1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 08Establishing and Maintaining a Therapeutic Relationship

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Holistic Model of Care Person is a unique blend of biological, psychological, and social functioning Environment –Internal and external forces View of environment is subjective

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Characteristics of a Therapeutic Relationship Acceptance – not judged or labeled by nurse’s standards Empathy – temporary access person’s feelings Active listening Explanations Mutual trust – most vital in nurse-client relationship Limit setting Reassurance Genuineness

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Self-Awareness Consciousness of one’s own individuality and personality –Connection between thinking and behavior –“Who am I?” –Honesty and openness

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Phases of a Therapeutic Relationship Focuses primarily on the client’s problems, developing goals for improvements, and promoting a return of independent living within societal norms Not a social interaction Orientation –Getting to know the client Working stage –Outcomes and interventions planned –Goals developed –Problem-solving skills utilized Termination –Allows the client to depend on his or her own strengths

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Professional Boundaries Centered on the condition of helpfulness “Spaces between the power of the nurse and the vulnerability of the client” Nurse must clarify boundaries with the client

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Overinvolvement Relationship with the client fulfills a personal need More concern for one client over another Further contact after termination phase Anything that hinders the client’s progress toward independence

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Response to Difficult Client Behaviors Observe and anticipate behaviors that may require an immediate or directed response Root is individual response to anxiety from environment or internal stressors

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Manipulation Demand for instant gratification Lack of self-control Nursing approach –Reinforce limits –Limits should be fair and explained thoroughly –Avoid reinforcing behavior –Focus on the client’s feelings –Maintain consistency

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Violence or Aggression Take precautionary measures Keep safety in mind—for the client and others nearby Recognize early signs –Communication and calm approach –Sometimes necessary to withdraw from location Precautionary Measures Pg. 118

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Altered Thought Processes Hallucinations, illusions, delusions Basic feeling of the client is fear/mistrust Therapeutic encounter –Genuine concern –Explanations that the client can understand –Purposeful movements/personal space maintained –Reestablish the client’s contact with reality

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sexually Inappropriate Behaviors or Aggression Tell the client that actions are unacceptable If behavior continues, terminate the session Unmanageable situation—consult with supervisor or colleague

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. The therapeutic nurse–client relationship consists of two phases: orientation and termination.

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: The therapeutic nurse–client relationship consists of three phases: an orientation phase, a working stage, and a termination point.

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A consciousness of our own personality and behavior in response to the world around us is called A. Empathy B. Self-awareness C. Orientation D. Genuineness

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Self-awareness Rationale: Self-awareness is a knowledge of the self as a whole person, including individuality and personality.

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Too much concern or not enough concern can both cross the limits of professional boundaries.

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: There is a delicate balance between knowing when to help and when not to help. Too much concern or not enough concern can cross the boundary standards.

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins