Done By: Nashmiah mohana Al-shammari Pro.Dr. Elham & Dr.Eassmat

Objective: At the end of this part the student will be able to: 1)Define The Nurse-patient relationship. 2)State the type of relationship. 3)Differentiate between social and professional relation ship. 4)Describe the 3 phases of the relationship. 5)Discuss the factor leading to effective of therapeutic relationship Outline: 1)Definition of nurse patient relationship. 2)Type of relationship. 3)Characteristics of therapeutic and social relationship. 4)Phases of nurse patient relationship. 5)Factor leading to effective of therapeutic relationship. 6)Empathy

The nurse's therapeutic relationship with a client is an interpersonal helping process based on theory: A)It is interpersonal : Because the nurse reaches out as one human being to another to enable the client to experience being listened to and having his personal worth affirmed.

B)It is helping : Because it is focused towards the client's care,well being,learning&growth. C)It is theory based: Because it requires knowledge and skill

1)Therapeutic relationship(helping) 2)Professional relationship(at work) 3)Social relationship(friends)

SocialTherapeutic *Interaction is primarily for reason of pleasure or companion-ship. *Concerned with helping the patients (regardless their sex,religion,race … etc.) *No person is in the position of responsibility of helping the other. *Require the help of person with scientific knowledge and special skills(the nurse). *There is no this intention.*There is intention of dealing with other's problem. *The goal is more or less social*The relation ship is purposeful directed toward a therapeutic. *It is up to the partners to share their personal affairs. *The relationship should not entail the nurse's personal matters or problems. *Unlimited.*Time limited.

I.Initial Phase: or pre-interaction phase : the Nurse should prepare to meet with a particular patient.

II.Orientation Phase 1)The nurse meets the patient and gathers necessary data. 2)Nurses use skills of observation and communication to formulate a nursing diagnosis 3)Clarify with the patient goals of the relationship and the process for attaining them. 4)Develop the treatment contract which includes: -Frequency -Length -Place of sessions -How termination will be decided

5)Mutual roles and responsibilities are defined in part through discussion 6)Summarize discussion of roles by specifying time,place and frequency of treatment sessions 7)Communicate to patient's hopes and that the assistance is useful to him

III.Working Phase: By working phase,the patient has an increased commitment to the work of relationship and is less guarded.This phase callsfor maintenance of therapeutic alliance as a context for pursuing the agreed goals through: 1)The nurse encourages discussion of current relationships and issues that are problematic for the client. 2)Help the patient to describe experiences in concrete specific way.

3)Observe patient's patterns of interaction as an indication of behaviors that create problem for the patient in other relationships. 4)Assess patient's level of anxiety about the topics discussed. 5)Accept low levels of anxiety to enhance learning. 6)Avoid high levels of anxiety to therapeutic alliance. 7)Assess patient's progress towards goals.

IV.Termination phase: Preparation for this phase starts at the beginning of the relationship with clarification of how long the relationship will continue. The termination phase may be due to: 1)Achieving goals set by the nurse and the patient. 2)Patient's discharge from the hospital. 3)Nurse has finished work in this section.

To achieve this termination phase,the nurse should: 1)Acknowledge the fourth coming termination. 2)Evaluate what has been achieved and learned during the relationship. 3)Gradually reduce the frequency and intensity of the session. 4)Encourage the client to participate in other relationships. 5)The nurse can share the genuine rections to termination in an appropriate way.

Respect: The nurse respect the patient through: 1)Recognize the client's feeling,beliefs and experiences. 2)Actively listen to the patient.

Genuineness; Genuineness in a relationship means real, i.e.:the nurse believes or feels what is expressed. This is congruence and is basic to establishment of interpersonal trust.

The nurse's genuineness encourages the patient to: 1)Self disclose. 2)Communicate information or emotions. 3)Differntiate between social relationship and authentic therapeutic relationship

Hope: When people face the repeated negative experiences and have hus lost respect for themselves,trust in their abilities and faith in their potentials,so the nurse should help the patient to: 1)Recognize her beliefs in these potentials. 2)Realize that he should continue taking the medication.

3)Convey to the patient any small changes and success and communicate them to the patient. 4)Assist the patient in seeing the self as confronting problems. 5)Help the patient to make changes that he wishes to make and are right for him

Empathy is significant in the nurse-client relationship. Empathy means: that the nurse comprehend what the client is experiencing,the nurse will undergo this through: 1)Observe the patient's physical demands and listening to content and the style of what is said. 2)Develop spontaneous,emotional awareness of the patient.

3)Develop the ability to alternate between effectively participating with the patients and intellectually observing the patient. 4)Differentiate between sympathy and empathy. Sympathy means that the nurse feels sorry for the patient.