Structuring The Relationship

Therapeutic relationship Primarily human connection and central to providing nursing care Therapeutic relationship refers to holistic approach of nursing care including physical, emotional, psychological and social health education and care.

Characteristics of Therapeutic relationship It is a healing relationship between health professional and client in need for care. The goal is to promote health and wellbeing It is an interdependent relationship

Types of Communication Intrapersonal Interpersonal

Intrapersonal Communication Individuals give themselves all kinds of positive and negative messages An example of positive self-talk is “I know I can do this!” An example of dysfunctional self-talk is “I’ll never get better.”

Interpersonal Communication Occurs between 2 or more people and contains both verbal and nonverbal messages Consists of: Social communication Therapeutic communication

Social Communication Occurs in everyday situations usually away from the work setting Interaction is superficial and light; usually not goal directed It’s purposes are to maintain relationships and for enjoyment Consists of sharing information equally between 2 or more individuals

Therapeutic Communication Occurs between the nurse and the client but is client focused It is a learned skill involving both verbal and nonverbal communication The purpose is to promote client growth The medium through which health promotion interventions occur Involves the disclosure of personal information by the client

Principles of the Nurse-Client Relationship The relationship is therapeutic rather than social The focus remains on the client’s issues rather than on the nurse’s or other issues The relationship is purposeful and goal directed It is objective versus subjective in quality It is time limited versus open ended

Therapeutic vs Social A therapeutic relationship is formed to help clients solve problems make decisions achieve growth learn coping strategies let go of unwanted behaviors reinforce self-worth examine relationships

Therapeutic vs Social The meetings between nurse and client are not for mutual satisfaction. The nurse can be friendly with the client, but is not there to be the client’s friend. The majority of the interaction is focused and therapeutic.

Client Focus During an interaction, a client may redirect the focus away from self by changing the subject, talking about the weather, etc. The nurse needs to recognize this as a divergent tactic, confront this behavior, and refocus the client.

Goal Direction The primary purpose of a therapeutic relationship is helping clients to meet adaptive goals. Nurse and client work together to identify problematic areas in client’s life Once goals are established, the nurse and client agree to work toward those goals.

Objective vs Subjective Nurses can be therapeutic only if they remain objective. Objectivity refers to remaining free from bias, prejudice, and personal identification in interaction with the client and being able to process information based on facts. Subjectivity refers to emphasis on one’s own feelings, attitudes, and opinions when interacting with the client.

Time-Limited Interactions Time of meetings Number of meetings that will take place Provides structure Lets client know that relationship will end

Role of Nurse Self-awareness Professional boundaries Level of involvement Therapeutic use of self Self-disclosure Code of ethics for nurses by ANA (2001)

Patient’s Bill of Rights Civil Rights Client Consent Communication Freedom from Harm Dignity and Respect Confidentiality Participation in Treatment Plan

Stages of the Nurse-Client Relationship Pre-orientation phase Orientation phase Working phase Termination phase

Preorientation Phase Takes place prior to meeting with the client 1st gather data about the client, his or her condition, and the present situation Nurse then examines his or her thoughts, feelings, perceptions, and attitudes about this particular client

Orientation Phase The nurse-client become acquainted; build trust and rapport A contract is established Includes time and place for the meeting, as well as the purpose of the meetings Dependability is imperative for both the nurse and the client Client strengths, limitations, and problem areas are identified Outcome criteria and a plan of care are established

Working Phase Orientation phase ends and working phase begins when the client takes responsibility for his or her own behavior change Client shows commitment to working on issues that have caused a life disruption Clients’ needs are prioritized- safety and health come first RN assists the client to change problematic behaviors in a safe environment

Termination Phase Relationship comes to a close This phase begins in the orientation phase when meeting times are established- lets the client know that the relationship will come to an end Avoids confusing the client who may be unable to recognized boundaries in a relationship Termination occurs when the client has improved or has been discharged

Assessment The Nurse-Client Interview The success of the interview depends on the development of trust, rapport, and respect between the nurse and client