NURSE-PATIENT RELATIONSHIP Flashcards
What are the types of relationship?
- Social Relationship
- Intimate Relationship
- Therapeutic Relationship
-Friendships and socialization
- Superficial communication
Social Relationship
-People with emotional commitment
- May include sexual or emotional intimacy and shared mutual goals
Intimate Relationship
-Caregiver and care receiver are involved
-Inclined towards healing growth, and illness prevention
Therapeutic Relationship
Requires both parties to recognize each other as unique and important human beings, which facilitates mutual learning
Mutually-significant experience
Focuses on needs, experiences, feelings, and the ideas of the patient only
Patient-centered
Nurse and patient agree about the areas to work on and evaluate the outcomes
Goal oriented
A nurse is first a stranger to the patient as the patient is to the nurse
Stranger
Provides specific answers to questions usually formulated with relation to a larger problem
Resource person
Identifies learning needs and provides information to the patient and significant others to address the learning needs
Teacher
allows the patient to take an active role in the care plan
Leader
the nurse may be viewed by the patient as a substitute figure of a significant other
Surrogate
The nurse understands various professional devices and possesses the clinical skills necessary to perform the interventions that are in the best interest of the client.
Technical Expert
The nurse uses “interpersonal techniques” to assist clients to learn to adapt to difficulties or changes in life experiences
Counselor
It is essential for the staff nurse working in psychiatry to have a general knowledge of basic counseling techniques.
Psychiatric Nurse as a Counselor
What are the basic counseling techniques
-Therapeutic use of self
-Therapeutic communication
Using self as a therapeutic tool to establish therapeutic relationships with clients and to help them grow, change, and heal
Therapeutic Use of Self
The process of developing understanding of one own’s values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths, and limitations and how these qualities affects others.
Self-Awareness
Self awareness activities
-Johari Window
-Journaling
Is the recognition of the unique pattern of values, attitudes, beliefs, behaviors, emotions, and needs and understanding about their impact on the self and others.
Self-Awareness
is a representation of the self and a tool that can be used to increase self-awareness (Luft, 1970).
Johari Window
The aspects of the self about which both the individual and others are aware
Open-Public Self
The part of the self that is known to others but remains hidden from the awareness of the individual.
Blind-Unaware Self
The part of the self that is known to the individual, but which the individual deliberately and consciously conceals from others
Hidden-Private Self
The part of the self that is unknown to both the individual and to others.
Unknown
Explores one’s thoughts and emotions through writing
Journaling
Ensures confidentiality as details are only disclosed to the therapist
Journaling
A deep, internal process in which people express their emotions, reactions, and perceptions.
Journaling
Types of Journaling
- Gratitude Journaling
- Reflective Journaling
- Health Journaling
A place to reflect upon and write down things one is thankful for
Gratitude Journaling
Entries focus on the person’s internal processes surrounding an event, like the discussion that took place during a class or counseling session, including personal values, beliefs, and experiences.
Reflective Journaling
allows the individual to write about emotions associated with medical condition or object of interest in a psychiatric condition
Health Journaling
Components of a Therapeutic Relationship
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 nonjudgmental attitude.
Rapport
Components of a Therapeutic Relationship
builds when the client is confident in the nurse and when the nurse’s presence conveys integrity and reliability
Trust
What are the Trusting Behaviors?
Consistency
Honesty
Approachability
Listening
Keeping promises
Components of a Therapeutic Relationship
means unconditional, non-judgmental attitude of the nurse towards the client
Respect (Unconditional positive regard)
Components of a Therapeutic Relationship
refers to the nurse’s ability to be open, honest, and “real” in interactions with the client.
Genuineness
-To be “real” means being aware of the one’s inner experience and to allow the quality of this inner experience to be apparent in the relationship
-Congruence
-Self- disclosure which reveals a quality of “humanness”
Genuineness
Is the ability to see beyond outward behavior and to understand the situation from the client’s point of view
Empathy
He created the Interpersonal Relationship and Milieu Therapy
Harry Stack Sullivan
Major Assumptions of Interpersonal Relationships and Milieu Therapy
-A healthy person is a social being with the ability to live effectively in relationships with others
-Mental illness was viewed as any degree of lack of awareness of or skills in the process of interpersonal relationships
Patient- to- patient interaction is seen as beneficial as is the focus of treatment
Therapeutic milieu (Interpersonal Relationships and Milieu Therapy)
acts as a participant observer and provides a corrective interpersonal relationship
Therapist
therapist participates in and observes the progress of the relationship
Participant observer
Created the Phases of the Nurse-Patient Relationship
Hildegard Peplau
What are the phases of the Nurse-Patient Relationship
-Orientation
-Identification
-Exploitation (Negative Connotation)
-Resolution
Exploitation factors
-Orientation
-Working
-Termination
-Directed by the nurse
-Problems and needs are clarified
-Hospital routines and expectations are explained
-Patient’s full participation is elicited
Orientation Phase
Major Tasks of Orientation Phase
-Establish trust
- Establish the Nurse-Patient Contract
-Ensuring confidentiality and data protection
What are the contents of the contract?
-Time, place, and length of sessions
-When sessions will terminate
-Who will be involved in the treatment plan
-Client responsibilities
-Nurse’s responsibilities
means respecting the client’s rights to keep private any information about his or her mental and physical health and related care
Confidentiality
Notifying the police, warning the intended victim, and/or taking other reasonable steps to protect the threatened individual.
“Duty to Protect”
Governing how data is collected, shared and used
Data Privacy
Protecting data from internal and external attackers
Data Security
The therapeutic work of the relationship is accomplished.
Working Phase
are outrageous stories or acting- out behaviors that challenges the nurse to stay focused and not to react or to be distracted
Testing Behaviors
may also indicate that the client is avoiding a subject because he is getting close into an uncomfortable truth.
Testing Behaviors
What’s in the working phase?
-Maintain the relationship
-In- depth data collection
-Explore perceptions of reality
-Developing positive coping mechanism
-Promoting a positive self- concept
-Facilitating behavior change
-Working through resistance
-Evaluating progress and redefining goals as appropriate
-Promoting Independence
Begins when the problem is resolved and ends when the relationship is ended.
Termination Phase
Stalling Maneuvers
-Client’s attempt to avoid terminating the relationship. The client may view the termination as an impending loss.
-Clients may act- out as if the problem has not been resolved.
Intervention for stalling maneuvers
-Acknowledge the feelings and assure that what they feel are normal responses to ending a relationship.
-Establish the reality of the separation by refocusing on the newly learned behaviors and skills. Resist being manipulated into repeated delays.
Discussion of Termination
-Nurses should attempt to make it official by saying “good-bye” and stating his or her feelings about the relationship.
-Acknowledge that you enjoyed the time with the client and will remember him or her.
-Never agree to see the client outside the therapeutic relationship
