Nursing is an Art is one of the major topics in Fundamental of Nursing. This focuses more on the tender loving care characteristics of a nurse.

1. NCM 122 Lec
Integral Aspects of Nursing

3. The Art
of
Nursing

4. XV.Nursing as an Art
A. Caring
1. Caring Practice Models
2. 6 C’s of Caring
3. Caring for Self and Others
B. Communicating
1. Process and Models
2. Therapeutic Communication
3. Helping Relationship
4. Communication and the
Nursing Process
C. Teaching
1. Health Promotion
2. Disease Prevention
3. Health Restoration and
Maintenance
4. Rehabilitation

8. Florence Nightingale
“The act of utilizing the environment
of the patient to assist him in his
recovery" (Nightingale, 1860).
Nightingale considered a clean, well-
ventilated, and quite environment
essential for recovery.

9. Virginia Henderson
"The unique function of the nurse is
to assist the individual, sick or well,
in the performance of those
activities contributing to health or
its recovery (or to peaceful death)".

10. American Nurses Association
(ANA) 1980
"Nursing is the
diagnosis and treatment
of human responses to
actual or potential
health problems".

11. Canadian Nurses Association
(CNA)
Described nursing practice as a
dynamic, caring, helping
relationship in which the nurse
assists the client to achieve and
obtain optimal health.

12. Certain themes are common to many of
these definitions
Nursing is caring.
Nursing is an art.
Nursing is a science.
Nursing is client centered.
Nursing is holistic.
Nursing is adaptive.
Nursing is concerned with health promotion,
health maintenance, and health restoration.
Nursing is a helping profession.

13. Client
centered
Holistic
ART
SCIENCE
Adaptive
concerned with health
promotion, health
maintenance, and health
restoration
Helping profession
CARING
? ?

14. THE NURSING PROFESSION ….AN ART
OR A SCIENCE?

15. The Nursing Profession has two different sides:
it is both Science and an Art

16. Nursing as a SCIENCE Let’s recall &
remember this!

17. Nursing as a SCIENCE
It is the “body of abstract knowledge”
arrived through scientific research and
logical analysis
Is the scientific knowledge and skills in
assisting individual to achieve optimal
health. It is the diagnosis and treatment
of human responses to actual or
potential problem.

18. The Nursing Profession has two different sides:
it is both Science and an Art

19. What is an ART?
the expression or application of human creative
skill and imagination, typically in a visual form
such as painting or sculpture, producing works
to be appreciated primarily for their beauty or
emotional power

20. What makes Nursing an ART?
The art of nursing may have been in each person
even before entering the profession. That innate
capacity to respond to the needs of individual is
already the art of nursing. In nursing school, this
vivacity is awakened through constant interaction
with the patients in various settings.
Nurses are called to perform relational work.
Therefore, the motivation to keep that art in us
should be continuously burning. We have the
power to heal the sick. An effective nurse is one
who gives nursing care independently and
collaboratively with other healthcare teams.

21. The art of nursing comes in as a nurse
independently does his or her job. The options
s/he considers in taking a certain action and
ultimately the action s/he does to respond to
patient needs are the art of nursing.
It is in the nurses’ hands to promote positive
changes in patients. Everyday we are faced with
patients who are in different conditions. In this
case, individualized nursing care is noteworthy.
Knowledge is not enough. Compassionate care is
paramount.
What makes Nursing an ART?

22. What makes Nursing an ART?
the art of nursing is our ability to connect with those around
us.
It is only when we begin direct patient care that we become
aware of the art of nursing.
The word art can be used to describe the results of a particular
task as well as the knowledge and skill required to perform
that task.
Like other more fashionable art forms, nursing can be
dramatic, inspirational, comedic, relaxing, comforting, joyful,
and even sad.
Nursing is also creative, existential, and has a particular
rhythm.
This intangible connection can create an environment of
healing, one that allows patients to fully participate in their
own recovery process.

23. What makes Nursing an ART?
Nurses teach, support, communicate, medicate,
and coordinate patient-care events.
Nurses are patient advocates who provide comfort
and hope to our patients and their families.
The art of nursing is in play when we just 'know'
what to do to meet a patient's emotional needs:
when to hold a patient's hand, stroke their brow,
crack a joke or even just sit and listen.
Most of this is being accomplished simultaneously
during each patient interaction.

24. What makes Nursing an ART?
“The science of nursing allows us to care for our patient's
bodies; but it's the art of nursing that calls me to the
profession and allows each nurse to touch souls.”

25. Nursing as an ART
“Nursing…its very essence lies in the creative
imagination, the sensitive spirit, and the
intelligent understanding that provides the very
foundation for effective nursing care”.
Donahue(1985)

26. Nursing as an ART
Is the art of caring sick and well
individual. It refers to the dynamic
skills and methods in assisting sick
and well individual in their
recovery and in the promotion and
maintenance of health. It involves
the creative application of
knowledge in the service of people

28. Identify the performances in the video that show
Nursing as a Science and as an Art.

29. Nursing is indeed an Art.

30. CARING

31. CARING
An Integral Aspects of Nursing

32. INTRODUCTION: Caring
In this age of technologic competence and efficiency, the knowledge and skills
embedded in caring practices are often overlooked.
Technology does not negate caring; in fact, the isolation that may accompany
technology makes the significance of caring all the more important (Diener &
Hobbs, 2012).
Caring is a dimension of human relating, and often referred to as the art of
nursing.
Smith (2013) proposes that nursing cannot exist without caring.
Caring is central to all helping professions, and enables people to create
meaning in their lives.
Caring is sharing deep and genuine concern about the welfare of another
person.

