1. Hospital….
• A part of social system
• Dealings with
 Professionals – Nurses, doctors, technicians,
paramedics
 Other personnel – housekeeping, dietary, laundry,
supplies, accounts…
 Clients, relatives, friends visitors, other customers
• All lead to public relations within the hospital

2. Public relations spring from human
relations
• Client – a bundle of expectations, anxieties, hopes
and fears
- Wants effective & satisfactory services
- Forms impressions of the hospital set up
• Health workers – Have personal and professional
needs
- Want job satisfaction & recognition of their
efforts
• Hospital administration – Wants efficiency and
maximum satisfaction of staff and patients
The ultimate outcome depends on ‘Human Relations’

3. HUMAN RELATIONS IN
NURSING

4. PROFESSIONALS IN HEALTH
TEAM
Nursing team
Physicians
Physical therapist
Nutritionist
Occupational therapist
Immunologist Dietician
Radiologist
Respiratory therapist
Pharmacist Lab technologist
Social workers Spiritual advisors

5. The nurse in the health team
• Health team - A group of people
who coordinate their particular skills
in order to assist a client or his
family, to achieve optimum health
• The quality and quantity of
personnel in the health team will
depend upon the needs of the client
The nurse is an important member of the health team

6. Relationship of nurse with the
members of health team

7. Nurse and the Physician
• Have team spirit & co-worker relationship
• Be loyal, honest and dependable
• Carry out instructions intelligently
• DO NOT take verbal orders.

8. Nurse & Nursing
superintendent
• Respect & cooperate
• Reporting punctually
• Maintain courtesy when taking ward rounds
• Take assistance for problem solving

9. Nurse and the Head nurse
• Head Nurse is the team leader
• Respect & support her
• Cooperate intelligently
• Reporting on duty and leaving off duty
• Hand over & take over important issues

10. Nurse and fellow nurses
• Treat seniors with respect
• Maintain good team work/ spirit
• Share information to achieve best care of the
sick
• Correctly hand over and take over patient
concerning information

11. Nurse and other hospital personnel
• Maintain good relationship with all
departments
• Maintain smooth coordination between patient
unit and the departments

12. Nurse and the non professional
workers
• Be decent & considerate
• Maintain good relationship
• Provide guidance and teaching

13. Nurse and the Client
• Treat as an individual
• Understand and help
• No discrimination.
• Do not accept any gifts/ favours.
• Help to adjust, cooperate and accept treatments
• Create confidence. Establish good N-Pt relationship.
Call by name.. Be pleasant, cheerful and courteous
• Do not get too familiar. Do not discuss personal
affairs.

14. Therapeutic nurse-client relationship
(TNCR)
• The core of nursing
• Nurses use their knowledge, skill and
judgment
• Applies to all nurses in all roles and practice
settings
 Therapeutic communication
 Client-centered care
 Maintaining boundaries
 Protecting the client from abuse

15. Complaints by clients and community
Complaints Situations
Indifferent care
Unfriendly behaviour of staff
Lack of ‘human touch’
Poor quality care Quality of linen, diet, equipment, facilities,
cleanliness etc
Lack of information & guidance About facilities & staff Oral information,
sign posting, boards
Lack of comforts Chairs, benches, drinking water, toilets….
Delays at almost every step
Overcrowding
Noise pollution
Poor sanitation

16. The ‘Human touch’..or ‘No touch’?

17. Types of the Relationship
Social
Friendship
Companion
Use small talk
superficial
Intimate
Emotional
commitment
May be sexual/
emotional
Intimacy
Therapeutic
Focus on client
needs
Experiences,
Feelings, ideas
Goal oriented

18. Traits of Therapeutic
Communication
• GGeennuuiinneenneessss
• PPoossiittiivvee RReeggaarrdd ((aacccceeppttaannccee))
• EEmmppaatthhyy
• TTrruussttwwoorrtthhiinneessss
• CCllaarriittyy
• RReessppoonnssiibbiilliittyy
• AAsssseerrttiivveenneessss

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

20. • Recognize that all behaviour has meaning and
seek to understand the cause
• Understand and respect the client
• Involve client in planning of care
• Provide information to promote client choice
• Enable the client to make informed decisions

21. Maintaining Boundaries
Nurse Client
Boundary

22. Maintain Boundaries in the
therapeutic nurse patient relationship
• Develop and follow plan of care with the client
• Recognize when boundaries are being crossed
• Set and maintain the appropriate boundaries within
the relationship
• Abstain from disclosing personal information unless
it meets the therapeutic need of the client
• Ensure that nursing strategies promote health and
well being of the client

23. Obstacles to the Therapeutic
Relationship:
• Inappropriate Boundaries
• Encouraging dependence
• Non acceptance/Avoidance
• Resistance
Role of nurse – Teacher, Caregiver, Advocate,
counselor

24. Crossing Boundaries
Nurse Client
Boundary

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

26. Phases of the Nurse-Client
Relationship

27. Pre-Orientation
• Self assessment - examine own feelings, fears,
anxieties.

28. Orientation
• Introductory Phase
- establish trust, share information with
client, discrete self-disclosure.
convey support, facilitate healing,
educate

29. The Working Phase
• Problems identified
Exploration- guide client to examine
feelings/responses, develop new coping
skills

30. Termination Phase
• Resolution phase
- Examine goals achieved
- Explore feelings
regarding termination
- Establish plan for
continuing assistance

31. Communicating with the client is
important!
We’re moving you
from intensive
care to intensive
billing

32. Non Verbal Communication
• Eye Contact, bbooddyy LLaanngguuaaggee,, ffaacciiaall EExxpprreessssiioonnss,,
ssiilleennccee,, vvooccaall ccuueess
• SSppaaccee ((ccoommffoorrtt zzoonnee))
• TToouucchh (( aaccttiioonn//ppeerrssoonnaall ssppaaccee –– uusseedd ccaauuttiioouussllyy))
• AAppppeeaarraannccee –– ccoommmmuunniiccaatteess aa ppaarrttiiccuullaarr iimmaaggee//oonnee’’ss
mmeennttaall ssttaattuuss (( uussee ooff ccllootthhiinngg,, mmaakkee--uupp eettcc..))
BBee aawwaarree ooff oowwnn nnoonn--vveerrbbaall ccuueess!!!!

33. Active Listening!!
• SS –– SSiitt ffaacciinngg tthhee cclliieenntt
• OO –– OOppeenn PPoossttuurree
• LL –– LLeeaann ffoorrwwaarrdd ttoowwaarrddss cclliieenntt
• EE –– EEssttaabblliisshh eeyyee ccoonnttaacctt
• RR-- RReellaaxx!!!!

34. Conditions Affecting
Communication
• Values
• Attitudes
• Beliefs
• Perceptions
• Culture or Religion
• Social Status
• Gender
• Age or developmental level
• Environment

35. Enhancing Communication
• SSiilleennccee
• SSuuppppoorrtt//rreeaassssuurraannccee
• SShhaarriinngg
OObbsseerrvvaattiioonnss
• AAcckknnoowwlleeddggee
ffeeeelliinnggss
• BBrrooaadd –– ooppeenn eennddeedd
ssttaatteemmeennttss
• IInnffoorrmmaattiioonn ggiivviinngg
• IInntteerrpprreettaattiioonn
• Restating
• Reflecting
• Clarification
• Confrontation
• Offering Alternatives
• Voicing doubt
• Role-playing
• Use of Humor – use
cautiously/discretely

36. Non-therapeutic communication
• Advising
• Agreeing
• Belittling feelings
• Challenging
• Defending
• Disagreeing
• Disapproving
• Probing

37. Caring for clients from different
socio-cultural backgrounds
• Important !! – Analyze self! – know your own
beliefs/values/customs/behaviors
• Avoid being judgmental
• Rules for communication vary since they arise from cultural
norms!
• Understand differences in communication among various
cultures
• Ask families for assistance regarding their culture
• Reflect on your emotions/journal write feelings

38. Therapeutic communications ?

40. 1. The nurse is meeting a new client on the
unit.Which action, by the nurse, is most
effective in initiating the nurse-client
relationship?
A. Introduce self and explain the purpose and the plan for the
relationship.
B. Describe the nurse’s family and ask the client to describe
his/her family.
C. Wait until the client indicates a readiness to establish a
relationship.
D. Ask the client why he/she was brought to the hospital.

