Chapter 5: Building the Nurse-Client Relationship Flashcards
Trust: This builds when?
The client is confident in the nurse and when the nurses presence conveys integrity and reliability . Develops when client believes that the nurse is consistent with their words.
Trust: Some behaviors that can be done to build trust include
caring, interest, understanding, consistency, honesty, keeping promises, and listening to client
Trust: Congruence occurs when?
the words and actions match.
Trust: Example of Congruence?
I am leaving and will be back at 2pm tomorrow. And is actually back at 2pm showing the words and action matched.
Trust: Example of Incongruent behavior?
When voice/body language is inconsistent with what they say. “Of Course I like you” but then slowly backing away.
Genuine Interest: When does this occur?
When the nurse is comfortable with the patient, aware of their strengths and limitations, and clearly focused
Genuine Interest: Example of dishonest or artifical behavior?
ASking a question and not waiting for an answer. or talking over them.
Genuine Interest: When is it useful to use a self-disclosure example?
Most helpful when they represent common day-to-day experiences and do not involve value-laden topics.
Genuine Interest: Example of a poor self-disclosure example?
It is rarely helpful to talk about your own divorce or infeditely.
Empathy: What is this?
Ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client
Empathy: By listening and sensing the importance of the sitation to the client, the nurse can imagine what?
The client’s feelings about the experience
Empathy: Both the client and nurse give the “goft of self”when empathy occurs meaning what?
The clienet feeling safe enough to share feelings and the nurse by listening closely enough to understand
Empathy: Several therapeutic communications help the nurse send empathetic messages. What are some techniques?
Reflection, Restatement, and clarification
Empathy: “I’m so confused. My son just visted and wants to know where the safety deposit box key is”. Example of reflectiona nd clarification to this question
Reflection: You’re confused because your son asked for the safety deposit key?
Clarification: Are you confused about the purpose of your sons visit?
Empathy: What is Sympathy?
Feelings of concern or compassion one shows for another
Empathy: Why is it problematic to use sympathy?
The nurses feelings of sadness and pity could influence the relationship and hinder nurses ability to focus on clients needs.
Acceptance: How can one convey acceptance to client?
The nurse does not become upset or responds negatively to a clients outbursts, anger, or acting out conveys accepance
Acceptance: This means acceptance of the person as
worthy
Acceptance: Appropriate response to John putting his hands around you in session?
“John, do not place your hand on me. We are working on your relationship with your girlfriend and that does not require you to touch me. Now, let’s continue”
Acceptance: Inapporpiate response to John putting his arms around you?
John, stop that! Whats gotten into you? I am leaving and maybe I’ll return tomorrow.
Positive Regard: What is thhis known as?
The nurse appreciates the client as a unique and worthwhile human being can respect the client regardless of his or her behavior, background, or lifestyle
Positive Regard: How can a nurse convey positive regard?
Calling the client by name, spending time with the client, and listening and responding openly
Positive Regard: The nurse should do what when making the care plan with the client?
Consider the clients ideas and preferances
Positive Regard: The nurse relies on presence, or attending, which i s
nonverbal and verbal communication techniques to make the client aware that he or she is receiving full attention
Positive Regard: Nonverbal techniques that create an atmosphere of presence include
leaning toward the client, maintaining eye contact, being relaxed, having arms resting at sides and having interested but netural atitude
Positive Regard: What does Verbally Attending mean?
The nurse avoids communicating value judgements about hte client’s behavior
Positive Regard: What is a proper way to verbally attend and respond if client says they yelled at their mom for an hour?
“What happened then” or “You must have been really upset”. The nurse avoided negative opinions or value judgements
Self-Awareness and Therapeutic Use Of Self: What is Self-Awareness?
Process of developing an understanding of one’s own values, beliefs, thoughts, feelings, atittudes, motivations, prejudices, stengths and limitations
Self-Awareness and Therapeutic Use Of Self: What are values?
Abstract standards that give a person a sense of right and wrong and establish a code of conduct for lviing
Self-Awareness and Therapeutic Use Of Self: What does the values clarififcation process have?
Choosing, Prizing, and Acting
Self-Awareness and Therapeutic Use Of Self: What is Choosing?
When person considers a range of possibilites and freely chooses the value that feels right
Self-Awareness and Therapeutic Use Of Self: What is Prizing?
When the person considers the value, cheerishes it, and pubicly attaches it to him or herself
Self-Awareness and Therapeutic Use Of Self: What is acting?
When the person puts value into action
Self-Awareness and Therapeutic Use Of Self: Example of Acting?
Being clean but having a messy roommate. They viewed the space differently, discussed the conflict of interest, and finally decided to negotiate with her roommate
Self-Awareness and Therapeutic Use Of Self: What are beliefs?
Ideas that one holds to be true.
Self-Awareness and Therapeutic Use Of Self: What are attitudes?
General feelings or a frame of reference aorund which a person organizes knowledge about the world
Self-Awareness and Therapeutic Use Of Self: Positive mental attitude occurs when
a person chooses to put a positive spin on an experience, a comment, or a judgement.
Therapeutic Use Of Self: What is this?
When by developing self-awareness and beginning to understand his or her attitudes, nurse can begin to use aspects of his or her personality, experiences, values , feelings, intelligence, needs to establish relationship with clients
Therapeutic Use Of Self: What is the Johari Window?
Creates a word potrait of a person in four areas and indicates how well they know themselves
Therapeutic Use Of Self: What are the Quadrants of the Johari Window?
1: Open/Public - Self-Qualities one knows about oneself and others also know
2. Blind/Unaware - Self qualities known only to other
3. Hidden/Private - Self qualities known only to oneself
4. Unknown - An empty quadrant to symbolize qualities as yet undiscovered
Therapeutic Use Of Self: What does a large quadrant one list show?
Indicates nurse is open to others
Therapeutic Use Of Self: what dooes a smaller quadrant 1 mean?
Nurse shares little about themselves
Therapeutic Use Of Self: What does a small quadrant 1/3 mean?
Person demonstrates little insight
Patterns of Knowing: What did Hildegard Peplau identify preconceptions as?
These are ways one person expcepts another to behave or speak and is a roadblock to the formation of an authentic relationship
Patterns of Knowing: Carper identified four patterns of knowing in nursing. What were they?
Empirical knowing (Derived from science of nursing), personal knowing (Life experiences), ethical knowing (Moral knowledge of nursing) and aesthetic knowing (art of nursing).
Patterns of Knowing: What do the four patterns of knowing show?
Provide the nurse when a clear method of observing and understanding every client interaction
Patterns of Knowing: Munhal added another pattern of knowing. What was it?
Unknowning. for the nurse to admit he or she does not know the client or the client’s subjective world .Nurse is open to seeing clients views without imposing their own beliefs.
Patterns of Knowing: Example of Empirical Knowing?
client with pain disoder begins to have an attack . Panic attack will raise pulse rate
Patterns of Knowing: Personal knowing example
clients face shows the panic
Patterns of Knowing: Ethical knowing example?
although the nurses shift has ended, he or she remains with client
Patterns of Knowing: Aesthetic knowing exampling?
Although the client shows outward signals now, the nursee has senses previously the clients jumpiness and subtle differences in clients demeanor
Relationships: Are categorized into what three categories?
Social, Intimate, and Therapeutic
Social Relationships: Primarily initiated for purpose of
friendship, socialization, compansionship, or accomplishment of a task
Social Relationships: Communication usually focuses on what?
Sharing ideas, feelings, and experiences and meets the basic needs for people to intereeact.
Social Relationships: Inn order for the nurse-client relationship to accomplish the goals, what must be done?
Social interactionmust be limited
Social Relationships: Example of this type of relationship?
When a nurse greets a client and chats abou tthe weather or sports event
Intimate Relationship: This has no place in what environment?
Nurse-client interaction
Therapeutic Relationship: What does this focus on?
The needs, experiences, feelings, and ideas of the client only
Therapeutic Relationship: What skills does the nurse use here?/
Communication skills, personal strengths, and understanding of human behavior to intereact with client
Therapeutic Relationship: Parameters are clear here. What do they include?
Focus is the clients needs, not the nurses
Phases: Peplau studied and wrote about the three phases when in interpersonal interactions. What were they
Orientation, working, and resolution/termination
Orientation Phase: This begins when?
The nurse and clients meet
Orientation Phase: When does this phase end?
Ends when client begins to identify problems to examine
Orientation Phase: What is established here?
Roles, purpose of meeting, and the parameters of subsequent meetings; identifies the client’s problems, and clarifies expectations
Orientation Phase: What is done before meeting patient?
Reads background material, becomes familiar with any medications, gathers necessary paperwork and arranges for quiet, private and comfortable setting
Orientation Phase: What must hte nurse consider before meeting patient?
Consider preconceptions about client to ensure he can put them aside and get to know the person
Orientation Phase: When meeting with the client, it is the nurses responsibility to establish..
a therapeutic environment that fosters trust and understanding.