33. Caring Practice
•
➢involves connection, mutual recognition, and involvement between
nurse and client.
➢Examples of caring, emerging from nursing situations:
• A client experiencing postoperative pain is given medication to
control her symptoms, and then the nurse talks quietly and holds her
hand for a few minutes as the pain resolves. The nurse’s presence, in
itself, provides comfort for the client.
• After the student nurse washes the hair of an older woman who is
immobilized and applies her makeup, she helps the woman into a
wheelchair to greet her daughter and grandchildren. The woman
is extremely grateful and her sense of dignity is enhanced by this
personal care.

34. ➢Just as clients benefit from caring practices, the nurses involved
in these situations experience caring through knowing that they
have made a difference in their clients’ lives.
➢When nurses feel free to concentrate their attention on others,
they can make a positive difference to clients.
➢The ability to give clients focused attention means leaving the
egocentric self behind.
Caring Practice

35. ❑Milton Mayeroff (1990), a noted philosopher, has proposed that to care for
another person is to help him grow and actualize himself.
❑Caring is a process that develops over time, resulting in a deepening and
transformation of the relationship. Recognizing the other as having potential
and the need to grow, the caregiver does not impose direction, but allows the
direction of the other person’s growth to help determine how to respond.
❑Mayeroff (1990) defines major ingredients of caring that provide structure and
further description of this process:
1. Knowing means understanding the other’s needs and how to respond to
these needs;
2. Alternating rhythms signifies moving back and forth between the
immediate and long-term meanings of behavior, considering the past;
3. Patience enables the other to grow in his own way and time;
4. Honesty includes awareness and openness to one’s own feelings and a
genuineness in caring for the other;
Caring as “Helping the Other Grow”

36. 5. Trust involves letting go, to allow the other to grow in his own way and own
time;
6. Humility means acknowledging that there is always moreto learn, and that
learning may come from any source;
7. Hope is belief in the possibilities of the other’s growth; and
8. Courage is the sense of going into the unknown, informed by insight from
past experiences.
➢ Mayeroff (1990) proposes that the caring process has benefits
for the one giving care thru:
✓ helping the other person grow, the caregiver moves toward self-actualization.
✓ caring and being cared for, each person “finds his place” in the world.
✓ serving others through caring, individuals live the meaning of their own lives.
Caring as “Helping the Other Grow”

37. ❑Caring is at the heart of nursing’s identity; indeed, the root of the word nursing
means “nurturance” or “care” (Smith, 2013).
❑ Nurse scholars have reviewed the literature, conducted research, and analyzed
nurses’ experiences, resulting in the development of theories and models of
caring.
❑These theories and models are grounded in humanism and the idea that caring
is the basis for human science.
❑Each theory develops different aspects of caring, describing how caring is unique
in nursing.
❑Several nursing theorists focus on caring:
▪ Culture Care Diversity and Universality (Leininger)
▪ Theory of Bureaucratic Caring (Ray)
▪ Caring, the Human Mode of Being (Roach)
▪ Nursing as Caring (Boykin and Schoenhofer)
▪ Theory of Human Care (Watson)
▪ Theory of Caring (Swanson)
NURSING THEORIES ON CARING

39. Awareness of one’s relationship to others, sharing their
joys, sorrows, pain, and accomplishments. Participation
in the experience of another.

40. Having the “knowledge, judgment, skills, energy, experience and
motivation required to respond adequately to the demands of one’s
professional responsibilities.”

41. Comfort with self, client, and others that allows one to build
trusting relationships.

42. Morals, ethics, and an informed sense of right and
wrong. Awareness of personal responsibility.

43. The deliberate choice to act in accordance with one’s desires as
well as obligations, resulting in investment of self in a task or
cause.

44. Appropriate bearing, demeanor, dress, and language that are in
harmony with a caring presence. Presenting oneself as someone who
respects others and demands respect.

45. RECLAIMING THE ART AND IMAGE OF
NURSING:
Participation in Healing Relationships.

46. REMEMBERING OUR HERITAGE….
THE ART AND SCIENCE OF CARING

47. NURSING AS A CALLING
⚫ Pittman (1985) in her article “goodbye
Florence,” stated that nurses’ struggle
for status has ended the age of
Florence nightingale.
⚫ Could it be that what nurses need to
gain status is to embrace the visionary
genius of Florence nightingale?

48. WHICH IMAGE………..?

49. “THE SEX OBJECT”
Portrayed as “sensual, romantic, hedonistic,
frivolous, irresponsible, promiscuous
individual” (Kalisch & Kalisch, 1982).
WHICH IMAGE………..?

50. A SACRED TRUST.
⚫ It was Florence Nightingale who created the
“art and science” model of professional
nursing practice and entrusted it to future
generations.
⚫ It is up to the nurses of the 21st Century to
ensure that the art of nursing is not
sacrificed at the altar of the gods of science
and technology, fiscal restraint and
bureaucracy.

