NCM 103 LECTURE

PROFESSOR/S: Prof. Imelda Salvador

Ongoing Research
OUTLINE • Increasing research in nursing is contributing to nursing
I. INTRODUCTION practice. Most early research was directed to the study
A. Profession | Professionalism | Professionalization of nursing education. Since the 1970s, nursing research
B. Criteria has focused on practice-related issues.
C. Nursing as a Profession Code of Ethics
1. Definition • Nurses have traditionally placed a high value on the
2. Characteristics worth and dignity of others. The nursing profession
3. Qualities requires integrity of its members; that is, a member is
II. ACCORDING TO BENNER expected to do what is considered right regardless of the
A. Level of Proficiency personal cost.
III. ROLES AND FUNCTIONS Autonomy
IV. FIELDS OF NURSING • A profession is autonomous if it regulates itself and set
standards for its members. To practitioners of nursing,
INTRODUCTION autonomy means independence at work, responsibility,
- This course deals with concept, principles, theories, and and accountability for one’s action.
techniques basic to nursing as profession, science, and Professional Organization
art. It emphasizes on the concept of man as a holistic • Operation under the umbrella of a professional
being and the professional roles of the nurse in health organization differentiates a profession from an
care setting. The learners are expected to utilize the occupation. Governance is the establishment and
nursing process and the basic nursing skills as primary maintenance of social, political, and economic
tool in health promotion, disease prevention, restoration, arrangements by which practitioners control their
maintenance, and rehabilitation. practice, their self-discipline, their working conditions,
A. and their professional affairs. Nurses, therefore, need to
Profession work within their professional organization.
- Has been defined as an occupation that requires C.
extensive education or a calling that requires special Nursing as a Profession
knowledge, skill, and preparation. • An occupation or calling requiring advanced training and
Professionalism experience in some specific or specialized body of
- Refers to professional character, spirit, or methods. It is knowledge which provides service to society in that
a set of attributes, a way of life that implies responsibility special field.
and commitment. • A profession must satisfy an indispensable social need
Professionalization and be based upon well established and socially
- It is the process of becoming professional, that is, of accepted scientific principles
acquiring characteristics considered to be professional.
• It must demand adequate pre-professional and cultural
B.
training.
Criteria of a Profession
• It must demand the possession of a body of specialized
Specialized Education
and systematic training
• In modern times, the trend in education for the • It must give evidence of needed skills which the public
professions has shifted toward in colleges and does not possess; that is, skills which are partly inherent
universities. Many nursing educators believe that the and partly acquired.
undergraduate nursing curriculum should include liberal
• It must have developed a scientific technique which is the
arts education in addition to the biologic and social
result of tested experience.
sciences and the nursing discipline.
• It must require the exercise of discretion and judgment
Body of Knowledge
as to time and manner of the performance of duty.
• As a profession, nursing is establishing a well-defined • It must have a group of consciousness design to extend
body of knowledge and expertise. scientific knowledge in technical language.
Service Orientation
• It must have a sufficient self-impelling power to retain its
• A service orientation differentiates nursing from an members throughout life. It must not be used as a mere
occupation pursued primarily for profit. Many consider steppingstone to other occupations.
altruism the hallmark of a profession.

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 • It must recognize its obligations to society by insisting • Empathy
that its members live up to an established code of ethics. o A characteristic of a good nurse is one that
Definition of Nursing shows empathy to each patient, making a true
• The act of utilizing the environment of the patient to assist effort to put themselves in their patients’ shoes.
him in his recovery. • Attention to Detail
• The unique function of the nurse is to assist the o Having a strong attention to detail is one of the
individual, sick or well, in the performance of those nurse personality traits that can easily and
activities contributing to health and its recovery that he quickly determine how successful they’ll be in
would perform unaided if he had the necessary strength, their role.
will, or knowledge, and to do this in such a way as to help • Problem Solving Skills
him gain independence as rapidly as possible. o Problem solving skills are essential to nursing,
• Nursing practice is a dynamic, caring, helping as nurses generally have the most one-on-one
relationship in which the nurse assists the client to time with patients and are often responsible for
achieve and obtain optimal health. much of the decision-making related to their
Related Themes to the Definitions above: care.
• Nursing is caring. • Stamina
• Nursing is an art. o Nurses exercise a unique balance of physical
and emotional stamina that few other industries
• Nursing is a science.
encounter. Effectively managing this skill is
• Nursing is client centered.
what makes a great nurse. Having sufficient
• Nursing is holistic. stamina is one of the most important qualities of
• Nursing is adaptive. a great nurse.
• Nursing is concerned with health promotion, health • Sense of Humor
maintenance, and health restoration. o Having a good sense of humor helps spread
• Nursing is helping profession. positivity to other nurses, patients, and their
Characteristics of Nursing families. In especially stressful times, patients
• Nursing is caring. and their family members are appreciative of
• Nursing involves close personal contact with the any efforts (no matter how small) to help bring
recipient of care. a bit of cheer.
• Nursing is concerned with services that take humans into • Commitment to Patient Advocacy
account as physiological, psychological, and sociological o Be an advocate for patients, with special
organisms. attention on their overall safety and deliver the
• Nursing is committed to promoting individual, family, highest quality of care. As one of the leading
community, and national health goals in its best manner qualities, a great nurse understands that patient
possible. advocacy is a mindset that must be practiced
• Nursing is committed to personalized services for all every day, with every patient, throughout every
persons without regard to color, creed, social or stage of the care continuum.
economic status. • Willingness to learn
• Nursing is committed to involvement in ethical, legal, and o A good nurse must possess a natural
political issues in the delivery of health care. willingness to learn for them to be truly
Personal Qualities of a Nurse beneficial. This important skill applies to nurses
• Caring of all ages, throughout every stage of their
o A nursing quality which makes all the difference career, from recent graduates to the highly
to patients. A nurse showing a natural tendency experienced.
to truly care about how their patients feel (and • Critical Thinking
in turn, how well they perform their job) will have o While having a strong willingness to learn is an
a significant impact on their success in the important skill in a good nurse, putting that
nursing field, which makes caring a key knowledge into successful practice requires an
indicator of a nurse’s success. ability to think critically—especially in high
• Communication Skills stress situations. A nurse with highly functioning
o A nurse’s role relies on the ability to effectively critical thinking skills is one of the most
communicate with other nurses, physicians, important characteristics of a professional
disciplines across other units, patients, and nurse. While this skill can be improved over
their families. time, it’s often something that comes more
naturally to some nurses than others.
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 • Time Management Expert
o Having the ability to implement effective time - Expert nurse has 5 years and above experience,
management is a key personality trait for performance is fluid, highly skilled, highly developed
nursing. Setting time aside for selfcare is also a perceptual acuity, flexible, highly proficient and has an
crucial component to time management. intuitively grasp of the situation.
Refusing to take a quick break or regroup
during an especially intense 12-hour shift won’t
benefit anyone involved in the care process. ROLES AND FUNCTIONS
• Leadership • Caregiver
o Exercising leadership skills in any role/level of o assist the client physically and psychologically
the organization shows a willingness to grow while preserving the clients’ dignity.
and adapt at one’s own pace. Mentorships from • Teacher
nursing leaders can also teach invaluable o the nurse helps clients learn about their health
lessons on how to become a great nurse. and the health care procedures they need to
• Experience perform to restore or maintain their health. The
o It’s important to note that as veteran nurses nurse assesses the client’s learning needs and
leave the healthcare industry and begin readiness to learn, sets specific learning goals
retirement, they’re taking with them years of in conjunction with the client, enacts teaching
experience, knowledge and many patient care strategies, and measures learning.
skills that cannot be quickly replaced and that • Client Advocate
can only come with time and practice. o acts to protect the client. In this role the nurse
Professional Qualities of a Nurse may represent the client’s needs and wishes to
• Must have a Bachelor of Science degree in nursing. other health professionals, such as relaying the
• Must be physically and mentally fit. clients’ wishes for information to the physician.
• Must have a license to practice nursing. They also assist clients in exercising their rights
and help them speak up for themselves.
ACCORDING TO BENNER • Counselor
- presents a systematic way of understanding how a o is the process of helping a client to recognize
learner whether a student, new or seasoned nurse and cope with stressful psychological or social
develops skills and understanding of a practice problems, to developed improved interpersonal
situation/event over time. relationship and to promote personal growth.
Novice • Change Agent
- A novice has no experience yet with only months or a o the nurse acts as a change agent when
year of nursing practice that was a limited performance, assisting clients to make modifications in their
inflexible and governed by context-free rules and own behavior.
protocols. • Leader
Advance Beginner o a leader influences others to work together to
- Advanced beginner is called for those who have at least accomplish a specific goal
1 year to 2 years of experience. Advanced beginners can • Manager
demonstrate skills within the minimally accepted o the nurse manages the nursing care of
standards. They experienced enough real situations to individuals, families, and communities as well
make judgments about them. as delegates nursing activities to ancillary
Competent workers and other nurses, and supervises and
- A nurse who has been on the job for 2 to 3 years who evaluates their performance
can demonstrate ability to prioritize client care • Research consumer
requirements. They differentiate important factors from o nurses often use research to improve client
less important aspects of care. care.
Proficient • Expanded Career Roles
- A proficient nurse has 3 to 5 years of experience and can o nurses are fulfilling expanded career roles, such
demonstrate holistic understanding of a client's condition as those of nurse practitioner, clinical nurse
and focuses on long-term goals. They operate more specialists, nurse midwife, nurse educator,
intuitively than does the competent nurse. They use nurse researcher, and nurse anesthetist.
maxims as guides for what to consider in a situation.

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FIELDS OF NURSING • School Health Nursing
• Institutional Nursing o School nurses must like children a lot. They
o The nurse, as a member of the health care often work alone and are responsible for the
team, participates in all phases of patient care school’s activities in the areas of health service,
of the acutely ill, the convalescing and the health education and environmental health and
ambulatory patient. The nurse cares for the safety. They perform a wide variety of services
patient in the hospital or in the out-patient including basic screening for vision, hearing,
department and plans for the nursing care and risk factors that would interfere with the
needs of the patient about to be discharged. development of a healthy lifestyle.
The nurse performs nursing measures that will • Clinic Nursing
meet the patient’s health needs while in the o Clinic nursing requires that a nurse possess
institution and helps him and his family plan for general skills. Usually, a doctor has been in
his further health care needs when he returns general practice for a number of years. It is with
home. him that the nurse acts as receptionist, answers
• Public Health Nursing or Community Health Nursing phone, does the billing, takes x-rays and ECGs,
o The National Health Program of the Philippines changes dressings, gives injections and assist
gives as much emphasis on the promotion of in physical examination.
health and prevention of diseases rather than • Advanced Practice Nursing
care of the sick. It needs a deeper involvement o The advanced practice nurse is an umbrella
and close cooperation with all members of the term for nurses who have specialized education
health team such as physicians, nurses, and experience beyond the basic nursing
epidemiologists, dentists, sanitary inspectors, program. This advanced practice requires the
sanitary engineers, nutritionists, health knowledge skills and supervised skills obtained
educators, social workers, the community, and through graduate study in nursing.
the barangay leaders • Independent Nursing Practice
• Private Duty Nursing o As the term implies “independent” means the
o A private duty nurse is a registered nurse who nurse is self-employed and provides
undertakes to give comprehensive nursing care professional nursing services to clients and
to a client on a one-to-one ratio. their families. They make referrals and
• Occupational Health Nursing or Industrial Nursing collaborate with physicians and other discipline
o The practice focuses on promotion, protection, as needed by the client or family.
and supervision of workers’ health within the
context of a safe and healthy work environment.
Occupational health nurses make independent
nursing judgments in providing health services.
This field of nursing requires special skills.
Helpful skills include ability to take and read
ECGs, eye screening, audiometer testing,
laboratory tests, and X-ray.
• Nursing Education
o Career opportunities in nursing education are
better today than even before. There is a
chronic shortage in all nursing education
programs. Nurses who like to consider teaching
as their field of expertise must be qualified for
the position. The career ladder in nursing
education starts with a Clinical Instructor’s
position up to the Dean of a College of Nursing.
• Military Nursing (The Nurse Corps)
o As in other civilian hospitals, nursing service in
the military seeks to provide the highest quality
of nursing care to patients: in-patients in the
hospitals and out-patient in the dispensaries.

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NCM 103 LECTURE
PROFESSOR: Prof. Imelda Salvador

OUTLINE CARING
- Is the intentional action that conveys physical and
I. NURSING AS AN ART
emotional security and genuine connectedness with
A. Caring
another person or group of people.
B. Communication
Caring Practice Model
C. Therapeutic Communication
II. THE HELPING RELATIONSHIP • involves connection, mutual recognition and
A. Phases involvement. Caring is considered by many nurses to be
B. Tasks and Skills an essential aspect of nursing.
III. THERAPEUTIC COMMUNICATION TECHNIQUE 6 Cs of Nursing
IV. BARRIERS TO COMMUNICATION • Care - is our core business and that of our organizations,
V. COMMUNICATION STRATEGIES FOR COMFORT and the care we deliver helps the individual and improves
VI. LIFESPAN CONSIDERATIONS the health of the whole community.
• Compassion - is how care is given through relationships
NURSING AS AN ART based on empathy, respect, and dignity - it can also be
- is the interpersonal relationship and interaction process described as intelligent kindness and is central to how
between the person and the nurse within a social people perceive their care.
environment during delivery of nursing care. • Competence - the ability to understand an individual’s
- is the intentional creative use of oneself, based upon skill health and social needs, and the expertise, clinical and
and expertise, to transmit emotion and meaning to technical knowledge to deliver effective care and
another. treatments based on research and evidence. All this is
- is more than a great deal of science. done to ensure the highest standard of care for each
- is more than just knowing; it is doing. patient.
- bridges information from nurses to patients in a skillful • Communication - is essential in healthcare and is
way. central to successful caring relationships and effective
- is the application of all the science known to nursing to teamwork.
give the utmost care the patient needs. • Courage - this includes courage to do the right thing for
Johari Window Model the people we care for to speak up when we have
• is a simple and useful tool for illustrating and improving concerns, and to have the personal strength and vision
self-awareness, and mutual understanding between to innovate and to embrace new ways of working.
individuals within a group. • Commitment - this means looking after your own health
• used to assess and improve a group's relationship with and maintaining a code of conduct in our social lives in
other groups. order to be that role model. You should continually strive
• is especially relevant due to modern emphasis on, and to provide the best possible guidance and care for your
influence of, behavior, empathy, cooperation, inter-group patients
development and interpersonal development. Caring for self and others
• Self-care - is any deliberate activity that we do in an
effort to provide for our physical, mental, and spiritual
well-being.
• Caring for self - is helping oneself grow and actualize
one’s possibilities. It means taking the time to nurture
oneself. This involves initiating and maintaining
behaviors that promote healthy living and well-being like
a balanced diet, regular exercise, adequate rest and
sleep, recreational activities and mediation and prayers.
• Caring as “Helping the Other Grow” - To care for
another person is to help him grow and actualize himself;
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. The caring process has

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 benefits for the one giving care; by helping the other ➢ Gestures
grow, the caregiver moves toward self-actualization – the o Hand
highest level of personality development in which people o Body
reach their full potential or capability. Factors Influencing Communication
• Development
COMMUNICATION • Gender
- A two-way process involving the sending and receiving • Values and perceptions
of messages • Personal space
- It is the interchange of information between two or more ➢ Proxemics – study of distance between people in
people their interactions
- It is a basic component of human relationships o Intimate Distance – actual contact
- In nursing, communication is a dynamic process used to (touching) to 1.5 feet
gather assessment data, to teach and persuade, and to o Personal Distance – 1.5 to 4 feet for
express caring and comfort. interviews
Purposes o Social Distance – 4 to 12 feet
• To send, receive, interpret, and respond appropriately o Public Distance – 12 feet and beyond
and clearly to a message, an interchange of information. • Territoriality
• To correct the information a person has about himself • Roles and relationships
and others. • Environment
• To provide the satisfaction or pleasure of expressing • Congruence
oneself • Interpersonal attitudes
Essential Components of the Human Communication System
• Sender/ Encoder – the originator or source of the idea. THERAPEUTIC COMMUNICATION
• Message – the idea. - Promotes understanding and can help establish a
• Channel – the means of transmitting (either verbally or constructive relationship between the nurse and the
nonverbally) the idea. client. The therapeutic helping relationship is client and
• Receiver/Decoder – someone to receive and interpret goal oriented.
the message. ➢ Attentive listening involves paying attention to the
• Response/Feedback – the response to the message. total message, both verbal and nonverbal, noting
Modes of Communication whether these communications are congruent.
• Verbal Communication - refers to the use of the spoken ➢ Physical attending is the manner of being present to
word to acknowledge, amplify, confirm, contrast, or another or being with another. Listening is what a
contradict other verbal and nonverbal messages. The person does while attending.
words used vary among individuals according to culture, Critical Elements of Effective Therapeutic Communication
socioeconomic background, age and education. • Convey to the patient and family that they are important
Considerations: to you and that you want to help them. There are many
➢ Pace and intonation – enthusiasm, sadness, anger ways to do this; you must do what is comfortable and
or amusement. Pacing may indicate interest, natural for you.
anxiety, fear boredom. • Convey honesty and trustworthiness.
➢ Simplicity ➢ Try not to overwhelm the patient with embarrassing
➢ Clarity and brevity or personal questions.
➢ Timing and relevance ➢ Don’t make promises you can’t keep
➢ Adaptability ➢ Try to be there when you say you will. If you are late,
➢ Credibility explain why.
➢ Humor • Communicate with each patient as an individual.
• Nonverbal communication - refers to an exchange of • Accept and respect the patient despite the symptoms of
information without the exchange of spoken words. It his illness.
often tells others more about what a person is feeling Nursing Intervention with Patients with Special
than what is actually said. Communication Needs
Systematic assessment of: • Blind Patients
➢ Physical appearance ➢ Always speak to the patient when you enter the
➢ Posture and Gait room so he will know who is there.
➢ Facial expressions ➢ Speak directly to the patient; do not turn your back.
o Eye contact

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 ➢ Speak to the patient in a normal tone of voice; he is PHASES OF HELPING RELATIONSHIP
blind, not deaf. - Pre-interaction phase: is the planning stage before an
➢ Speak to the patient before touching him/her. interview.
➢ Offer to help with arrangements for patients who - Introductory phase: referred to as the orientation or
may enjoy hearing music or reading Braille pre-helping phase, is important because it sets the tone
literature. for the rest of the relationship.
• Deaf Patients ➢ The three stages of this introductory phase are:
➢ Look directly at the patient when speaking with o Opening the relationship
him/her. o Clarifying the problem
➢ Do not cover your mouth when speaking because o Structuring and formulating the contract
the patient may read lips. ➢ Goals of the Orientation Phase
➢ If the patient does not lip-read, charts with pictures o Establish tone and guidelines for the
may be used, or simply writing your questions or relationship
comments on a piece of paper may be helpful. o Identify each other by name
➢ Charts with hand signs are available at the local o Clarify roles of both people
society for deafness and/or hearing preservation. o Establish an agreement about the relationship
• Patients Speaking a Foreign Language o Provide the patient with orientation to the
➢ Obtain a translator if possible healthcare system
➢ Have a chart with basic phrases in English and the - Working phase: the nurse and the client begin to view
foreign language. each other as unique individuals. They begin to
➢ Consider using charts with pictures. appreciate and care about each other.
Developing Conversation Skills ➢ Caring is sharing deep and genuine concern about
• Control the tone of your voice the welfare of another person.
• Be knowledgeable about the topic of conversation ➢ Once caring develops, the potential for empathy
increases.
• Be flexible
➢ Goals of the Working Phase
• Be clear and concise
o Work together to meet the patient’s needs
• Avoid words that might have different interpretations
o Provide whatever assistance is needed to
• Be truthful achieve each goal
• Keep an open mind o Provide teaching and counseling
• Take advantage of available opportunities - Termination phase: is often expected to be difficult and
Developing Listening Skills filled with ambivalence.
• Sit when communicating with a patient ➢ Goals of the Working Phase
• Be alert and relaxed and take your time o Examine goals of helping relationship for
• Keep the conversation as natural as possible attainment
• Maintain eye contact if appropriate o Make suggestions for future efforts if necessary
• Use appropriate facial expressions and body gestures o Encourage patient to express his or her
• Think before responding to the patient emotions about the termination
• Do not pretend to listen ➢ On the other hand, because caring attitudes have
developed, it is natural to expect some feelings of
• Listen for themes in the patient’s comments
loss, and each person needs to develop a way of
• Use silence, therapeutic touch, and humor appropriately
saying good-bye.
THE HELPING RELATIONSHIP
TASK AND SKILLS FOR EACH PHASE
- Nurse-patient relationship are referred as interpersonal
Pre-interaction phase
relationship, therapeutic relationship or as helping
➢ Tasks: The nurse reviews pertinent assessment
relationship. Helping is a growth-facilitating process.
data, knowledge, considers potential areas of
Goals
concern, and develops plans for interaction.
• Help clients manage their problems in living more ➢ Skills: Organized data gathering: recognizing
effectively and develop unused or underused limitations and seeking assistance as required.
opportunities more fully. Introductory phase
• Help clients become better at helping themselves in their o Opening the relationship
everyday lives. ➢ Tasks: Both client and nurse identify each other by
name. When the nurse initiates the relationship, it is
important to explain the nurse's role to give the client

