This document discusses therapeutic communication and the nurse-patient relationship. It defines therapeutic communication as an interpersonal interaction between the nurse and patient where the nurse focuses on meeting the patient's specific needs to effectively exchange information. The goals of therapeutic communication are to establish a therapeutic relationship, identify the patient's most important needs, assess how the patient views their problem, and help the patient express their emotions. The document outlines various techniques used in therapeutic communication including listening, informing, reflecting, and suggesting. It also discusses the components that make up a therapeutic nurse-patient relationship, such as rapport, empathy, warmth, and genuineness. The relationship aims to help patients communicate distressing thoughts/feelings and problem solve with alternative behaviors.

1. THERAPEUTIC COMMUNICATION AND NURSE-PATIENT
RELATIONSHIP
PREPARED BY
Mrs. Divya Pancholi
M.Sc. (Psychiatric Nursing)
Assistant Professor
SSRCN, Vapi

2. COMMUNICATION
 It is a process of exchanging or sharing ideas, feeling, and
information.

3. COMMUNICATION
PROCESS
3
Sender
Source
Encoder
Receiver
Decoder
message
Channel
Feedback

4. ELEMENTS OF COMMUNICATION
Sender
Receiver
Message
Channel
Feedback (Effect)

5. TYPES OF COMMUNICATION
 One way communication
 Two way communication
 Interpersonal
communication
 Serial communication
 Verbal communication
 Non verbal
communication
 Formal communication
 Informal communication
 Visual communication
 Telecommunication

6. THERAPEUTIC COMMUNICATION

7. DEFINITION
It is an interpersonal interaction between the
nurse and the patient during which the nurses
focuses on the patient’s specific needs to
promote an effective exchange of information.

8. GOALS OF THERAPEUTIC COMMUNICATION
 Establish a therapeutic nurse-patient relationship
 Identify the most important patient’s needs
 Assess the patient’s perception of the problem
 Facilitate the patient's expression of emotions
 Implement the interventions designed to address the
patient’s needs

9. PRINCIPLES/CHARACTERISTICS OF THERAPEUTIC COMMUNICATION
The patient should be the primary focus of interaction
 A professional attitude sets the tone of the therapeutic
relationship
 Use self-disclosure cautiously and only when it has a therapeutic
purpose.
 Avoid social relationship with patients
 Maintain patient confidentiality
 Assess the patient’s intellectual competence to determine the level
of understanding

10. CONTI…
 Implement interventions from a theoretic base
 Maintain a non-judgemental attitude. Avoid making
judgements about patient’s behaviour
 Avoid giving advice.
 Guide the patient to reinterpret his or her experiences,
rationally.

11. THERAPEUTIC COMMUNICATION TECHNIQUE
(LIBRARY THESISSS FINAL CHAPTER)
Listening
Informing
Broad opening
Restating
Reflection
Theme identification
Sharing perceptions
Suggesting
Silence
Focusing
Clarification
Humor

12. LISTENING
 It is an active process of receiving
information.
 Responses on the part of the nurse such as
maintaining eye to eye contact, nodding,
gesturing and other forms of receptive non-
verbal communication convey to the patient
that he is being listened to and understood.
THERAPEUTIC VALUE:
 Non-verbally communicates to the patient

13. INFORMING
 The skill of information giving.
 For example, “I think you need to
know more about your
medications.”
THERAPEUTIC VALUE:
 Helpful in health teaching or
patient education about relevant
aspects of patient’s well-being
and self care.

14. BROAD OPENING
 Encouraging the patient to select
topics for discussion.
 For Example, “What are you
thinking about?”
THERAPEUTIC VALUE:
 Indicates acceptance by the nurse
and the value of patient’s initiative.

15. RESTATING
 Repeating the main thought
expressed by the patient.
 For example, “You say that your
mother left you when you were 5
year old.”
THERAPEUTIC VALUE:
 Indicates that the nurse is listening
and validates, reinforces or calls
attention to something important
that has been said.

16. REFLECTION
 Directing back the patient’s ideas, feelings,
questions and content.
 For example: “You are feeling tense and
anxious and it is related to a conversation
you had with your husband last night.”
THERAPEUTIC VALUE:
 Validates the nurse’s understanding of what
the patient is saying and signifies empathy,
interest and respect for the patient.

17. THEME IDENTIFICATION
 This involves identification of underlying
issues or problems experienced by the
patient that emerge repeatedly during the
course of the nurse-patient relationship.
 For example, “You are smiling, but I sense
that you are really very angry with me.”
 THERAPEUTIC VALUE:
Conveys the nurse’s understanding to the
patient and has the potential for clearing up
confusing communication.