51. THE NURSE- A RARE COMBINATION OF ARTIST,
SCIENTIST AND HEALER.

52. MORE THAN TECHNICAL SKILLS…

53. ⚫ Wisdom and Insight.
⚫ Love of humanity.
⚫ The ability to share another’s pain.
⚫ Courage to Offer Hope
⚫ Courage to Face the Unknown
⚫ Profound compassion.
⚫ Presence and Connectedness
⚫ Comfort with our own and others’ spirituality
⚫ Empowers Others
⚫ A Sense of Humour
QUALITIES OF THE HEALER……

54. THE ART OF HEALING TOUCH…..

55. A LOVE OF HUMANITY…….

56. COURAGE TO OFFER HOPE……

57. COURAGE TO FACE THE UNKNOWN…

58. A SENSE OF HUMOUR……

59. CARING FOR THE VULNERABLE……

60. EMPOWERING SELF AND OTHERS……

61. CONNECTEDNESS BRINGS MUTUAL
HEALING……

62. RELATIONAL CARING BRINGS JOY TO
THOSE CARED FOR AND THE CARER…

63. CARING PRESENCE AND
INTERCONNECTEDNESS BRINGS HOPE……

64. THE HEART OF NURSING….
⚫ The heart of nursing is the CARING
presence and connectedness of the nurse,
the nurse as healer, the integration of
caring and healing and the exploration of
the meaning that patients and families
attach to sickness and death.
⚫ Science is in awe of, and places great trust
in its accomplishments. The heart of the
nurse is in awe of the raw courage of the
human spirit and stays to offer healing
when science has failed.

65. THE ART OF BEING…….
⚫ The courage
to stay when
the limits of
science and
technology
have been
reached

66. THE MUTUALITY OF CARING…
⚫ Jean Watson stated that when we include caring and
love into our work, we discover that nursing is not
just a job but a life-giving and life receiving career
for a lifetime of growth and learning. Watson (2001)
⚫ According to Hall “It is the experience of caring and
the memories of these experiences which lead to
confidence, self-esteem and energy…..engagement
with patients enriches, protects and empowers the
healer.” Hall (1997)

67. ENGAGEMENT WITH PATIENTS ENRICHES,
EMPOWERS AND PROTECTS THE
HEALER……..

68. CARING IS AN HONOR AND A
PRIVILEGE…….

69. NURSES HAVE….CONFIDENCE, SELF
ESTEEM &ENERGY…..

70. CARE FOR EACH OTHER AND HAVE A
PASSION FOR NURSING……

71. NURSING IS…..A LIFE-GIVING AND LIFE-
RECEIVING CAREER……

72. ….FOR A
LIFETIME OF
GROWTH
AND
LEARNING.

73. What makes Nursing
different from
Medicine?

74. NURSING & MEDICINE
NURSING COMPLEMENTS
MEDICINE
•MEDICINE IS DISEASE
ORIENTED
•NURSING FOCUSES ON THE
HUMAN RESPONSE

75. NURSING…. WHAT IS IT???
ATTENTION TO FULL RANGE OF
HUMAN RESPONSES TO HEALTH
& ILLNESS
76
•INCORPORATE THE CLIENT’S
EXPERIENCE

76. NURSING…. WHAT IS IT??? 77
•PROVISION OF CARING RELATIONSHIP
THAT FACILITATES HEALTH & HEALING
“The nursing profession began with a genuine
desire to serve and care for others, combined with
a sense of compassion and commitment.”
“Nurses stay by the side of those they serve
through the worst times and celebrate with
patients and families in the best times.”

77. NURSING…. WHAT IS IT???
“There is an intimacy nurses and
patients share which is understood.”
“The essence of nursing is an
unconditional love for mankind.”
“To be called a nurse is an honor,
a profession of the highest realm.“

78. MAINTAINING CARING
PRACTICE

79. MAINTAINING CARING PRACTICE:
Caring for SELF
✓The concept of caring for self seems almost foreign to many nurses and students of
nursing because of the professional emphasis on meeting others’ needs.

80. MAINTAINING CARING PRACTICE:
Caring for SELF
….nurses take on multiple commitments to family, work, school, and
community, they risk exhaustion, burnout, and stress…
Obstacles to self-care may be professional, related to the demands of a particular work
setting, or may be personal, such as poor health habits or unrealistic expectations of self

81. ✓Despite these challenges, it
is imperative that nurses
attend to their own needs,
because caring for self is
central to caring for others.
TIME OUT!!!

82. Care for Self
✓Mayeroff (1990) describes caring for self as helping
oneself grow and actualize one’s possibilities.
✓Self-care, when defined as responding to one’s own
needs to grow, is the opposite of the self-complacency
that often accompanies egocentricity.
✓Caring for self means taking the time to nurture
oneself.
✓This involves initiating and maintaining behaviors that
promote healthy living and well-being.
✓Self-care focuses on care of the self in the deepest
sense.
✓Self-awareness and self-esteem are intimately
connected to self-care.

83. Care for Self
✓ Each person is unique and possesses individual strengths
and weaknesses.
✓ Self-care practices are intentionally created by the self and
vigilantly maintained.
✓ This is a lifelong unfolding process, leading to wholeness
that comes from and contributes to self-esteem.
✓ In its code of ethics, the American Holistic Nurses
Association (2012) states that “the nurse has a
responsibility to model health care behaviors. Holistic
nurses strive to achieve harmony in their own lives and
assist others striving to do the same.”
✓ Individuals with high self-esteem can critically problem
solve and tackle obstacles more effectively.
✓ Selfcare practices build self-esteem, leading to feelings of
comfort and accomplishment.

84. Care for Self

85. Care for Self: Healthy Lifestyle
Nutrition
Activity &
Exercise
Recreation
Avoiding
Unhealthy
Patterns

86. Care for Self: MIND–BODY THERAPIES
Meditation
Storytelling
Music
therapy
Yoga

87. COMMUNICATING
A Integral Aspects of Nursing

88. ➢is a critical skill for nursing. It is the
process by which humans meet
their survival needs, build
relationships, and experience
emotions
Communication
➢In nursing, communication is a dynamic process used to gather
assessment data, to teach and persuade, and to express caring
and comfort. It is an integral part of the helping relationship

89. Communicating
➢communication is the interchange of
information between two or more people;
➢in other words, the exchange of ideas or
thoughts (talking and listening or writing
and reading); thoughts are expressed to
others by gestures or body actions; a
transmission of feelings or a more
personal and social interaction between
people;
➢is any means of exchanging information or
feelings between two or more people.
➢It is a basic component of human
relationships, including nursing.
➢Intention: to obtain a response.
➢Thus, communication is a process.
➢ 2 main purposes:
a. to influence others ; b. to gain
information
➢ Communication can be described as
helpful or unhelpful.
➢ Nurses who communicate effectively are
better able to collect assessment data,
initiate interventions, evaluate outcomes
of interventions, initiate change that
promotes health, and prevent the safety
and legal problems associated with nursing
practice.
➢ The communication process is built on a
trusting relationship with a client and
support people.
➢ Effective communication is essential for
the establishment of a nurse–client
relationship.

