COMMUNICATION AND THE

CLIENT-NURSE RELATIONSHIP
SELF-AWARENESS
• literally the awareness of the self ; self-
consciousness
• being self-aware is particularly important
for healthcare professionals who need to
manage their cognitive, affective and
behavioral self in order to engage
effectively in therapeutic relationships.
JOHARI’S WINDOW
• Devised by American psychologists
Joseph Luft and Harry Ingham in
1955 while researching group
dynamics at the University of
California Los Angeles.
• first published in the Proceedings of
the Western Training Laboratory in
Group Development by UCLA
Extension Office in 1955.

• derived from the names of the two

inventors, Jo and Hari.
• a simple and useful tool for illustrating
and improving self-awareness, and
mutual understanding between
individuals within a group.

• used to assess and improve group’s

relationship with other groups.
• also referred to as Disclosure or
Feedback Model of Self-awareness
and Information Processing Tool.
The FOUR Johari Window
Perspectives
• OPEN AREA

• BLIND AREA

• HIDDEN AREA

• UNKNOWN AREA
1. OPEN AREA
• what is known by the person about him or
herself and is also known by others.

2. BLIND AREA
• what is unknown by the person about him
or herself but which others know.
3. HIDDEN AREA
• what is known by the person about him or
herself that others do not know.

4. UNKNOWN AREA
• what is unknown by the person about him
or herself is also unknown by the others.
INCREASING SELF-AWARENESS

• knowing one’s self.

• recognizing one’s strengths and

limitations.
Methods of Increasing
Self-awareness:

• IMPLICATION
• ENCOURAGING ASSESSMENT OF
EMOTIONS
• TRANSLATION INTO FEELINGS
• IMPLICATION
 non-verbal
 the person doesn’t tell you what
he/she is feeling, but is implied.

• ENCOURAGING ASSESSMENT OF
EMOTIONS
 the person is encouraged to
verbalize his/her emotions.
• TRANSLATION INTO FEELINGS
 what was implied, is now spoken
verbally.
FOUR Types:
• BLUNT
• FLAT
• INAPPROPRIATE
• REFLECTION
• BLUNT
 very frank or straightforward and
shows no delicacy or consideration
• FLAT
 without any interest or excitement
• INAPPROPRIATE
 not suitable

• REFLECTION
 one must be clever in answering or
responding to what the patient says
INTROSPECTION
• act of examining one’s own thoughts and
emotions by concentrating on the inner
self.

• tendency to direct one’s interest, thoughts

and energies inward or toward things
concerned only with the self.
DISCUSSION
• an act or instance of discussing
• consideration or examination by argument
and comment
• consideration of a subject by a group; an
earnest conversation.
• a formal discourse on a topic; an exposition.
Role Playing
• one of the therapeutic communication
techniques.
• involves acting out a particular
situation.
• can be used for attitude change and to
promote self-awareness.
• One of the specific ways in which role
playing can be used to resolve conflicts
and increase self-awareness is through a
dialogue that requires the patient to
take the part of each person or each side
of the problem. This way patient can
express feelings and opinions and gives
reality base for the probable response
from the other party involved in the
conflict.
Levels of Communication
• INTRAPERSONAL COMMUNICATION
• INTERPERSONAL COMMUNICATION
• TRANSPERSONAL COMMUNICATION
• SMALL GROUP COMMUNICATION
• PUBLIC COMMUNICATION
• INTRAPERSONAL COMMUNICATION

 Powerful form of communication that

ours within an individual.
 Also called self-talk, self
verbalization and inner thought.
 Positive self-talk can be used as a tool
to enhance appropriate self-
expression.
• INTERPERSONAL COMMUNICATION
 One-to-one interaction between the
nurse and another person that often
occurs face to face.

 Most frequently used in nursing

situations and lies at the heart of
nursing practice.
• Takes place within a social context and
includes all the symbols and cues used
to give and receive meaning
• TRANSPERSONAL
COMMUNICATION
 Interaction that occurs within a
person’s spiritual domain.

 Nurse’s who value the importance of

human spirituality often use this form
of communication with clients and for
themselves.
• SMALL GROUP COMMUNICATION

• Interaction that occurs when a small

number of persons meet together.

• Usually goal directed and requires an

understanding of group dynamics.
 • Two main principles that are important
to ensure effective communication and
working relationships between people
in any group:
a.)Respect people as partners,
b.)Listen actively to other people
in the group.
• PUBLIC COMMUNICATION
• Interaction with an audience.