18. SHARING PERCEPTIONS
 Asking the patient to verify the nurses
understanding of what the patient is
thinking or feeling.
 For example: “You are smiling, but I
sense that you are really very angry
with me.”
THERAPEUTIC VALUE:
 Conveys the nurse’s understanding to
the patient and has the potential for
clearing up confusing communication.

19. SUGGESTING
 Presentation of alternative ideas for the
patient’s consideration relative to problem
solving.
 For example, “Have you thought about
responding to your boss in a different way
when he raises that issue with you? You could
ask him if a specific problem has occurred.”
THERAPEUTIC VALUE:
 Increases the patient’s perceived notions or
choices.

20. SILENCE
 Lack of verbal communication for a therapeutic
reason.
 For Example, Sitting with a patient and non-
verbally communicating interest and
involvement.
THERAPEUTIC VALUE:
 Allows the patient time to think and gain
insight, slows the pace of the interaction and
encourages the patient to initiate conversation
while enjoying the nurse’s support,
understanding and acceptance.

21. FOCUSING
 Questions or statements that help the
patient expand on a topic of importance.
 For Example: “I think that we should talk
more about your relationship with your
father.”
THERAPEUTIC VALUE:
 Allows the patient to discuss central issues
and keeps the communication process
goal-directed.

22. CLARIFICATION
 Attempting to put vague ideas or unclear thoughts
of the patient into words to enhance the nurse’s
understanding or asking the patient to explain
what he means.
 For example: “I am not sure what you mean. Could
you tell me about that again?”
 THERAPEUTIC VALUE:
 It helps to clarify feelings, ideas and perceptions of
the patient and provides and explicit correlation
between them and the patient’s actions.

23. HUMOR
 The discharge of energy through comic
enjoyment of the imperfect.
 For example, “That gives a whole new meaning
to the word nervous,” said with shared kiddling
between the nurse and patient.
THERAPEUTIC VALUE:
 Can promote insight by making repressed
material conscious, resolving paradoxes,
tempering aggression and revealing new
options, and is a socially acceptable form of
sublimation.

24. THERAPEUTIC NURSE-PATIENT RELATIONSHIP

25. DEFINITION
Relationship-
 A relationship is defined as being related or state of
affinity between two individual.
Therapeutic nurse patient relationship-
 It is an interaction process in which the nurse fulfils her
role by using her professional knowledge and skills in
such way that she is able to help the patient physically,
socially and emotionally.

26. TYPES OF RELATIONSHIP
Social relationship
Intimate relationship
Therapeutic relationship

27. 1. SOCIAL RELATIONSHIP
 It is defined as a relationship that is
primarily initiated with the purpose of
friendship, socialization , enjoyment or
accomplishing task.
 Mutual needs are met during social
interaction.
 E.g. participants share ideas, feelings
and experiences.

28. 2. INTIMATE RELATIONSHIP
 It occurs between two individuals who
have an emotional commitment to each
other.
 Those in an intimate relationship usually
react naturally with each other.
 Often the relationship is a partnership
wherein each member cares about the
other’s need for growth and satisfaction.

29. 3. THERAPEUTIC RELATIONSHIP
 This relationship differs from both a
social and intimate relationship in that
the nurse maximizes inner
communication skills, understanding of
human behaviour and personal
strengths, in order to enhance the
patient’s growth.
 The focus of the relationship is on the
patient’s ideas, experiences and
feelings.

30. GOALS OF THERAPEUTIC NURSE- PATIENT RELATIONSHIP
 Facilitating communication of distressing
thought and feeling.
 Helping client examine self-defeating.
 Assisting client with problem solving.
 Behavior and test alternatives.
 Promoting self-care and independence.

31. COMPONENTS OF THERAPEUTIC NURSE-PATIENT
RELATIONSHIP
Rapport Empathy Warmth genuineness

32. 1. RAPPORT
 Rapport is a relationship or communication, especially when useful and
harmonious.
 It is the crux of a therapeutic relationship between the nurse and the
patient.
 It is-
 A willingness to become involved with another person
 Growth towards mutual acceptance and understanding of individuality
 The nurse establishes rapport through demonstration of
understanding, warmth and non-judgemental attitude. A skilled nurse will
be able to establish rapport that will alleviate the patient’s problems.
When rapport develops, the patient feels comfortable with the nurse and
finds it easier to self-disclose.
 The nurse also feels comfortable and recognizes that an interpersonal
bond or alliance is developing.

