Top-Rated Free Essay
Preview

Therapeutic Nurse-Patient Relationship

Powerful Essays
1462 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Therapeutic Nurse-Patient Relationship
Aquinas University
Graduate School
Legazpi City
Advanced Psychiatric Nursing 2
Topic: Therapeutic Nurse-Patient Relationship * Nurse-Patient Communication * Nurse-Patient Relationship * Stages of Development of a Therapeutic Relationship * Nursing Process * Assessment * Nursing Diagnosis * Outcome Identification * Planning * Intervention * Evaluation
Reported by: Christine Karen Belga, RM, RN
Therapeutic
nurse-patient relationship
Communication
* 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 * Controlling * Narcissism
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 * GIVING RECOGNITION-Acknowledging, indicating awareness * Making Observations-Verbalizing what the nurse perceives * Offering Self-Making oneself available * Placing Event in Time or Sequence-Clarifying the relationship of events in time * Presenting Reality-Offering for consideration that which is real * Reflecting-Directing client actions, thoughts, and feelings back to client * Restating-Repeating the main idea expressed * Seeking Information-Seeking to make clear that which is not meaningful or that which is vague * Silence-Absence of verbal communication, which provides time for the client to put thoughts or feelings into words, regain composure, or continue talking * Suggesting Collaboration-Offering to share , to strive, to work with the client for his or her benefit * Summarizing-Organizing and summing up that which has gone before * Translating into Feelings-seeking to verbalize client’s feelings that he or she expresses only indirectly * Verbalizing the Implied-Voicing what the client has hinted at or suggested * Voicing Doubt-Expressing uncertainty about the reality of the client’s perceptions
Reminder:
Allow client to express feelings more often than possible without being judgmental in order to understand what is going on with the client. This would facilitate better action in dealing with client’s concerns thus helping him arrive at solutions at his own pace.
Nontherapeutic Communication Techniques * Advising-telling the client what to do-Agreeing- indicating accord with the client * Agreeing-Indicating accord with the client * Belittling Feelings expressed-Misjudging the degree of the client’s comfort * Challenging-Demanding proof from the client * Defending-Attempting to protect someone or something from verbal attack * Disagreeing-Opposing the client’s ideas * Disapproving-Denouncing the client’s behavior or ideas * Giving approval-Sanctioning the client’s behavior or ideas * Giving Literal Responses-Responding to a figurative comment as though it were a statement of fact * Indicating the existence of an external source-“What makes you say that?”, “What made you do that?”, “Who told you that you are a prophet?” * Interpreting-Asking to make conscious that which is unconscious * Introducing an unrelated topic-Changing the subject * Making stereotyped comments-Offering meaningless cliches or trite comments * Probing-Persistent questioning of the client * Reassuring-Indicating there is no reason for anxiety * Rejecting-Refusing to consider or showing contempt for the client’s behavior, ideas * Requesting an explanation-Asking the client to provide reasons for thoughts, feelings, behaviors, events * Testing-Appraising the client’s degree of insight * Using Denial-Refusing to admit that a problem exists

PHASES OF THERAPEUTIC NURSE-PATIENT RELATIONSHIP The nurse patient relationship is an end result of series of interaction between the nurse and patient over a period of time with the nurse focusing on need and problem of patient and his family while using the scientific knowledge and specific skills of nursing profession.
The nurse must possess: * Accountability * Focus on client needs * Clinical competence * Supervision
Pre-interaction phase Pre interaction is a phase which a nurse goes through before actual interaction with the patient. This phase begins when the nurse is assigned a patient to develop therapeutic relationship with him till she goes to him for interaction
Reactions of Nurse in Pre-Interaction Phase * The nurse thinks and feels about the patient before interacting according to her knowledge, fears and miss concepts. * She tries to collect information from secondary sources like the patient’s records, a resource person and other nurses working in the ward.
INTRODUCTORY /ORIENTATION PHASE Begins when the nurse goes to the patient, introduces herself and gets introduction about him. The orientation phase ends when the nurse and he patient begin to accept each other as a unique human being.
Establishment trust - trust is nurtured by demonstrating genuineness and empathy, developing positive regard, showing consistency, and offering assistance in alleviating the client’s emotional pain or problems.
Four important issues need to be addressed: a) Parameters of the relationship b) Formal or informal contract c) Confidentiality d) Termination

