Introduction to Medical-Surgical Nursing, 6th ed.
5
Lesson Plans for
The Nurse-Patient Relationship
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 5.1:
2. Define the concept of self.
4. Compare the meaning of the terms patient and client.
6. List commonly held expectations of patients and families.
8. Describe basic components of communication.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to topics related to the nurse-patient relationship.
2 Chapter 5 The Nurse-Patient Relationship _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) To develop a therapeutic relationship with a patient, it is important for the nurse to establish
a) authority
b) sympathy c) compliance
d) acceptance
2) Beliefs and values are acquired __________.
a) throughout one’s life
b) by middle age c) when elementary school starts
d) through the media
3) An important component of knowledge is __________.
a) gratification of needs
b) critical thinking c) competent skills performance
d) spiritual care
4) A client may be viewed as someone who is __________.
a) ill
b) receiving Medicare benefits c) a consumer of services
d) undergoing an elective procedure
5) A nurse’s desire to help others is an essential characteristic for which function?
a) Helper role
b) Patient safety and security c) Nursing assessment
d) Sympathetic response
6) Aggressive communication is best described as __________.
a) premature advice
b) false reassurance c) violating the rights of others
d) absence of veracity
7) The best example of empathy is which of the following?
a) “I understand exactly how you feel. My pet died more than a year ago, and I still cry about it.”
b) “Let me call your husband for you and explain to him exactly how you feel.”
c) “I know you’re alone. When you’re discharged, I’ll come by and take you shopping once a week.”
d) “I understand you must be feeling overwhelmed. Tell me how the nursing staff can try to help
you.”
8) Ethical conflicts often arise when the __________.
a) good of one contrasts with the good of many
b) patient is compliant
c) nurse acts as helper
d) family relinquishes control
9) Which of the following is an appropriate therapeutic communication technique?
a) Premature advice
b) Silence c) False reassurance
d) Commanding
10) A unique friendship behavior would include __________.
a) absence of intimacy
b) goal direction c) secrets
d) nonjudgmental attitude
_____________________________________________________ Chapter 5 The Nurse-Patient Relationship 3
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: A caring nursing assistant has wanted to be a nurse for a long time. She wonders if a more
rounded course load with classes like psychology, chemistry, art, and English might be beneficial, even
though these courses are not always required for a nursing degree. What would be the most appropriate
way to respond to this nursing assistant?
Answer: A well-rounded course load can certainly be beneficial to the nursing student. An appropriate
Question: A nursing student finds out that her instructor received a complaint about the student from one
of her patients. The patient took offense to the constant touching by the nursing student. How can the
student avoid offending future patients?
Answer: Before initiating assessment and patient care, the student needs to be aware of her reason for
4 Chapter 5 The Nurse-Patient Relationship _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
Instructor Preparation
Textbook Objectives Covered
1. Define the holistic view of nursing.
3. Discuss the use of self in the practice of nursing.
5. Describe the meaning of the AHA Patient Care Partnership document.
7. Describe guidelines for nurse-patient relationships.
8. Describe basic components of communication.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Speaker: legal nurse consultant
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying the nurse-patient relationship, including:
• A holistic view of nursing care
• Use of the self in nursing care
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
Key Terms
• self (p. 57)
• empower (p. 60)
• holism (p. 57)
• Part IIC: 1 (p. 24)
Assignments 2 hours
1
• Review Questions for the NCLEX Examination: 2, 3 (p. 65)
READ – Textbook (pp. 57–58)
REVIEW
• Figure 5-1: Physiologic, psychologic, sociologic, and spiritual influences (p. 58)
• Figure 5-2: All people should be treated with respect (p. 59)
ANSWER – Text
2
READ – Textbook (pp. 57–58)
ANSWER – Study Guide
_____________________________________________________ Chapter 5 The Nurse-Patient Relationship 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
3
• Part IIC: 3 (p. 24)
• Part IIID: 3, 7, 8 (p. 25)
READ – Textbook (pp. 57–58)
REVIEW
• Figure 5-3: The judicious use of touch conveys the message (p. 64)
• Table 5-1: A comparison: The nurse as a helping person (p. 61)
ANSWER – Study Guide
4
READ – Textbook (p. 59)
5
READ – Textbook (pp. 59–60)
ANSWER – Study Guide
• Part IIC: 6 (p. 24)
• Part IIID: (p. 25)
6
READ – Textbook (p. 60)
7
• Part IIC: 2, 4, 5, 7 (pp. 24-25)
• Part IIID: 4, 9, 10 (pp. 25-26)
READ – Textbook (pp. 60–61)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1 (p. 65)
ANSWER – Study Guide
8
READ – Textbook (pp. 61–64)
REVIEW
• Table 5-2: Therapeutic and nontherapeutic communication techniques (p. 63)
• Table 5-3: Options for oral language assistance (p. 64)
ANSWER – Study Guide
• Part IB: 1-8 (p. 24)
6 Chapter 5 The Nurse-Patient Relationship _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 5
The Nurse-Patient Relationship
1
A Holistic View of Nursing Care
• Holism is a way of viewing people as whole individuals
TALKING POINTS:
• Physiologic, psychological, sociologic, and spiritual influences on individual behaviors
become integrated into a plan of care.
