Therapeutic relationship

THERAPEUTIC RELATIONSHIP

MRS BINCY VARGHESECLINICAL TUTOR

INTRODUCTION

“ 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

“ 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

TYPES OF RELATIONSHIP

1. Social Relationship

2. Intimate Relationship

3. Therapeutic Relationship

SOCIAL RELATIONSHIP

• 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

INTIMATE RELATIONSHIP

• 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.

THERAPEUTIC RELATIONSHIP

• 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

GOALS OF NURSE PATIENT RELATIONSHIP

1. Help to understand his/her problems.

2. Cope with present problems.3. Identify emerging problems.

4. Find out new alternatives to problems

5. Communicate6. Try out new patterns of

behaviour7. Socialize

FACTORS DETERMINING EFFECTIVE NURSE PATIENT

RELATIONSHIP

1. Self Awareness

2. Attitude towards the patient

3. Ability of developing the rapport

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

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

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

QUALITIES OF THERAPEUTIC NURSE PATIENT RELATIONSHIP

1. Genuineness (real and honest)2. Sincerity3. Respect4. Love and affection5. Concern6. Listen7. Empathy (ability to feel with patient)8. Good communication skills9. Exploration of problems10.Self discipline

PHASES OF THERAPEUTIC NURSE PATIENT RELATIONSHIP

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

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

Working Phase

• Maintain the trust and rapport• Solve the patient’s problems• Continuously evaluate the progress

towards goal attainment

Resolution phase/Termination Phase

• The mutually agreed goals may have been reached

• The patient may be discharged from hospital

• Review the progress made

THERAPEUTIC IMPASSESObstacles or blocks which occurs

in Therapeutic Nurse Patient relationship

• 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

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

• Created by the nurse• The nurse identifies the patient with

someone significant to her life (reaction of intense love or caring, hostility)

COUNTER TRANSFERENCE

GIFT GIVING

BOUNDARY VIOLATION

• 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)

OVERCOMING THERAPEUTIC IMPASSES

• 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

COMMUNICATION SKILL

• SENDER• MESSAGE• RECEIVER• FEEDBACK

ELEMENTS

• 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

• 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

• Give explanation at patient’s level of understanding

• Focus on strength of patient

PRINCIPLES OF PSYCHIATRIC NURSING

• Counsellor• Surrogate parent• Teacher• Social agent• Coordinator• Client Advocate

ROLE OF NURSE

• Researcher• Administrator• Supervisor• Case Manager

ROLE OF NURSE (contd..)