Module 5 - Therapeutic Relationship and Therapeutic Communication

Question 1

Peplau described the nurse-patient relationshup as evolving through distinct interlocking and overlapping phases. What are the 3 phases?

Answer 1

1. Orientation phase
2. Working Phase
3. termination Phase
   (additional phase - preorientation phase, where nurse prepares for orientation such as by patient research)

Question 2

describe what happens during the orientation phase

Answer 2

o	Establishing rapport
o	Parameters of the relationship
o	Formal or informal contract
o	Confidentiality
o	Terms of termination

Question 3

what happens during the working phase

Answer 3

o	Maintain relationship
o	Gather further data
o	Promote patient’s:
o	Problem-solving skills
o	Self-esteem
o	Use of language
o	Facilitate behavioural change
o	Overcome resistance behaviours
o	Evaluate problems and goals
o	Redefine them as necessary
o	Promote practice and expression 
of alternative adaptive behaviours

Question 4

describe the termination phase

Answer 4

o Summarize goals and objectives achieved
o Discuss ways for patient to incorporate new coping strategies learned
o Review situations of relationship
o Exchange memories
(Can be difficult for those with a feeling of abandonment; Most important in understanding boundaries)

Question 5

2. Compare and contrast a social relationship and a therapeutic relationship in terms of purpose, focus, communications style, and goals

Answer 5

Social relationships
• Initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task
• Mutual needs are met
• Communication to give advice, or to give or ask for help
• Content of communication superficial 
Therapeutic Relationships:
• Needs of the patient identified and explored
• Clear boundaries established
• Problem-solving approaches taken
• New coping skills developed
• Behavioral change encouraged
• Have a beginning, middle and end

Question 6

Explore qualities that foster a therapeutic nurse-patient relationship

Answer 6

•	Consistency
•	Pacing
•	Listening
•	Initial impressions 
•	Promoting patient comfort and balancing control
•	Patient factors include
	Trust
	Active participation

Question 7

Define Empathy

Answer 7

An attitude that conveys respect, acceptance, and validation of the patient’s strengths.
o Essentially it means “temporarily living in the other’s life, moving about in it delicately without making judgements

Question 8

define genuineness

Answer 8

Genuinenes, Or selfawareness of one’s feelings as they arise within the relationship and the ability to communicate them when appropriate, is a key ingredient in building trust

Question 9

Describe positive regard, and attitudes and actions that can convey positive regard

Answer 9

Implies respect. It is the ability to view another person as being worthy of being cared about and as someone who has strengths and achievement potential
o Attitudes – willingness to work with the patient
o Actions – attending, suspending value judgments, calling the individual by their first or last name, and helping patients develop their own resources

Question 10

Explain the concepts of transference and counter-transference

Answer 10

Transference—patient unconsciously and inappropriately displaces onto nurse feelings and behaviours related to significant figures in patient’s past (intensified in relationships of authority)
Countertransference—nurse displaces feelings related to people in nurse’s past onto patient
o Patient’s transference to nurse often results in countertransference in nurse
o Common sign of countertransference in nurse is over-identification with the patient

Question 11

identify situations of blurring boundaries and roles within the nurse-patient relationship

Answer 11

• When relationships slip into social context
• When nurse’s needs are met at expense of patient’s needs
• transference and Countertransference