Theraeutic nurse patient relationship


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Theraeutic nurse patient relationship

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  2. 2. CONCEPT…A relationship is defined as a state ofbeing related or a state of affinitybetween two individuals.The nurse & client interact with eachother in the health care system withthe goal of assisting the client to usepersonal resources to meet his or herunique needs.
  3. 3. www.drjayeshpatidar.blogspot.com1. Social Relationships2. Intimate Relationships3. Therapeutic Relationships
  4. 4. 1. Social Relationships A social relationship can be defined as arelationship that is primarily initiated withthe purpose of friendship, socialization,enjoyment or accomplishing a task. Mutual needs are met during socialinteraction. For example, participants share ideas,feelings &
  5. 5. 2. Intimate Relationships An intimate relationship occurs between twoindividuals who have an emotionalcommitment to each other. Those in an intimate relationship usuallyreact naturally with each other. Often the relationship is a partnershipwherein each member cares about theother’s need for growth &
  6. 6. 3. Therapeutic Relationships The therapeutic relationship betweennurse & the patient differs from both asocial & an intimate relationship in that thenurse maximizes inner communicationskills, understanding of human behavior &personal strengths, in order to enhance thepatient’s growth. The focus of the relationship is on thepatient’s ideas, experiences &
  7. 7. Facilitating communication of distressingthoughts & feelings. Assisting the client with problem solving Helping the client examine self-defeatingbehaviors & test-alternatives. Promoting self-care & independence.
  8. 8. www.drjayeshpatidar.blogspot.com1. Rapport2. Empathy3. Warmth4. Genuineness
  9. 9. 1. Rapport is a relationship orcommunication especially whenuseful & harmonious. It is a willingness to becomeinvolved another person.
  10. 10. 2. Empathy is an ability to feel with the patientwhile retaining the ability to critically analyzethe situation. In empathy process the nurse receivesinformation from the patient with an open,non-judgmental acceptance, &communicates this understanding of theexperience & feelings so that the patientfeels understood. This serves as a basis forthe relationship.
  11. 11. 3.Warmth is the ability to help the clientfeel cared for & comfortable.It shows acceptance of the client as aunique individual.
  12. 12. 4.Genuineness involve being one’sown self.This is implies that the nurse is awareof her thoughts, feelings, values &their relevance in the immediateinteraction with the client.
  13. 13. CHARACTERISTICS OFTHERAPEUTIC NURSE-PATIENTRELATIONSHIP… The therapeutic relationship is the corner-stone of psychiatric-mental health nursing,where observation & understanding ofbehavior & communication are of greatimportance. It is a mutual learningexperience & a corrective emotionalexperience for the patient. The nature of the therapeutic relationship ischaracterized by the mutual growth ofindividuals who “dare” to become related todiscover love, growth & freedom.
  14. 14. Count… The therapeutic relationship is based on thebelief that the patient has potential & as aresult of the relationship, “will grow to hisfullest potential”. In a therapeutic relationship the nurse &patient work together towards the goal orassisting the patient to regain the innerresources in order to meet life challenges &facilitate growth. The interaction ispurposefully established, maintained &carried out with the anticipated outcome of
  15. 15. ETHICS ANDRESPONSIBILITIES… Ethics has been defined as a branch of philosophythat refers to the study of values that conform to themoral standards of a profession. The American Nurses Association has identified fourprimary principles to guide ethical decisions.Governing the relationship between the nurse & thepatients, these principles include the patient’s right toautonomy (making decisions for oneself)The patient’s right to beneficence (doing good by thenurse)The patient’s right to justice or fair treatment, andThe patient’s right to veracity (honest) & truth by thenurse, regarding the patient’s condition & treatment.
  16. 16. Count… Nurses’ respect for the patient’s dignity, autonomy,cultural beliefs, & privacy is of particular concern inpsychiatric-mental health nursing practice. The nurse serves as an advocate for the patient & isobliged to demonstrate non-judgmental & non-discriminatory attitudes & behaviors that aresensitive to patient diversity. An essential aspect of the patient’s response is theright to exercise personal choice about participationin proposed treatments. The responsible use of the nurse’s authorityrespects the patient’s freedom to choose amongexisting alternatives & facilities awareness ofresources available to assist with decision making.
  17. 17. Count… Nurses working with psychiatric-mentalhealth patients are prepared to recognize thespecial nature of the provider-patientrelationship & take steps to assuretherapeutic relationships are conducted in amanner that adheres to the mandatesstipulated in the ANA Code for Nurses (ANA1985). Unethical behavior (for example, omission ofinformed consent, breach of confidentiality,undue coercion, boundary infringement) &illegal acts can increase the patient’s
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  19. 19. www.drjayeshpatidar.blogspot.com1. Pre-interaction phase2. Introductory or Orientation phase3. Working phase4. Termination phase
  20. 20. This phase begins when the nurse isassigned to initiate a therapeuticrelationship & included all that the nursethinks, feels or does immediately prior tothe first interaction with the patient.
  21. 21. Count…www.drjayeshpatidar.blogspot.comNurse’s tasks in the pre-interactionphase:Explore own feelings, fantasies &fearsAnalyze own professional strengths &limitations.Gather data about patient wheneverpossible.Plan for first meeting with patient.
  22. 22. Count…• Difficulty in self analysis & self acceptance.• Anxiety• Boredom• Anger• Indifference• Depression
  23. 23. Help from peers and supervisor inself analysis & facing reality. Analyze herself & recognize herasset & limitation.
