Developing 20 Therapeutic 20 Relationships 1


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Developing 20 Therapeutic 20 Relationships 1

  1. 1. The Nurse-Patient Relationship: Developing the Therapeutic Relationship 1
  2. 2. Developing Therapeutic Relationships At the completion of this session students will:  Formulate a list of therapeutic techniques  Have reviewed the phases of a therapeutic one-to- one relationship  Compare and contrast social and therapeutic relationships  Be aware of the potential boundary violations that may occur during a therapeutic relationship  Define self-awareness and describe a strategy for developing self-awareness 2
  3. 3. Exercise Discuss within groups these following questions:  What is a relationship?  What does it mean to be therapeutic?  How does the therapeutic relationship differ from other relationships? 3
  4. 4. The Therapeutic relationship is a concept that is fundamental to the identity of mental health nurses 4
  5. 5. Characteristics of a therapeutic relationship  Nurse takes responsibility for the conduct of the relationship  Relationship has a specific purpose and a health related goal  Relationship terminates when the identified goal is met  Focus of the relationship is on the client  Relationship is entered through necessity  Choice of whom to be in the relationship is not available to either the nurse or the client  Self-disclosure is limited for the nurse but encouraged for the client  Understanding should always be put into words 5
  6. 6. The Mental Health Nurse role within the relationship  Route to understanding  Finding meaning to the experience  Creating opportunities for change to occur  Problem solving  Health promotion  Being a resource for clients  education 6
  7. 7. Peplau’s six nursing roles  Stranger role  Resource role  Teaching role  Counselling role  Surrogate role  Active leadership role 7
  8. 8. Enhancing growth in others  Genuineness – Congruence  Empathy – Understanding ideas expressed and feelings present in the other  Positive regard – Some actions manifest an attitude of respect (attending, suspending value judgments) 8
  9. 9. Enhancing growth in others  Helping Clients Develop Resources – Awareness, encouragement  Self disclosure – Appropriate (feelings, attitudes and beliefs) 9
  10. 10. Exercise: Recognising role limitations in self-disclosure 1. Make a list of phrases that describe your own personality, such as:  I am shy  I get angry when criticised  I find conflicts hard to handle  I am sexy 2. Mark each descriptive phase with one of the following: A. Too embarrassing or intimate to discuss in a group B. Could discuss in a group of peers C. This behaviour characteristic might affect my ability to function in a therapeutic manner if disclosed 10
  11. 11. Exercise cont’d Discuss in groups: 1. What criteria were used to determine the appropriateness of self-disclosure? 2. How much variation is there in what each of you would share with others in a group or clinical setting? 3. Were there any behaviours commonly agreed on that would never be shared with a client? 4. What interpersonal factors about the client would facilitate or impede self-disclosure by the nurse? 5. What have you learnt from this exercise that could be useful in future encounters with clients? 11
  12. 12. Phases of the Nurse-Client relationship  Preorientation – Planning for the first interaction with client – Identifying nurse concerns  Orientation – Compressed due to short hospitalisations; longer in community-based care – Issues: trust, parameters of relationship, contract, confidentiality, termination 12
  13. 13. Phases of the Nurse-Client relationship  Working – Tasks: – Maintain relationship – Gather further information – Promote client problem-solving skills, self-esteem and communication – Facilitate behavioural change – Overcome resistance behaviours – Evaluate problems and goals and redefine them as necessary – Practice and express alternative adaptive behaviours 13
  14. 14. Phases of the Nurse-Client relationship  Termination – Deal with intense feelings regarding the experience – Summarise goals and objectives – Review client plans for the future – Finalise termination 14
  15. 15. Boundary Blurring  Relationship slips into a social context  Nurse behaviour meets personal needs at expense of client  Under helping  Over helping  Controlling  Narcissism 15
  16. 16. Boundary Blurring  Transference – the unconscious emotional reaction patients have in a current situation that is really based on previous relationships and experiences – Main Issue – the wish to be taken care of and to have needs met – Forms may be severe or subtle – Can be positive and negative 16
  17. 17. Boundary Blurring  Counter- Transference – Reactions based on the nurses past experience – May lead the nurse to have inappropriate responses to a patients action 17
  18. 18. Boundary Blurring  Transference – Interventions – Recognise the transference or counter- transference – Examine gently but directly – Limit setting 18
  19. 19. Factors beneficial to relationships  Consistent regular and private interactions with client – Consistency in assigned nurse – Regular routine of activities  Being honest and congruent  Letting client set the pace  Listening to client concerns  Positive initial attitudes and preconceptions  Promoting client comfort and balancing control  Client demonstrating trust and actively participating in relationship 19
  20. 20. Factors hampering relationship  Lack of nurse availability  Lack of nurse self-awareness  Nurse negative feelings about client 20
  21. 21. Self-awareness  Recognising the nature of ones own attitude, emotions and behaviour  a keen sense of self awareness acts as a barometer of the relationship process 21
  22. 22. Exercise – Developing self- awareness An effective way of raising self-awareness is the use of questioning.  In order to raise your awareness of some important issues ask yourself the following questions then discuss your responses in small groups 22
  23. 23. 1. What kinds of values do I hold as a important framework for living? 2. Where do these values come from? 3. How do they inform my understanding of what it is to be a person in this world? 4. How has my family of origin influenced how I view the world? 5. What values did my family hold as important? 6. What do I see as important in family life? 7. What do I know about why I choose to be a nurse? 8. What are the pervading social attitudes towards people in mental distress? 9. What are my beliefs about people in mental distress or with mental illness? 10. What experiences have I had that influence how I feel about people with mental illness? 23