2.1 Therapeutic Nurse-Patient Relationship Flashcards
Nurse-Patient Relationship
- Foundation of psychiatric nursing
- Nurse and patient must both recognize each other as unique and important
- Relationship where mutual learning occurs
- Therapeutic interpersonal relationship is the process where nurses provide care to patients in need of psychosocial intervention
Therapeutic use of self - Instrument for delivery of care
Interpersonal communication - tools of psychosocial intervention
Therapeutic Relationship
- Interaction between 2 people where both contribute to a climate of healing, growth promotion, and/or illness prevention
- Nurse and patient both perceive each other as a human being
- GOAL ORIENTED WHERE BOTH PARTIES DECIDE ON THE GOAL
- Most often goal is learning/growth to bring about positive change
Problem Solving Model
- Goals of Therapeutic Relationship
- Identify the problem
- Discuss the desired change (promote patient to discuss changes they desire)
- Discuss which changes are possible and which are not
- Discuss alternate strategies for creating change
- Weigh the benefits/consequences of each alternative
- Assist patient with selecting an alternative
- Encourage patient to implement change
- Provide positive feedback for patient’s change attempts
- Assist patient in evaluating the outcomes of the change
Therapeutic Use of Self
- Ability to use one’s own personality to establish relate ableness and structure nursing interventions
Conditions of Establishing a Therapeutic Relationship
- Empathy - Ability to see beyond outward behavior and understand a situation from a patients point of view. Used to understand a patients thoughts and feelings
- Genuineness - Ability to be honest, open and real in interactions. Be real means aware of what someone is experiencing internally and to make it apparent in the relationship
- Respect - Believe in dignity and worth of an individual despite unacceptable behavior. Unconditional and nonjudgmental respect.
- Trust - Confidence in a persons presence, reliability, integrity, and sincere desire to provide assistance when requested. BASIS OF THERAPEUTIC RELATIONSHIP
- Rapport - Special feeling between both patient and nurse based on acceptance, warmth, friendliness, common interest, trust, and nonjudgmental attitude.
Phases of Therapeutic Nurse-Patient Relationship
Stage 1 - Pre-interaction
- When you first meet the patient
- Assess and obtain information from the patient
(Charts, significant others, feelings)
(Examine own feelings of fear and anxiety about working with a patient)
Stage 2 - Orientation
- Nurse and patient become acquainted with each other
- Create environment to establish trust and rapport
- Establish contract that details expectations/responsibilities of both parties
- Gather assessment
- Identify strengths/limitations of patient and formulate nursing diagnoses
- Set mutually agreed upon goals
- Develop plan of action that is realistic
- Explore feelings of both patient and nurse
Stage 3 - Working
- Therapeutic work of the relationship
- Maintain trust/rapport
- Promote the patients insight/perception of reality
- Problem-solving
- Overcome resistance behaviors of patient
- Continuous evaluation
TRANSFERENCE
- Patient displaces feelings of their past onto the nurse. This includes anger, hostility, uncooperativeness, resistance, or overwhelming affection/dependency. This interferes therapeutic relationships.
COUNTERTRANSFERENCE
- Nurse’s behavior/emotional response to patient. Can be due to unresolved feelings towards a significant other from the nurses past or from transference feelings from the patient.
Stage 4 - Termination
- End of nurse-patient relationship
- Due to goals being met, patient being discharged
Therapeutic Conclusion of Relationship
- Progress has been made towards attainment of goals
- Plan of action for more adaptive coping in the future has been established
- Feelings of termination of relationship is recognized and have been explored
Boundaries in Nurse-Patient Relationship
- Determines the extents of acceptable limits
Professional Boundaries
Self-Disclosure
- Appropriate only when information may therapeutically benefit the patient
- Never ok to meet nurses needs
Gift Giving
- May be part of the culture/value of a patient
- NEVER ACCEPT FINANCIAL GIFTS (sometimes it is okay to donate the money to charity of patient’s choice)
- If acceptance of a small gift is appropriate, the nurse can share the gift with other staff members
Touch
- Required for therapeutic procedures
Caring Touch - Touching of patient when there is no physical need
- Touching/hugging can be beneficial if deemed within therapeutic intent
Friendship/Romantic Association
- Nurse should withdraw from nurse-patient relationship if patient and nurse are acquainted and they have issues keeping it professional
- ROMANTIC AND SEXUAL RELATIONSHIPS ARE NEVER APPROPRIATE
WARNING SIGNS OF BREENCHING PROFESSIONAL BOUNDARIES
- Favoring one patients care over another
- Swapping patient assignments to care for a particular patient
- Frequent thinking of patient when out of work
- Keeping secrets with the patient
- Giving special attention to a patient
- Sharing personal information with a patient
- Changing dress styles when working with a patient
- Spending free time with a patient
- Continued contact with a patient even after discharge
Interpersonal Communication
- Both participants perceive each other, listen to each other, and are mutually involved in creating a relationship
- Both sender and receiver bring certain pre-existing conditions to the exchange that influence the intended messages and how they are interpreted
Values and Attitudes and Beliefs
- Learned ways of thinking
- Children gain value systems from their parents
- These ways of thinking are usually retained until adulthood or develop new attitudes as they mature
- Influences communication (prejudice expressed verbally through negative stereotyping)
Culture/Religion
- Cultural norms or ideas provide basis for our way of thinking
- Learned and differ from society to society
- Influence communication (symbolic gestures such as a cross around the neck can communicate religious beliefs)
Social Status
- High-status person are associated with gestures that communicate their higher-power position
- Examples include less eye contact, relaxed posture, louder voice, greater height, when communicating with those of lower status
Gender
- Gender signals recognized as either masculine or feminine.
Age/Developmental Level
- Adolescents use words such as “dude” or “groovy”
- Developmental communication such as sign language for those who are deaf or blind people who never learn non-verbal gestures with words which can change the connotation of a word.
Environment
- Place where communication occurs
Territoriality - Innate tendency to own space. Influence interactions when it takes place in an environment “owned” by one or another.
Density - Number of people in a given space. Prolonged high-density situations may influence aggression, stress, criminal activity, hostility, towards others and deterioration of mental health.
Distance - Various cultures use space to communicate
Distance
Intimate distance - Closest distance between individuals
Personal distance - Close conversations (with friends or colleagues)
Social distance - Distance when conversating with strangers/acquaintances
Public distance - Distance when speaking in public or yellowing to someone a distance away
NONVERBAL COMMUNICATION
Physical Appearance/Dress
- Physical appearance and dress influence interpersonal responses and are primary determinants of such responses.
- Clothing, hair, tattoo, cosmetics, jewlery
Body Movement and Posture
- The way an individual positions their body communicates self-esteem, gender identity, status, interpersonal warmth/coldness
Touch
- Powerful communication tool
- Can elicit positive/negative reactions
- Appropriateness is culturally determined
Facial Expressions
- Reveals emotional states.
- Serve to compliment other communication behaviors and can even take the place of verbal communication
Eye Behavior
- Connection occurs through eye contact
- Eye contact can convey interest in American culture
- Eye contact indicates communication channel is open and is usually the initiating factor in verbal interactions
Vocal Cues and Paralanguage
- Pitch, tone, and loudness of spoken messages, or rate of speaking
- Greatly influence how people interpret verbal messages
