Therapeutic relationship in psychiatric nursing

1. THERAPEUTIC RELATIONSHIP
MRS BINCY VARGHESE
CLINICAL TUTOR

2. INTRODUCTION

3. “ The relationship between a
healthcare professional and a client
(patient). It is a mean by which the
Therapist and a client hope to
engage with each other and effect
beneficial change in the client”
DEFINITION OF THERAPEUTIC
RELATIONSHIP

4. “ The interaction process in which the
Nurse fulfills her role by using her
professional knowledge and skill in
such a way that she is able to help
the patient physically, socially and
emotionally”
DEFINITION OF THERAPEUTIC
NURSE PATIENT RELATIONSHIP

5. TYPES OF RELATIONSHIP

6. 1. Social Relationship
2. Intimate Relationship
3. Therapeutic Relationship

7. SOCIAL RELATIONSHIP

8. • A social relationship is primarily
initiated for the purpose of friendship,
socializations and companionship
• The communication is usually centered
around sharing ideas, feelings and
experiences and meets the basic needs
of people.
• In Therapeutic Nurse patient
relationship, the social relationship
must be limited

9. INTIMATE RELATIONSHIP

10. • A healthy intimate relationship involves
two people who are emotionally
committed to each other and both
concerned about having their needs met
and helping each other.
• The relationship may include sexual or
emotional intimacy as well as sharing of
mutual goals
• It has no place in the nurse patient
relationship.

11. THERAPEUTIC RELATIONSHIP

12. • It focuses on the needs, experiences,
feelings and ideas of the client.
• The areas to be worked on are agreed on
and the outcomes are continually
evaluated.
• The nurse uses communication skills,
personal strengths and understanding of
human behaviour to interact with the
client

13. GOALS OF NURSE PATIENT
RELATIONSHIP

14. 1. Help to understand his/her
problems.
2. Cope with present problems.
3. Identify emerging problems.

15. 4. Find out new alternatives to
problems
5. Communicate
6. Try out new patterns of
behaviour
7. Socialize

16. FACTORS DETERMINING
EFFECTIVE NURSE PATIENT
RELATIONSHIP

17. 1. Self Awareness
2. Attitude towards the patient
3. Ability of developing the rapport

18. Self Awareness
• Self awareness includes self concept, beliefs
and values.
• If a nurse has a positive self concept about
herself she will be confident in caring for the
patient. But if she has developed a negative
self concept, she will not be able to help the
patient

19. Attitude towards the patient
• Nurse must develop an attitude of
acceptance of the patient, tolerance of
his/her disturbed behaviour and
helping the patient
• She should avoid passing the
judgement on the patient

20. Ability of developing the
rapport
• It is defined as a relationship of mutual
sympathy and understanding especially
between patient and therapist.
• The essential qualities for developing
rapport are warmth, genuineness and
empathy

21. QUALITIES OF THERAPEUTIC
NURSE PATIENT RELATIONSHIP

22. 1. Genuineness (real and honest)
2. Sincerity
3. Respect
4. Love and affection
5. Concern
6. Listen
7. Empathy (ability to feel with patient)
8. Good communication skills
9. Exploration of problems
10.Self discipline

23. PHASES OF THERAPEUTIC NURSE
PATIENT RELATIONSHIP

24. Peplau’s Interpersonal Theory (1962).
Preinteraction/ Preorientation phase
• Get available information about the patient
from his/her case file, significant others or
other health care team members.
• Examine your own feelings, fears and
anxieties

25. Orientation Phase
• Create an environment of trusting
relationship
• Assessment
• Identify patient’s problems, strength
• Formulate nursing diagnosis
• Set goals which are mutually agreeable
• Develop plan of action

26. Working Phase
• Maintain the trust and rapport
• Solve the patient’s problems
• Continuously evaluate the progress
towards goal attainment

27. Resolution phase/Termination
Phase
• The mutually agreed goals may have been
reached
• The patient may be discharged from
hospital
• Review the progress made

28. THERAPEUTIC IMPASSES
Obstacles or blocks which occurs
in Therapeutic Nurse Patient
relationship

29. • Resistance occurs when patient consciously
or unconsciously conceals the problems
(acting out, forgetful, be silent)
• Nurse can help client to overcome
resistance by pointing out their progress
and strength

30. TRANSFERENCE
Transference is an unconscious
response whereby client identifies the
nurse with some significant others.
Feelings and attitudes about the other
person are transferred to the nurse

31. • Created by the nurse
• The nurse identifies the patient with
someone significant to her life
(reaction of intense love or caring,
hostility)
COUNTER TRANSFERENCE

32. GIFT GIVING

33. BOUNDARY VIOLATION

34. • It occurs when a nurse goes beyond the
established therapeutic relationship and
enters into a social, economic or personal
relationship with the patient.
• (patient takes nurse on lunch and dinner,
nurse accepts gifts, nurse does business
with patient, nurse talks about personal
matters with patient, nurse meets patient
outside hospital setting)

35. OVERCOMING THERAPEUTIC
IMPASSES

36. • Be prepared to be exposed to powerful
emotional feelings
• Nurse must have knowledge about
impasses
• The reason behind the behaviour must be
explored
• Try to solve the problem

37. COMMUNICATION SKILL

38. • SENDER
• MESSAGE
• RECEIVER
• FEEDBACK
ELEMENTS

39. • Accept the patient as he is
• Use self understanding as
therapeutic tool
• Use consistent behaviour
• Give reassurance in subtle manner
• Change patient’s behaviour through
emotional experience
PRINCIPLES OF PSYCHIATRIC
NURSING

40. • Avoid unnecessary increase in
patient’s anxiety
• Maintain nurse patient relationship
• Avoid physical or verbal force
• Provide care to the patient as a
person
PRINCIPLES OF PSYCHIATRIC
NURSING

41. • Give explanation at patient’s level of
understanding
• Focus on strength of patient
PRINCIPLES OF PSYCHIATRIC
NURSING

42. • Counsellor
• Surrogate parent
• Teacher
• Social agent
• Coordinator
• Client Advocate
ROLE OF NURSE

43. • Researcher
• Administrator
• Supervisor
• Case Manager
ROLE OF NURSE (contd..)