Structuring The Relationship

1. Structuring The Relationship

2. Therapeutic relationship • Primarily human connection and central to providing nursing care • Therapeutic relationship refers to holistic approach of nursing care including physical, emotional, psychological and social health education and care.

3. Characteristics of Therapeutic relationship • It is a healing relationship between health professional and client in need for care. • The goal is to promote health and wellbeing • It is an interdependent relationship

4. Types of Communication • Intrapersonal • Interpersonal

5. Intrapersonal Communication • Individuals give themselves all kinds of positive and negative messages • An example of positive self-talk is “I know I can do this!” • An example of dysfunctional self-talk is “I’ll never get better.”

6. Interpersonal Communication • Occurs between 2 or more people and contains both verbal and nonverbal messages • Consists of: • Social communication • Therapeutic communication

7. Social Communication • Occurs in everyday situations usually away from the work setting • Interaction is superficial and light; usually not goal directed • It’s purposes are to maintain relationships and for enjoyment • Consists of sharing information equally between 2 or more individuals

8. Therapeutic Communication • Occurs between the nurse and the client but is client focused • It is a learned skill involving both verbal and nonverbal communication • The purpose is to promote client growth • The medium through which health promotion interventions occur • Involves the disclosure of personal information by the client

9. Principles of the Nurse-Client Relationship • The relationship is therapeutic rather than social • The focus remains on the client’s issues rather than on the nurse’s or other issues • The relationship is purposeful and goal directed • It is objective versus subjective in quality • It is time limited versus open ended

10. Therapeutic vs Social • A therapeutic relationship is formed to • help clients solve problems • make decisions • achieve growth • learn coping strategies • let go of unwanted behaviors • reinforce self-worth • examine relationships

11. Therapeutic vs Social • The meetings between nurse and client are not for mutual satisfaction. • The nurse can be friendly with the client, but is not there to be the client’s friend. • The majority of the interaction is focused and therapeutic.

12. Client Focus • During an interaction, a client may redirect the focus away from self by changing the subject, talking about the weather, etc. • The nurse needs to recognize this as a divergent tactic, confront this behavior, and refocus the client.

13. Goal Direction • The primary purpose of a therapeutic relationship is helping clients to meet adaptive goals. • Nurse and client work together to identify problematic areas in client’s life • Once goals are established, the nurse and client agree to work toward those goals.

14. Objective vs Subjective • Nurses can be therapeutic only if they remain objective. • Objectivity refers to remaining free from bias, prejudice, and personal identification in interaction with the client and being able to process information based on facts. • Subjectivity refers to emphasis on one’s own feelings, attitudes, and opinions when interacting with the client.

15. Time-Limited Interactions • Time of meetings • Number of meetings that will take place • Provides structure • Lets client know that relationship will end

16. Role of Nurse • Self-awareness • Professional boundaries • Level of involvement • Therapeutic use of self • Self-disclosure Code of ethics for nurses by ANA (2001)

17. Patient’s Bill of Rights • Civil Rights • Client Consent • Communication • Freedom from Harm • Dignity and Respect • Confidentiality • Participation in Treatment Plan

18. Stages of the Nurse-Client Relationship • Pre-orientation phase • Orientation phase • Working phase • Termination phase

19. Preorientation Phase • Takes place prior to meeting with the client • 1st gather data about the client, his or her condition, and the present situation • Nurse then examines his or her thoughts, feelings, perceptions, and attitudes about this particular client

20. Orientation Phase • The nurse-client become acquainted; build trust and rapport • A contract is established • Includes time and place for the meeting, as well as the purpose of the meetings • Dependability is imperative for both the nurse and the client • Client strengths, limitations, and problem areas are identified • Outcome criteria and a plan of care are established

21. Working Phase • Orientation phase ends and working phase begins when the client takes responsibility for his or her own behavior change • Client shows commitment to working on issues that have caused a life disruption • Clients’ needs are prioritized- safety and health come first • RN assists the client to change problematic behaviors in a safe environment

22. Termination Phase • Relationship comes to a close • This phase begins in the orientation phase when meeting times are established- lets the client know that the relationship will come to an end • Avoids confusing the client who may be unable to recognized boundaries in a relationship • Termination occurs when the client has improved or has been discharged

23. AssessmentThe Nurse-Client Interview • The success of the interview depends on the development of trust, rapport, and respect between the nurse and client