Advanced Psychiatric Nursing 2
Topic: Therapeutic Nurse-Patient Relationship
* Nurse-Patient Communication
* Nurse-Patient Relationship
* Stages of Development of a Therapeutic Relationship * Nursing Process
* Nursing Diagnosis
* Outcome Identification
Reported by: Christine Karen Belga, RM, RN
* Communication, the process of sharing ideas, information, and messages with others in a particular time and place. Therapeutic relationships
The therapeutic nurse-client relationship is the basis, the very core, of all psychiatric nursing treatment approaches regardless of specific aim. * Heldigard Peplau- She introduced the concept of nurse-client relationship in 1952 in her ground-breaking book Interpersonal Relations in Nursing. Goals in a therapeutic relationship:
* Facilitating communication of distressing thoughts and feelings * Assisting clients with problem solving to help facilitate activities of daily living * Helping clients examine self-defeating behaviours and test alternatives * Promoting self-care and independence
COMPONENTS OF A THERAPEUTIC RELATIONSHIP
* P-OSITIVE REGARD-unconditional, non-judgmental attitude, implies respect irregardless of the patient’s behavior, background or lifestyle * A-CCEPTANCE-nurse does not become upset or respond negatively to a client’s outbursts, anger or acting out * G-ENUINE INTEREST-nurse is clearly focused and is comfortable with it and reliability himself/herself (client can detect artificial behavior) * E-MPATHY-ability of the nurse to perceive the meanings and feelings of the patient and communicates that understanding to the patient * T-RUST-patient is confident of the nurse and the nurse’s presence conveys integrity and reliability * SELF-AWARENESS & THERAPEUTIC USE OF SELF
Self-awareness- process of developing an understanding of one’s own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths and limitations and how these qualities affect others Therapeutic Use of Self-the nurse beginning to use aspects of his or her personality, experiences, values, feelings, intelligence, needs, coping skills and perceptions to establish relationship with clients Establishing Boundaries
The client’s needs are separated from the nurse’s needs, and the client’s role is different from that of the nurse.
Boundaries are at risk of blurring, which may lead to non-therapeutic relationship. * Overhelping
Role blurring is often a result of unrecognized transference or countertransference. Transference - the patient’s emotional response to the therapist Countertransference - counter-transference occurs when the therapist begins to project his or her own unresolved conflicts onto the client.
THERAPEUTIC COMMUNICATION TECHNIQUES
* ACCEPTING-indicating reception
* BROAD OPENING-Allowing the client to take the initiative in introducing the topic * CONSENSUAL VALIDATION-Searching for mutual understanding, for accord on the meaning of the words * ENCOURAGING COMPARISON-Asking that similarities and differences be noted * ENCOURAGING DESCRIPTION OF PERCEPTIONS-Asking the client to verbalize what she or he perceives * ENCOURAGING EXPRESSION- Asking the client to appraise the quality of his or her experience * EXPLORING-Delving further into a subject or idea.
* FOCUSING-concentrating on a single point
* FORMULATING A PLAN OF ACTION-Asking the client to consider kinds of behavior likely to be appropriate in future situations * GENERAL LEADS-Giving encouragement to continue
* GIVING INFORMATION-Making available the facts that the client needs...