41. 2. Mrs. F. has remained close to the nurse all day.
When the nurse talked with other clients
during dinner, Mrs. F. tried to regain the
nurse’s attention and began to shout, “You’re
just like my mother. You pay attention to
everyone but me!” The best interpretation of
this behavior is that
A. Mrs. F. is exhibiting resistance.
B. Mrs. F. has been spoiled by her family.
C. The nurse has failed to meet Mrs. F’s needs.
D. Mrs. F. is demonstrating transference.

42. 3. The nurse is caring for a rural client who says, “I
don’t want you to touch me.I’ll take care of
myself.” Which nursing response is most
therapeutic?
A. “Okay, if that’s what you want.I’ll just leave this cup for
you to collect your urine.”
B. “If you don’t want our care, why did you come here?”
C. “Why are you being so difficult? I only want to help
you.”
D. “It sounds as though you want to take care of yourself.
Let’s work together so you can do things for yourself.”

43. 4. The client says to the nurse “I am going to die, I wish
my family would stop hoping for a cure! I get so
angry when they carry on like this! After all, I’m the
one who’s dying.” The most therapeutic response is:
A. “You’re feeling angry that your family continues to hope for
you to be cured.”
B. “I think we should talk more about your anger with your
family.”
C. “Well, it sounds like you’re being pessimistic. After all, years
ago people died of pneumonia.”
D. “Have you shared your feelings with your family?”

44. 5. The nurse employed in a mental health clinic is greeted
by a neighbor in a local grocery store. The neighbor
says to the nurse, “How is Carol doing? She is my
best friend and is seen at your clinic every week.” The
most appropriate nursing response is which of the
following?
A. “I’m not supposed to discuss this, but because you are my
neighbor, I can tell you that she is doing great!”
B. I’m not supposed to discuss this, but because you are my
neighbor, I can tell you that she really has some problems!”
C. “If you want to know about Carol, you need to ask her
yourself.”
D. “I cannot discuss any client situation with you.”

45. 6. The nurse is preparing the client for the
termination phase of the nurse-client
relationship. Which nursing task is most
appropriate for this phase?
A. Identifying expected outcomes
B. Planning short term goals
C. Making appropriate referrals
D. Developing realistic solutions

46. 8. A client looks at a mirror and cries out, “I
look like a bird. This is not my face.” The
nurse responds therapeutically by saying:
A. “What kind of a bird do you think you are?”
B. “That must be very distressing to you, your face does not
look different to me.”
C. “Maybe the light is playing tricks on you.”
D. “Why do you think that you look like a bird?”

47. 9. A 32 year old mother of 2 young children diagnosed
with cervical cancer with metastasis, tells her nurse
“I’m going to die, aren’t I ?” The nurse’s most
appropriate response would be:
A. “No, you are not . After all you are receiving the latest
treatment available, and your doctor is one of the best in this
area.”
B. “We are all going to die sometime.”
C. “What did your doctor tell you?”
D. “I don’t know. You have a serious illness. Do you have
feelings that you would like to talk about?”

48. 10. A client relates angrily to the nurse that his
wife says he is selfish. Which response by
the nurse would be most helpful?
A. “That’s just her opinion.”
B. “I don’t think that you are selfish.”
C. “Everyone is a little bit selfish.”
D. “You sound angry – tell me more about what
happened.”

49. 11. The most therapeutic response a nurse could
make to a student who begins to cry upon
learning that a failing grade was received on
a final exam is:
A. “You’ll make it next time.”
B. “Failing an exam is an upsetting thing to happen.”
C. “How close were you to passing?”
D. “It won’t seem so important 5 years from now.”

50. ThanQ