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 an idea of what to expect. When the client initiates Termination Phase
the relationship, the nurse needs to help the client ➢ Tasks: Nurse and client accept feelings of loss. The
express concerns and reasons for seeking help. client accepts the end of the relationship without
Vague, open-ended questions, such as "What's on feelings of anxiety or dependence.
your mind today?" are helpful at this stage. ➢ Skills: For the nurse: summarizing skills; for the
➢ Skills: A relaxed, attending attitude to put the client client: ability to handle problems independently.
at ease. It is not easy for all clients to receive help. Four Levels of Communication
o Clarifying the problem • Intrapersonal
➢ Tasks: Because the client initially may not see the • Interpersonal
problem clearly, the nurse's major task is to help • Small-group
clarify the problem. • Organizational
➢ Skills: Attentive listening, paraphrasing, clarifying,
and other effective communication techniques THERAPEUTIC COMMUNICATION TECHNIQUES
discussed in this chapter. A common error at this Using silence
stage is to ask too many questions of the client. - Accepting pauses or silences that may extend for several
Instead focus on priorities. seconds of minutes without interjecting any verbal
o Structuring and formulating the contract response.
➢ Tasks: Nurse and client develop a degree of trust Examples:
and verbally agree about (a) location, frequency, ➢ Sitting quietly (or walking with the client) and waiting
and length of meetings, (b) overall purpose of the attentively until the client is able to put thoughts and
relationship, (c) how confidential material will be feelings into words.
handled, (d) tasks to be accomplished, and (e) Providing general leads
duration and indications for termination of the - Using statements or questions that (a) encourage the
relationship. client to verbalize, (b) choose a topic of conversation and
➢ Skills: Communication skills listed above and ability (c) facilitate continued verbalization.
to overcome resistive behaviors if they occur. Examples:
Working phase ➢ "Can you tell me how it is for you?"
➢ Tasks: Nurse and client accomplish the tasks ➢ "Perhaps you would like to talk about....”
outlined in the introductory phase, enhance trust and ➢ "Would it help to discuss your feelings?"
rapport, and develop caring. ➢ "Where would you like to begin?”
o Exploring and understanding thoughts and feelings ➢ "And then what?"
➢ Tasks: The nurse assists the client to explore Being specific and tentative
thoughts and feelings and acquires an - Making statements that are specific rather than general,
understanding of the client. The client explores and tentative rather than absolute
thoughts and feelings associated with problems, Examples:
develops the skill of listening, and gains insight into ➢ “Rate your pain on a scale of 0-10” (specific
personal behavior. statement)
➢ Skills: Listening and attending skills, empathy, ➢ "Are you in pain?" (general statement)
respect, genuineness, concreteness, self- ➢ "You seem unconcerned about your diabetes
disclosure, and confrontation. Skills acquired by the (tentative statement)
client are non-defensive listening and self- ➢ "You don't care about your diabetes and you never
understanding. will." (absolute statement)
o Facilitating and taking action Using open-ended questions
➢ Tasks: The nurse plans programs within the client's - Asking broad questions that lead or invite the client to
capabilities and considers long-and short-term explore (elaborate, clarify, describe, compare, or
goals. The client needs to learn to take risks (i.e., illustrate) thoughts or feelings Open-ended questions
accept that either failure or success may be the specific only the topic to be discussed and invite answers
outcome). The nurse needs to reinforce successes that are longer than one or two words.
and help the client recognize failures realistically. Examples:
➢ Skills: Decision-making and goal setting skills. Also, ➢ "I’d like to hear more about that."
for the nurse: reinforcement skills; for the client risk ➢ "Tell me about....”
taking. ➢ "How have you been feeling lately?”
➢ "What brought you to the hospital?”
➢ "What is your opinion?”

