1. Structuring The Relationship

2. 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.

3. 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

4. Types of Communication
Intrapersonal
Interpersonal

5. 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.”

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

7. 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

8. 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

9. 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

10. 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

11. 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.

12. 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.

13. 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.

14. 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.

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

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

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

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

19. 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

20. 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

21. 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

22. 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

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