90. ELECTRONIC COMMUNICATION
 Advantages
 Fast
 Efficient
 Legible
 Improves communication, continuity of care
 Disadvantages
 Client confidentiality risk
 Socioeconomics

91. ELECTRONIC COMMUNICATION
 Do not use e-mail
 Urgent information
 Jeopardy to client’s health
 Highly confidential information
 Abnormal lab data
 Other guidelines
 Agency-specific standards and guidelines
 Part of medical record
 Consent, identify as confidential

92. EFFECTIVE
WRITTEN COMMUNICATION
 Does not convey nonverbal cues
 Same as verbal
 Appropriate language and terminology
 Correct grammar, spelling, punctuation
 Logical organization
 Appropriate use and citation of resources

93. FACTORS INFLUENCE
COMMUNICATION PROCESS
 Development & gender
 Sociocultural characteristics
 Values and perception
 Personal space and territoriality
 Roles and relationships
 Environment
 Congruence
 Attitudes

94. DEVELOPMENT
 Language and communication skills develop through
stages
 Communication techniques for children
 Play
 Draw, paint, sculpt
 Storytelling, word games
 Read books; watch movies, videos
 Write

95. GENDER
 Females and males communicate differently from
early age
 Boys → establish independence, negotiate status
 Girls → seek confirmation, intimacy

96. SOCIOCULTURAL CHARACTERISTICS
 Culture
 Education
 Economic level

97. VALUES AND PERCEPTION
 Values → standards that influence behavior
 Perceptions → personal view of an event
 Unique personality traits, values, experiences
 Validate

98. PERSONAL SPACE
 Defined as distance people prefer in interactions with
others
 Proxemics
 Intimate distance →frequently used by nurses
 Personal distance → less overwhelming
 Social distance → increased eye contact
 Out of reach for touch
 Public distance

99. PERSONAL SPACE INFLUENCES COMMUNICATION IN SOCIAL AND
PROFESSIONAL INTERACTIONS. ENCROACHMENT INTO ANOTHER
INDIVIDUAL’S PERSONAL SPACE CREATES TENSION.

100. TERRITORIALITY
 Space and things
 Individual considers as belonging to self
 Knock before entering space
 May be visible
 Curtains around bed unit
 Walls of private room
 Removing chair to use at another bed

101. ROLES AND RELATIONSHIPS
 Between sender and receiver
 First meeting versus developed relationship
 Informal with colleagues
 Formal with administrators
 Length of relationship

102. ENVIRONMENT
 Can facilitate effective communication
 Key factors
 Comfort
 Privacy

103. CONGRUENCE
 Congruence
 Verbal and nonverbal aspects match
 Seen by nurse and clients
 Incongruence
 Sender’s true meaning in body language
 Improving nonverbal communication
 Relax; use gestures judiciously
 Practice; get feedback on nonverbal

104. ATTITUDES
 Interpersonal attitudes
 Attitudes convey beliefs, thoughts, feelings
 Caring, warmth, respect, acceptance
 Facilitate communication
 Condescension, lack of interest, coldness
 Inhibit communication
 Effective nursing communication
 Significantly related to client satisfaction
 Respect

105. BARRIERS TO COMMUNICATION
Stereotyping
Agreeing and
disagreeing
Being defensive
Challenging
Probing
Testing
• Rejecting
• Changing topics
• Unwarranted
reassurance
• Passing judgment
• Giving common
advice

106. THERAPEUTIC
COMMUNICATION

107. THE HELPING
RELATIONSHIPS

108. HELPING RELATIONSHIPS
❑Nurse–client relationships are referred to by some as interpersonal
relationships, by others as therapeutic relationships, and by still others as
helping relationships.
❑Helping is a growth-facilitating process that strives to achieve three basic
goals (Egan, 2014):
1. Help clients manage their problems in living more effectively and
develop unused or underused opportunities more fully.
2. Help clients become better at helping themselves in their everyday
lives.
3. Help clients develop an action-oriented prevention mentality in
their lives.
❑A helping relationship may develop over weeks of working with a client, or
within minutes.

109. HELPING RELATIONSHIPS
❑The keys to the helping relationship are :
a. the development of trust and acceptance between the nurse and the
client
b. an underlying belief that the nurse cares about and wants to help the
client
❑ The personal and professional characteristics of the nurse and the client
influence the helping relationship.
❑Age, gender, appearance, diagnosis, education, values, ethnic and cultural
background, personality, expectations, and setting can all affect the
development of the nurse–client relationship.
❑Consideration of all these factors, combined with good communication skills
and sincere interest in the client’s welfare, will enable the nurse to create a
helping relationship.
❑Characteristics of helping relationships are :

110. HELPING RELATIONSHIPS
❑Characteristics of helping relationships are :
✓Is an intellectual and emotional bond between the nurse
and the client and is focused on the client.
✓ Respects the client as an individual, including
• Maximizing the client’s abilities to participate in
decision making and treatments
• Considering ethnic and cultural aspects
• Considering family relationships and values
✓Respects client confidentiality
✓Focuses on the client’s well-being
✓Is based on mutual trust, respect, and acceptance.

