CLASS PRESENTATION

ON
COMMUNICATION
AND
INTERPERSONAL RELATIONSHIP

SUBJECT:ADVANCED NURSING

SUBMITTED TO, SUBMITTED BY,

MADAM ROSHNA DEBASHRITA MISRA

FACULTY MEMBER 1ST YEAR M.SC NURSING

GOVT.COLLEGE OF NURSING GOVT.COLLEGE OF NURSING

KALIMPONG KALIMPONG
 INTRODUCTION
Communication is a dynamic, reciprocal process of sending and receiving messages.
Communication is more than the act of talking and listening. From the first cry of a newborn to
the whisper of a person who is dying, the primary purpose of a communication is to share
information and obtain a response. People use communication to meet their physical,
psychosocial, emotional and spiritual needs

DEFINITION OF COMMUNICATION

“Communication is a means of persuasion to influence the other so that the desired effect is
achieved”.
-Aristotle
“A process by which two or more people exchange ideas,facts,feelings or impressions in ways that
each gains a ‘common understanding’ of meaning,intent and use of a message”.
-Paul Leagens

Communication is ‘any act by which one person gives to or receives from person information about
that person’s needs desires, perception, knowledge or affective states’.

Communication may be intentional or unintentional, may involve conventional or unconventional

signals, may take linguistic or non-linguistic forms and may occur through spoken or other modes.

PURPOSES OF COMMUNICATION

 It should not be logically contradictory with itself.

 Should be expressed in terms of human behavior.
 Should be consistent with the ways in which people do communicate.
 Should be specific
LEVELS OF COMMUNICATION

• INTRAPERSONAL COMMUNICATION
• INTERPERSONAL COMMUNICATION
• GROUP COMMUNICATION – PUBLIC SPEAKING

INTRAPERSONAL COMMUNICATION

It is conscious internal dialogue, sometimes known as self-talk. It is language use or thought

internal to the communicator. The individual becomes his or her own sender and receiver,
providing feedback to him or herself in an ongoing internal process. It can be useful to envision
intrapersonal communication occurring in the mind of the individual in a model which contains a
sender, receiver and feedback loop.
INTERPERSONAL COMMUNICATION

 It is communication between two or more people.

• Face to Face conversation between two people is the most frequent form of interpersonal
communication.
• Nurses use interpersonal communication to gather information during assessment, to teach about
health issues to explain care and to provide comfort and support.

GROUP COMMUNICATION

• It is interaction that occurs among several people.

• Small group communication occurs when you engage in an exchange of ideas with two or more
individuals at the same time.

PUBLIC SPEAKING
• It is a unique form of group communication. Generally the speaker addresses a dozen to hundreds
of people, and varying degrees of interaction occur.
• Speaker may deliver a speech talk directly with a group of audience members or have open
discussion with the group. It is at the heart of our economy, society and politics.
• Nurses often engage in public speaking to educate groups of people about health issues.

THE COMMUNICATION PROCESS

• Communication requires a sender, a message, a receiver and a response or feedback.

• Communication is a two-way process involving the sending and the receiving of a message.
Because the intent of communication is to elicit a response the process of ongoing; the receiver of
the message then becomes the sender of a response, and the original sender then becomes the
receiver.

•Message
•Source (sender)
•Channel
•Receiver
•Feedback (response)
1. MODES OF COMMUNICATION
2.
3. • VERBAL COMMUNICATION
4. • NONVERBAL COMMUNICATION
5.
6. FACTORS IN VERBAL AND NONVERBAL MODES OF
COMMUNICATION
7.
8. • VERBAL
9. a) Pace and intonation
10. b) Simplicity
11. c) Clarity and brevity
12. d) Timing and relevance
13. e) Adaptability
14. f) Credibility
15. g) Humor
16.
17. NONVERBAL
18. Facial expression
19. Posture and Gait
20. Personal Appearance
21. Gestures
22. Touch
23.
24.
CHARACTERISTICS OF EFFECTIVE COMMUNICATOR
25.
26. An effective verbal communicator:
27. • Clarifies
28. • Listens
29. •Encourages empathically
30. • Acknowledges
31. • Restates/repeats
32.
33. An effective nonverbal communicator:
34. • Relaxes
35. • Opens up
36. • Leans toward the other person
37. • Establishes eye contact
38. • Shows appropriate facial expressions
39.
THE MOST COMMON WAYS WE COMMUNICATE

FACTORS INFLUENCING THE COMMUNICATION PROCESS

Development
Gender
Values And Perceptions
Personal Space
Territoriality
Roles And Relationships
Time
Environment
Congruence
Interpersonal attitudes

THERAPEUTIC COMMUNICATION

• Therapeutic communication means that nurses use their communication in such a way that it will
be benefit to their patient.
• Therapeutic communication differs from normal communication in that it introduces an element
of “empathy’’ into what can be traumatic experience for the patient and also the patient are made
to feel validated.
IMPORTANCE OF THERAPEUTIC COMMUNICATION

• It impels a feeling of comfort in the face of patient.

• To increase self-worth or decrease psychological distress by collecting information to determine
the illness, assessing and modifying the behaviour and providing health information.

THERAPEUTIC COMMUNICATION TECHNIQUES

USING SILENCE
BEING SPECIFIC AND TENTATIVE
USING OPEN-ENDED QUESTIONS
USING TOUCH RESTATING OR PARAPHRASING
SEEKING CLARIFICATION
PERCEPTION CHECKING OR SEEKING CONSENSUAL VALIDATION
OFFERING SELF
ACKNOWLEDGING
GIVING INFORMATION
CLARIFYING TIME OR SEQUENCE
PRESENTING REALITY
FOCUSING REFLECTING
SUMMARISING AND PLANNING

BARRIERS TO COMMUNICATION

STEREOTYPING
AGREEING AND DISAGREEING
BEING DEFENSIVE
CHALLENGING
PROBING
TESTING
REJECTING
CHANGING TOPICS AND SUBJECTS
UNWANTED REASSUARENCE
PASSING JUDGEMENT
GIVING COMMON ADVICE

FIVE WAYS TO FACILITATE THERAPEUTIC COMMUNICATION

MAINTAIN PAIENT – CENTERED TEACHING

SUPPRESS PREJUDICES
CREATE A THERAPEUTIC ENVIRONMENT
BE ALERT TO NON VERBAL CLUES
ESTABLISH A TRUSTING RELATIONSHIP

INTERPERSONAL RELATIONSHIP
An interpersonal relationship is a strong deep or close association / acquaintance between two or
more people that may range in duration from brief to enduring. The nurse is an important of the
health care team that must work in co-operation and harmony for the care of the patient. This co-
operation and harmony depends upon the IPR that is maintained among the members of the health
care team.

THEORETICAL ASSERTION

• The purpose of nursing achieved though the establishment of a human to human relationship.
• The human condition is shared by all human being.
• Most people at one time or another and in varying degrees will experience joy, contentment,
happiness and love.
• All persons, at sometime in their lives will be confronted by illness and pain. • The quality and
quantity of nursing care delivered to an ill human being is greatly influenced by nurse’s perception
of the client.
• The term patient and nurses are stereotyped and only useful for communicate economy.
• The roles of the nurse and patients must be transcended to establish a human to human
relatedness.
• Illness and suffering are spiritual encounters as well as emotional physical experience.
• Communication process enables the nurses to establish a human to human relationship and
thereby fulfil the purpose of the nursing profession.
• Individual can be assisted top find meaning in the experience of illness and suffering then
individual can cope with the problem exchanged by these experience.
• The spiritual and ethical values of the nurse, about illness suffering will determine the excellent
top which she will be able to assist individuals and families to find meaning these difficult
experiences.
• It is the responsibility of the professional nurse practitioner to assist individuals and families to
find meaning in illness and suffering.

PRINCIPLES OF IPR

• Learn everyone’s, name and never address anyone by nick name.

• Respect every one’s individually. Each member of a team is as important as other.( Keep up the
status of every member)
• Do not impose anything on anybody.
• Keep emotions under control.
• Do not give and take personal favour.
• Don’t be afraid to admit ignorance
• The team leader should not make any excuse regarding his or her responsibility.
• Develop the habits of listening and focus attention on the problem.
• Do not do or say anything that will disturb others faith.
• Give importance to others and practice justice
• The members of team should be loyal, honest dependable and willing to carry out the directions
of the team leader.
• There should be team spirit or team feeling among the members. Each member should work for
the interest of the group.
• There should be mutual understanding between the members. They should be willing to give and
take corrections.
• There should be delegation of responsibility in a group and every member should carry out his or
her responsibility to the satisfaction of the groups.
• The relationship between the members of a group should be decent and considerate.
• Teach the newcomer about the job. Make sure that all the assignments are understood.
• The new comer of the group should feel; at home when he joins the group.
• Establish a good rapport among the member in order to achieve the aim.
• Every member should be familiar with organizations plan and the policies of the group.
• Be up to date with the information that is going around
• Avoid arguments in the group.
• Talk in terms of other man’s interest.
• Praise the slightest improvement made by others. Use words of encouragement.
• Have a smiling face always.
• Prepare yourself mentally to accept the worst if necessary.

CHARACTERSTICS OF IPR

• Helping relationship is a therapeutic relationship in nursing which promoting a psychological

climate that brings a positive change in the client and promote his group.
• Facilitative characteristics
• Action oriented

FACILITATIVE CHARACTERISTICS

• They are the essential message for the nurse to establish positive and supportive relationship with
the client.
• These are condition that creates an emotional environment in which a patient feels comfortable
and safe.
• TRUST It may be defined as the belief that other will provide in terms of need and distress trust
fosters open therapeutic communication to foster the nurse’s act consistently, reliably and
competently.
• EMPATHY It’s the ability to understand and enter the client’s frame of reference. Empathy is
sensing, comprehensive and sharing the client’s frame of reference beginning with the problem that
the client recognises in other words. It is a phase of sensitive and objective look at what another
person experiences.
• CARING It is having a positive regard for another person. It is basic in helping relationship.
Nurses can show caring by expediting clients as who they are and respecting them as individuals. It
promotes trust and decrease anxiety and distress.
• AUTONOMY AND MUTUALITY It is the ability to the self director. Mutuality involves sharing
with another. These are important in any helping relationship.
• GENUINESS It is considered to be most basic of helping conditions. The helper needs you be
aware of his own feelings. He should be comfortable with who he is so that he does not lookout his
own feelings from himself.
• NON POSSESSIVE WARMTH It simply means unconditional positive regard, respect for others
and praising the other
ACTION ORIENTATION These are conditions that assist a person to move towards his goals.
Action oriented characteristic are used on the nurse patient relationship to progress beyond the
initiation process.
• CONCRETENESS IN COMMUNICATION A person is helped when he is encouraged to
express his concern in specific and personal terms.
• IMMEDIACY The nurse attends to any interpersonal process within the therapeutic relation.
• SENSITIVE CONFRONTATION It is non-judgemental point out of discrepancy in a helping
behaviour. It should be used carefully and should never used in earlier phase of therapeutic
relationship.

INTERPERSONAL COMMUNICATION

• It occurs between two or more person with a goal to exchange messages.

• Most of the nurse’s day is spent communicating with the patient, family members and member of
health care team.
• The nurses’ ability to communicate effectively at this level influences the nurses interpersonal
sharing, problem solving, goal attainment, team building and effectiveness in critical nursing roles.
(E.g.:- care giver, teacher, counsellor, leader, manager, and patient advocate)

MODEL PRESENTING HUMAN TO HUMAN RELATIONSHIP

• The model represents the interaction between the nurse and patient or recipient of her care.
• The major characteristics of this experience are that the nursing need of the individuals is met.
• The half circle at the point of original encounter indicates the possibility of and need for
developing encounter into therapeutic relationships.
• As the interaction process progresses towards rapport the circle joins in to one full circle,
representing that the potential for a therapeutic relationship has been attained.

MID-RANGE THEORY OF IPR

• Hildegard Peplau’s (1952:1997) mid-range theory of interpersonal relationships is considered an

essential theory frame work for the study of interpersonal relationships.
• The model describes how the nurse-client relationship can facilitate the identification and
accomplishments of therapeutic goals top enhance client and family well-being.
• In today’s health care environment nurse-client relationships are of short duration concise and
effective. Despite the brevity of the relationship, Peplau’s basic principles partnership and
terminating a relationship remain relevant.
• Peplau’s frame work for interpersonal relationships is applicable to all areas of nursing.

MAJOR CONCEPTS
• The theory explains the purpose of nursing to help others identify their felt difficulties.
• Nurses should apply principles of human relations to the problems that arise at all levels of
experience.
• Peplau’s theory explains the phases of interpersonal process, roles in nursing situations and
methods of studying nursing as an interpersonal process.
• Nursing is an interpersonal process because it involves interaction between two or more
individuals with a common goal.
• The attainment of goal is achieved through the use of a series of steps following a series of
pattern.
• The nurse and patient work together so both become mature and knowledgeable in the process.

DEFINITIONS

• Person- A developing organism that tries to reduce anxiety caused by needs.

• Environment- Existing forces outside the organism and in the context of culture.
• Health- A word symbol that implies forward movement of personality and other ongoing human
process in the direction of creative, constructive, productive, personal and community living.
• Nursing- A significant therapeutic interpersonal process. It functions cooperatively with other
human process that makes health possible for individuals in communities.

PEPLAU’S SIX NURSING ROLES

• Stranger: Receives the client the same way one meets a stranger in other life situations, provides
an accepting climate that builds trust.
• Resource role: Answers questions, interprets clinical treatment data, and gives information.
• Teaching role: Gives instructions and provides training, involves analysis and synthesis of the
learner experience.
• Counselling role: Helps client understand and integrate the meaning of current life circumstances
provide guidance and encouragement to make changes.
• Surrogate role: Helps client clarify domains of dependence, interdependence and independence
and acts on client’s behalf as an advocate.
• Leadership role: Helps client assume maximum responsibility for meeting treatment goals in a
mutually satisfying way.
• Technical expert Consultant Health teacher Tutor Socializing agent Safety agent Manager of
environment Mediator Administrator Recorder observer Researcher.

PHASES OF INTERPERSONAL RELATIONSHIP

• The nurse-client relation is therapeutic not social in nature.

• It is always client centred and goal directed.
• It is objective rather than subjective. The intent of a professional relationship is for client
behaviour to change.
• It is a limited relationship, with the goal of helping the client find more satisfying behaviour
patterns and coping strategies and increase self worth.
• It is not for mutual satisfaction.
• Peplau’s developmental stages parallel to the nursing process.
 • The orientation phase correlates with the assessment phase of the nursing process.
• The identification component of the working phase corresponds to the planning phase, where as
the exploitation phase parallels the implementation phase.
• The final resolution phase of the relationship corresponds to the evaluation phase of the nursing
process.

PRE INTERACTION PHASE

• The pre interaction phase is the only one in which the client does not directly participate.
Awareness of professional goal is important.
• The preinteraction phase occurs before you meet the client. In this phase you will gather
information about the client. In this phase, the nurse and client do not have direct communication.
• First phase in Peplau’s theory is orientation phase.

ORIENTATION PHASE

• The nurse enters the relationship in the “Stranger” role and begins the process of developing trust
by providing the client with basic information about the nurse and essential information about the
purpose, nature, and time available for the relationship.
• It is also referred to as the introductory or the prehelping phase is important because it sets the
tone for the rest of the relationship.
• It begins when you meet the client.
• The goal in this phase is to establish rapport and trust.
• This phase begins with introductions, followed by an initial exchange of information.
• During this phase verbal and nonverbal communication occurs.
40. 50. WORKING PHASE / IDENTIFICATION PHASE • It is the planning phase. The conversation
in the working phase turns active problem solving related to assess health care needs. • Clients are
able to discuss deeper, more difficult issues and experiment with new role and actions.
41. 51. WORKING PHASE/ IDENTIFICATION PHASE (CONT.) • Working phase focuses on self
direction and self management to whatever extent is possible in promoting the clients health and
well-being. • It is the active part of the relationship. • During this phase, caring is communicated,
thoughts and feelings are expressed, mutual respect is maintained, and honest verbal and nonverbal
expression occurs. • Key communication goals are to assist the client to clarify feelings and
concerns
42. 52. EXPLOITATION PHASE • Use of professional assistance for problem solving alternatives. •
Individual feels as an integral part of the helping environment. • The principles of interview
techniques must be used in order to explore, understand and adequately, deal with the underlying
problem. • Patient may fluctuate on independence. • Nurse aids the patient in exploiting all avenues
of help and progress made towards the final step.
43. 53. TERMINATION PHASE • In the termination phase, the nurse and client evaluate the client’s
responses to treatment, and explore the meaning of the relationship and what goals have been
achieved. Nurses need to be sufficiently aware of their own feelings so that they may use them
constructively without imposing them on the client. • Patient drifts away and breaks bond with
nurse and healthier emotional balance is demonstrated and both become mature individuals.
44. 54. TERMINATION PHASE (CONT.) • The termination phase is the conclusion of the
relationship, whether at the end of the nurse’s shift or on the client’s discharge from the unit,
 facility or service. If communication has been effective, the termination phase prepares the nurse
and client for future interactions
45. 55. INTERPERSONAL THEORY AND NURSING PROCESS • Both are sequential and focus on
therapeutic relationship. • Both use problem solving techniques for the nurse and patient to
collaborate on, with the end purpose of meeting the patient needs.
46. 56.  Leads to termination. Occurs after other phases are completed successfully.  May led to
termination and initiation data seeking RESOLUTION  Based on mutually expected behaviour 
Patient initiated family. EVALUATION  May be accomplished by patient nurse or  Patient
actively mutually set goals and drawing help  Plans initiated towards achievement of 
Interdependent goal setting IMPLEMENTATION EXPLOITATION  Mutually set goals
IDENTIFICATION  Define needs NURSING DIAGNONSIS PLANNING  Felt need.  Non
continuous collection  May not be a felt need. ORIENTATION analysis  Data collection and
(Continuous). ASSESSMENT
47. 57. CONCLUSION • Communication is essential wherever there are people living and working
together. Interpersonal relationship is also an important factor in our day to day communication,
especially in the field of nursing. Considerable thought and attention have been given to the subject
of IPR. Nursing is a caring profession and basically the primary role of a nurse is to render on
effective harmonious relationship to the patient so both communication and interpersonal
relationship are both sides of a coin.