Anne Byrne

Communication in the Helping Relationship

Communication is central to all helping relationships since, without communication, the provider of help will be unable to convey to the recipient either the intent to help or the form in which help will be given. In nursing, where helping is paramount to success, communication occurs at many levels and in many contexts. Communication is affected by the individual’s own attributes and by the settings or environments in which communication occurs. This chapter begins by exploring definitions and models which psychologists have put forward to explain the process of communication. In it, the focus is placed on communication as an interpersonal process, that is, a process in which the transfer of information takes place within a context of personal interaction. The functions of language and of verbal and non-verbal aspects of communications are all seen as part of the same system. In addition, barriers to effective communication between individuals and techniques for improving these communication skills will be detailed. Specific examples will be given to illustrate the importance of communication to the successful practice of nursing.

Stress, Illness and Nursing Practice

Stress is one of the most widely used concepts in the fields of psychology and psychosocial medicine, and its usage by lay people is even more widely spread. It arises in all kinds of contexts to imply an extraordinary pressure or challenge placed on the individual either from sources outside (most typically) or from internal conflicts, confusions and concerns. Stress is commonly held to be ubiquitous: no one escapes it at some stage or another. A minority of people are unfortunate enough to experience it more often than others, and rarely, though dramatically, a small few suffer from an almost continuous state of stress over a long period of time.

Elements of Psychology

Psychology is the science of behaviour. It addresses the ways in which organisms behave, or respond to their environments, or react to the myriad stimuli which surround and continually impinge upon them. In more advanced organisms psychology seeks to explain how they perceive, learn, reason, think and feel. Psychology is concerned with the totality of behaviours evident on direct observation. But it also studies the nature of complex environmental stimuli evoking and initiating those behaviours, and the even more complex mechanisms, unobserved but inferred, which are interposed between the stimulus and response, and which mould, mediate, regulate, shape and impose recognizable patterns of individuality on behaviour. From the perspective of the human organism, psychology may be seen as the science most closely and centrally involved with understanding and explaining the adjustment of the individual to the environment. In so far as some individuals fail to adjust, psychology may also be seen as the science of behavioural abnormality or maladaptation. Psychology is, in fact and nature, the complete human science.

Burnout and its Management in Nursing

No matter how it is viewed, nursing is a personally taxing profession. It carries with it a broad range of duties and responsibilities, and a complex and demanding set of both personal and professional expectations, often in the absence of anything close to adequate support and backup. Nurses are expected to be technically competent and personally caring. In addition, they are required to be dominant in some circumstances and subservient in others. They are also expected to be respectful of the organizational hierarchy within which they work even though that hierarchy may sometimes lack logic. Above all, nurses are expected to be present and available at all times to attend to the many and often conflicting needs of their patients and their superiors. Not surprisingly, burnout is a relatively common experience within the nursing profession.

The Influence of Person Perception on the Helping Relationship

Living and working within any society brings with it a multitude of highly interwoven interactions between people. In all these interactions, we constantly form impressions of other people with whom we are involved. We do this in order to predict their future behaviour and to complete our social or other transactions with them as effectively as possible (Argyle, 1984). The process of forming impressions of others is often referred to as person perception (Hansen, 1984a). The ways in which nurses perceive both patients and themselves, the processes underlying the establishment of perceptions of others, and the consequences of such perceptions, once established, all have a fundamental influence on the nurse’s approach to the practice of her profession. This chapter considers person perception in nursing, first from a theoretical perspective and then, through examples, demonstrates how person perception may be managed for the benefit of both patient and nurse.

Counselling: the Nurse Practitioner’s Guide

In Chapter 2 we explored nursing as a helping relationship. This chapter looks at the nature of counselling from a practical point of view. Since nursing is a profession requiring well developed skills in interpersonal interaction, communication and the management of emotional stress, it seems that the need for basic counselling skills is pre-eminent and self-evident.

Emotions and the Helping Relationship

Emotion, of one kind or another, is a ubiquitous accompaniment to illness, and one of the most widespread and enduring of all the attributes nurses will observe in their patients. The term ‘emotion’ has both a popular and a technical meaning. Popular usage ties emotion to an experiential response occurring when an individual encounters circumstances in the psychosocial environment requiring extremes of adaptation. The essence of emotion, however, is experiential; emotions are intense sensations within the individual, certainly coupled with attitudes, beliefs and perceptions regarding the surrounding environment and those in it. Above all, emotion is a state of felt sensation, the quality of which varies with the nature of the environmental precipitant.

Nursing as a Helping Relationship

At its most fundamental level the practice of nursing involves the intense and some times deeply personal interaction between two individuals, the one being defined by the characteristics of suffering and dependency and the other by the attributes of helping, caring and healing. Much of what a nurse does in her professional role involves the use of technology to relieve suffering, alleviate symptoms and bring about with all possible haste the processes of recovery and so enable the patient to return to his or her normal life. In this role the interaction between the nurse and patient is very much a unidirectional one in which the nurse assumes the position of the authoritative professional whose function is to apply the techniques of treatment and healing, and to lead the patient with competence and confidence through to the point where the relationship is no longer necessary.

Group Processes and the Practice of Nursing

A vast array of human behaviours, including many if not all of the helping behaviours, are to be seen only within groups. Consequently, psychologists have become interested in such things as the structure of human groups, how these groups form, the process of group decision making, and patterns of group leadership. Groups are so pervasive within our society that sometimes it is difficult to identify exactly what to study. Groups may form because of friendship, profession, physical proximity, race, gender, religion, or indeed virtually any other category of individual characteristic or situation we can think of. They can consist of just a few people or thousands (Smither, 1988).