Therapeutic Relationships-Ch5-T1

Question 1

Therapeutic Relationship

Answer 1

The ability to build therapeutic relationships is one of the most important skills a nurse can develop.
Crucial to success of interventions with clients requiring psychiatric care.
Therapeutic relationship + communication within it serve as underpinning for treatment & success.

Question 2

Components of a therapeutic relationship

Answer 2

Nurse is responsible for developing this relationship & promoting communication.
Factors that enhance the nurse-client relationship:
Trust
Behaviors such as caring, interest, understanding, consistency, honesty, promise keeping, listening (see Box 5.1,p. 80).
Congruence is essential – words & actions match.
Genuine interest –perceived as genuine person.
Nurse demonstrates self-comfort, self-awareness of strengths and limitations, clear focus.
Be open, honest, use active listening.
Empathy
Putting oneself in client’s shoes.
Client and nurse giving “gift of self” when empathy occurs – the client by feeling safe enough to share feelings & the nurse by listening and demonstrating understanding.
Different from sympathy (feelings of concern or compassion; can shift the focus to the nurse’s feelings).
Acceptance (no judgments; set boundaries) – the behavior is inappropriate but the person is accepted, valued & worthy.
Be firm, set limits on behavior.
Positive regard (unconditional nonjudgmental attitude) – respect
Use presence or attending (verbal/nonverbal communication to convey nurse is listening).
Lean forward, eye contact, arms at sides

Question 3

congruence

Answer 3

words and actions match

Question 4

genuine interest

Answer 4

percieved as a genuine person.

Nurse must demonstrate self-comfort, self-awareness of strengths and limitations, clear focus

Question 5

empathy

Answer 5

putting oneself in clients shoes.

Client and nurse giving “gift of self” when empathy occurs

Question 6

how is empathy different from sympathy

Answer 6

sympathy is feelings of concern or compassion; can shift the focus to the nurs’s feelings.

empathy is when the nurse puts onself in the clients shoes

Question 7

Acceptance

Answer 7

(no judgements, set boundaries)–the behavior is inappropriate but the person is accepted valued and worthy

Question 8

positive regard

Answer 8

unconditional nonjudgemental attitude - RESPECT

Use presence or attending (verbal/nonverbal communication to convey nurse is listening).
Lean forward, eye contact, arms at sides.

Question 9

Know self

Answer 9

develop understanding of one’s own thoughts, beliefs, values.

Question 10

self awareness about VALUES

Answer 10

(sense of right and wrong, code of conduct for living)

Question 11

self awareness: gaines insight through the clarification process

Answer 11

Values clarification
Choosing – consider options & choose value that feels right.
Prizing – cherishes value & attaches it to him/her self.
Acting – put value into action.
Beliefs - ideas one holds true.
Attitudes – feeling or frame of reference around which a person organizes knowledge about the world (see Boxes 5.2 & 5.3, pp. 83-84

Question 12

Attitudes

Answer 12

feeling or frame of reference around which a person organizes knowledge about the world

Question 13

Beliefs

Answer 13

• ideas one holds true

Question 14

Acting

Answer 14

put value into action

Question 15

Prizing

Answer 15

cherishes value & attaches it to him/her self.

Question 16

Therapeutic Use of Self

Answer 16

Through self-awareness the nurse can use aspects of his/her personality, experiences, values, feelings, intelligence, needs, coping skills, perceptions to establish relationships beneficial to clients.
Concept developed by H. Peplau
Therapeutic use of self – nurses must understand themselves to promote growth& avoid limiting client’s choices to those valued by the nurse.

Question 17

Who was the theorist that developed the concept of the therapeutic use of self

Answer 17

Peplau

Question 18

Johari window

Answer 18

tool to learn about oneself so that you can use the therapeutic use of self

4 quadrants: open/public self; blind/unaware self; hidden/private self; unknown

1st Step – nurse appraises own qualities (list values, attitudes, strengths, feelings, desires, etc.).

2nd step – Find out others perceptions by interviewing – ask people to identify your positive/negative qualities

3rd step – compare lists & assign qualities to quadrants.

Goal: move qualities from quadrants 2, 3, 4 into quadrant 1
Indicates nurse is gaining self-knowledge & awareness.

Question 19

Patterns of Knowing

Answer 19

Ways of observing, understanding client interactions.

Question 20

List the patterns of Knowing

Answer 20

Four patterns (Carper, 1978; see Table 5.1, p. 85).
Empirical (derived from nursing science) – panic attack, pulse increases.
Personal (from life experiences) – client’s face shows panic.
Ethical (from moral nursing knowledge) – shift over, nurse remains with client.
Aesthetic (from art of nursing) – sensing, intuition.

Fifth pattern : unknowing (Munhall, 1993)
Nurse admits lack of knowledge of client or understanding of client’s subjective world.
Authentic encounter devoid of any preconceptions.
Nurse is open to hearing client’s views without imposing his/her own values.

Question 21

Types of Relationships

Answer 21

social
intimate
therapeutic

Question 22

Describe a social: type of relationship

Answer 22

Purpose of friendship, socialization, companionship, or task accomplishment.
Superficial communication; shifting roles; outcomes rarely assessed

Question 23

Describe an intimate: type of relationship

Answer 23

Emotional commitment of two persons.

Individual needs met; assistance with helping each other meet needs

Question 24

Describe a therapeutic: type of relationship

Answer 24

Focus on needs, experiences, feelings, ideas of client only.
Use of communication skills, personal strengths, understanding of human behavior by nurse.
Joint agreement on areas to work on; outcome evaluation.

Question 25

Peplau’s model of establishing a therapeutic relationship includes three phases:

Answer 25

Orientation
Working
Termination
Overlapping, interlocking of phases

Question 26

Orientation Phase: peplau model of establishing a therapeutic relationship

Answer 26

Meeting nurse, client.
Establishment of roles.
Discussion of purposes, parameters of future meetings.
Clarification of expectations.
Identification of client’s problems.
Nurse–client contracts/confidentiality, duty to warn/self-disclosure

Question 27

Working Phase: peplau model of establishing a therapeutic relationship

Answer 27

Two sub-categories:

Problem identification: issues or concerns identified by client; examination of client’s feelings and responses.

Exploitation: examination of feelings and responses; development of better coping skills, more positive self-image, behavior change, independence.

Possible transference/countertransference.

Question 28

Termination Phase: peplau model of establishing a therapeutic relationship

Answer 28

Begins when client’s problems are resolved.
Ends when relationship is ended.
Deals with feelings of anger or abandonment that may occur; client may feel termination as impending loss.

Question 29

Behaviors Diminishing Therapeutic Relationships

Answer 29

Inappropriate boundaries (relationship becomes social or intimate).
Feelings of sympathy, encouraging client dependency.
Non-acceptance of client, avoidance
Nursing Boundary Index (see Table 5.4, p.91)
Warning signals of abuse of the nurse-client relationship (see Box 5.4, p. 92).

Question 30

Therapeutic Roles of the Nurse in a Relationship

Answer 30

Teacher (coping, problem solving, medication regimen, community resources).

Caregiver (therapeutic relationship, physical care).
Advocate (ensuring privacy and dignity, informed consent, access to services, safety from abuse and exploitation).

Parent surrogate
Methods to avoid inappropriate relationships between nurses and clients (see Box 5.5, p. 93).

Question 31

Self-Awareness Issues

• define
• helpful activities
• development of self awareness

Answer 31

Nurse’s self-awareness: crucial to developing therapeutic relationships.

Helpful activities: values clarification, journaling, group discussions, reading.

Development of self-awareness: continual, ongoing process.