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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 5: Therapeutic Relationships.

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Presentation on theme: "Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 5: Therapeutic Relationships."— Presentation transcript:

1 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 5: Therapeutic Relationships

2 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Relationship One of the most important skills a nurse can develop Crucial to success of interventions with clients requiring psychiatric care

3 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Therapeutic Relationship Trust –Behaviors such as caring, interest, understanding, consistency, honesty, promise keeping, listening (Box 5.1) –Congruence is essential Genuine interest –Self-comfort, self-awareness of strengths and limitations, clear focus

4 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Therapeutic Relationship (contd) Empathy –Putting oneself in clients shoes Client and nurse giving gift of self –Different from sympathy (feelings of concern or compassion; focus shifting to nurses feelings) Acceptance (no judgments; set boundaries) Positive regard (unconditional nonjudgmental attitude)

5 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Self-Awareness Know self –Values (sense of right and wrong, code of conduct for living) Values clarification Choosing Prizing Acting –Beliefs –Attitudes (Box 5.2 and Box 5.3)

6 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: A nurse displays empathy by showing feelings of concern and compassion.

7 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Empathy is putting ones self into the clients shoes. –Sympathy is showing feelings of concern and compassion.

8 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Use of Self Use of aspects of personality, experience, values, feelings, intelligence, needs, coping skills, perceptions to establish relationships beneficial to clients –Concept developed by H. Peplau

9 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Use of Self (contd) Johari window: tool to learn about oneself –4 quadrants: open/public self; blind/unaware self; hidden/private self; unknown –Goal: move qualities from quadrants 2, 3, 4 into quadrant 1

10 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Use of Self (contd)

11 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Patterns of Knowing Ways of observing, understanding client interactions Four patterns (Carper, 1978; Table 5.1) –Empirical (derived from nursing science) –Personal (from life experiences) –Ethical (from moral nursing knowledge) –Aesthetic (from art of nursing)

12 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Patterns of Knowing (contd) Fifth pattern (Munhall, 1993): unknowing –Nurse admits lack of knowledge of client or understanding of clients subjective world

13 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Relationships Social –Purpose of friendship, socialization, companionship, or task accomplishment –Superficial communication; shifting roles; outcomes rarely assessed Intimate –Emotional commitment of two persons –Individual needs met; assistance with helping each other meet needs

14 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Relationships (contd) Therapeutic –Focus on needs, experiences, feelings, ideas of client only –Use of communication skills, personal strengths, understanding of human behavior by nurse –Joint agreement on areas to work on; outcome evaluation

15 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: A social relationship involves superficial communication for the purposes of friendship or task accomplishment.

16 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True A social relationship occurs for friendship, socialization, companionship or task achievement. It involves superficial communication with shifting roles.

17 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Establishing a Therapeutic Relationship Peplaus model of three phases –Orientation –Working –Termination (Table 5.3) Overlapping, interlocking of phases

18 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Establishing a Therapeutic Relationship: Orientation Phase Meeting nurse, client Establishment of roles Discussion of purposes, parameters of future meetings Clarification of expectations Identification of clients problems Nurse-client contracts/confidentiality, duty to warn/self-disclosure

19 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Establishing the Therapeutic Relationship: Working Phase Problem identification: issues or concerns identified by client; examination of clients feelings and responses Exploitation: examination of feelings and responses; development of better coping skills, more positive self-image, behavior change, independence Possible transference/countertransference

20 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Establishing the Therapeutic Relationship: Termination Phase Begins when clients problems are resolved Ends when relationship is ended Deals with feelings of anger or abandonment that may occur; client may feel termination as impending loss

21 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Behaviors Diminishing Therapeutic Relationships Inappropriate boundaries (relationship becomes social or intimate) Feelings of sympathy, encouraging client dependency Nonacceptance of client, avoidance (Box 5.4)

22 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question During the working phase of a nurse-client relationship, which of the following would occur? A.Expectations are clarified B.Nurse-client contracts are established C.Feelings of loss are addressed D.Client feelings are examined

23 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D.Clients feelings are examined During the working phase, the client identifies issues or concerns and his or her feelings and responses are examined. –Expectations are clarified and contracts are established during the orientation phase. Feelings of loss are addressed during the termination phase.

24 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Roles of the Nurse in a Relationship Teacher (coping, problem solving, medication regimen, community resources) Caregiver (therapeutic relationship, physical care) Advocate (ensuring privacy and dignity, informed consent, access to services, safety from abuse and exploitation) Parent surrogate (Box 5.5)

25 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Self-Awareness Issues Nurses self-awareness: crucial to developing therapeutic relationships Helpful activities: values clarification, journaling, group discussions, reading Development of self-awareness: continual, ongoing process


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