Chapter 8: Therapeutic Relationships Flashcards
What are the 4 core concepts of patient- and family-centered care?
(1) dignity and respect, (2) information sharing, (3) patient and family participation, and (4) collaboration in policy and program development
What is the first connection between the patient and the nurse used to establish?
an understanding that the nurse is safe, confidential, reliable, and consistent
What is the therapeutic use of self?
the use of unique personality traits and talents that we can use to bond with others and promote healing
Who is licensed to practice psychotherapy?
psychiatric-mental health advanced practice registered nurses, psychiatrists, and psychologists
What is a therapeutic relationship between the nurse and patient focused on?
the patient’s ideas, experiences, and feelings
What are 5 things a nurse must do when creating a therapeutic relationship with the patient?
Identify the needs of the patient and explore them.
Establish clear boundaries.
Encourage alternate problem-solving approaches.
Help the patient develop new coping skills.
Support behavioral change
If the nurse and patient only meet a few times and the relationship is limited but may be substantial, useful, and important for the patient, what is this known as?
a therapeutic encounter
Who is responsible for maintaining boundaries between the patient and the nurse?
the nurse
What happens if a nurse is under-involved in a therapeutic relationship?
Nurses who are under-involved with patients may be at the least disinterested and neglectful and at the worst guilty of patient abandonmen
What may over-involvement lead to in a therapeutic relationship?
boundary crossings, boundary violations, and professional sexual misconduct
What is the least serious form of over-involvement?
boundary crossings
What are two common circumstances in which boundaries are crossed?
(1) when the relationship slips into a personal context and
(2) when the nurse’s needs (for attention, affection, and emotional support) are met at the expense of the patient’s needs
What are some examples of boundary crossing?
accepting gifts or cash, planning a business together, excessive touching of the patient, and trying to influence the patient’s political/religious beliefs
What is the most extreme form of boundary crossing?
sexual misconduct
What is blurring the roles in the nurse-patient relationship often a result of?
unrecognized transference or countertransference
What is transference?
when the patient unconsciously and inappropriately displaces onto the nurse feelings and behaviors related to significant figures in the patient’s past (e.g. “you remind me of my sister, brother, father, mother, etc”)
What kind of gifts are acceptable for the nurse to take from the patient?
gifts of nominal value (homemade cookies, chocolates, etc. for the whole treatment team)
What happens during countertransference?
the nurse unconsciously displaces feelings related to significant figures in the nurse’s past onto the patient
What does countertransference often result in?
over-involvement and it impairs the therapeutic relationship
What are values?
abstract standards that represent an ideal, either positive or negative
What is empathy?
when someone tries to see the world from another’s point of view
What is sympathy?
feeling pity or sorrow for others
Why is it important to encourage patients to use their own resources?
it helps minimize the patients’ feelings of helplessness and dependency and validates their ability to bring about change
What is the greatest trigger for the development of a patient’s nurse-focused transference?
The degree of authority the nurse has over the patient