111. HELPING RELATIONSHIPS
❑ Phases of the Helping Relationship: Tasks and Skills
Please Review!

112. HELPING RELATIONSHIPS
Whatever the practice setting, the nurse establishes
some type of helping relationship in which mutual goals
(outcomes) are set with the client or, if the client is
unable to participate, with support people. Although
special training in counseling techniques is
advantageous, there are many ways of helping clients
that do not require special training

113. DEVELOPING
HELPING
RELATIONSHIPS
Listen actively.
Help to identify what the person is feeling.
Put yourself in the other person’s shoes (i.e., empathize).
Be honest.
Be genuine and credible.
Use your ingenuity.
Be aware of cultural differences that may affect meaning and
understanding.
Maintain client confidentiality.
Know your role and your limitations.

114. HELP TO IDENTIFY WHAT THE
PERSON IS FEELING.
✓Often clients who are troubled are unable to
identify or to label their feelings and
consequently have difficulty working them out or
talking about them.
✓Responses such as “You seem angry about taking
orders from your boss” or “You sound as if
you’ve been lonely since your wife died” can
help clients recognize what they are feeling and
talk about it.
BACK

115. PUT YOURSELF IN THE OTHER PERSON’S SHOES
✓Like empathize
✓Communicate to the client
in a way that shows an
understanding of the
client’s feelings and the
behavior and experience
underlying these feelings.
BACK

116. BACK
Nursing is often described as providing
empathetic or compassionate care to patients.
• 4 Terms are frequently used to describe the
emotional work of nursing

117. BACK

119. BE HONEST
In effective relationships nurses
honestly recognize any lack of
knowledge by saying “I don’t know the
answer to that right now”;
openly discuss their own discomfort
by saying, for example, “I feel
uncomfortable about this discussion”;
and admit tactfully that problems do
exist, for instance, when a client says
“I’m a mess, aren’t I?
BACK

120. USE YOUR INGENUITY
There are always many courses of action to
consider in handling problems.
Whatever course is chosen needs to further
the achievement of the client’s goals
(outcomes), be compatible with the client’s
value system, and offer the probability of
success.
BACK

121. BE AWARE OF CULTURAL DIFFERENCES
THAT MAY AFFECT MEANING AND
UNDERSTANDING
 To facilitate nurse–client
interaction, recognize the
language(s) and/or dialect(s)
the client uses.
 Provide a bilingual interpreter as
needed for clients who have
limited English language skills.
BACK

122. MAINTAIN CLIENT CONFIDENTIALITY
To maintain the client’s right to privacy, share
information only with other health care
professionals as needed for effective care and
treatment.
BACK

123. KNOW YOUR ROLE AND
YOUR LIMITATIONS
 Every person has unique strengths
and problems.
 When you feel unable to handle
some problems, the client should be
informed and referred to the
appropriate health professional.
 Clarify functions and roles, specifically
what is expected of the client, the
nurse, and the primary care provider
BACK

124. Case Study

125. COMMUNICATION
AND
THE NURSING PROCESS

126. NURSING MANAGEMENT:
ASSESSING
To assess the client’s communication abilities, the nurse
determines communication impairments or barriers and
communication style.
Remember that culture may influence when and how a
client speaks.
Obviously, language varies according to age and
development.
With children, the nurse observes sounds, gestures, and
vocabulary.

127. ASSESSING: IMPAIRMENTS TO COMMUNICATION
Language Deficits
 Determine the client’s primary language for communicating and whether a fluent interpreter is
required.
 The language skills of some clients who use English as a second language may be inadequate to
meet their needs.
Sensory Deficits
The ability to hear, see, feel, and smell are important adjuncts to communication. Deafness can
significantly alter the message the client receives; impaired vision alters the ability to observe
nonverbal behavior, such as a smile or a gesture; inability to feel and smell can impair the client’s
abilities to report injuries or detect the smoke from a fire. For clients with severe hearing
impairments, follow these steps:
• Look for a medical alert bracelet (or necklace or tag) indicating hearing loss.
• Determine whether the client wears a hearing aid and whether it is functioning.
• Observe whether the client is attempting to see your face to read lips.
• Observe whether the client is attempting to use hands to communicate with sign language.

128. Cognitive Impairments
 Any disorder that impairs cognitive functioning (e.g., cerebrovascular
disease, Alzheimer’s disease, and brain tumors or injuries) may affect a
client’s ability to use and understand language.
 These clients may develop total loss of speech, impaired articulation, or
the inability to find or name words.
 Certain medications such as sedatives, antidepressants, and neuroleptics
may also impair speech, causing the client to use incomplete sentences or
to slur words.
 The nurse assesses whether these clients respond when asked question
and, if so, assesses the following: Is the client’s speech fluent or hesitant?
Does the client use words correctly? Can the client comprehend
instructions as evidenced by following directions?
ASSESSING: IMPAIRMENTS TO COMMUNICATION

129.  Can the client repeat words or phrases? In addition, the nurse assesses the
client’s ability to understand written words: Can the client follow written
directions? Can the client respond correctly by pointing to a written word? Can
the client read aloud? Can the client recognize words or letters if unable to read
whole sentences? The nurse uses large, clearly written words when trying to
establish abilities in this area.
 When the client is unconscious, the nurse looks for any indication that suggests
comprehension of what is communicated (e.g., tries to arouse the client
verbally and through touch). Ask a closed question like “Can you hear me?” and
watch for a nonverbal response such as a nod of the head for yes or a shake for
no; or ask for a hand squeeze or blink of the eye once for yes or twice for no.
ASSESSING: IMPAIRMENTS TO COMMUNICATION

130. Structural Deficits
 Structural deficits of the oral and nasal cavities and respiratory system can
alter a person’s ability to speak clearly and spontaneously. Examples include
cleft palate, artificial airways such as an endotracheal tube or tracheostomy,
and laryngectomy (removal of the larynx). Extreme dyspnea (shortness of
breath) can also impair speech patterns.
ASSESSING: IMPAIRMENTS TO COMMUNICATION
Paralysis
If verbal impairment is combined with paralysis of the upper extremities that
impairs the client’s ability to write, the nurse should determine whether the client
can point, nod, shrug, blink, or squeeze a hand. Any of these gestures could be
used to devise a beginning communication system.

131.  In assessing communication style, the nurse considers both verbal and nonverbal
communication.
 In addition to physical barriers, some psychological illnesses (e.g., depression or
psychosis) influence the ability to communicate.
 The client may demonstrate constant verbalization of the same words or phrases, a
loose association of ideas, or flight of ideas.
Verbal Communication
 When assessing verbal communication, the nurse focuses on three areas: the
content of the message, the themes, and verbalized emotions.
Nonverbal Communication
 Consider nonverbal communication in relation to the client’s culture.
 Pay particular attention to facial expression, gestures, body movements, affect,
tone of voice, posture, and eye contact
ASSESSING: STYLE OF COMMUNICATION

132. NURSING MANAGEMENT: DIAGNOSING
 Impaired Verbal Communication may be used as a nursing diagnosis when an
individual experiences a “decreased, delayed, or absent ability to receive,
process, transmit, and/or use a system of symbols” (Herdman & Kamitsuru,
2014).
 Communication problems may be receptive (e.g., difficulty hearing) or expressive
(e.g., difficulty speaking).
 The nursing diagnosis Impaired Verbal Communication may not be useful when
an individual’s communication problems arecaused by a psychiatric illness.
 For example, a client with depression may have difficulty expressing feelings or
have slowed thinking or responses; clients who have anxiety have decreased
ability to focus; and clients with schizophrenia may have auditory hallucinations
(hearing voices) and have difficulty hearing the nurse’s voice at the same time
(Boyd, 2012; Kneisl & Trigoboff, 2013).

133. NURSING MANAGEMENT: DIAGNOSING
 If the communication issue is due to the client having a problem coping, the
diagnoses of Fear or Anxiety may be more appropriate.
 Other NANDA nursing diagnoses (Herdman & Kamitsuru, 2014) used for clients
experiencing communication problems that involve impaired verbal
communication as the etiology could include the following:
• Anxiety related to impaired verbal communication
• Powerlessness related to impaired verbal communication
• Situational Low Self-Esteem related to impaired verbal communication
• Social Isolation related to impaired verbal communication
• Impaired Social Interaction related to impaired verbal communication.

134. NURSING MANAGEMENT: PLANNING
 When a nursing diagnosis related to impaired verbal communication has
been made, the nurse and client determine outcomes and begin
planning ways to promote effective communication.
 The overall client outcome for individuals with Impaired Verbal
Communication is to reduce or resolve the factors impairing the
communication.
 Specific nursing interventions will be planned from the stated etiology.
Examples of outcome criteria to evaluate the effectiveness of nursing
interventions and achievement of client goals follow.

135. NURSING MANAGEMENT: PLANNING
 The client:
• Communicates that needs are being met.
• Begins to establish a method of communication:
• Signals yes/no to direct questions using vocalization or agreed on physical cue (i.e., eye
blink, hand squeeze).
• Uses verbal or nonverbal techniques to indicate needs.
• Perceives the message accurately, as evidenced by appropriate verbal and/or nonverbal
responses.
• Communicates effectively:
• Using dominant language
• Using translator/interpreter
• Using sign language
• Using word board or picture board
• Using a computer.
• Regains maximum communication abilities.
• Expresses minimum fear, anxiety, frustration, and depression.
• Uses resources appropriately

136. NURSING MANAGEMENT: IMPLEMENTING
 Nursing interventions to facilitate communication with clients who have problems with speech or
language include manipulating the environment, providing support, employing measures to
enhance communication, and educating the client and support person.
Manipulate the Environment
 A quiet environment with limited distractions will make the most of the communication efforts of
both the client and the nurse and increase the possibility of effective communication.
 Sufficient light will help in conveying nonverbal messages, which is especially important if visual or
auditory acuity is impaired. Initially, the nurse needs to provide a calm, relaxed environment,
which will help reduce any anxiety the client may have.
 Remember that any factor that affects communication can create feelings of frustration, anxiety,
depression, or hostility in the client.
 Communication normally contributes to a client’s sense of security and feelings that he or she is
not alone, so communication problems may cause some clients to feel isolated and confused.
 To further reduce these emotions, the nurse should acknowledge and praise the client’s attempts
at communication

137. Provide Support
❖ The nurse should convey encouragement to the client and provide nonverbal reassurance,
perhaps by touch if appropriate.
❖ If the nurse does not understand, it is critical to let the client know so that he or she can
provide clarification with other words or through some other means of communication.
❖ When speaking with a client who will have difficulty understanding, the nurse should check
frequently to determine what the client has heard and understood.
❖ Using open-ended questions will assist the nurse in obtaining accurate information about the
effectiveness of communication. For example, a female client, who has limited English skills, is
being taught about diet related to her Crohn’s disease.
❖ If the nurse asks, “Do you understand what to eat?” the client may nod her head yes. However,
this does not give the nurse confirmation that the client received the message given.
❖ Rather the nurse needs to say, “What do you think will be good for you to eat when you go
home?” The nurse’s body language (e.g., gestures, posture, facial expression, and eye contact)
should convey acceptance and approval.
NURSING MANAGEMENT: IMPLEMENTING