33. 2. EMPATHY
 Definition: It is the ability to fell with the patient while
retaining the ability to critically analyse the situation.
OR
It is the ability to put oneself in another person’s
circumstances and feelings.
 The nurse need not necessarily have to experience it, but
to be able to imagine the feelings associated with the
experience.
 In empathy, nurse receives information from the patient
an open, non-judgemental acceptance, and communicates
this understanding of the experience and feelings so that
patient feels understood.

34. DIFFERENCE BETWEEN EMPATHY AND SYMPATHY

35. 3. WARMTH
 Warmth is the ability to help the
patient feel cared for and
comfortable.
 It shows acceptance of the
patient as a unique individual.
 It involves a non-possessive
caring for the patient as a
person and willingness to share
the patient’s joys and sorrows.

36. 4. GENUINENESS
 Genuineness involves being one’s own self.
 This implies that the nurse is aware of her
thoughts, values and theory relevance in
the immediate interaction with a patient.
 The nurse’s response to the patient is
sincere and reflects her internal response.
 It is also important that the nurse’s verbal
and non-verbal communication
corresponds with each other.

37. CHARACTERISTICS OF THERAPEUTIC NURSE-PATIENT RELATIONSHIP
 Therapeutic relationship is the corner-stone of psychiatric
mental health nursing, where observation and understanding
of behaviour and communication are great importance. It is
a mutual learning experience and corrective emotional
experience for the patient.
 Nature of therapeutic nurse-patient relationship is
characterized by the mutual growth of individuals.

38. CONTI…
 It is based on belief that the patient has potential, and as a
result of the relationship, will grow to his fullest potential.
 In therapeutic relationship the nurse and patient work
together towards the goal or assisting the patient to regain
the inner resources in order to meet life challenges and
facilitate growth. The interaction is purposefully established,
maintained and carried out with the anticipated outcome of
helping the patient to gain new coping and adaptation skills.

39. DYNAMICS OF THERAPEUTIC NURSE-PATIENT RELATIONSHIP
Thera
peutic
use of
self
Gainin
g self-
aware
ness
Power Trust
Intimac
y
Respe
ct

40. 1. THERAPEUTIC USE OF SELF
 It is defined as, “the ability to use one’s personality
consciously and in full awareness in an attempt to
establish relatedness and to structure nursing
interventions.”
 Peplau described that nurses must clearly
understand themselves to promote patient’s growth,
change and heal.

41. 2. GAINING SELF-AWARENESS
 Self Awareness is the process of understanding
one’s own beliefs, thoughts, motivations, biases and
limitations and recognising how they affect others.
 Without self-awareness, nurses will find it
impossible to establish and maintain therapeutic
relationships with patients.

42. JOHARI WINDOW / THERAPEUTIC WINDOW
 It is a representation of the self & a tool that can be
used to increase self-awareness.
 Increased self-awareness allows an individual to
accept the differences in others, & to observe each
[person’s right to respect & dignity.

43. JOHARI WINDOW
KNOWN TO SELF UNKNOWN TO SELF
KNOWN TO OTHERS
1 2
OPEN /PUBLIC SELF
Behaviours, feelings and
Known to the individual and
others
BLIND / UNAWRE OF SELF/ THE
UNKNOWING SELF
Things that other know but the
individual does not know
UNKNOWN TO
OTHERS
3 4
PRIVATE / HIDDEN SELF
Things about self known only to
self
UNKNOWN SELF
Aspects of the self that are
unknown to the individual and
others

44. DESCRIPTION OF JOHARI WINDOW
 Step 1: Nurse has to appraise her own qualities by
creating list of them: values, attitudes, feelings, strengths,
behaviours, accomplishments, needs, desires and
thoughts.
 Step II: To find out the perceptions of others by
interviewing them and asking them to identify qualities,
both positive and negative, they see in the nurse.
 Step III: To compare lists and to assign qualities to the
appropriate quadrant.

45. CONTI…
• If quadrant 1 is the longest list, this indicates that the nurse is
open to others,
• A smaller quadrant 1 means that the nurse shares little about
herself with others.
• If quadrant 1 and 3 both are small, the person demonstrates
little insight.
The goal is to work towards moving qualities from 2,3 and
4 into quadrant 1 (Qualities known to self and others) which
indicates that the nurse is gaining self-knowledge and

46. 3. POWER
 The appropriate use of power in a caring manner
enables the nurse to work with the patient towards
the patient’s goals and to ensure that the patient’s
goals the patient’s vulnerable position in the nurse-
patient relationship is not taken advantage of.

