Chapter 5 Therapeutic Relationships Flashcards
Importance of Maintaining Therapeutic Relationships in Nursing
One of the most important skills a nurse can develop
Crucial to success of interventions w/ clients requiring psychiatric care
Components of Therapeutic Relationships: Trust
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
Congruence
Words & actions match
Components of Therapeutic Relationships: Genuine Interest
Self-comfort
Self-awareness,
Clear focus
Client can detect dishonest behavior
Components of Therapeutic Relationships: Empathetic Communication
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
Components of Therapeutic Relationships: Acceptance
No judgments
Set boundaries
Components of Therapeutic Relationships: Positive Regard
Unconditional, nonjudgmental attitude
Self-Awareness
The process of developing an understanding of one’s own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, and limitations
Values
Abstract standards that give a person a sense of right & wrong & establish a code of conduct for living
Therapeutic Use of Sense of Self Developed by H.Peplau
Use of personality, experience, values, feelings, intelligence, needs, coping skills, perceptions to establish relationships w/ clients
Personal actions arise from conscious and unconscious responses
Social Relationship
Friendship, socialization, companionship, or
task accomplishment
Sharing ideas; shifting roles; outcomes rarely
assessed
Intimate Relationship
Emotional commitment of two persons
Individual needs met; assistance with helping
each other meet needs
Therapeutic Relationship
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
Behaviors that Diminish Therapeutic Relationships
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
Establishing a Therapeutic Relationship: Orientation
Phase
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
Establishing a Therapeutic Relationship: Working
Phase
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
Establishing a Therapeutic Relationship: Termination
Phase
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
Therapeutic Roles of a Nurse
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”
Compassion Fatigue
Leaving the unit, and still feeling worry, and compassion for a client