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 ➢ "You said you were frightened yesterday. How do Offering self
you feel now?" - Suggesting one's presence, interest, or wish to
Using touch understand the client without making any demands or
- Providing appropriate forms of touch to reinforce caring attaching conditions that the client must comply with to
feelings. Because tactile contacts vary considerably receive the nurse's attention.
among individuals, families, and cultures, the nurse must Examples:
be sensitive to the differences in attitudes and practices ➢ “I’ll stay with you until your daughter arrives."
of clients and self. ➢ "We can sit here quietly for a while; we don't need to
Examples: talk unless you would like to.”
➢ Putting an arm over the client’s shoulder. Placing ➢ "I’ll help you to dress to go home, if you like.”
your hand over the client's hand. Giving information
Restating or paraphrasing - Providing in a simple and direct manner, specific factual
- Actively listening for the client's basic message and then information the client may or may not request. When
repeating those thoughts and/or feelings in similar words. information is not known, the nurse states this and
This conveys that the nurse has listened and understood indicates who has it or when the nurse will obtain it.
the client’s basic message and also offers clients a Examples:
clearer idea of what they have said ➢ "Your surgery is scheduled for 11 AM tomorrow.”
Examples: ➢ "You will feel a pulling sensation when the tube is
➢ Client: I couldn't manage to eat any dinner last night removed from your abdomen.”
not even the dessert. ➢ "I do not know the answer to that, but I will find out
Nurse: "You had difficulty eating yesterday.” from Mrs. King, the nurse in charge.”
➢ Client: "Yes, I was very upset after my family left and Acknowledging
I have trouble talking to strangers.” - Giving recognition, in a nonjudgmental way, of a change
Nurse: "You find it difficult talking to people you do in behavior an effort the client has made, or a contribution
not know?" to a communication. Acknowledgment may be with or
Seeking clarification without understanding, verbal or nonverbal.
- A method of making the client's broad overall meaning of Examples:
the message more understandable. It is used when ➢ "You trimmed your beard and mustache and washed
paraphrasing is difficult or when the communication is your hair.”
rambling or garbled. To clarify the message, the nurse ➢ "I notice you keep squinting your eyes. Are you
can restate the basic message or confess confusion and having difficulty seeing?”
ask the client to repeat or restate the message. ➢ "You walked twice as far today with your walker"
- Nurses can also clarify their own message with Clarifying time or sequence
statements. - Helping the client clarify an event, situation, or happening
Examples: in relationship to time.
➢ “I’m puzzled. Examples:
➢ "I'm not sure I understand that." ➢ Client: "I vomited this morning."
➢ "Would you please say that again?" Nurse: “Was that after breakfast?”
➢ "Would you tell me more?" ➢ Client: "I feel that I have been asleep for weeks."
Perception checking or seeking consensual validation Nurse: "You had your operation Monday and today
- A method similar to clarifying that verifies the meaning of is Tuesday"
specific words rather than the overall meaning of a Presenting reality
message. - Helping the client to differentiate the real from the unreal.
Examples: Examples:
➢ "I meant this rather than that." ➢ "That telephone ring came from the program on
➢ "I'm sorry that wasn't very clear. Let me try to explain television.”
another way.” ➢ "I see shadows from the window coverings.”
➢ Client: "My husband never gives me any presents. ➢ "Your magazine is here in the drawer. It has not
Nurse: "You mean he has never given you a present been stolen.”
for your birthday or Christmas? Focusing
Client: "Well - not never. He does get me something - Helping the client expand on and develop a topic of
for my birthday and Christmas, but he never thinks importance it is important for the nurse to wait until the
of giving me anything at any other time client finishes stating the main concerns before
attempting to focus. The focus may be an idea or a
feeling; however, the nurse often emphasizes a feeling

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 to help the client recognize an emotion disguised behind Being defensive
words - Attempting to protect a person or health care services
Examples: from negative comments. These responses prevent the
➢ Client: "My wife says she will look after me, but I client from expressing true concerns. The nurse is saying
don't think she can, what with the children to take "You have no right to complain." Defensive responses
care of and they're always after her about something protect the nurse from admitting weaknesses in the
- clothes, homework, what's for dinner that night." health care services, including personal weaknesses.
Nurse: "Sounds like you are worried about how well Examples:
she can manage. ➢ Client: "Those night nurses must just sit around and
Reflecting talk all night. They didn't answer my light for over an
- Directing ideas, feelings, questions or content back to hour."
clients to enable them to explore their own ideas and Nurse: "I'll have you know we literally run around on
feelings about a situation. nights. You're not the only client, you know."
Examples: Challenging
➢ Client: "What can I do?” - Giving a response that makes clients prove their
Nurse: "What do you think would be helpful?" statement or point of view. These responses indicate that
Client: "Do you think I should tell my husband?" the nurse is failing to consider the client's feelings,
Nurse: "You seem unsure about telling your making the client feel it necessary to defend a position.
husband." Examples:
Summarizing and planning ➢ Client: "I felt nauseated after that red pill."
- Stating the main points of a discussion to clarify the Nurse: "Surely you don't think I gave you the wrong
relevant points discussed. This technique is useful at the pill?"
end of an interview or to review a health teaching ➢ Client: "I feel as if I am dying."
session, it often acts as an introduction to future care Nurse: "How can you feel that way when your pulse
planning. is 60?"
Examples: ➢ Client: "I believe my husband doesn't love me."
➢ "During the past half hour we have talked about....” Nurse: "You can't say that; why, he visits you every
➢ “Tomorrow afternoon we may explore this further." day."
➢ "In a few days I'll review what you have learned Probing
about the actions and effects of your insulin.” - Asking for information chiefly out of curiosity rather than
➢ "Tomorrow, I will look at your feeling journal.” with the intent to assist the client. These responses the
are considered prying and violate the client's privacy.
BARRIERS TO COMMUNICATION Asking "why" is often probing and places the client in a
Stereotyping defensive position.
- Offering generalized and oversimplified beliefs about Examples:
groups of people that are based on experiences too ➢ Client: "I was speeding along the street and didn't
limited to be valid. These responses categorize clients see the stop sign
and negate their uniqueness as individuals. Nurse: "Why were you speeding?"
Examples: ➢ Client: "I didn't ask the doctor when he was here."
➢ "Two-year-olds are brats." Nurse: "Why didn't you?"
➢ "Women are complainers.” Testing
➢ "Men don't cry." - Asking questions that make the client admit to
➢ "Most people don't have any pain after this type of something. These responses permit the client only
surgery." limited answers and often meet the nurse's need rather
Agreeing and disagreeing than the client's.
- Akin to judgmental responses, agreeing and disagreeing Examples:
imply that the client is either right or wrong and that the ➢ "Who do you think you are?" (forces people to admit
nurse is in a position to judge this. These responses their status is only that of client)
deter clients from thinking through their position and may ➢ "Do you think I am not busy?" (forces the client to
cause a client to become defensive. admit that the nurse really is busy)
Examples: Rejecting
➢ Client: "I don't think Dr. Broad is a very good doctor. - Refusing to discuss certain topics with the client. These
He doesn't seem interested in his patients." responses often make clients feel that the nurse is
Nurse: "Dr. Broad is head of the Department of rejecting not only their communication but also the clients
Surgery and is an excellent surgeon." themselves.

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 Examples: - Nurse has a positive impact by keeping the client
➢ "I don't want to discuss that. Let's talk about...." informed, encouraged, or coached.
➢ "Let's discuss other areas of interest to you rather Examples:
than the two problems you keep mentioning." ➢ "Your feelings are very normal in this situation,"
➢ "I can't talk now. I'm on my way for coffee break." ➢ "You are doing really well; this is a very difficult
Changing topics and subjects procedure."
- Directing the communication into areas of self-interest ➢ "Taking these steps is hard, but you are improving.
rather than considering the client's concerns is often a Good work!"
self-protective response to a topic that causes anxiety. ➢ "Most families in this situation have these types of
These responses imply that what the nurse considers feelings and thoughts."
important will be discussed and that clients should not Therapeutic touch
rose garden." discuss certain topics. - The nurse, when appropriate, maintains physical contact
Examples: with the client, and reassures and comforts the client.
➢ Client: "I'm separated from my wife. Do you think I Examples:
should have sexual relations with another woman?" ➢ "How about if I hold your hand during this
Nurse: "I see that you're 36 and that you like procedure."
gardening. This sunshine is good for my roses. I ➢ "I am just going to rub your shoulder for a minute
have a beautiful rose garden.” until the pain medication starts to work.”
Unwarranted reassurance Competent physical and technical skills
- Using clichés or comforting statements of advice as a - The nurse's level of professionalism and efficiency
means to reassure the client. These responses block the decreases the anxiety and promotes comfort.
fears, feelings, and other thoughts of the client. Examples:
Examples: ➢ “This will just take a second with a little pin prick to
➢ "You'll feel better soon." start this IV. You have excellent veins."
➢ "I'm sure everything will turn out all right." ➢ "We do this procedure frequently. Do you have any
➢ "Don't worry." questions we haven't answered yet?"
Passing judgement Vigilance
- Giving opinions and approving or disapproving - The client trusts that the nurse is involved in his/her care.
responses, moralizing, or implying one's own values. Examples:
These responses imply that the client must think as the ➢ "I am back to check on how you are doing."
nurse thinks, fostering client dependence. ➢ "I will not be gone for more than 30 minutes and if
Examples: you need me before, use the call light and I will
➢ "That's good (bad)." come. Does 30 minutes sound doable to you?"
➢ "You shouldn't do that."
➢ That's not good enough." COMMUNICATION STRATEGIES FOR PROVIDING COMFORT
➢ "What you did was wrong” (right). Infants
Giving common advice - Infants communicate through their senses. Teach
- Telling the client what to do. These responses deny the parents about the importance of touch.
client's right to be an equal partner. Note that giving - They respond best to a high-pitched, soft or gentle tone
expert rather than common advice is therapeutic. of voice and eye contact.
Examples: Toddlers and Preschoolers
➢ Client: "Should I move from my home to a nursing - Allow time for them to complete verbalizing their thoughts
home?" without interruption.
Nurse: "If I were you, I'd go to a nursing home, where - Provide a simple response to questions because they
you'll get your meals cooked for you." have short attention spans.
- Drawing a picture can provide another way for the child
COMMUNICATION STRATEGIES FOR PROVIDING COMFORT to communicate.
Empathy School-Age Children
- An expression of understanding of "how it is for the client" - Talk to the child at his or her eye level to help decrease
who is distressed, suffering, or sad. intimidation.
Examples: - Include the child in the conversation when
➢ "I hear how this is for you." communicating with the parents.
➢ "I understand how hard this is for you." Adolescents
Positive talk - Take time to build rapport with the adolescent.
- Adversity of situation validated. - Use active listening skills.

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 - Project a nonjudgmental attitude and nonreactive
behaviors, even when the adolescent says disturbing NCM 103 LECTURE
remarks. PROFESSOR: Prof. Imelda Salvador
Elders
- Older adults may have physical or cognitive problems OUTLINE
that necessitate nursing interventions for improvement of
communication skills. Some of the common ones are as I. HEALTH
follows: A. Health
➢ Sensory deficits, such as vision and hearing B. Illness
➢ Cognitive impairment, as in dementia C. Wellness
➢ Neurological deficits from strokes or other II. THE HUMAN DIMENSIONS OF HEALTH
neurological conditions, such as aphasia A. Factors Affecting Health
(expressive and/or receptive) and lack of movement B. Tasks and Skills
➢ Psychosocial problems, such as depression. III. HEALTH CARE DELIVERY SYSTEM
- Recognition of specific needs and obtaining appropriate A. Types of Health Care Delivery Services
resources for clients can greatly increase their V. COMMUNICATION STRATEGIES FOR COMFORT
socialization and quality of life. Interventions directed VI. LIFESPAN CONSIDERATIONS
toward improving communication in clients with these
HEALTH
special needs are as follows:
- a state of complete physical, mental, and social well-
➢ Make sure that assistive devices, glasses, and
being, not merely the absence of disease.
hearing aids are being used and are in good working
ILLNESS
order.
- the unique response of a person to a disease.
➢ Make referrals to appropriate resources, such as
WELLNESS
speech therapy.
- an active state, oriented toward maximizing the potential
➢ Make use of communications aids, such as
of the individual.
communication boards, computers, or pictures,
- state of well-being
when possible.
➢ Keep environmental distractions to a minimum.
THE HUMAN DIMENSIONS OF HEALTH
➢ Speak in short, simple sentences, one subject at a
- Physical: genetic inheritance, age, developmental level,
time-rein force or repeat what is said when
race, and gender
necessary.
➢ Always face the person when speaking-coming up - Emotional: how the mind affects body function and
behind someone may be frightening. responds to body conditions
➢ Include family and friends in conversation. - Intellectual: cognitive abilities, educational background,
➢ Use reminiscing, either in individual conversations and past experiences
or in groups, to maintain memory connections and - Environmental: housing, sanitation, climate, pollution of
to enhance self-identity and self-esteem in the older air, food, and water
adult. - Sociocultural: economic level, lifestyle, family, and
➢ When verbal expression and nonverbal expression culture
are incongruent, believe the nonverbal. Clarification - Spiritual: spiritual beliefs and values
of this and attentiveness to their feelings will help
promote a feeling of caring and acceptance.
➢ Find out what has been important and has meaning
to the person and try to maintain these things as
much as possible. Even simple things such as
bedtime rituals become important if they are lost in
a hospital or extended care setting.

Factors Affecting Health

• Political
• Environmental
• Economic
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 • Cultural Providers of Health Care
• Social • Nurse
• Alternative care provider
• Case manager
• Dentist
• Dietician or nutritionist
• Occupational therapist
• Paramedical team
• Physician
• Physician assistant
• Podiatrist
• Respiratory therapist
• Social worker
• Spiritual support personnel
• Unlicensed assistive personnel
Factors Affecting Health Care Delivery
HEALTH CARE DELIVERY SYSTEM • Increasing number of elderlies
- Health Care System is the totality of services offered by • Advances in technology
all health disciplines. • Economics
- Its purpose is to provide care to the ill and injured. • Uneven distribution of services
Types of Health Care Delivery Services • Women’s health
- Primary prevention: consist of health promotion and • Access to health care
illness prevention. (ex. Condom, Vaccinations) • Health insurance & accountability act
➢ Health Promotion: behavior motivated by the • The homeless and the poor
desire to increase well-being and actualize human • Demographic changes
health potential (Pender, Murdaugh, Parsons)
➢ Disease Prevention: behavior motivated by a
desire to actively avoid illness, detect it early or
maintain functioning within the constraints of illness
(Pender, Murdaugh, Parsons)
- Secondary prevention: consist of diagnosis and
treatment.
- Tertiary prevention: consist of rehabilitation, health
restoration and palliative care.
Types of Health Care Agencies and Services
• Public Health
• Physicians’ Offices
• Ambulatory Care Centers
• Occupational Health Clinics
• Hospitals
• Sub-acute Care Facilities
• Extended Care (long-term) Facilities
• Retirement and Assisted Living Centers
• Rehabilitation Centers
• Home Health care Agencies
• Day-Care Centers
• Rural are
• Hospice Services
• Crisis Centers
• Mutual and Self-Help Groups

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