Nursing-Patient Interaction

Is the use of oral, gestures and facial expression of the client and nurse in
establishing a nurse-patient relationship.

Phases of Nurse-Patient Interaction

1. Orientation - During this phase, the individual has a felt need and seeks
professional assistance. The nurse helps the individual to recognize and
understand his/ her problem and determine the need for help.
2. Identification - The patient identifies with those who can help him/ her. The
nurse permits exploration of feelings to aid the patient in undergoing illness as an
experience that reorients feelings and strengthens positive forces in the
personality and provides needed satisfaction.
3. Exploitation - During this phase, the patient attempts to derive full value from
what he/ she are offered through the relationship. The nurse can project new
goals to be achieved through personal effort and power shifts from the nurse to
the patient as the patient delays gratification to achieve the newly formed goals.
4. Resolution -The patient gradually puts aside old goals and adopts new goals.
This is a process in which the patient frees himself from identification with the
nurse.
Techniques Effective in Nurse-Patient Interaction

1. Reflection. Repeating content or feelings. You might simply repeat what

the patient has said, to give him time to mull it over or to encourage him
to respond. Or, and often more effectively, you can reflect on what you
think the patient is feeling. "It sounds like you're concerned about your
family." or "I don't think you're very happy about this." By reflecting on his
feelings, you may be encouraging him to talk about something he may
have been hesitant to bring up himself. Or you may be helping the patient
to identify his own feelings about something.

2. Restating. Rephrasing a question or summarizing a statement. "You're

asking why these tests are needed?" or "In other words, you think you're
being treated like a child."
3. Facilitation. Occasional brief responses, which encourage the speaker to
continue. A nod of the head; an occasional verbal cue, such as "go on" or
"I see;" and maintaining eye contact throughout the conversation all imply
that you are listening and that you understand. (
4. Open-ended questions. Questions that encourage the patient to expound
on a topic. If you want to encourage the patient to speak freely, you might
ask "How are you feeling?" rather than "Are you in pain?"
5. Closed-ended questions. Questions, which focus the patient on a specific
topic. If you want a short, straight answer, ask a question which will allow
only for a direct response, such as "When was your accident?" or "Do you
have pain after eating?"
6. Silence. A quiet period that allows a patient to gather his thoughts. Of
course, this would be an occasional practice, used when you feel that the
 patient could use a little time to think about his response to a question or
just to think.
7. Broad openings. A few words to encourage the patient to further discuss a
topic; for example, "and after that..." or "you were saying..."
8. Clarification. Statements or questions that verify a patient's concern or
point. "I'm a bit confused about...Do you think you could go over that
again please?"
Barriers in Nurse-Patient Interaction

1. Transference – development of an emotional attitude of the patient either

positive or negative towards the nurse.
2. Resistance - development of ambivalent feelings toward self exploration.
3. Counter Transference – transference as experienced by the nurse.