Orientation Phase: What can the nurse say to patient when first meeting the client?
Hi there. My nam eis Kevin and I’m from ivy tech. I’m going to be coming around for the next four weeks and would love to follow you. We will meet every Monday at 11 in the conference room B. It’s important to share that I will share some of what we talk about with my instructor. Nothing to your family.
Orientation Phase and Nurse-Client Contracts: What should every contract contain with the patient?
Time, Place, Length of Session
When Sessions will Terminate
Who will be involved in the treatment plan
Client Responsbilities
Nurses Responsibilites
Orientation Phase and Confidentiality: What does this mean?
Respecting the clients right to keep private any information about his or her mental and physical health and related care. Means allowing only those delaing with clients care to have access to the information
Orientation Phase and Confidentiality: What should the nurses do about secrets?
Avoid promises to keep secrets. Can backfire especially if the client talks about harming themselves.
Orientation Phase and Confidentiality: Example of what to say if client says how they are jumping out of a window tonight?
“I Cannot keep such a promise, especially if it invovles your safety. I sense you are feeling frightened. The staff and I will help keep you safe”
Orientation Phase and Confidentiality: What is the duty to warn?
How if a homicidal threat is made, decision requires nurse to notify intended victims and police of such a threat.
Orientation Phase and Confidentiality: Client needs to know the limits of what?
Confidentialy i the nurse-client interaction and how the nurse will use and share this information with professionals
Orientation Phase and Self-Disclosure: What does this mean?
Revealing personal information such as biographical information and personal ideas, thoughts, and feelings about oneself to client.
Orientation Phase and Self-Disclosure: Why would the nurse use self-disclosure?
To convey support, educate clients and demonstrate thaht a client’s anxiety is normal and that many people deal with stress and problems in their lives
Orientation Phase and Self-Disclosure: What is the most important thing to remember tabout this?
Never shift the focus away from the patient to yourself.
Working Phase: Usually divided into what two subphahses?
Problem identification (client identifies the isues or concerns causing problems) and exploitation (nurse guides the client to examine feelings and responses and develop better coping skills and a more positive self-image.
Working Phase: Testing behavior challenges the nurse how?
To stay focused and not to react or to be distracted . Client is uncomfortable beause we are getting too close to the truth
Working Phase: What do do if client using testing behaviors to avoid the subject?
“It seems as if we have hit an uncomfortable spot for you. Would you like to let itgo for now?”
Working Phase: What is Transference?
When the client unconsciously transfers to the nurse feelings he or she has for signifcant others
Working Phase: Example of patient with negative experiences with authority figures using transference?
May display similar reactiosn of negativity and resistance to the nurse, who is also viewed as an authority
Termination: What is this phase?
The final stage in the nurse-client relationship. Egins when problems are resolved and ends when relationship ends
Termination: What should nurse do if client tries to reopen and discuss old resolved issues?
Should identify the client’s stalling maneuvers and refocus the client on newly learned behaviors and ksilsl to handle the problem
Termination: What is a good way to end the relationship saying wise?
“I think we’ve had a very productive time together. You have learned so many new ways to do so and so. When you come back for a followup, I willw ant to hear all about how things have changed”
Inappropriate Boundaries: One of the bgigest risk for boundary violations is when the nurse believes..
“there is no way I would ever do anything nontherapeutic “
The primary caregiving role in mental health setting is the implementation of the therapeutic relationship to build
trust, explore feelings, asist the client in problem-solving and help the client meet psychosocial needs
What is Advocacy?
Process of acting on the client’s behlf when he or she cannot do so. This includes ensuring privacy and dignity, promoting informed ocnsent, preventing unnecessary examinations and procedures and accessing needed services.
What is compassion fatigue?
Type of secondary traumatic stress or burnout that comes from working through traumatic experiences with clients. Nurse takes on burden of those experiences
What factors enhance the nurse-client relationship?
Trust and ongruence, genuine interest, empathy, acceptance, and positive regard
What are the four patterns Carper identified?
Empirical, aesthetic, personal and ethical
What did Munhall establish?
The pattern of unknowing as an openness tha tthe nurse brings to the relationship that prevents preconceptions from clouding his or her view of the client
What type of relationship is a nurse-client relationship?
therapeutic
Factors that dimish the nurse-client relationship include
loss of or unclear boundaries, intimacy and abuse of power
Therapeutic roles of the nurse in the nurse-client relationship include
teacher, caregiver, advocate and parent surrogate
