Chapter 5 Therapeutic Relationships

Question 1

Importance of Maintaining Therapeutic Relationships in Nursing

Answer 1

One of the most important skills a nurse can develop

Crucial to success of interventions w/ clients requiring psychiatric care

Question 2

Components of Therapeutic Relationships: Trust

Answer 2

Trust builds when a client is confident in the nurse & when the nurse’s presence conveys integrity & reliability
- Client believes the nurse’s actions & words match

Some behaviors the nurse can exhibit to build trust:
- Caring
- Interest
- Understanding
- Consistency
- Honesty
- Keeping promises
- Listening

Question 3

Congruence

Answer 3

Words & actions match

Question 4

Components of Therapeutic Relationships: Genuine Interest

Answer 4

Self-comfort
Self-awareness,
Clear focus

Client can detect dishonest behavior

Question 5

Components of Therapeutic Relationships: Empathetic Communication

Answer 5

Responding to unspoken feelings or concerns in a way that encourages the client to say more

Different from sympathy (feeling sorry for them)
- Empathy: Trying to understand where the client is coming from

Question 6

Components of Therapeutic Relationships: Acceptance

Answer 6

No judgments

Set boundaries

Question 7

Components of Therapeutic Relationships: Positive Regard

Answer 7

Unconditional, nonjudgmental attitude

Question 8

Self-Awareness

Answer 8

The process of developing an understanding of one’s own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, and limitations

Question 9

Values

Answer 9

Abstract standards that give a person a sense of right & wrong & establish a code of conduct for living

Question 10

Therapeutic Use of Sense of Self Developed by H.Peplau

Answer 10

Use of personality, experience, values, feelings, intelligence, needs, coping skills, perceptions to establish relationships w/ clients

Personal actions arise from conscious and unconscious responses

Question 11

Social Relationship

Answer 11

Friendship, socialization, companionship, or
task accomplishment

Sharing ideas; shifting roles; outcomes rarely
assessed

Question 12

Intimate Relationship

Answer 12

Emotional commitment of two persons

Individual needs met; assistance with helping
each other meet needs

Question 13

Therapeutic Relationship

Answer 13

Focus on needs, experiences, feelings, ideas of client only

Use of communication skills, personal strengths, understanding of human behavior

Joint agreement on areas to work on; outcome
evaluation

Nurse’s level of self-awareness can benefit or
hinder the relationship

Question 14

Behaviors that Diminish Therapeutic Relationships

Answer 14

Inappropriate boundaries (relationship becomes social or intimate)
- Maintain 3-6 feet from the relationship

Feelings of sympathy, encouraging client dependency
- Let patients take active role, if you take on too many tasks for the patient, they will not want to do it themselves

Nonacceptance and avoidance

Question 15

Establishing a Therapeutic Relationship: Orientation
Phase

Answer 15

Meeting nurse, client

Establishment of roles

Discussion of purposes, parameters of future meetings
- Discuss discharge to show that there is an end to their situation

Clarification of expectations

Identification of client’s problems

Nurse–client contracts, confidentiality, self-disclosure

Question 16

Establishing a Therapeutic Relationship: Working
Phase

Answer 16

Client-Centered Phase

Problem identification: Client identifies issues or concerns.

Exploitation
- Examination of feelings and responses
- Development of better coping skills, more positive
self-image, behavioral change, independence

Possible transference/countertransference

Question 17

Establishing a Therapeutic Relationship: Termination
Phase

Answer 17

Begins when client’s problems are resolved
- Deemed safe enough to go back into the community

Ends when relationship is ended

Client may feel termination as impending loss.

Clients often try to avoid termination

Question 18

Therapeutic Roles of a Nurse

Answer 18

Teacher: Coping, problem-solving, medication regimen, community resources

Caregiver: Therapeutic relationship, physical
care

Advocate: Ensuring privacy and dignity, informed consent, access to services, safety from abuse & exploitation

Parent surrogate: Seen in client dependency
- Doing tasks for them (bathing them), you will start to see them as a “child”, and they will become more dependent on you as a “parent”

Question 19

Compassion Fatigue

Answer 19

Leaving the unit, and still feeling worry, and compassion for a client