Therapeutic Relationships

Question 1

Define contract as it relates to a therapeutic relationship.

Answer 1

An agreement, either stated or written, that contains the place, time, date, and duration of the meetings between nurse and patient.

Question 2

What is empathy?

Answer 2

The ability of one person to imagine him- or herself inside another’s world and see things from the other person’s perspective and to communicate this understanding to the other person.

Question 3

What is genuineness?

Answer 3

Self-awareness of one’s feelings as they arise within the nurse–patient relationship and the ability to communicate them when appropriate.

Question 4

What is the orientation phase?

Answer 4

The phase during which the nurse conducts the initial interview; can last for a few meetings or extend over a longer period.

Question 5

What is the pre-orientation phase?

Answer 5

The phase of the therapeutic relationship during which the nurse prepares for the orientation phase—for instance, familiarizing him- or herself with the patient’s background or engaging in self-reflection.

Question 6

What is rapport?

Answer 6

A relationship characterized by trust, support, and understanding.

Question 7

What is a social relationship?

Answer 7

A relationship that is initiated primarily for the purpose of friendship, socialization, enjoyment, or accomplishment of a task. Mutual needs are met during social interaction (e.g., participants share ideas, feelings, and experiences).

Question 8

What is the termination phase?

Answer 8

The final, integral phase of the nurse–patient relationship, during which the patient and nurse summarize the achievement of goals and discuss the continued implementation by the patient of strategies learned.

Question 9

What is a therapeutic encounter?

Answer 9

A brief, informal meeting between nurse and patient that is useful and important for the patient.

Question 10

What is a therapeutic relationship?

Answer 10

A relationship in which the nurse maximizes his or her communication skills, understanding of human behaviours, and personal strengths to enhance the patient’s growth.

Question 11

What is the therapeutic use of self?

Answer 11

One’s individual, genuine ways of being with another person based upon one’s personal values and beliefs of humanity and enhanced by the application of micro communication skills to guide the process of developing, maintaining, and terminating a therapeutic relationship.

Question 12

What is the working phase?

Answer 12

The phase of the nurse–patient relationship during which the nurse and patient identify and explore areas that are causing problems in the patient’s life.

Question 13

How are social conversations characterized?

Answer 13

May include giving advice
Meeting basic dependency needs such as a listening ear or support during a stressful time
Content may remain superficial
Roles may shift
Little emphasis on the evaluation of the interaction

Question 14

How are therapeutic conversations characterized?

Answer 14

Focus is on the patient’s ideas, experiences, feelings, and personal issues
Identify areas of exploration
Evaluate
Roles don’t shift - focus is on patient, not the nurse

Question 15

What are the 6 key philosophical assumptions in Barker’s Tidal Model?

Answer 15

• a belief in the virtue of curiosity
• recognition of the power of resourcefulness, instead of focusing
  on problems, deficits, or weaknesses
  respect for the patient’s wishes instead of being paternalistic
• acceptance of the paradox of crisis as opportunity
• acknowledging that all goals must belong to the individual patient
• the virtue of pursing elegance: the simplest possible means should
  be sought (Barker, P. 2001).

Question 16

In order for the nurse to begin the process of engagement using the Tidal Model, what must be accepted?

Answer 16

• Recovery is Possible
• Change is inevitable
• Ultimately, the patient knows what is best for him or her
• The patient possesses all the resources he or she needs to begin the recovery journey
• The patient is the teacher, while the helpers are the pupils
• The helper needs to be creatively curious, and to learn what needs to be done to help the person (Barker, P. 2001).

Question 17

Define empowerment.

Answer 17

Psychological sense of personal control, involvement, influence, and awareness of options in one’s life

Question 18

What is the goal of motivational interviewing?

Answer 18

Goal is empowerment to change

Question 19

What are characteristics of motivational interviewing?

Answer 19

Aimed at behaviour change.
Patient Centered
Directive
Change Continuum – concrete steps taken to increase readiness for change
Ambivalence and Resistance expected

Question 20

What are techniques for motivational interviewing?

Answer 20

Reflective Listening
Assess for:
- Conviction
- Confidence
Eliciting motivational statements
Examining ambivalence

Question 21

What does Peplau’s proposed nurse-patient process aim to assist with?

Answer 21

• patient’s boundary management
• independent problem solving
• decision making that promotes autonomy

Question 22

What is usually at the root of boudary blurring?

