Organizational climate , including appropriate timing and physical setting to
convey the desired meaning of the communication.
Consultation for planning of communication; involves special preparation.
Message should convey something of value to the receiver in the light of his needs
and interest.
The communication action following a communication is effective communication
as it speaks more than his/her words.
The sender has to understand receivers attitude and reaction by careful, alert and
proper listening to ensure that the desired meaning of the message has been
comprehended by the receiver.
Credibility is very important.
12

Communication programme should make use of existing facilities to the great extent
possible and should avoid challenging them unnecessarily.

FACTORS INFLUENCING COMMUNICATION

1. Perceptions: It is the personal view of events, ie. Each person senses, interprets and
understands the events differently; it is formed by experience and expectations.
2. Values: These are standards that influence behaviour; what person considers important in
life and thus influence expression of thoughts and ideas.
3. Emotions: Subjective feelings about events.The way a person communicates with others is
influenced by emotions.
4. Socio-subjective feelings about events: Culture is the sum total of the learned way
doing,feeling and thinking.
5. Knowledge: Knowledge of handling different level persons is essential for
communication.
6. Role and relationships: Communication is more effective when the participants remain
aware of their role in a relationship.
7. Environment: Warm and comfortable environment facilitates good communication.
8. Space and territoriality: Territoriality is the drive to gain, maintain and defend an
exclusive right to an area of space. It provides people with a sense of identity, security and
control.
BARRIERS OF COMMUNICATION
It denotes the factors which causes communication as a failure; can be classified as;
1. Physical/environmental barriers Noise, invisibility, environmental and physical
discomfort, distraction and ill health,climate,time,place,medium etc.
2. Personal barriers Language, mental status, personality complexes,bias and prejudice,
impatience, inhibition attitude etc.
3. Physiological barriers Difficuties in health , expression ,moods attitudes,relationships,
disease conditions etc.
4. Psychological barriers Prejudices, inattention, disinterest, feeling of anxiety and
unfulfilled curiosity, level of intelligence, comprehension difficulties.
5. Cultural barriers Language variation, customs, believes, religion, attitude etc.
(differences between urban education and education)
6. Background barriers previous learning , cultural background , previous environment of
working etc.
ELEMENTS OF PROFESSIONAL COMMUNICATION
Professional appearance ,demeanor ,and behaviour are important in establishing the
nurses, trustworthiness and competence.
Courtesy :
Common courtesy is part of professional communication. To practice courtesy ,
the nurse says hello and goodbye, knocks on doors before entering and uses selfintroduction. The nurse also states his or her purpose , addresses people by name,
13

says please and thank you to team members, and apologizes for advertently making an
error or causing someone distress.
Use of Names :
Self-introduction is important. The nurses failure to give a name ,indicate
status(e.g., registered nurse or licenced practical nurse) or acknowledge the client can
create uncertainity about the interaction and convey an impersonal lack of
commitment or caring.Addressing others by name conveys respect for human dignity
and uniqueness.Avoid terms of endearment such as honey, dear, grandma or
sweetheart. Avoid referring to clients by diagnosis, room number, or other attribute ,
which is demeaning and sends the message that the message that the nurse doesnot
care enough to know the person as an individual.
Privacy and confidentiality:
Maintaining confidentiality is an important aspect of professional behaviour. It is
essential that the nurse safeguard the clients right to privacy.Gossiping about others
violates nursing ethical codes and practice standards. Respect for clients is
demonstrated when the nurse treats others with dignity and maintains their physical
emotional privacy.
Trustworthiness
Trust is relying on someone without doubts or question.Being trustworthy
means helping others without hesitation when help is needed.To foster trust, the nurse
communicates warmth and demonstrates consistency,reliability ,honesty and
competence.
Autonomy and Resposibility
Autonomy is the ability to be self-directed and independent in accomplishing
goals and advocating for others.Professional nurse make choices and accept
responsibilities for the outcomes of their actions(Townsend,2003). They take initiative
in problem solving and communicate in a manner that reflect what they really need
and want(Burden,1997).
Assertiveness
According to Darley (2002) assertiveness comprises respect for others,respect
for yourself,self awareness and effective,clear and consistent communication.
Assertiveness conveys a sense of self assurance while also communicating respect for
the other person (Stuart and Laraia,2001). The advantages of assertive behaviour
include the following (Balzer Riley,2000)
It is more likely you will get what you want when you ask for it.
People respect clear,open,honest communication.
You stand up for your own rights and experience self-respect.
You avoid the invitation of aggression when the rights of others are violated.
You are more independent.
You become a decision maker.
You feel more peaceful and comfortable with yourself.
Nurses can teach assertiveness skills to others as a means for promoting personal
health.
COMMUNICATION TECHNIQUES
14