47. 4. TRUST
To maintain trust in the relationship, it is
important that the nurse keeps promises to
patients.
If trust is breached, then it becomes very
difficult to re-establish it.

48. 5. INTIMACY
 Intimacy relates to the kinds of activities nurses
perform for the patients that create personal and
private closeness on many levels.
 This can involve physical, psychological, spiritual
and social elements.

49. 6. RESPECT
Respect for the dignity and worth of the
patient is fundamental to the relationship.
The nurse needs to know and understand the
culture and other aspects of the patient’s
individuality and to take these into account
when providing service.

50. THERAPEUTIC IMPASSES- DEFINITION
They are the blocks in the progress of
therapeutic nurse-patient relationship.

51. THERAPEUTIC IMPASSES
Resistance
Transference
Countertransference
Boundary
violation
Gift giving

52. 1. RESISTANCE
 Causes:
 Client’s unwillingness to change
when the need for change is
recognized
 A reaction by the patient to the
nurse who has moved too rapidly
too deeply into the client’s feelings
 Intentionally or unintentionally
communicated lack of respect
 Inappropriate role model of
therapeutic behaviour
 Secondary gain
 Favourable environment
 Interpersonal changes
 Situational changes
 Material advantages
Pateint’s attempt to remain unaware of anxiety producing
aspects within himself.

53. FORMS OF RESISTANCE
 Suppression
 Repression
 Intensification of symptoms
 Hopeless outlook
 Self devaluation
 Forced flight of ideas
 Intellectual inhibitions
 Acting out
 Irrational behaviour
 Superficial talk
 No insight
 Refuses to assume
responsibility

54. MANAGEMENT
 Active listening
 Clarification – Give for focused idea of what is happening.
 Reflection – Helps the patient to become aware of what
has been going in his mind.
 Explore behavior to find possible reason.
 Maintain open communication with supervisor

55. 2. TRANSFERENCE
 Unconscious response of the client in which he experiences feelings
and attitudes towards the nurse, associated with significant figures in
early life.
• Such response utilize the defense mechanism of displacement.
• Transference reactions are harmful to the therapeutic process only if
they remain ignored or unexplained.
 Types:
I. Hostile transference
II. Dependent reaction transference

56. I. Hostile transference
 Client will internalize the feelings of anger and hostility as
depression and discouragement.
 Detachment, forgetfulness, irrelevant chattering, go back
or preoccupied with his childhood experiences.
 The client may express doubt about nurse’s training,
experience or personal adjustment.
 The client externalizes his hostility into critical, irritable and
defiant.

57. II. Dependent reaction transference
 This reaction exhibits in the clients who are submissive,
subordinate, who will regard the nurse as “God like” figure.
 Client over values the nurse’s characteristics and qualities.
 The client continues to demand more form nurses.
 If his needs were not fulfilled, he will become hostile and
contempt.

58. MANAGEMENT
• No need to terminate relationship unless poses a serious barrier
to therapy or safety.
• Nurse should work with patient in sorting out past from the present
• Assist patient in identifying the transference & reassign a new &
more appropriate meaning to the current nurse patient relationship.
• The goal is to guide the patient to independence by teaching them
assume responsibility for their own behaviors, feeling & thoughts &
to assign the correct meaning to the relationship based on the
present circumstances instead of past.

59. 3. COUNTER TRANSFERENCE
 The nurse’s specific emotional response generated
by the client’s qualities.
 Types:
1. Reactions of intense love or caring
2. Reactions of intense disgust or hostility
3. Reactions of intense anxiety often in response to
resistance by the patient

60. FORMS OF COUNTERTRANSFERENCE DISPLAYED BY
NURSES
 Difficulty in empathizing with patient in certain problem areas
 Recurrent anxiety, unease or guilt related to patient
 Personal or social relationship with patient
 Encouraging patient’s dependency, praise or affection
 Sexual or aggressive fantasies towards patient
 Arguing with patient or tendency to “push” patient before he is
ready
 Feeling angry or impatient because of patient’s unwillingness to
change

61. MANAGEMENT
• 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.

62. 4. BOUNDARY VIOLATION
It occurs when the nurse
goes outside the
boundaries of
therapeutic relationship
and establishes a
personal, social
relationship with the
client.