• Requires special adaptations in the ff:

• eye contact
• gestures
• voice inflection
• use of media materials to
communicate messages effectively.
• Effective public communication
increases audience knowledge about
health-related topics, health issues,
and other issues important to the
nursing profession.
ELEMENTS OF THE
COMMUNINCATION PROCESS
• INPUT
• SENDER
• CHANNEL
• NOISE
• RECIEVER
• OUTPUT
• CODE
• INPUT
• The sender has an intention to
communicate with another person.
This intention makes up the content of
the message.
• SENDER
• The sender encodes the message. Thus
he gives expression of the content.
• CHANNEL
• The message is sent via a channel,
which can be made of a variety of
materials. In acoustic
communication it consists of air, in
written communication of paper or
other writing materials.
• NOISE
• The channel is subjected to various
sources of noise. One example is
telephone communication, where
numerous secondary sounds are
audible. Even a solid channel such as
paper can be crushed or stained.
Such phenomena are also noise in
the communicative sense.
• RECIEVER
• The receiver decodes the incoming
message, or expression. He
“translates” it and thus recieves the..

• OUTPUT
• This is the content decoded by the
receiver.
• CODE
• In the process, the relevance of a code
becomes obvious: The code of the
sender and receiver must have at least
a certain set in common in order to
make communication work.
FACTORS INFLUENCING
COMMUNICATION
• Ability of individual to send and receive messages
• Perceptions of sender and receiver
• Personal Space
• Territoriality
• Roles and Relationships
• Time Environment
• Attitudes
• Emotions and Self-esteem
Models of Communication
• MODELS
• A theoretical way of understanding a
concept or idea. It aims to present
communication as a process.
• like a map representing features of a
territory.
• not be comprehensive.
• We need therefore to be selective,
knowing why we are using it and what
we hope to gain from it.
MODELS OF COMMUNICATION
• Aristotle’s Model Of Communication
• The Shannon-Weaver Mathematical
Model
• Berlo’s model of communication
• Ecological Model Of Communication
ARISTOTLE’S MODEL OF COMMUNICATION

• Definition of RHETOTRIC:
• The faculty of observing in any given
case the available means of
persuasion
• Speaker-centerd model
• Study of communication as “Rhetoric”
 • Rhetoric communication falls into THREE
DIVISIONS:
• ETHNOS
• nature or qualities of communicator
• LOGOS
• nature, structure and content of the
message
• PATHOS
• nature, feelings and thoughts of the
audience or reciever
• 
THE SHANNON-WEAVER
MATHEMATICAL MODEL
• The concept of this model became staples
in communication research:
• ENTROPY
• measure or uncertainty in a system.
• “Uncertainty” or entropy increases in
exact proportion to the number of
messages from which the source has to
choose.
• REDUNDANCY
• degree to which information is not
unique in the system.
• NOISE
• the measure of information not
related to the message
• CHANNEL CAPACITY
• measure of the maximum amount of
information a channel can carry
• Insturmental Model
• Most common model used in low-level
communication context
• Solves technical problem of how
accurately transmission can occur
• Reflects a common sense understanding
of what communication is?
BERLO’S MODEL OF
COMMUNICATION
• There has to be a balance between the
source and the receiver if we want the
communication process to be efficient.
 The balance exist in the ff:
 Communication Skills
 Knowledge
 Social System
 Culture
 Attitude
  SOURCE
 includes oral, written, electronic or
any other kind of “symbolic”
generator-of messages.
 MESSAGE
 central element, stressing the
transmission of ideas
 RECEIVERS
 Target of communication
 
ECOLOGICAL MODEL OF
COMMUNICATION
• Initializing an integrated part of
communication
• A field can be remade y altering the
organization format
• Invent and evolve language
• Creation and maintenance of
relationships we have with others
• Learn how to create messages through
the act of consuming other people
messages
Verbal Communication
• uses spoken or written words.
• a code that conveys specific meaning
as words are combined.
• Vocabulary, Denotive and Connotative
Meaning, Pacing, Intonation, Clarity
and Brevity, Timing and Relevence
Aspects of Verbal
Communication
 Vocabulary
 Denotive and Connotative Meaning
 Pacing
 Intonation
 Clarity and Brevity
 Timing and Relevence
Nonverbal Communication
• sometimes called body language which
includes
 gestures
 body movements
 use of touch
 physical appearance
• often tells others more about what a
person is feeling than what is actually
said
• reinforces or contradicts what is said
verbally
• Observing nonverbal behavior efficiently
requires a systematic assessment of the
person’s overall personal appearance,
posture and gait, facial expressions,
and gestures.
PERSONAL APPEARANCE

 Clothing and adornments can be

sources of information about a client. It
may convey social and financial status,
culture, religion, group association,
and self-concept. How a person
dresses indicates a person’s feelings. A
nurse should observe how the client
dresses and be sensitive to it.
POSTURE AND GAIT
• The ways people walk and carry
themselves are often indicators of self-
concept, current mood, and health.
Erect posture and an active stride
indicate a happy client while a slouched
posture indicates a depressed client.
FACIAL EXPRESSION
• No part of the body is as expressive as
the face. By observing the facial
expressions of a client, the nurse might
be able to know if the client has the
feelings of surprise, fear, anger, sadness,
happiness, etc.
THERAPEUTIC COMMUNICATION
• Therapeutic communication promotes
understanding and can help establish a
constructive relationship between the
nurse and the client. This kind of
communication is client and goal
directed.
Attentive Listening
• Listening attentively
• Using all the senses
• An important technique in nursing
• An active process that requires energy
and concentration
• Involves paying attention to the total
message, both verbal and nonverbal
Attentive Listening
• Absorbs both the content and the
feeling the person is conveying, without
selectivity
• Involves listening for key themes in the
communication
• A highly developed skill but should be
learned with practice
Therapeutic Communication
Techniques
• Using silence
• Providing general leads
• Being specific and tentative
• Using open-ended questions
• Using touch
• Restating or paraphrasing
• Seeking clarification
• Perception checking or seeking consensual validation
• Offering self
• Giving information
Therapeutic Communication
Techniques
• Acknowledging
• Clarifying time sequence
• Presenting reality
• Focusing
• Reflecting
• Summarizing and planning
• Stereotyping
• Agreeing and disagreeing
• Being defensive
• Challenging
• Probing
Therapeutic Communication
Techniques
• Testing
• Rejecting
• Changing topics and subjects
• Unwarranted reassurance
• Passing judgment
• Giving common advice
RELATIONSHIP PRINCIPLES
• The relationship is an intellectual and
emotional bond between the nurse and
the client and is focused on the client.
• Respect the client as an individual.
• Maximize the client’s abilities to
participate in decision making and
treatment.
Relationship principles
• Consider ethnic and cultural aspects.
• Consider family relationships and values.
• Respect client confidentiality.
• Focus on the client’s well being or
welfare.
• The relationship is based on mutual trust,
respect and acceptance.
Relationship principles
• A relationship may develop over weeks
of working with client or over minutes.
• The relationship is influenced by the
personal and professional
characteristics of the nurse and the
client.
• Good communication skills and sincere
interest in the client’s welfare will
Relationship principles
enable the nurse to create a good helping
relationship with the patient.
• Age, sex, appearance, diagnosis,
education, values, ethnic and cultural
background, personality, expectations and
setting can all affect the development of
the relationship between client and nurse.
PHASES IN NURSE-CLIENT
RELATIONSHIP
• Pre interaction Phase
• Introductory phase
• Working phase
• Termination phase
PRE INTERACTION PHASE
• similar to the planning stage before an
interview.
• information such as client’s name,
address, age, medical history and
social history are the ones in the nurse’s
hand in this phase.
• implies the nurse’s planning for the
initial visit or face-to-face meeting.
INTRODUCTORY PHASE
• the orientation phase or the pre
helping phase.
• sets the tone for the rest of the
relationship
• During this phase, the client and the
nurse closely observe each other and
the form judgments about the other’s
behavior.
• includes getting to know each other
and developing a degree of trust.
• The three stages of this introductory
phase are the opening the relationship,
clarifying the problem and structuring
and formulating the contract.
• Resistive behaviors and testing
behaviors may be displayed in this
phase.
• In this phase, the client should begin to:
• Develop trust in the nurse
• View the nurse as a competent professional
capable of helping
• View the nurse as honest, open and
concerned about his welfare
• Believe the nurse will respect client
confidentiality and cultural values and beliefs
• Feel comfortable talking with the nurse
about feelings and other sensitive issues.
WORKING PHASE
• During this phase the nurse and the
client:
• begin to view each other as unique
individuals
• begin to appreciate this uniqueness
and care about each other.
• The two major stages of this phase are:
 Exploring and understanding
thoughts and feelings
 Facilitating and taking action

• In this phase, the nurse helps the client

to:
 Explore thoughts, feelings and
actions
 Plan a program of action to meet pre-
established goals
• The nurse requires the following SKILLS for this phase:
 Empathy
 therapeutic empathy
 emotional empathy
 emotive engagement/ embodiment
• Respect
• Genuineness
• Concreteness
• Self-disclosure
• Confrontation
TERMINATION PHASE
• expected to be difficult and filled with
ambivalence
• each person needs to develop a way of
saying goodbye.
• One method that can be used to
terminate relationship is summarizing
or reviewing the process
• may include sharing reminiscences of
how things were at the beginning of the
relationship and comparing them to how
they are now.
• the phase where the client turns into his
independence
• Follow-up phone calls can be helpful in
this phase
TECHNIQUES THAT HELP
PROMOTE EFFECTIVE
COMMUNICATIONS
• Reduce or resolve the impaired communication
• For patients who have impaired communication the
ff. can be used:
 Dominant language
 Word board/ picture board
 Translator
 Sign language
 Computer
• Consider the correct intonation of the voice when
talking to the patient.
• Avoid monotonous rhythms or very rapid rhythms
because these can be perceived as lack of energy or
interest, anxiety or fear.
• The nurse should consider simplicity, clarity, timing
and relevance, adaptability and credibility when
choosing words to say or write for the patient.
• The nurse should be aware of the nonverbal
communication expressed by the patient like
posture and gait, facial expression and hand
movements/ gestures.