In carrying out any plan of care, nurses need to use communication techniques that
are appropriate for clients individual needs. It is necessary to learn the communication
techniques that serve as a foundation for professional communication.
1. Therapeutic communication techniques
2. Non-therapeutic communication techniques
1. Therapeutic communication techniques
Therapeutic communication techniques are specific responses that encourages the
expression of feelings and ideas and convey the nurses acceptance and respect. Learning
these techniques helps the student develop awareness of the variety of nursing responses
available for use in different situations. Tremendous satisfaction will result as therapeutic
relationships and outcomes are achieved.
a) Active listening: Active listening means to be attentive to what the client is saying both
verbally and non-verbally. Active listening facilitates client communication. Several
non-verbal skills have been identified as facilitative skills for attentive listening. They
can be identified by the acronym SOLER (Townsend,2003):
S sit facing the client. This posture gives the message that the nurse is there to listen
and is interested in what the client is saying.
O observe an open posture (ie. Keep arms and legs crossed).This posture suggests
that the nurse is open to what the client says.
L Lean toward the client. This posture conveys that the nurse is involved and
interested in the interaction.
E Establish and maintain intermittent eye contact. This behaviour coveys the nurses
involvement in and willingness to listen to what the client is saying. Absence of eye
contact or shifting of the eyes gives the message that the nurse is not interested in
what is being said.
R Relax. It is important to communicate a sense of being relaxed and comfortable
with the client. Restlessness communicates a lack of interest and may also convey a
feeling of discomfort that may be transferred to the client.
b) Sharing observations : Nurses makes many observations by commending on how the
other people looks, sounds or acts. Stating observations often helps the client
communicate without the need for extensive questionning,focusing or clarification.This
technique help start a conversation with quit or withdrawn persons. Eg: The nurse
interpreting fatigue as depression or assuming that untouched food indicates lack of
interest in meeting nutritional goals. You look tired, You seem different today
or I see you havent eaten anything.
c) Sharing empathy: Empathy is the ability to understand and accept another persons
reality,to accurately perceive feelings and to communicate this understanding to the
other. Eg: the nurse might say to an angry client who has low mobility after stroke: It
must be very frustrating to know what you want and not be able to do it.
d) Sharing hope: Nurses recognise that hope is essential for healing and learn to
communicate a sense of possibility to others.Appropriate encouragement and positive
feedback are important in fostering hope and self-confidence and for helping people
achieve their potential and reach their goals. Eg: The nurse might say to a client
discouraged about a poor prognosis. I believe you will find a way to face your
situation, because I have seen your courage and creativity in the past.
15

e) Sharing humour: Humour is an important but underused resource in nursing

interactions.Humour has positive effects on both a persons psyche and physiology.
Laughter signifies positive events to people; it may contribute to feelings of
togetherness, closeness and friendliness.Further more, humour tends to minimise the
effect of negative factors and protects from difficulties.
f) Sharing feelings : Emotions are subjective feelings that result from ones thought and
perceptions.Feelings are not right,wrong, good or bad ,although they may be pleasant or
unpleasant.If feelings are not expressed, stress and illness can occur.Nurses can help
clients express emotions by making observations, acknowledging feelings, encouraging
communication,giving permission to express negative feelings and modelling healthy
emotional self-expression.
g) Using touch: Touch is one of the nursess most potent forms of communication. Nurses
are previlaged to experience more of this intimate form of personal contact than almost
any other professional. Many messages such as affection, emotional
support,encouragement,tenderness and personal attention are conveyed through touch.
h) Using silence: Silence can prompt people to talk.Silence allows clients to think and gain
insight,its the time sort out feelings,think how to say things,and consider what has been
communicated. The nurse should allow the client to break the silence,particularly when
the client has initiated it. It become therapeutic during times of profound sadness or
grief.
i) Providing information: Providing relevant information tells other persons what they
need or want to know so they can make decisions,experience less anxiety, and feel safe
and secure.Clients have a right to know about their health status and what is happening
in their environment.
j) Clarifying: To check whether understanding is accurate, the nurse can restate an unclear
or ambiguous message to clarify the senders meaning.
k) Focussing: Focusing is used to centre on key elements or concepts of a message. If
conversation is vague or rambling or clients begin to repeat themselves,focussing is a
useful technique.
l) Paraphrasing: Paraphrasing is restating anothers message more briefly using ones
words. Through paraphrasing, nurse sends feedback that lets the client know that the
client is actively involved in the search for understanding.
m) Asking relevant questions : Nurse ask relevant questions to seek information needed for
decision making.Ask only one question at a time and fully explore one topic before
moving to another area.Open-ended questions allows the client to take the
conversational lead and introduce pertinent information about a topic.
n) Summarizing: summarising is a concise view of key aspects of an interaction.It brings a
sense of satisfaction and closure to an individual conversation and is helpful in
termination of nurse-client relationship.
o) Self-disclosure: Self disclosures are subjectively true, personal experiences about the
self and are intentionally revealed to another person.The nurse may choose to share
experiences or feelings that are similar to those of the client and may emphasize both the
similarities and differences.
p) Confrontation: To confront someone in a therapeutic way, the nurse helps the other
person become more aware of inconsistencies in his/her feelings,attitudes,beliefs and
16