WORKING PHASE During the working phase, the nurse and client together identify and explore areas in the client’s life that are causing problem.
Task of working phase * Maintain the relationship * Gather further data * Promote the client’s problem-solving skills, self-esteem, and use of language. * Facilitate behavioural change * Overcome resistance behaviours * Evaluate problems and goals and redefine them as necessary. * Promote practice and expression of alternative adaptive behaviours.
The nurse’s awareness of personal feelings and reactions to the client is vital for effective interactions with the client.
BARRIERS OF WORKING PHASE * Testing of the nurse * The patient tests the nurse for the ability and competence. * He may deliberately be aggressive to test whether he is able to arouse anger in the nurse * Progress of the patient * Difficulty in collecting and interpreting the data * Fear of closeness
STRATEGIES TO OVERCOME BARRIERS * Learn the subject in depth * Taking help from supervisors and experts * Discussions with peer group

TERMINATION PHASE
Reasons for termination * Symptoms relief * Improved social functioning Greater sense of identity * Development of more adaptive behaviors * Accomplishment of the client’s goals * Impasses in therapy that the nurse is unable to resolve
TASK OF TERMINATION * Bring a therapeutic end to the relationship. * Review feelings about relationship. * Evaluate progress towards goal. * Establish mechanisms for meeting future therapy needs. * Summarize entire communication and follow up treatments.
BARRIERS OF TERMINATION PHASE * The patient may ask the nurse to write to him or come back from duty and see him. * Gift giving * The nurse may withdraw earlier from the patient due to her own anxiety she may not interact with the patient
STRATEGIES TO OVERCOME * Nurse needs to explore her own feelings and thoughts about separation from the patient which will help her to accomplish the task of termination phase * The patient should be explained that ‘every relationship terminates’ * Getting help from supervisors * After discharge the patient comes for intervention he or she should be referred to a second in charge.

You May Also Find These Documents Helpful

  • Best Essays

    THERAPEUTIC RELATIONSHIP

    • 2921 Words
    • 12 Pages

    Chambers M. (1998) Interpersonal mental health nursing: research issues and challenges. Journal of psychiatric and mental health nursing 5: 203-211.…

    • 2921 Words
    • 12 Pages
    Best Essays
  • Powerful Essays

    Neal (2003) states a therapeutic relationship can be described as being between nurse and patient and is based on patients’ needs for care assistance and guidance. It is a relationship that is established solely to meet the patient’s needs and is, therefore, therapeutic in nature.…

    • 2673 Words
    • 11 Pages
    Powerful Essays
  • Better Essays

    Communication (from Latin "communis", meaning to share) is the activity of conveying information through the exchange of thoughts, messages, or information, as by speech, visuals, signals, writing, or behavior. Communication “is a fundamental aspect of all human relationships” and is an essential element of good care.…

    • 1117 Words
    • 5 Pages
    Better Essays
  • Good Essays

    Post Assess MH

    • 564 Words
    • 3 Pages

    The nurse needs additional information/ validation so w/ appropriate questioning the nurse should be able to get more clear/ detailed information of what client means…

    • 564 Words
    • 3 Pages
    Good Essays
  • Good Essays

    Their expressions,angers.Their up sides and down sides,their good days and bad days.Their frustrations concerns their agresives attitudes to ward the nurse in spite of all,the nurse has the duty to do his or her job in at the same level or even deeper,showing compassion in concern to the patient.…

    • 672 Words
    • 3 Pages
    Good Essays
  • Good Essays

    Caring In Nursing

    • 487 Words
    • 2 Pages

    Caring has been a primal concept and the heart of nursing since before it became recognized as a profession. The word “nursing” itself means to nurture or care (Smith, Turkel & Wolf, 2013) and so in my opinion, it is not possible to respond to the calls of nursing without caring at its forefront. This unit’s readings have not changed by views, but rather enhanced them. I have learned about the historical debate that has taken place with those who oppose caring as being part of the unique perspective of nursing. For example, Mary Jane Smith argues that caring is present in many professions, not only in nursing, and so it is not unique to nursing (Smith et al., 2013). While it is true that caring is used in all types of professions and ultimately in all human relations, nursing is the only discipline that is developing knowledge about how caring “facilitates health, healing and the quality of life” (Smith et al., 2013).…

