Therapeutic Relationship all rights reserved Austin Community College

Nurse Patient Relationship Relationship is a partnership Relationship is a partnership Holistic View: treat body, mind, spirit Holistic View: treat body, mind, spirit Emphasizes self-care and responsibility Emphasizes self-care and responsibility Individual seen in context of family and community Individual seen in context of family and community THERAPEUTIC USE OF SELF THERAPEUTIC USE OF SELF

What is psychotherapy? Modifies thoughts, feelings and behavior in the context of a therapeutic relationship Modifies thoughts, feelings and behavior in the context of a therapeutic relationship How is the Nurse Patient relationship different than a friendship? How is the Nurse Patient relationship different than a friendship?

3 Phases of Nurse Patient Relationship: 1: Orientation Time when Nurse and Patient introduce themselves and nurse defines limits and boundaries of the relationship. Make a verbal contract. Time when Nurse and Patient introduce themselves and nurse defines limits and boundaries of the relationship. Make a verbal contract. Introduces termination Introduces termination Confidentiality must be discussed Confidentiality must be discussed Can not keep “secrets” Can not keep “secrets” Student Nurse examine own feelings; issues of self disclosure must be clear. Goal is TRUST Student Nurse examine own feelings; issues of self disclosure must be clear. Goal is TRUST

2. Working Phase Client begins to share concerns with the nurse. Client begins to share concerns with the nurse. Client will talk about session before and tie it in. Client will talk about session before and tie it in. Phase may happen immediately or not at all. Phase may happen immediately or not at all.

3. Termination Phase Patient and nurse review relationship Patient and nurse review relationship Often pt. feels free to share more. Often pt. feels free to share more. Feelings: sad, relieved, angry, anxious Feelings: sad, relieved, angry, anxious May ignore event altogether May ignore event altogether

Issues in the Nurse / Patient Relationship Transference: Phenomenon of projection of thoughts, feelings, and wishes onto the nurse who has come to represent a figure from the patients past. Transference: Phenomenon of projection of thoughts, feelings, and wishes onto the nurse who has come to represent a figure from the patients past. Occurs in all relationships. Occurs in all relationships. Usually same sex parent Usually same sex parent Overreactions of pts. usually transference. Overreactions of pts. usually transference.

Countertransference When Pt. represents someone from the nurses past. When Pt. represents someone from the nurses past. Identified by an overreaction on the part of the nurse. Identified by an overreaction on the part of the nurse. Can be a part of the self that nurse does not like. Example would be not liking a patients indecision or dependence. Can be a part of the self that nurse does not like. Example would be not liking a patients indecision or dependence. Alcoholism can cause strong feelings. Alcoholism can cause strong feelings.

Other Factors Countertransference issues are best dealt with by clinical supervision. Countertransference issues are best dealt with by clinical supervision. For students; tell instructor For students; tell instructor Rescue fantasy: Common response of nursing and medical students. Don’t expect too much of yourselves or your patient. Rescue fantasy: Common response of nursing and medical students. Don’t expect too much of yourselves or your patient.