1. Therapeutic Nurse – Client Relationship
Lina Wardam, RN. PNS

2. What is the therapeutic nurse-client relationship?
???? Questions ????
What is the therapeutic nurse-client relationship?
What is the importance of developing a therapeutic relationship
What are the characteristics of therapeutic relationship?
What regulates the nurse-client relationship?
What are the phases of the therapeutic relationship

3. Therapeutic Relationship
It is a mutual structured human- to- human interaction between nurse and client that is directed toward corrective experiences for the client.
Therapeutic relationship refers to holistic approach through which the nurse uses self therapeutically to care for the client’s health (physical, emotional, intellectual, spiritual and social)

4. The therapeutic nurse-client relationship
Therapeutic use of self is the instrument for delivery of care to clients in need of psychosocial intervention.
Interpersonal communication techniques are the “tools” of psychosocial intervention

5. Therapeutic Use of Self
Definition - ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions
Nurses must possess self-awareness, self-understanding, and a philosophical belief about life, death, and the overall human condition

6. Therapeutic use of self
Using self therapeutically means, being present with the client at the moment of interaction.
Being present with the client means being aware about:
Own capacity to provide help
When to stand back
When to speak
When to withhold comments
Being present communicates to the client comfort, strength and healing.

7. Importance of the therapeutic relationship in nursing
The nurse-client relationship is the foundation on which nursing care is established.
The therapeutic interpersonal relationship is the process through which the nursing process is carried to provide nursing care for clients in need

8. Patients don’t care how much you know…..
…………unless they know how much you care

10. How do Social Relationships differ from Therapeutic Relationships?

11. Characteristics of nurse-client relation
Mutual & interdependent
Client centered
Focus is on potential & actual health care needs
Goal empower clients to achieve maximum level of wellbeing
Has a clear professional boundary
Has defined beginning and end

12. Focus is on potential & actual health care needs & empower clients
A therapeutic relationship is formed to empower clients to
Solve problems
Make decisions
Achieve growth
Learn coping strategies
Let go of unwanted behaviors
Reinforce self-worth
Examine relationships

13. What regulates nurse-client relationship?
Role of the patient
Role of the nurse
Patient’s rights
Ethical principles
Job description
Organizational policies and protocols

14. Role of Nurse Self-awareness Professional boundaries
Level of involvement
Therapeutic use of self
Self-disclosure

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

16. Ethical principles directing nurse- client relationship
Do no harm
Do good
Promote goodness
Prevent harm
Autonomy “all people have freedom of choice
Justice “all people are equal”.
Veracity “always be truthful”.

17. Phases of a Therapeutic Nurse-Client Relationship
Pre-orientation
Orientation
Working
Termination

18. Phases of the therapeutic relationship Pre-orientation
Aims:
Develop a theoretical background.
Develop self awareness (auto-diagnosis).
Develop helping skills.
Preliminary data collection about the client

19. Phases of the therapeutic relationship Pre-orientation
Strategies:
Exploration and introspection into one’s own beliefs values and attitudes , biases, or stereotypes towards patients and mental illness. (carry auto-diagnosis of thought, feelings about assigned client)
Analyze own professional strengths and limitations (expected transference – counter transference)
Self sharing (supervisor or clinical instructor)
Receiving feedback from others. (peers, team member, supervisor)
Rehearsing new behaviors of helping skills.
Collect information about the client (chart, nurses, physician, family …etc.)

20. Openness, acceptance and understanding.
Phases of the therapeutic relationship: Pre-orientation techniques – skills
Reflection on one’s own experiences and it’s effect on interacting with patients and peers and health care team.
Self disclosure.
Asking for feedback
Active listening.
Openness, acceptance and understanding.

21. Phases of the therapeutic relationship orientation phase
Aims :
To establish a working (trust) relationship
To negotiate a contract (structure and goals of the relationship)
To make an assessment
To clarify and define problems (Reason of seeking help)

22. Phases of the therapeutic relationship: orientation phase - strategies
Develop structure: identify names, roles of each nurse and client, responsibilities and expectations from each, purpose of the relationship, meeting location, time and length of interaction, length of the relationship and confidentiality issues.
Exploration: helping the client to examine and elucidate their concern. The purpose is clarification and common understanding between client and nurse.
Prioritizing and focusing: Deciding what is the core problem and which one to tackle first.
Communicating core values: Nurse has to show acceptance, understanding, respect…etc.

23. Responding & facilitative skills
Phases of the therapeutic relationship: orientation phase – exploration techniques (skills)
Asking questions
Making statements
Responding & facilitative skills
Seeking Clarification
Restatement
Paraphrasing
Stating observation
Testing discrepancies
Using Silence
Clarifying time in sequence
Reflection
Summarizing

24. Working Phase Aims: Strategies
Starts with the commitment of the client to work on problem
Prioritizing client’s needs determines immediate problems that needs attention (safety & physical health problems then socially unacceptable behaviors)
Strategies
Communicating core values
Exploration strategies
Intervention strategies

25. Working Phase: Intervention skills
Giving feedback
Problem solving
Giving information
Confrontation
Helping with feelings

26. Working phase: Intervention responses communication skills
Mirroring
Matching responses
Using appropriate vocabulary
Focusing
Using metaphors
Reframing
Presenting reality
Role playing
Encouraging plan formation
Giving feedback
Asking for validation
Anticipatory guidance
True reassurance
Self disclosure
Offering self
Encouraging evaluation

27. Termination Phase Aims: Strategies: Skills:
To decide an appropriate change:
To transfer learning: to implement change
To end counseling relationship.
Strategies:
Goal setting: guided fantasy, role play…etc.
Action planning
Evaluating: is this action helping me cope better with my concerns.
Ending
 Skills:
Foundation skills.