Slide 3
able to grow and change.
Values, Beliefs, and Attitudes
• Values
• Principles shared by members of a society that determine what is desirable or
worthwhile
• Reflected in the worth given to an idea or action
• Beliefs
TALKING POINTS:
• What affects the lifelong process of acquiring values and beliefs?
Slide 4
Knowledge
• A component of self that is acquired through experience or study
• The safe practice of nursing depends on one’s knowledge base
TALKING POINTS:
• With whom do nurses share their knowledge?
_____________________________________________________ Chapter 5 The Nurse-Patient Relationship 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
Slide 5
Knowledge (cont.)
• Critical thinking enables the nurse to
• Think through problems in an efficient and organized manner
TALKING POINTS:
• Provide students with a picture of a random family at graduation. Make the statement
“This is the Jones family at graduation.” Ask students to agree or disagree. Discuss the
process of critical thinking through this example.
Slide 6
Skills
• Nursing care involves using many skills that require efficiency and safety
• The nurse must master the skills required to carry out nursing interventions
• Interpersonal skills help nurses communicate effectively and establish caring relationships
TALKING POINTS:
Slide 7
Skills (cont.)
• Developing a therapeutic nurse-patient relationship
• A humanistic system of values
• Ability to instill faith and hope
Slide 8
• Ability to provide a supportive, protective, and corrective mental, physical,
Skills (cont.)
• Developing a therapeutic nurse-patient relationship (cont.)
• Ability to promote interpersonal teaching and learning
TALKING POINTS:
• What communication techniques do you use in everyday life that have helped you
develop therapeutic relationships?
4
Slide 9
Patient Versus Client
• Those who prefer the word client believe it denotes a feeling of partnership or working
with someone and that the word patient has a connotation of doing to or for someone
TALKING POINTS:
8 Chapter 5 The Nurse-Patient Relationship _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
5
Slide 10
Patient’s Rights
• Patients are entitled to receive quality care in a safe, supportive, nurturing environment
• In 1973, the American Hospital Association issued a Patient’s Bill of Rights, outlining
hospital patients’ rights and incorporating the components of quality care
• Nurses are in a position to be certain that many of these rights are respected
Patient’s Rights (cont.)
• One way to help patients feel respected as individuals is to always address and refer to
them by name
TALKING POINTS:
• Is it appropriate for a nurse to call a patient by a nickname or pet name such as
“Sweetie”?
• Older people should be treated with the same respect as younger people.
6
Slide 12
Patient Expectations: Explanation of Care
• Patients must be given the information they need to be active participants in their care
• Patients need and are entitled to an explanation of the care to be given
• Patients knowledgeable about their care are more likely to be active participants
TALKING POINTS:
• How do you empower patients to participate in their own care?
Slide 13
Patients as Partners in Care
• Patients who see themselves as partners in their care are likely to accept responsibility for
it
• The patient can assume an active role from the point of admission
• The patient’s family also should be encouraged to participate in the care
TALKING POINTS:
• A sense of responsibility may improve compliance with the plan of care, thereby
preventing needless complications.
• When is your first opportunity to set the tone for a relationship with the patient that
encourages participation?
Slide 14
• For a nurse-patient relationship to be therapeutic, the nurse must be able to see patients’
• Encourage patients to share thoughts and feelings freely without fear of being judged
Acceptance of Patient Behaviors
• Illness is a stressful event that can cause people to react in unusual ways
• Individuals behave differently than they would under normal circumstances, and nurses
_____________________________________________________ Chapter 5 The Nurse-Patient Relationship 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
Acceptance of Patient Behaviors (cont.)
• The nurse must be willing to accept unconditionally the patient’s values, beliefs,
behaviors, and attitudes
TALKING POINTS:
• What are examples of personally held beliefs that can potentially affect patient care with
the nurse being unaware? How can those situations be avoided?