behavious. This technique improves clients self-awareness and helps the client recognise
growth and deal with important issues. This should be use only after trust has been
established. Eg: You say youve already decided what to do,yet youre still talking a lot
about your options.
2. Non-Therapeutic communication techniques
Certain communication techniques can hinder or damage professional relationships.
Nontherapeutic techniques tends to discourage further expression of feelings and ideas and
may discourage further expression of feelings and ideas and may engender negative
responses or behaviours in others.
a) Asking personal questions : Asking personal questions that are not relevant to the
situation, simply to satisfy the nurses curiosity , is not appropriate professional
communication. Eg. Why dont you and John get married?
b) Giving personal opinions: If I were you, Id put your mother in a nursing home.
When the nurse gives a personal opinions it taking decision making away from the
client .Personal opinions differ from professional advice.At times client needs
suggestions and help to make choices.
c) Changing the subject: Lets not talk about your problems with the insurance
company.Its time for your walk. Changing the subject when another person is trying
to communicate something important is rude and shows a lack of empathy.It blocks
the further communication and the communication is interrupted and the client may
fail to openly express feelings..
d) False reassurance: Dont worry,everything will be allright. When a client is
seriously ill or distressed,the nurse may be tempted to offer hope to the client with
statements such as You will be fine. Offering reassurance not supported by facts or
based in reality can do more harm than good.
e) Sympathy: Sympathy is concern,sorrow, or pity felt for the client generated by the
nurses personal identification with the clients needs.
f) Asking for explanation: Why are you so anxious? A nurse may be tempted to ask
the other person to explain why the person believes, feels or has acted in a certain
way.
g) Approval or disapproval: Judgemental responses by the nurse often contains terms
such as should,ought,good,bad, right or wrong. Approving implies thet the behaviour
being praised is the only acceptable one. Disapproving implies that the clients must
meet the nurses expectations or standards. Eg. You shouldnt even think about
assisted suicide,its not right .
h) Defensive response: No one here would intentionally lie to you. Becoming
defensive in the face of criticism implies the other person has no right to an opinion.
To discover reasons for the clients anger or dissatisfaction, the nurse must listen
uncritically.By avoiding defensiveness the nurse can defuse anger and uncover deeper
concerns.
i) Passive or aggressive responses: Things are bad,and theres nothing I can do about
it. Passive responses serve to avoid conflict or sidestep issues.They reflect feelings of
sadness,depression, anxiety, powerlessness and hopelessness. Aggressive response
provoke confrontation at the other persons expense.They reflect feeling of anger,
frustration, resentment, and stress.
17

j) Arguing: How can you say you didt sleep a wink, when I heard you snoring all
night long? Challenging or arguing against perceptions denies that they are real and
valid to the other person.They imply that the other person is lying, misinformed or
uneducated.The skilful nurse can give information in a way to avoid argument.
Adapting communication techniques for the clients with special Needs
Communicating with older adults who have communication Needs/Barriers
Always start the communication process by checking for a hearing aid.
Amplify your voice if necessary.
Get the clients attention before speaking.Face them so that they can see
your mouth.
Structure the environment so it is conducive to good communication.
Minimise visual and auditory distractions.Make sure there is adequate
lighting.
When caring for elderly clients with communication disorders,remember
their deficit.
Dont expect to communicate in the same way as you would with a
nonimpaired person.Instead,act as a communication partner whose job is
to facilitate the clients self-expression and comprehension.
Speak slowly and clearly while maintaining eye contact.Use short
sentences with simple words.
Supplement your words with simple gestures.
Summarise the most important points of the conversation.
Give clients plenty of time to ask and answer questions.
Be a good listener despite time constraints that makes listening difficult.
Strict to one topic at a tie.
Whenever possible, have a family member or caregiver in the room with
you.This person will usually be most familiar with the clients
communication patterns and can assist in the communication process.
Communicating with clients who cannot speak clearly(Aphasia, dysarthria,
muteness)
Listen attentively, be patient and dont interrupt.
Ask simple questions that require yes or no answers.
Allow time for understanding and response.
Use visual cues (e.g., words,pictures and objects) when possible.
Allow only one person to speak at a time.
Donot shout or speak too loudly.
Encourage the client to converse.
Collaborate with speech therapist as needed.
Use communication aids:
Pad and felt-tipped pen or Magic slate
Communication board with commonly used words,letters,or
pictures denoting basic needs.
Cal bells or alarms
Sign language
Use eye blinks or movements of fingers for simple responses (yes or no)
18