    • 487 Words
    • 2 Pages
    Good Essays
  • Good Essays

    I believe that the core of nursing is in the nurse-patient relationship. Nurses have the abilities to develop a therapeutic relationship that focuses on the needs of the patients. The best way to achieve effective nurse-patient relationship is through communication. Communication barriers have been one of the major causes of poor patient care. And if these communication barriers were lifted, it can help the nurse earn the patients’ trust while also creating some boundaries.…

    • 565 Words
    • 3 Pages
    Good Essays
  • Satisfactory Essays

    Registered Nurse with extensive experience in the healthcare field. Goals direct. Exceptional leadership ability and good professional judgment. Strong patient advocacy.…

    • 306 Words
    • 2 Pages
    Satisfactory Essays
  • Better Essays

    Nursing Theorist Grid

    • 1905 Words
    • 8 Pages

    Theory’s Historical background: Orlando developed her theory in the 1950s after receiving grants for studies integrating mental health concepts into nursing education. This was the first inductively developed nursing…

    • 1905 Words
    • 8 Pages
    Better Essays
  • Good Essays

    20110616163506944

    • 1634 Words
    • 8 Pages

    Communication is best defined as “the transmission of information and meaning from one individual or group to another.”…

    • 1634 Words
    • 8 Pages
    Good Essays
  • Satisfactory Essays

    Nursing theorist grid

    • 487 Words
    • 2 Pages

    b. The nurse should quickly respond to patients’ immediate need. The nurse should use their five senses to determine what the most immediate need is and confirm with patient to see if assumption is correct. After the nurse implements the solution the nurse should then follow up with the patient to determine if the solution worked.…

    • 487 Words
    • 2 Pages
    Satisfactory Essays
  • Powerful Essays

    Est1 Task 2

    • 600 Words
    • 3 Pages

    Hildegard Peplau believed that there was more to nursing than just tasks that were required to be accomplished. She defined nursing as being therapeutic in the form of a healing art which assisted individuals with health care needs. She also believed that “nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal” (currentnursing.com, n.d.). These beliefs and subsequent theories formulated provide the framework for the development and implementation of bedside…

    • 600 Words
    • 3 Pages
    Powerful Essays
  • Satisfactory Essays

    Nursing Process

    • 543 Words
    • 3 Pages

    Nursing Diagnosis (ADPIE) is the next step in the nursing process. This phase is critical to the nursing…

    • 543 Words
    • 3 Pages
    Satisfactory Essays
  • Good Essays

    My Nursing Philosophy

    • 741 Words
    • 3 Pages

    and act in accordance within the scope of practice. Nurses should possess qualities such as;…

    • 741 Words
    • 3 Pages
    Good Essays
  • Better Essays

    Rn Interview

    • 2869 Words
    • 12 Pages

    Nursing, is a profession that I have long admired and considered to be one of the most gratifying positions that a person can hold due to the ability to positively affect so many people’s lives. This also comes with a huge responsibility to constantly be aware and monitor one’s own emotional state while adjusting to each patients needs and maintaining a high level of professionalism. When looking at the two areas of professionalism and emotional intelligence I believe that they are absolutely essential to the development of a well rounded nurse. Emotional intelligence is defined as nurses who have insight and an understanding of their own and others emotions and behavior (Watson-Druee, 2012). Professionalism has long been the topic of conversation among health professionals due to its meaning and how different people interpret it. Professionalism in its most basic understanding is; attaining the highest quality of care by maintaining standards and demonstrating good judgment and competence at all times (Hughes, 2012). When considering these areas I have come to understand and define them in my own way; I’ve also been able to interview another healthcare professional and get their insight into these issues.…

    • 2869 Words
    • 12 Pages
    Better Essays

Related Topics