Safety and Security
• Nurses have great responsibility for keeping patients physically and psychologically safe
• A patient needs to feel that a nurse can act quickly and decisively in a crisis
confidence in the nurse
TALKING POINTS:
• List some specific competencies nurses need to meet to enable patient safety and
security
7
Slide 17
The Helper Role
• Characteristics necessary for the nurse to assume a helping role
• Awareness of self
• Ability to analyze one’s own feelings
• Ability to serve as a model to others
TALKING POINTS:
• A helping role occurs when one person reaches out to help another.
• What is the goal of a helper role?
Slide 18
authoritarian approaches can also interfere.
The Helper Role (cont.)
• Nurses administer patient care, act as advocates, give psychosocial support, and provide
health education and counseling
• The nurse strives to establish and maintain a therapeutic relationship
• The first step in developing a therapeutic relationship is to build trust
TALKING POINTS:
• One strategy to build a therapeutic relationship is to encourage patients to share personal
stories about their lives.
10 Chapter 5 The Nurse-Patient Relationship _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
8
Slide 19
Communication
• Exchanging ideas, beliefs, thoughts, and feelings between people
• Involves a message, sender, and receiver
• Sender gives the message to the receiver
• Two types of language: verbal and nonverbal
TALKING POINTS:
• Communication skills are essential for carrying out the helper role.
• What are examples of nonverbal language?
• What does this statement mean? “Information-giving is not communication.”
Slide 20
Communication (cont.)
• Verbal language
• Conveys meanings through words
• Nonverbal language
• Conveys meaning through symbols and actions, not words
• Body position, facial expression, gestures, moaning, crying, laughing, and smiling
Slide 21
Communication (cont.)
• Assertive communication
• Ability to express yourself without violating the rights of another
• Aggressive communication
• Violates the rights of others
• Listening
• Active process: trying to understand what is said
• Listener must display genuine interest and concentration to derive meaning from the
words
TALKING POINTS:
• What are two essential parts of communication?
Slide 22
Professional Communication
• Refers to the factors that help create a therapeutic relationship
• Common courtesy
• Introducing yourself to patients and their families
• Addressing patients respectfully by their last names
• Maintaining privacy and confidentiality
• Being trustworthy
• Being self-directed
• Remaining self-assured
_____________________________________________________ Chapter 5 The Nurse-Patient Relationship 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
Slide 23
Therapeutic Communication
• Can be learned through study, observation, and practice
• You must be open, honest, nonjudgmental
• Self-awareness is basic to meaningful interactions
• Must actively seek to be cognizant of your own thoughts, feelings, values, beliefs, and
behaviors
Slide 24
Communication
• Self-explore and assess how the following areas may affect your ability to establish a
therapeutic nurse-patient relationship
• Ethnic, cultural, socioeconomic background
• Attitudes, values, opinions, beliefs
• Unresolved experiences that are still emotionally laden
• Physical and psychological strengths and weaknesses
TALKING POINTS:
• How can misconceptions about patient culture affect communication?
Slide 25
Communication (cont.)
• Data to obtain holistic assessment of patient
• Patient’s age
• Patient’s cultural background
• Patient’s perception of his or her illness
TALKING POINTS:
• How can poor communication techniques affect interviewing the patient and receiving
accurate data?
Slide 26
• Accept your patient’s needs and feelings
Listening
• Tips for effective listening include
• Make sure you hear what is said; focus on the message, clarify if needed
TALKING POINTS:
• You must listen and attempt to understand what the patient is saying.
• What is processing?
12 Chapter 5 The Nurse-Patient Relationship _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
Slide 27
Empathic Response
• Empathy
• The ability to identify with and understand another person’s situation, feelings, and
motives
TALKING POINTS:
• How does empathy differ from sympathy?
Slide 28
Question 1
• Which of the following is a true statement about therapeutic relationships?
A. They focus on the family unit.
B. There is no need to accept the patient as a unique individual.
C. They are goal-oriented, focusing on the individual.
D. A judging attitude is necessary in providing nursing care.
TALKING POINTS:
Slide 29
Question 2
• Which of the following is a true statement about values, beliefs, and attitudes?
A. Your values, attitudes, and beliefs are expressed in your behavior as you interact with
patients.
B. Self-awareness is not important in knowing one’s own values, beliefs, and attitudes.
C. Values are reactions that flow from attitudes and beliefs.
D. Value judgments occur infrequently in providing nursing care.
TALKING POINTS:
_____________________________________________________ Chapter 5 The Nurse-Patient Relationship 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss how holism forms a context for the
provision of nursing care.
• Ask the students to write five words to
working definition of holism.
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
2
student to explain how the object represents
his or her self.
DISCUSS
• Discuss how identifying the components of
self can help a nurse provide better care.