63. POSSIBLE BOUNDARY VIOLATIONS
 Nurse accepts free gifts from the patient
 Having personal or social relationship with patient
 Nurse attends a social function of patient
 Nurse regularly reveals personal information to
patient
 Nurse routinely hugs or has physical contact with
patient

64. TYPES OF BOUNDARY VIOLATIONS
 Role boundaries
 Time boundaries
 Place and space
boundaries
 Money boundaries
 Gift and service
boundaries
 Clothing Boundaries
 Language boundaries
 Self-disclosure
boundaries
 Post-discharge social
boundaries
 Physical contact
boundaries

65. MANAGEMENT
 Nurses have to follow certain limitations in establishing
and maintaining therapeutic nurse-patient relationship
 Too personal involvement in client's affair has to be
avoided
 Ambiguity and misunderstanding with other staff has to
be avoided
 Adverse feelings, e.g. sexual and other temperaments with
the client have to be avoided
 Ethics and moral principles have to be followed.

66. 5. GIFT GIVING
 Offering voluntarily some
valuable item or material to
others as a form of
gratitude.
 Type of Gifts:
 Tangible: sweets or
Bouquet
 Intangible: Expressing
thanks, warmth

67. COMMON INTERVENTIONS TO OVERCOME THERAPEUTIC
IMPASSES
 Nurse must have knowledge of the impasses and recognise
behaviours that indicate their existence.
 Nurse must reflect on feelings, explore reasons behind such
behaviours.
 Co-workers are more likely than other to recognise the
phenomenon initially and give feedback to the nurse about it.
 Nurse must examine their strengths, weaknesses, prejudices and
values before they can interact more appropriately with patients.
 Transference reactions of patients must also be examined, gently
but directly.

68. CONTI…
 Nurses must be open and clear about their genuine
reactions when patients misperceive behaviour.
 Nurses should also state actions that they can and cannot
take to meet patient’s needs.
 Limit setting is useful when patients act inappropriately
towards the nurse.
 Maintain open communication with her supervisor, who
can then guide her in making adequate progress in
handling such resistance reactions.

69. PHASES OF THERAPEUTIC NURSE PATIENT RELATIONSHIP
1. Pre-interaction
2.
Orientation
or
introductory
3. Working
4.
Terminatio
n
GIVEN BY PEPLAU

70. 1. PRE-INTERACTION PHASE

71. DESCRIPTION
This phase begins when the nurse is assigned
to initiate a therapeutic relationship & included
all that the nurse thinks, feels or does
immediately prior to the first interaction with
the patient.

72. TASKS FOR
PRE-INTERACTION PHASE
Nurse explores own fears and anxieties
Analyze own professional strengths and
limitations
Gather data about patient whenever
possible
Plan for first meeting with patient

73. PROBLEMS ENCOUNTERED
Difficulty in self-analysis & self
acceptance.
Anxiety
Nurse experience boredom, anger,
indifference and depression.

74. WAYS TO OVERCOME
1. Help from Peers and supervisor in self analysis
and facing reality:
 The nurse needs help from her supervisor and peers
in self-analysis and facing reality in order to help
patients do likewise.
 The nurse may in consultation with her supervisor,
identify in writing goals for the initial interaction and
decide the methods to be used in achieving goals.

75. CONTI…
2. Analyse herself & recognise her strengths
and weaknesses:
The nurse also needs to be consciously aware of
the reasons for choosing a particular event.
The nurse who is able to use this information in
relating to patients in a natural, congruent and
relaxed manner.

76. 2. INTRODUCTORY /
ORIENTATION
PHASE

77. DESCRIPTION
It is during the introductory phase that the
nurse & patient meet for the first time.
One of the nurse’s primary concerns is to find
out why the patient sought help.

78. TASKS OF
INTRODUCTORY/ ORIENTATION PHASE
 Establish rapport, trust and acceptance
 Establish communication, assist in the verbal expression
of thoughts and feelings
 Gather data, including the patient’s feelings, strengths
and weaknesses
 Define patient’s problems, set priorities for nursing
intervention
 Mutually set goals

79. PROBLEMS ENCOUNTERED
Problem is related to the manner in which
the nurse and patient perceive each other.
Problems related to establishing an
agreement between the nurse and patient.

80. BARRIERS TO THE
INTRODUCTORY/ ORIENTATION PHASE
Contract? Why? Not going to stay for
long?
Social class
Anxiety, not caring for patient needs
Transference
Counter transference

81. WAYS TO OVERCOME
Formulating a contract:
Elements of a nurse-patient contract:
Exchanging names of nurse and patient
Explanation of roles of nurse and patient
Explanation of responsibilities of nurse and patient
Discussion of purpose
Discussion of date, time and place
Description of meeting conditions for termination
Confidentiality

82. 3.WORKING PHASE

83. DESCRIPTION
Most of the therapeutic work is carried out
during the working phase.
The nurse & the patient explore relevant
stressors & promote the development of
insight in the patient.

84. TASKS OF
WORKING PHASE
 Collection of data from patient, source files
 Helps patient identify his problems
 Helps patient to communicate
 Helps patient to socialize
 To understand his active participation in the experience
 To find out alternative solutions
 To try out new behaviors
 Prepares for termination of treatment

85. BARRIERS IN THE
WORKING PHASE
 Testing of the nurse by the patient
 Delayed progress
 Difficulty collecting and analyzing data
 The nurse’s fear of closeness
 Life stresses of the nurse
 Resistance behaviors
 Transference and counter transference reactions

86. WAYS TO OVERCOME
 Conferences with supervisors and group discussions with other members
of the staff. He helps the nurse to increase her ability to collect and
interpret data, apply concepts and synthesize the data obtained.
 There will be times when the nurse believes she is making little or no
progress, either in helping the patient or in gaining knowledge. This time
emotional support is needed and the task of supervisor to encourage the
nurse to proceed.
 Most nurses may exhibit a reluctance to write and analyse process
records or to engage in a discussion with the supervisor about the
content of records. Discussion of the meaning of behaviour and ways to
overcome it is essential.

87. CONTI…
HANDLING RESISTANCE:
 By listening carefully and find out about any
resistance, reasons for resistance.
 Nurse should maintains open communication with
her supervisor, who can then guide her in making
adequate progress in handling such resistance
reactions.

88. 4. TERMINATION PHASE

89. FACTORS OF READINESS OF PATIENT FOR TERMINATION PHASE
Signs and symptoms reduced
Socialization occurs
Communication improves
Able to manage activities of daily
living

90. CAUSES OF TERMINATION
 Ready
 Patient leaves, does not return
 Duty changes, training experience over
 Discharged from hospital

91. PREPARATION FOR TERMINATION
Decide about termination
Inform the patient
Encourage patient to express his feelings
about termination: fears, anxieties

92. TASKS FOR TERMINATION
 Establish reality of separation
 Mutually explore feelings of rejection, loss, sadness,
anger and related behavior
 Review progress of therapy and attainment goals
 Formulate plans for meeting future therapy needs

93. PROBLEMS ENCOUNTERED
 Patients may perceive termination as desertion and may
demonstrate angry behaviour.
 Some patients attempt to punish the nurse by not talking during
the last few interactions or by ignoring termination completely,
they may act as if nothing has changed and the interactions will go
on as before.
 Other patients react to the threatened loss by becoming depressed
or assuming an attitude of not caring.
 Fault finding behaviour: Patient may state that the therapy is not
beneficial or not working , he may refuse to follow through or
something that has been agreed upon before.

94. CONTI…
 Resistance comes in the form of “Flight to health”, which is exhibited by
a patient who suddenly declares that there is no need for therapy, he
claims to be alright and wants to discontinue therapeutic relationship, this
may be a form of denial or fear of the anticipated grief over separation.
 “Flight to illness” occurs when a patient exhibits sudden return of
symptoms, this is an unconscious effort to show that termination is
inappropriate and the nurse is still needed, the patient may disclose new
information about him or more problems or even threaten to commit
suicide in an attempt to delay parting.
 Nurse’s inability or unwillingness to make specific plans and implement
them.

95. WAYS TO OVERCOME
 Nurse should be aware of the patient’s feelings and be able to deal
with them appropriately.
 Nurse can assist the patient by openly eliciting his thoughts and
feelings about termination.
 The nurse showing less interest in the patient than shown earlier and
may be disengaging self form the patient several days before the final
interaction. The task of supervisor is to discuss frankly with the nurse
the meaning of the behaviour.
 Supervisor then initiates action to assist the nurse to persevere and
intensify her efforts to prepare both self and patient for his eventual
release form the hospital.

96. ROLE OF NURSE IN THERAPEUTIC NURSE-PATIENT RELATIONSHIP
ROLES OF NURSESURROGATE
COUNSELLOR
RESOURCE
PERSON
TEACHER
STRANGERLEADER