138. Employ Measures to Enhance Communication
 First determine how the client can best receive messages: by listening, by looking, through touch, or
through an interpreter.
 Ways to help communication include keeping words simple and concrete and discussing topics of interest to
the client.
 It is often helpful to use alternative communication strategies such as word boards, pictures, or paper and
pencil.
 Often interpreters can assist a client and nurse to communicate when the client lacks fluency in the
dominant language.
 Some hospitals have a list of interpreters for various languages who can assist at the bedside.
 If the client’s support person offers to interpret, it is important to ask the client’s permission, for the sake of
confidentiality. Then instruct the person interpreting to translate as precisely as possible, without
interruption.
Educate the Client and Support People
 Sometimes clients and support people can be prepared in advance for communication problems, for
example, before an intubation or throat surgery.
 By explaining anticipated problems, the client is often less anxious when problems arise.
NURSING MANAGEMENT: IMPLEMENTING

139. NURSING MANAGEMENT: EVALUATING
 Evaluation is useful for both client and nurse communication.
Client Communication
 To establish whether client outcomes have been met in relation to communication, the
nurse must listen actively, observe nonverbal cues, and use therapeutic communication
skills to determine that communication was effective.
 Examples of statements indicating outcome achievement include “Using picture board
effectively to indicate needs” or “The client stated, ‘I listened more closely to my daughter
yesterday and found out how she feels about our divorce.’”
Nurse Communication
 For nurses to evaluate the effectiveness of their own communication with clients, process
recordings are frequently used.
 A process recording is a verbatim (word-for-word) account of a conversation.
 It can be taped or written and includes all verbal and nonverbal interactions of both the
client and nurse.

141. TEACHING
An Integral Component of Nursing

142. INTRODUCTION:TEACHING
➢Teaching client education is a major aspect of nursing practice
➢Teaching clients and families about their health needs is a major role of the
nurse.
➢An important independent nursing function
❖Is defined as a system of activities intended to produce learning
❖The teaching process is intentionally designed to produce specific learning
❖The teaching–learning process involves dynamic interaction between
teacher and learner.
❖Each participant in the process communicates information, emotions,
perceptions, and attitudes to the other

143. TEACHING
❑Nurses teach a variety of learners in various
settings.
❑They teach clients and their families or
significant others in the hospital, primary care
clinics, urgent care, managed care, the home,
and assisted living and long-term care facilities.
❑Nurses teach large and small groups of learners
in community health education programs.
❑Nurses also teach professional colleagues and
other health care personnel in academic
institutions such as vocational schools,
colleges, and universities, and in health care
facilities such as hospitals or nursing homes.
❑

144. LEARNING
o Is defined as a change in human disposition or capability that persists and
that cannot be solely accounted for by growth.
o Learning is represented by a change in behavior.
oLike all people, clients have a variety of learning needs.
o A learning need is a desire or a requirement to know something that is
presently unknown to the learner.
o Learning needs include new knowledge or information but can also include
a new or different skill or physical ability, or a new behavior or a need to
change an old behavior.

145. LEARNING

146. LEARNING: Compliance vs Adherence

147. LEARNING: Learning Domains
• Bloom (1956) identified three domains or areas of learning:
DOMAINS DESCRIPTIONS EXAMPLES
1. COGNITIVE the “thinking” domain, includes six
intellectual abilities and thinking
processes beginning with knowing,
comprehending, and applying to
analysis, synthesis, and evaluation
Client lists down the reasons why insulin is
needed and what to do when not feeling
well.
2. AFFECTIVE The “feeling” domain, deals with
personal issues such as “attitudes,
beliefs, behaviors, and emotions”
The client accepts the chronic implications
of diabetes and maintain self-esteem.
3. PSYCHOMOTOR the “skill” domain, includes fine and
gross motor abilities such as giving an
injection
The client demonstrates how to self-
administer insulin.

148. Teaching and Learning
• Three main theories of learning are behaviorism, cognitivism, and
humanism.
• A number of factors affect learning, including:
age and developmental stage, motivation, readiness, active
involvement, relevance, feedback, nonjudgmental support, simple to
complex learning, repetition, timing, environment, emotions,
physiological events, cultural aspects, and psychomotor ability.

149. • Many adults in the United States use the Internet to access
health information.
• Nurses need to know and integrate this technology into their
teaching plans.
Teaching and Learning
Low health literacy is a silent epidemic. It is
associated with poor health outcomes and
higher health care costs.

150. NURSE AS EDUCATOR
➢Being an educator or teacher is an important and
primary role for the nurse.
➢Clients and families have the right to health education in
order to make informed decisions about their health.
➢The nurse is in a position to promote healthy lifestyles
through the application of health knowledge, the change
process, learning theories, and the nursing and teaching
process when teaching clients and their families.

151. Areas for Client Education

152. TEACHING vs NURSING PROCESS
• Teaching, like the nursing process, consists of six activities: assessing
the learner, diagnosing learning needs, developing a teaching plan,
implementing the plan, evaluating learning outcomes and teaching
effectiveness, and documenting instructional activities.

153. NURSING MANAGEMENT:
NURSING PROCESS
•ASSESSING
✓Using the “teach back” technique helps the nurse assess the client’s
understanding of what was taught.