  24. 24. It is during the introductory phase that thenurse & patient meet for the first time. One of the nurse’s primary concerns is tofind out why the patient sought help.
  25. 25. Count…www.drjayeshpatidar.blogspot.comNurse’s tasks in the Orientation phase: Establish rapport, trust & acceptance Establish communication Gather data, including the client’s feelings,strengths & weaknesses Define client’s problems; set priorities fornursing intervention Mutually set goals
  26. 26. Count…• Perception of each other as uniqueindividual may not take place.• Problems related to establishing anagreement or pact between the & patient.
  27. 27.• Nurse must be willing to relate honestly toher feeling & share it with supervisor.• Nurse must feel free to reveal self withoutfear of criticism.• Difficulty may be faced in assisting a nursewith countertransference since most of thisbehavior is unconsciously determined.• A alert supervisor can detect this & guidethe nurse appropriately.
  28. 28. Most of the therapeutic work is carriedout during the working phase. The nurse & the patient explore relevantstressors & promote the development ofinsight in the patient.
  29. 29. Count…www.drjayeshpatidar.blogspot.comNurse’s tasks in the working phase:• Gather further data; explore relevantstressors• Promote patient’s development of insight &use of constructive coping mechanism.• Facilitate behavioral change; encourage himto evaluate the results of his behavior• Provide him with opportunities forindependent functioning.• Evaluate problems & goals & redefine as
  30. 30. Count…• Testing of nurse by the patient.• Unrealistic assumption about progress ofpatient.• The nurse’s fear of closeness.• Life stressors of nurse.• Resistance behavior.• Transference• Countertransference
  31. 31. Count…• Conferences with the supervisors & groupdiscussions with other members of the staff.• There will be times when the nurse believesshe is making little or no progress.• Handling resistances.
  32. 32. This is the most difficult, but mostimportant phase of the therapeutic nurse-patient relationship. The goal of this phase is to bring atherapeutic end to the relationship.
  33. 33. Count…www.drjayeshpatidar.blogspot.comNurse’s tasks in the Termination Phase: Establish reality of separation Mutually explore feelings of rejection, loss,sadness, anger & related behavior. Review progress of therapy & attainment ofgoals Formulate plans for meeting future therapyneeds.
  34. 34. Count…• Anger• Punitive behavior• Depression or assuming non caring attitude• Flight to health• Flight to illness.• Nurse’s inability or unwillingness to makespecific plans & implement them.
  35. 35. Nurse should be aware of patients feeling &be able to deal with them appropriately. Assist the patient by openly eliciting histhoughts & feelings about termination. Supervisor can assist the nurse inpreparing patient for discharge.
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  37. 37. www.drjayeshpatidar.blogspot.com1.Resistance2.Transference4.Gift giving5.Boundry violation
  38. 38.• Resistance is thepatient’s attempt toremain unaware ofanxiety producingaspects within himself.• It’s a natural learnedreluctance to avoidanceof verbalizing or evenexperiencing troubledaspects of self.
  39. 39. Active listening Clarification – Give for focused idea ofwhat is happening. Reflexion – Helps the patient to becomeaware of what has been going in his mind. Explore behavior to find possible reason. Maintain open communication withsupervisor
  40. 40.• It is an unconscious response of the patientin which he experiences feeling & attitudestowards the nurse that were originallyassociated with significant figures in hisearly life.• Such response utilize the defensemechanism of displacement.• Transference reactions are harmful to thetherapeutic process only if they remainignored & unexamined.
  41. 41.• No need to terminate relationship unless poses aserious barrier to therapy or safety.• Nurse should work with patient in sorting out pastfrom the present• Assist patient in identifying the transference &reassign a new & more appropriate meaning to thecurrent nurse patient relationship.• The goal is to guide the patient to independence byteaching them assume responsibility for their ownbehaviors, feeling & thoughts & to assign thecorrect meaning to the relationship based on thepresent circumstances instead of past.
  42. 42.• It’s a therapeutic impasse createdby the nurse.• It refers to nurse’s specificemotional response generated bythe qualities of the patient.• In this case the nurse identifiesthe patient with individuals fromher past & personal needs willinterfere with therapeuticeffectiveness.• The nurse’s unresolved conflictsabout authority, sex,assertiveness & independenceten to create problems ratherthan solve them.
  43. 43.• Need not terminate relationship.• Support the nurse.• Assist her identifying countertransference.• Discuss with superiors.• Self examination.• Pursue to find out source of problem.• Exercise control countertransference.• Peer consultation & professional meetings.
  44. 44. Receiving a gift from patient make thenurse to inhibit independent decisionmaking & create a feeling of anxiety orguilt. Gift is something of value is voluntarilyoffered to another person, usually toconvey a gratitude.
  45. 45. The timing of a particular situation, theintent of giving & the contextual meaningof giving of the gift.
  46. 46.It occurs when nurse goes outsidethe boundaries of therapeuticrelationship & establishes a social,economic or personal relationshipwith the patient.
  47. 47.• Receives feedback that her behavior is intrusive withpatient or their families.• Has difficulty in setting limit with patient.• Relates the patient to a friend or family member.• Has sexual feeling towards a patient.• Feels that she is the only one who understands thepatient.• Receives feedback that she is too involved with apatient or family.• Feels that other staffs are too critical or jealous of herrelationship with the patient.
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