Chapter 7: Relationship Development Flashcards
attitude
a frame of reference around which an individual organizes knowledge about his or her world.
belief
An idea that one holds to be true. Only when the belief is acted on does it become a value.
7 Nurse subroles
The Stranger The Resource Person The Teacher The Leader The Surrogate The Technical Expert The Counselor
The Stranger
A nurse is at first a stranger to the client. The client is also a stranger to the nurse.
The Resource Person
The nurse provides information related to the client’s health care.
The Teacher
The nurse identifies learning needs and provides information required by the client or family to improve the health situation.
The Leader
Democratic leadership in nursing situations implies that the patient will be permitted to be an active participant in designing nursing plans for him.
Autocratic leadership promotes overvaluation of the nurse and clients’ substitution of the nurse’s goals for their own.
Laissez-faire leaders convey a lack of personal interest in the client.
The Surrogate
For the client, the nurse fulfills basic needs, which is associated with mothering.
The Technical Expert
The nurse possesses the clinical skills necessary to perform the interventions that are in the client’s best interest.
The Counselor
The nurse uses “interpersonal techniques” to help clients learn to adapt to difficulties or changes in life experiences.
nurse therapist
having graduate preparation in psychiatric/mental health nursing
values
abstract standards, positive or negative, that represent an individual’s ideal mode of conduct and ideal goals.
therapeutic use of self
the ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention
value system
Established very early in life by the primary caregivers. It is culturally oriented; it may change; and it consists of beliefs, attitudes, and values.
Rational beliefs
Ideas for which objective evidence exists to substantiate their truth.
Irrational beliefs
Ideas held as true despite the existence of objective contradictory evidence. Delusions can be a form of irrational beliefs.
Faith “blind beliefs”
An ideal that an individual holds as true for which no objective evidence exists.
Stereotype
A socially shared belief that describes a concept in an oversimplified or undifferentiated matter.
The Open or Public Self
aspects of the self about which both the individual and others are aware.
The Unknowing Self
the part of the self that is known to others but remains hidden from the awareness of the individual.
The Private Self
the part of the self that is known to the individual, but which the individual deliberately and consciously conceals from others.
The Unknown Self
the part of the self that is unknown to both the individual and to others.
Rapport
implies special feelings on the part of both the client and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a non- judgmental attitude
Trust
feel confidence in that person’s presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested
self- confidence
derived out of knowledge gained through achievement of personal and professional goals, as well as the ability to integrate these roles and to function as a unified whole.
concrete thinking
focuses thought processes on specifics rather than generalities, and immediate issues rather than eventual outcomes
confidentiality
what is discussed will not be repeated outside the boundaries of the health-care team
unconditional positive regard
believe in the dignity and worth of an individual regardless of his or her unacceptable behavior
genuineness
nurse’s ability to be open, honest, and “real” in interactions with the client
congruence
Consistence
self-disclosure
It should never be undertaken for the purpose of meeting the nurse’s needs.
4 Phases of Relationship Development
(1) the preinteraction phase
(2) the orientation (introductory) phase
(3) the working phase
(4) the termination phase
Preinteraction phase
Obtain information about the client from chart, significant others, or other health team members.
Examine one’s own feelings, fears, and anxieties about working with a particular client.
working phase
Maintain trust and rapport.
Promote client’s insight and perception of reality.
Use problem-solving model to work toward achievement of established goals.
Overcome resistance behaviors.
Continuously evaluate progress toward goal attainment.
termination phase
Therapeutic conclusion of relationship occurs when:
Progress has been made toward attainment of the goals.
A plan of action for more adaptive coping with future stressful situations has been established.
Feelings about termination of the relationship are recognized and explored.
Transference
occurs when the client unconsciously transfers to the nurse feelings formed toward a person from his or her past
boundary
border or a limit
Material boundaries
physical property that can be seen, such as fences that border land
Countertransference
refers to the nurse’s behavioral and emotional response to the client. These responses may be related to unresolved feelings toward significant others from the nurse’s past, or they may be generated in response to transference feelings on the part of the client.
Personal boundaries
boundaries that individuals define for themselves.
Professional boundaries
limit and outline expectations for appropriate professional relationships with clients
Gift-giving
Attention should be given to what the gift-giving means to the client, as well as to institutional policy
Touch
when it is used appropriately, it can have a therapeutic effect on the client
Friendship or romantic association
If the nurse is unable to accomplish this separation, he or she should withdraw from the nurse-client relationship
Gift-giving
Attention should be given to what the gift-giving means to the client, as well as to institutional policy.
Touch
Be aware of the meaning to the patient and the patient’s culture. When it is used appropriately, it can have a therapeutic effect on the client
Friendship or romantic association
If the nurse is unable to accomplish a separation, he or she should withdraw from the nurse-client relationship
Concerns associated with professional boundaries
self-disclosure
gift-giving
touch
developing a friendship or romantic association
breach of professional boundaries
The nurse repeatedly requests to be assigned to a specific client.
The nurse shares the details of her divorce with the client.
The nurse makes arrangements to meet the client outside of the therapeutic environment.
orientation phase
Creating an environment for the establishment of trust and rapport.
Establish contract for intervention.
Gather assessment data.
Identify client’s strengths and weaknesses.
therapeutic relationship
an interaction between two people (usually a caregiver and a care receiver) in which input from both participants contributes to a climate of healing, growth promotion, and illness prevention.
