cation) or “Describe where you were and what you were
doing when you collapsed”(placing events in time and
sequence). Assessment of context focuses on whowas
there, whathappened, whenit occurred, howthe event
progressed, and whythe client believes it happened
as it did.
UNDERSTANDING SPIRITUALITY
Spiritualityis a client’s belief about life, health, ill-
ness, death, and one’s relationship to the universe.
Spirituality differs from religion,which is an orga-
nized system of beliefs about one or more all-powerful,
all-knowing forces that govern the universe and offer
guidelines for living in harmony with the universe and
others (Andrews & Boyle, 2003). Spiritual and reli-
gious beliefs usually are supported by others who
share them and follow the same rules and rituals for
daily living. Spirituality and religion often provide
comfort and hope to people and can greatly affect a
person’s health and health care practices.
The nurse must first assess his or her own spiri-
tual and religious beliefs. Religion and spirituality are
highly subjective and can be vastly different among
people. The nurse must remain objective and non-
judgmental regarding the client’s beliefs and must not
allow them to alter nursing care. The nurse must
assess the client’s spiritual and religious needs and
guard against imposing his or her own on the client.
The nurse must ensure that the client is not ignored
or ridiculed because his or her beliefs and values
differ from those of the staff (Chant et al., 2002).
As the therapeutic relationship develops, the
nurse must be aware of and respect the client’s reli-
gious and spiritual beliefs. Ignoring or being judgmen-
tal will quickly erode trust and could stall the rela-
tionship. For example, a nurse working with a Native
American client could find him looking up at the sky
and talking to “Grandmother Moon.” If the nurse did
not realize that the client’s beliefs embody all things
with spirit including the sun, moon, earth, and trees,
the nurse might misinterpret the client’s actions as
inappropriate.
Chapter 7 gives a more detailed discussion on
spirituality.
CULTURAL CONSIDERATIONS
Cultureis all the socially learned behaviors, values,
beliefs, and customs transmitted down to each gen-
eration. The rules about the way in which to conduct
communication vary because they arise from each cul-
ture’s specific social relationship patterns (Kreps &
Kunimoto, 1994). Each culture has its own rules gov-
erning verbal and nonverbal communication. For ex-
ample, in Western cultures the handshake is a non-verbal greeting used primarily by men often to size
up or judge someone just met. For women, a polite
“hello” is an accepted form of greeting. In some Asian
cultures, bowing is the accepted form of greeting and
departing and a method of designating social status.
Because of these differences, cultural assessment
is necessary when establishing a therapeutic relation-
ship. The nurse must assess the client’s emotional
expression, beliefs, values, and behaviors; modes of
emotional expression; and views about mental health
and illness.
When caring for people who do not speak English,
the services of a qualified translator who is skilled
at obtaining accurate data are necessary. He or she
should be able to translate technical words into an-
other language while retaining the original intent of
the message and not injecting his or her own biases.
The nurse is responsible for knowing how to contact
a translator, regardless of whether the setting is
inpatient, outpatient, or in the community.
The nurse must understand the differences in
how various cultures communicate. It helps to see how
a person from another culture acts and speaks toward
others. U.S. and many European cultures are individ-
ualistic; they value self-reliance and independence
and they focus on individual goals and achievements.
Other cultures, such as Chinese and Korean, are col-
lectivistic, valuing the group and observing obliga-
tions that enhance the security of the group. Persons
from these cultures are more private and guarded
when speaking to members outside the group and
sometimes may even ignore outsiders until they are
formally introduced to the group.
Cultural differences in greetings, personal space,
eye contact, touch, and beliefs about health and ill-
ness are discussed in-depth in Chapter 7.THE THERAPEUTIC
COMMUNICATION SESSION
Goals
The nurse uses all the therapeutic communication
techniques and skills previously described to help
achieve the following goals:- Establish rapport with the client by being em-
pathetic, genuine, caring, and unconditionally
accepting of the client regardless of his or her
behavior or beliefs. - Actively listen to the client to identify the
issues of concern and to formulate a client-
centered goal for the interaction. - Gain an in-depth understanding of the
client’s perception of the issue, and foster
empathy in the nurse–client relationship. - Explore the client’s thoughts and feelings.
124 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP