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Therapeutic Nurse – Client Relationship
Lina Wardam, RN. PNS
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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
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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)
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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
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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
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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.
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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
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Patients don’t care how much you know…..
…………unless they know how much you care
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How do Social Relationships differ from Therapeutic Relationships?
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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
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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
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What regulates nurse-client relationship?
Role of the patient Role of the nurse Patient’s rights Ethical principles Job description Organizational policies and protocols
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Role of Nurse Self-awareness Professional boundaries
Level of involvement Therapeutic use of self Self-disclosure
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Patient’s Bill of Rights
Civil Rights Client Consent Communication Freedom from Harm Dignity and Respect Confidentiality Participation in Treatment Plan
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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”.
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Phases of a Therapeutic Nurse-Client Relationship
Pre-orientation Orientation Working Termination
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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
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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.)
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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.
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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)
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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.
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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
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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
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Working Phase: Intervention skills
Giving feedback Problem solving Giving information Confrontation Helping with feelings
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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
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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.
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