154. NURSING MANAGEMENT:
NURSING PROCESS

155. NURSING MANAGEMENT:
NURSING PROCESS
•PLANNING
✓ Teaching strategies chosen by the nurse should be suited
to the client and to the material to be learned.
✓ A teaching plan is a written plan consisting of learning
outcomes, content to teach, and strategies to use in
teaching the content.
✓ The plan must be revised when the client’s needs change
or the teaching strategies prove ineffective.

156. Selected Teaching Strategies

157. Selected Teaching Strategies

158. NURSING MANAGEMENT:
NURSING PROCESS
•IMPLEMENTING
✓The nurse needs to be flexible in implementing any teaching plan because the plan
may need revising.
✓The client may become tired sooner than anticipated or be faced with too much
information too quickly, the client’s needs may change, or external factors may
intervene.
✓For instance, the nurse and the client plan to change his dressing at 10 am, but
when the time comes, the client wants to observe the nurse once more before
actually doing it himself.
✓In this case, the nurse alters the teaching plan and discusses any desired
information, provides another demonstration, and defers teaching the
psychomotor skill until the next day.
✓It is also important for nurses to use teaching techniques that enhance learning and
reduce or eliminate any barrier to learning such as pain or fatigue.
Guidelines for Teaching

159. NURSING MANAGEMENT:
NURSING PROCESS
•EVALUATING
✓ Evaluating the teaching–learning process is both an ongoing and a final process
in which the client, nurse, and support people determine what has been learned.
Evaluating Learning
❑The process of evaluating learning is the same as evaluating client achievement of
desired outcomes for other nursing diagnoses.
❑Learning is measured against the predetermined learning outcomes selected in the
planning phase of the teaching process.
❑ Thus, the outcomes serve not only to direct the teaching plan but also to provide
outcome criteria for evaluation:
❑ For example, the outcome “Selects foods that are low in carbohydrates” can be
evaluated by asking the client to name such foods or to select low-carbohydrate foods
from a list

160. NURSING MANAGEMENT:
NURSING PROCESS
•DOCUMENTING
✓ Documentation of client teaching is essential to
communicate the teaching to other health professionals and
to provide a record for legal purposes.

161. PHILOSOPHY
IN
NURSING

162. Every nurse has a patient that reminds them why they became a nurse in the
first place. Mine was Joe. Joe was in the beginning stages of Alzheimer’s. He
had moments with and moments without his memory, but the hardest part of the
aging condition for Joe were his night terrors. He would wake up in the middle of
the night screaming absolute bloody murder, but if I just went in there and held
his hand for a few moments, I could usually get him to calm down.
But then he wanted to talk. He would ask me if I could change his treatments,
and I’d say, "No Joe, I can’t, I’m just a nurse. But what about my medications,
can you fix those? And I’d say, no Joe, I can’t, I’m just a nurse."
But because I couldn’t do those things for Joe, we connected on other levels. He
would ask me about volleyball, we would talk about his grandbabies, and he
would tease me about being the only nurse on the unit that can reach the gauze
on the top shelf.
It was a lot of laughs with Joe, but then one night, everything changed. I found
him in his room, crying. And I went over to him and I lifted his head up out of his
hands and I said, "Joe, I know that this is really hard, but you are not defined by
this disease. You are not just Alzheimer’s, you are still Joe." And he looked right
back at me, almost to look through me and said, "Nurse Kelly, then the same
goes for you. Although you say it all the time, you are not just a nurse, you
are my nurse, and you have changed my life because you have cared about
me."
And that’s when it hit me. Patients are people with family and friends, and I don’t
want to be a nurse that ever pretends, because you’re not a room number and a
diagnosis when you are in the hospital. You’re a person, very first, and Joe
reminded me that day that I’m a lifesaver. I’m never going to be just a nurse.

163. WHAT ISYOUR
PHILOSOPHY IN
NURSING

164. • References:
•
• Books
• Fundamentals of nursing (2017). (9th ed.). St. Louis, MO: Mosby Elsevier.
• Berman, A., Snyder S., and Frandsen G. (2017) Kozier And Erbs Fundamentals Of Nursing (10th ed).
• Berman, A., Snyder S., and Frandsen G. (2018) Clinical Nursing Skills and Techniques (9th ed). St. Louis, MO: Mosby Elsevier
• Williams, P. (2018) deWit's Fundamental Concepts and Skills for Nursing (5th ed.). SG: Mosby, Elsevier
•
• E- Journals
•
• Feo, R., Kitson, A., & Conroy, T. (2018) How fundamental aspects of nursing care are defined in the literature: A scoping
review.
• Journal of Clinical Nursing, 27(11), 2189-2229. Retrieved October 5, 2018 from doi:10.1111/jocn.14313
• Kim, SJ. (2018). Effects of Leadership, Critical Thinking Disposition, Professional Self-conception of Nurse on Happiness
in Nursing
• Students. Korean Association of Medical Journal Editors, 25(1), 1-10. Retrieved October 5, 2018 from
doi:10.7739/jkafn2018.25.1.1
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evidence
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•
•
• CD-ROM (Book Companion)
•
• Dewit, S. C. (2009). Fundamental concepts and skills for nursing [electronic resource].
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• Berman, S. (2008). Fundamentals of nursing: concepts, process & graphic [electronic resource].
• Kockrow, C. (2006). Foundations of nursing [electronic resource].
• Carol, T. (2005). Fundamentals of nursing [electronic resource].
• Perry, P. (2005). Fundamentals of nursing, 6th ed. (star world) [electronic resource].
• Harkreader. (2004). Fundamentals of nursing: caring and clinical judgment [electronic resource].
• Kozier, E. & Berman, S. (2004). Fundamentals of nursing: concepts, process [electronic resource].