difficulty finding ways to solve the problem or when
working with a group of people whose divergent view-
points hinder finding solutions. It involves several
steps:
- Identify the problem.
- Brainstorm about all possible solutions.
- Select the best alternative.
- Implement the selected alternative.
- Evaluate the situation.
- If dissatisfied with results, select another
alternative and continue the process.
Identifying the problem involves engaging the
client in therapeutic communication. The client tells
the nurse the problem and what he or she has tried
to do to solve it:
Nurse: “I see you frowning. What is going on?”
(making observation; broad opening)
Client: “I’ve tried to get my husband more involved
with the children other than yelling at them when he
comes in from work, but I’ve had little success.”
Nurse: “What have you tried that has not worked?”
(encouraging expression)
Client: “Before my surgery, I tried to involve him
in their homework. My husband is a math whiz. Then
I tried TV time together, but the kids like cartoons
and he wants to watch stuff about history, natural
science, or travel.”
Nurse: “How have you involved your husband in
this plan for him to get more involved with the chil-
dren?”(seeking information)
Client: “Uh, I haven’t. I mean, he always says he
wants to spend more quality time with the kids, but
he doesn’t. Do you mean it would be better for him to
decide how he wants to do this—I mean, spend qual-
ity time with the kids?”
Nurse: “That sounds like a place to start. Per-
haps you and you husband could discuss this issue
when he comes to visit, and decide what would work
for both of you.”(formulating a plan of action)
It is important to remember that the nurse is fa-
cilitating the client’s problem-solving abilities. The
nurse may not think the client is choosing the best or
most effective solution, but it is essential that the
nurse supports the client’s choice and assists him or
her to implement the chosen alternative. If the client
makes a mistake or the selected alternative isn’t suc-
cessful, the nurse can support the client’s efforts and
assist the client to try again. Effective problem-
solving involves helping the client to resolve his or
her own problems as independently as possible.
COMMUNITY-BASED CARE
As community care for people with physical and men-
tal health problems continues to expand, the nurse’s
role expands as well. The nurse may become the major
caregiver and resource person for increasingly high-
risk clients treated in the home and their families and
will become more responsible for primary prevention
in wellness and health maintenance. Therapeutic com-
munication techniques and skills are essential to suc-
cessful management of clients in the community.
Caring for older adults in the family unit and in
communities today is a major nursing concern and
responsibility. It is important to assess the relation-
ships of family members; identifying their areas of
agreement and conflict can greatly affect the care of
clients. To be responsive to the needs of these clients
and their families for support and caring, the nurse
must be able to communicate and relate to clients
and establish a therapeutic relationship.
When practicing in the community, the nurse
needs self-awareness and knowledge about cultural
differences. When the nurse enters the home of a
client, the nurse is the outsider and must learn to ne-
gotiate the cultural context of each family by under-
standing their beliefs, customs, and practices and not
judging them according to his or her own. Asking
the family for help in learning about their culture
demonstrates the nurse’s unconditional positive re-
gard and genuineness. Families from other cultural
backgrounds often respect nurses and health care
professionals and are quite patient and forgiving of
the cultural mistakes that nurses might make as they
learn different customs and behaviors.
Another reason the nurse needs to understand
the health care practices of various cultures is to make
sure these practices do not hinder or alter the pre-
scribed therapeutic regimens. Some cultural healing
practices, remedies, and even dietary practices may
alter the client’s immune system and may enhance or
interfere with prescribed medications.
The nurse in community care is a member of the
health care team and must learn to collaborate with
the client and family as well as other health care
providers who are involved in the client’s care such
as physicians, physical therapists, psychologists, and
home health aides.
Working with several people at one time rather
than just the client is the standard in community care.
Self-awareness and sensitivity to the beliefs, behav-
iors, and feelings of others are paramount to the suc-
cessful care of clients in the community setting.SELF-AWARENESS ISSUES
Therapeutic communication is the pri-
mary vehicle that nurses use to apply the nursing
process in mental health settings. The nurse’s skill in
therapeutic communication influences the effective-
ness of many interventions. Therefore the nurse must
evaluate and improve his or her communication skills128 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP