Interpersonal Relationships Professional Communication (Chapter 12)

  1. THERAPEUTIC USE OF SELF

    • Definition: The deliberate use of a nurse's personality, insights, perceptions, and judgments as a therapeutic tool to facilitate healing and health in others. This requires a high level of self-awareness and self-reflection to ensure personal biases do not interfere with patient care.

    • Authenticity vs. Presence:

      • Authenticity: Being genuine and sincere. It involves being true to oneself while maintaining a professional role, ensuring that the nurse’s verbal and non-verbal behaviors are congruent.

      • Presence: The state of 'being with' the patient. It is characterized by being physically, psychologically, and emotionally available. This involves active listening and demonstrating that the patient's concerns are the clinician's primary focus.

    • The Nurse-Client Relationship: These concepts form the bedrock of the relationship, moving the interaction from a purely technical exchange to a humanized, therapeutic encounter.

  2. PROMOTING PERSON-CENTERED COMMUNICATION

    • Key Concepts:

      • Respect: Avoiding devaluing behaviors or condescending terms (e.g., ‘Honey’ or ‘Sweetie’). It includes recognizing the person by their preferred name and not defining them by their illness.

      • Caring: An intentional action demonstrating commitment. According to Jean Watson, it involves sustaining a relationship that supports the individual's integrity.

      • Compassion: Linked to Sister Simone Roach’s 6C's (Compassion, Competence, Conscience, Confidence, Commitment, Comportment). It is the empathetic awareness of suffering with a desire to alleviate it.

      • Empowerment: Fostering partnerships where individuals are assisted to take charge of their lives. It avoids the ‘power-over’ dynamic which can lead to disempowerment and poor health outcomes.

      • Trust: Built through consistency, honesty, and openness. It is the safety net that allows patients to share vulnerable information.

      • Empathy: Sharing another’s emotions while remaining non-judgmental. It enhances patient satisfaction and health engagement.

      • Mutuality: Recognition of reciprocity and a shared commitment to achieving individualized health goals.

      • Truthfulness and Honesty: Essential for transparency and informed consent. Without honesty, trust remains fragile.

      • Confidentiality: Maintaining the privacy of sensitive information, which is part of the Professional Code of Ethics (e.g., Canadian Nurses Association).

      • Acceptance: Unconditional positive regard, regardless of a patient's choices or background.

      • Confidence: Demonstrating competence and self-assurance, which builds a sense of security for the patient.

  3. REDUCING RELATIONSHIP BARRIERS

    • Personal and Organizational Barriers:

      • Anxiety: Can lead to physical manifestations such as increased heart rate or falling oxygen levels (as seen in the Mr. Syds case example). Use calm tones and active engagement to counter this.

      • Stereotyping: Generalizing individuals based on group characteristics. Overcome this by viewing each person through a unique, individualized lens.

      • Cultural Barriers: Misalignments between nurse and patient values. Address this with cultural competence training and ensuring culturally safe care.

      • Organizational Constraints: Workload and time pressures. Prioritizing communication as a core nursing intervention rather than a peripheral task helps mitigate these.

  4. ANXIETY AND PROXEMICS

    • Reducing Anxiety:

      • Techniques: Use active listening, validate feelings, and employ the TeamSTEPPS C.U.S. tool (‘I am Concerned’, ‘I am Uncomfortable’, ‘This is a Safety issue’).

      • Student Anxiety: Preparation, self-reflection, and professional mentorship can reduce the anxiety students feel when entering clinical practice.

    • Proxemics (Personal Space): Understanding space preferences is vital for person-centered communication:

      • Intimate Zone: (0 \text{ to } 18) inches. Restricted to physical care.

      • Personal Zone: (18 \text{ inches to } 4 \text{ feet}). Ideal for most therapeutic conversations.

      • Social Zone: (4 \text{ to } 12) feet. Used for group interactions or less personal exchanges.

    • Impact: Misjudging space can lead to a patient feeling threatened or anxious, particularly if their cultural identification requires larger personal boundaries.

  5. STAGES OF THE CARING PROCESS (C.A.R.E.)

    1. C - Connect: Introducing yourself and making a human connection.

    2. A - Appreciate: Acknowledging the patient's unique situation and feelings.

    3. R - Respond: Implementing interventions that evidence caring (the ‘Doing’ component).

    4. E - Empower / Evaluate: Enabling the patient to participate in care and checking the effectiveness of communication outcomes.

  6. NURSING ACTIONS FOR EMPATHY

    • Recognition and Classification of Requests:

      • Information Requests: Seeking facts.

      • Action Requests: Seeking nursing interventions.

      • Understanding / Emotion Requests: Seeking validation (e.g., ‘I’m scared’). Recognizing these allows for deeper empathetic connections.

    • Attending Behaviors (SOLER):

      • S: Sit squarely.

      • O: Open posture.

      • L: Lean in toward the person.

      • E: Eye contact.

      • R: Relax.

    • Empathetic Responses: Utilizing mirroring, validating statements, and open-ended questions to signal comprehension of the patient's internal experience.