 Communicating with clients who are cognitively impaired

Reduce environmental distractions while conversing

Gets clients attention prior to speaking

Use simple sentences and avoid long explanations

Ask one questions at a time

Allow time for client to respond

Be an attentive listener
Include family and friends in conversations,especially in subjects known to
client.
Communicating with clients who are unresponsive
Call client by name.
Communicate both verbally and by touch
Speak to client as though he/she could hear.
Explain all procedures and sensations.
Provide orientation to person,place and time.
Avoid talking about client to others in his or her presence.
Communicating with clients who donot speak English
Speak to client in normal tone of voice (shouting may be interpreted as anger)
Establish method for client to signal desire to communicate (call light or bell)
Provide an interpreter(translator) as needed
Avoid using family members,especially children as interpreters.
Develop communication board,pictures or cards.
Translate words from native language into English list for client to make basic
requests.
Have dictionary (English/Spanish and so forth) available if client can read.
HOW COMMUNICATION SKILLS HELP NURSES?
A critical component of nursing practice is the ability to communicates effectively. It
helps nurses in many ways:
General trust between nurse and clients.
Provides professional satisfaction.
Is a means for bringing about change , ie, nurse listens,speaks and acts to negotiate
changes that promotes clients well-being.
Is the foundation of the relationship between the nurse and other members of the
health team.
Helps to promote managerial efficiency.
Provides basis for leadership action.
Provides means of co-ordination.

INTERPERSONAL RELATIONSHIP
The nurse is an important member of the health care team that must work in cooperation and harmony for the care of the patient.This co-operation and harmony depends
upon the interpersonal relationship that is maintained among the members of the health care
team.
Meaning:
19

The interpersonal relationship is Any of all behaviour which a person undertake in the
presence of others.(Jerald)
It is the learning experience where by two people interact to face an immediate health
problem to share if possible in reserving it into adopt a situation.
Factors influencing Nurse-Patient Relationship

Personal experience

Specific health oriented experience

General life experience

Essentials if IPR
1.Effective and efficient communication
2.Non-verbal communication which is appropriate to the situation
Principles of IPR
1) Learn everyones name and never address anyone by nickname.
2) Respect everyones individuality.Each member of a team is important as the other.
3) Do not impose anything on anybody.
4) Keep emotion under control.
5) Dont be afraid to admit ignorance.
6) Do not give and take personal favour.
7) The team leader should not make any excuse regarding his or her responsibility.
8) Develop habit on listening and focus attention on the problem.
9) Do not say or do anything that will disturb others faith.
10) Give importance to others and practice justice.
11) The members of team should be loyal,honest,dependable and willing to carry out the
directions of the team leader.
12) There should be team spirit or team feeling among the members. Each member should
work for the interest of the group.
13) There should be mutual understanding between the members.There should be willing
to give and take corrections.
14) There should be delegation or responsibility in a group and every member should
carry out his/her responsibility to the satisfaction of the group.
15) The relationship between the members of a group should be decent and considerate.
16) Teach the newcomer about the job.Make sure that all the assignments are understood.
17) The newcomer of the group should feel at home where he joins the group.
18) Establish a good rapport among the members in order to achieve the aim.
19) Every member should be familiar with the organisations plan and policies of the
group.
20) Be upto date with the information that is going around.
21) Avoid arguments in the group.
22) Talk in terms of other mans interest.
23) Praise the slightest improvement made by others.Use words of encouragement.
24) Have a smile face always.
25) Prepare yourself mentally to accept the worst if necessary.
Characteristics of IPR
20

Helping relationship is a therapeutic relationship in nursing which promotes a

psychological climate that brings a positive change in the client and promote his group.
i.
Facilitative characteristics
ii.
Action orientation
i. Facilitative characteristics
They are essential messages for the nurses to establish positive and supportive
relationship with the client.These are conditions that create an emotional environment in
which a patient feel comfortable and safe.
Trust
Empathy
Caring
Autonomy and mutuality
Geniuses
Non-possesssive warmth
ii. Action orientation
These are conditions that assist a person to move towards his goals.Action oriented
characteristics are used on the nurse patient relationship to progress beyond the initiation
process.
Concreteness in communication
Immediacy
Sensitive confrontation
Phases of IPR
The nurse client relationship is therapeutic, not social in nature.It is always client
centered and goal directed. It is objective rather than subjective. The indent of a professional
relationship is for client behaviour to change.The phases of a helping relationship includes:
1. Pre-interaction phase
2. Orientation phase
3. Working phase
4. Termination phase
1. Pre-interaction phase/pre-orientation phase:
Before meeting the client,the nurse :
Gathers data about the client, reviewing available data including the clients condition,
medical and nursing history.
Talks to other caregivers who may have information about the client.
The nurse also utilizes the process of autodiagnosis to determine his/her own
perceptions , a commitment to non-judgementalism and the avoidance of stereotyping
are imperative.
Anticipates health concerns or issues that may arise.
Identifies a location and setting that will foster comfortable ,private interaction.
Plan enough time for the initial interaction.
2.

Orientation phase:
The nurse and client meet and get to know one another.
The nurse Sets the tone for the relationship by adopting a warm,empathetic,caring
manner.
21

 The purpose of orientation phase is to become acquainted with the client, gain
rapport, demonstrate genuine caring and understanding and establish trust.
This phase usually lasts 2 to 10 sessions but with some clients can take many months.
The nurse closely observes the client and expects to be closely observed by the client.
Begins to make inferences and form judgements about client messages and behaviour.
Assess the clients health status, prioritise the clients problems and identifies the
clients goals.
Clarifies the clients and nurses roles.
Lets the client know when to expect the relationship to be terminated.
3. Working phase
The nurse and the client work together to solve problems and accomplish goals.
The purpose of this phase is to bring about positive changes in the clients
behaviour ,with focus on the here and now.
Working phase ideally begins when the client assumes responsibility to uphold the
limits of the relationship.
Adjustments may have to be made ,depending on the clients length of stay.
In this phase, the nurse:
Encourages and helps the client to express feelings about his or her health.
Provide information needed to understand and change behaviour.
Encourages and helps the client to set goals.
Uses therapeutic communication skills to facilitate successful interactions.
Uses appropriate self-disclosure and confrontation.
4. Termination phase
The ending of the relationship.
The purpose of this phase is to dissolve the relationship and assure the client that
she/he can be independent in some or all of his/her functioning.
Ideally, termination phase begins during the orientation phase.
The nurse reminds the client that termination is near.
Termination normally occurs when the client has improved sufficiently for the
relationship to end, but it may also occur if a client is transferred or you as a nurse
leave the facility.
The nurse evaluate the goal achievement with the client.
The nurse achieves a smooth transition for the client to other caregivers as needed.
Model representing human-human relationship
The model represents the interaction between the nurse and patient or recipient of
her care.The major characteristics of this experience is that the nursing needs of the
individual is met.The half circle at the point of original encounter indicates the possibility of
and need for developing encounter in to therapeutic relationships. As the interaction process
progresses towards rapport, the circle joints in to one full circle, representing that the
potential for a therapeutic relationship has been attained.
The human to human relationship in nursing situation is the means through
which the purpose of nursing is accomplished.The human to human relationship is
established when the nurse and the recipient of her care attain a rapport after having
22

progressed through the stage of the original encounter,emerging identities,empathy and

sympathy.

Rapport

Nurse

Nurse and
patient

Patient

sympathy
Patient

Nurse
Empathy

Nurse

Patient
Emerging identities

Nurse

Patient
Original encounter

Human

Human

CONCLUSION
Considerable thought and attention have been given to the subject to
interpersonal relationship. It has become a fad lately for almost everyone to consider himself
an expert on that subject.Only a responsible and highly motivated individual can help in
meeting the fundamental needs and healing processes of others. There are other motivating
influences in selecting a helping or healing profession.This interpersonal relationship is
primarily an experiences or series of experience between nurse and patient. The major
characteristics of these experiences is that the nursing needs of the individual are met.

BIBLIOGRAPHY
1. Potter Patricia A., Perry Anne Griffin, Fundamentals of Nursing, 6 th edition, Elsevier
Publications, Page no.425-444.

23

2. Park.K, Preventive and social Medicine, 19 th edition,Bhanot publications, page no.707709.

3.Basheer S.P , A concise textbook of Advanced Nursing Practice(2013), Emmes medical
Publishers, Page no.551-560.
4. Samta Soni, Text book of Advanced Nursing Practice(2013), Jaypee Publications, page
no.134-149.

24