2nd-year B.Sc Nursing Communication and Educational Technology unit-2 Interpersonal Relations class-2 Barriers of interpersonal relationship part 2

1. BARRIERS OF IPR
and
METHODS OF
OVERCOMING
PART- 2
BY,
VEDANTHAVINOD
ASSISTANT LECTURER
CCON-MYSORE

2. The common impasses are as follows:
RESISTANCE
TRANSFERENCE
COUNTER
TRANSFERENCE
BOUNDARY
VIOLATIONS

3. COUNTERTRANSFERENCE
•Counter transference is a therapeutic impasses created by
the nurse's specific emotional response to the qualities of
the patient.
• This transference happens in the nurse towards the
patient. Here, the nurse links the identity of the present
patient with individuals they have met in the past and as a
result, these personal needs interfere with their
therapeutic effectiveness.

4. TYPES
Three types of counter transferences can be
described:
1.Reactions of intense love and caring
2.Reactions of intense disgust or hostility and
3. Reactions of intense anxiety, often in response
to resistance exhibited by the patient.

5. •These reactions can be considered as powerful
tools for exploring and uncovering inner states
of the nurse.
•They are destructive only if they are ignored or
not taken seriously.

6. •This phenomenon can happen in a group too:
for example, an intensive care unit (ICU) team
taking care of a patient for a prolonged period
of time might face power struggles during the
time of discharge.

7. FORMS OF COUNTER
TRANSFERENCES
•Inability to empathize with patient in certain
problem areas.
•Depressed feelings during or after the sessions/shift.
• Carelessness about implementing the contract by
being late, running overtime, etc. Drowsiness during
the shifts.

8. •Feeling anger or impatience because of
patient's unwillingness to change.
•A tendency to focus repeatedly on only one
aspect or looking at the information presented
by the patient.

9. MANAGEMENT OF COUNTER
TRANSFERENCE
•The therapeutic relationship need not be
terminated. But should be supervised without
getting ignored.
•The supervisor should support the nurse to
understand the feelings of counter
transference.

10. •If the nurse identifies the counter
transference by herself, she should discuss
the same with her seniors.
•Peer consultation and professional meeting
will be helpful in managing counter
transference.

11. BOUNDARYVIOLATIONS
•BoundaryViolations is the final but very important
therapeutic impasse is boundary violations.
•This occurs when a nurse goes outside the
boundaries of the therapeutic relationships and
establishes a social, economic or personal
relationship with a patient.

12. Different Ways of Boundary
Violations and Overcoming
Them

13. • Any degree of intimate behaviors or sexual exchange
or contact with a patient should be considered as
serious boundary violations.
• Sexual contact of any kind is never therapeutic and
never acceptable within the nurse-patient
relationship.
INTIMACY AND SEXUAL BOUNDARIES

14. ROLE BOUNDARIES
• Problems with role boundaries require the
insight of the nurse and maintaining the
relationship within therapeutic limits.

15. TIME BOUNDARIES
Odd and unusual treatment hours that have
no therapeutic necessity must be evaluated as
potential boundary violations.

16. PLACE AND SPACE BOUNDARIES
•These are related to place where the treatment
takes place.
•In inpatient settings, nurse should preferably
document the time spent in patient's room along
with the indication for visit and measures taken to
respect boundary concerns

17. MONEY BOUNDARIES
Bartering or seeing an indigent patient for
free should be carefully reviewed for potential
boundary violation.

18. LANGUAGE BOUNDARIES
Too familiar, sexual, off-color or leading
language constitutes a boundary violation.

19. CLOTHING BOUNDARIES
The nurse need to dress in an appropriate
therapeutic manner.

20. SELF-DISCLOSURE BOUNDARIES
Self-disclosure boundaries: Inappropriately timed
self-disclosure by the nurse and nurse self -disclosure
that lacks therapeutic value are suspect of boundary
violation.

21. GIFT BOUNDARIES
Gifts can take many forms:
• Gifts as token of reciprocation for the care given.
• Gift intended to manipulate of change the quality of care given or the nature of
the nurse patient relationship.
• Gift given as perceived obligation by the patient.
• Gifts received by chance. Gifts given to the organization to recognize
excellence of care received.
• The timing of event, the intent of giving and the contextual meaning of giving
of the gift should be kept in mind before deeming it as a violation.

22. ANY DOUBTS??

23. THANKYOU