Answer 22

Transference and counter-transference phenomena

Question 23

Which of the following is an example of an action that is acceptable in a social relationship but not in a therapeutic relationship?
Giving advice
Listening actively
Clarifying feelings
Giving positive regard

Answer 23

Giving advice

Question 24

According to Rogers, which of the following is a synonym for genuineness?
Respect
Empathy
Congruence
Positive regard

Answer 24

Congruence

Question 25

Which is the phase of the nurse–patient relationship that may cause anxieties to reappear and past losses to be reviewed?
Preorientation phase
Orientation phase
Working phase
Termination phase

Answer 25

Termination phase

Question 26

When a nurse’s bias delays the development of a therapeutic relationship, what therapeutic relationship attribute will be most affected?
Assess the patient’s symptoms
Assess boundary issues with the patient
View the patient with positive regard
Engage in values clarification with the patient

Answer 26

View the patient with positive regard

Question 27

To help a patient develop personal resources, the nurse must first be aware of which of the following?
The patient’s strengths
Negative transferences
Counter-transferences
Resistances

Answer 27

The patient’s strengths

Question 28

One of the possible sources of boundary violations is placing the focus on which of the following?
Meeting the nurse’s needs
Identifying patient disturbances
Assessing the patient’s ego strength
Assessing the patient’s weaknesses

Answer 28

Meeting the nurse’s needs

Question 29

In the process of trying new values, which step shows the highest commitment to personal development?
Cherishing the value
Publicly stating affirmation of the value
Choosing a stand consistent with the value from among several alternatives
Consistently acting in ways that repeatedly affirm the value

Answer 29

Consistently acting in ways that repeatedly affirm the value

Question 30

What is the event referred to when a nurse and patient meet and genuine concern is expressed which improves the relationship?
As a crisis intervention
As a therapeutic encounter
As an autonomous interaction
As a preorientation phenomenon

Answer 30

As a therapeutic encounter

Question 31

During which phase of the therapeutic nurse–patient relationship is a formal or informal contract between the nurse and patient established?
Preorientation phase
Orientation phase
Working phase
Termination phase

Answer 31

Orientation phase

Question 32

The nurse would address which of the following goals in attempting to establish a therapeutic nurse–patient relationship? (Select all that apply.)
Assisting the patient in identifying self-defeating behaviours
Encouraging the patient to make decisions when appropriate
Providing the patient with opportunities to socialize
Facilitating the patient’s communication of disturbing feelings or thoughts

Answer 32

Assisting the patient in identifying self-defeating behaviours
Encouraging the patient to make decisions when appropriate
Facilitating the patient’s communication of disturbing feelings or thoughts

Question 33

Which of the following is the primary difference between a social and a therapeutic relationship?
Type of information exchanged
Amount of satisfaction felt
Type of responsibility involved
Amount of emotion invested

Answer 33

Type of responsibility involved

Question 34

A patient states, “That nurse never seems comfortable being with me.” How could the nurse be described?
Not seeming genuine to the patient
Transmitting fear of patients
Unfriendly and aloof
Controlling

Answer 34

Not seeming genuine to the patient

Question 35

The pre-orientation phase of the nurse-patient relationship is characterized by the nurse’s focus on which of the following?
Self-analysis of strengths, limitations, and feelings
Clarification of the nursing role
Changing the patient’s dysfunctional behaviour
Incorporating coping skills into the patient’s routine

Answer 35

Self-analysis of strengths, limitations, and feelings

Question 36

The orientation phase of the nurse-patient relationship focuses on which of the following?
The nurse identifying personal biases
The nurse and patient identifying patient needs
Overcoming resistance to changing behaviour
Reviewing situations that occurred in previous meetings

Answer 36

The nurse and patient identifying patient needs

Question 37

Patient reactions of intense hostility or feelings of strong affection toward the nurse are common forms of which of the following?
Resistance
Transference
Counter-transference
Emotional reaction

Answer 37

Transference

Question 38

The outcome of the nurse’s expressions of sympathy instead of empathy toward the patient often leads to which of the following?
Enhanced patient coping
Lessening of patient emotional pain
Increased hope for patient improvement
Decreased patient communication

Answer 38

Decreased patient communication

Question 39

The use of empathy and support begins in which of the following stages of the nurse-patient relationship?
Orientation stage
Working stage
Identification stage
Resolution stage

Answer 39

Orientation stage

Question 40

A patient reports that her mother-in-law is very intrusive. The nurse responds, “I know how you feel. My mother-in-law is nosy, too.” The nurse is demonstrating which of the following?
Self-disclosure in an appropriate way
Permission to the patient to continue
Counter-transference
Empathy to establish trust

Answer 40

Counter-transference

Question 41

A patient tells the nurse “I really feel close to you. You are like the friend I never had.” The nurse can assess this statement as indicating the patient may be experiencing which of the following?
Congruence
Empathetic feelings
Counter-transference
Positive transference

Answer 41

Positive transference

Question 42

The nurse is finding it difficult to provide structure and set limits for a patient. The nurse should self-evaluate for which of the following?
Boundary blurring
Value dissonance
Covert anger
Empathy

Answer 42

Boundary blurring