• Have students bring to class an object,
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe your
view of self. Do you apply the way you see
3
her abilities to be an effective nurse.
DISCUSS
• Discuss the importance to a nurse of
identifying his or her own values. Note that
the values of patients should also be
identified and respected, especially when
they differ from those of the nurse.
• Discuss the requirements for developing a
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss how
values that are held by those living in your
geographic location differ from those living a
great distance away. What are some of the
things that create these differences?
4
DISCUSS
• Lead a class discussion on the different
connotations of the terms patient and client.
Ask students to identify which term they
prefer and why.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Do you prefer
the term client or patient? Why?
14 Chapter 5 The Nurse-Patient Relationship _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
5
DISCUSS
• Discuss the Patient’s Bill of Rights and how
each of these rights preserves the dignity
and individuality of patients.
• Divide the class into small groups. Have
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Research the
origins of the Patient’s Bill of Rights. What
did you find out? What is most surprising?
6
DISCUSS
• Discuss how the explanation of care must be
given in a way that patients can understand.
• Discuss factors that may affect a patient’s
desire to participate in care decisions.
• Present the following scenarios to the class:
• A nurse panics and starts to cry when
she finds her tracheotomy patient
coughing in uncontrollable spasms.
• A nurse finds her patient lying on the
floor in the bathroom, awake, alert, and
POST AND COMMENT
• Post the following scenarios online and have
students comment.
• A nurse panics and starts to cry when
she finds her tracheotomy patient
coughing in uncontrollable spasms.
• A nurse finds her patient lying on the
floor in the bathroom, awake, alert, and
in no apparent distress. She quickly
reassures the patient that she’ll get help,
assesses that the patient appears
_____________________________________________________ Chapter 5 The Nurse-Patient Relationship 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
7
DISCUSS
• Discuss how a helper is different from a
friend. Have students identify what the nurse
can do to maintain a professional
relationship with the patient while providing
help and support.
• Divide the class into small groups. Have
each group discuss the reasons a nurse
needs to have the following characteristics in
order to assume the helper role:
• Awareness of self
POST AND COMMENT
• Post the following discussion topic online
and have students comment. What do you
feel are the most important components of
the nurse-patient relationship?
8
DISCUSS
• Discuss how verbal and nonverbal
communication must be used to convey a
consistent message.
• Discuss examples of nontherapeutic
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Explain the
statement “information-giving is not
communication.” How does this apply to
Critical Thinking Question
A 58-year-old patient, recently admitted for hypertension and congestive heart failure, has
been resistant to patient teaching regarding his new medications for blood pressure,
potassium replacement, and heart rhythm. The patient asks why he needs to know about his
medications and why the nurse doesn’t simply tell the patient’s wife what to do. How should
the nurse respond?
Discussion Guidelines: The patient could be very distressed by his illness and hospitalization.
Keeping this in mind, the nurse can gently explain that all patients have a right to know about their
16 Chapter 5 The Nurse-Patient Relationship _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 5.1
Instructor Notes/Student Feedback
_____________________________________________________ Chapter 5 The Nurse-Patient Relationship 17
Introduction to Medical-Surgical Nursing, 6th ed.
5
Assessments for
The Nurse-Patient Relationship
CHAPTER OBJECTIVES
Lesson 5.1:
2. Define the concept of self.
4. Compare the meaning of the terms patient and client.
6. List commonly held expectations of patients and families.
8. Describe basic components of communication.
Assessments by Lesson & Objective
Lesson 5.1
1
Evolve Instructor Resources
• Test Bank: 9, 24
2
Study Guide
• Part IIC: 1 (p. 24)
Evolve Instructor Resources
• Test Bank: 10
Evolve Student Resources
3
Study Guide
• Part IIC: 3 (p. 24)
• Part IIID: 3, 7, 8 (p. 25)
Evolve Instructor Resources
• Test Bank: 10, 16
Evolve Student Resources
4
Evolve Instructor Resources
• Test Bank: 4
5
Study Guide
• Part IIC: 6 (p. 24)
• Part IIID: (p. 25)
18 Chapter 5 The Nurse-Patient Relationship _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
6
Evolve Instructor Resources
• Test Bank: 17
Evolve Student Resources
• NCLEX Review: 5
7
Study Guide
• Part IA: 1-3 (p. 23)
Evolve Instructor Resources
• Test Bank: 11, 18-21, 25, 26
Evolve Student Resources
• NCLEX Review: 3, 6-8
8
Study Guide
• Part IB: 1-8 (p. 24)
Evolve Instructor Resources
Instructor’s Notes/Student Feedback