Therapeutic Relationships-Ch5-T1 Flashcards
Therapeutic Relationship
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.
Components of a therapeutic relationship
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
congruence
words and actions match
genuine interest
percieved as a genuine person.
Nurse must demonstrate self-comfort, self-awareness of strengths and limitations, clear focus
empathy
putting oneself in clients shoes.
Client and nurse giving “gift of self” when empathy occurs
how is empathy different from sympathy
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
Acceptance
(no judgements, set boundaries)–the behavior is inappropriate but the person is accepted valued and worthy
positive regard
unconditional nonjudgemental attitude - RESPECT
Use presence or attending (verbal/nonverbal communication to convey nurse is listening).
Lean forward, eye contact, arms at sides.
Know self
develop understanding of one’s own thoughts, beliefs, values.
self awareness about VALUES
(sense of right and wrong, code of conduct for living)
self awareness: gaines insight through the clarification process
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
Attitudes
feeling or frame of reference around which a person organizes knowledge about the world
Beliefs
- ideas one holds true
Acting
put value into action
Prizing
cherishes value & attaches it to him/her self.
Therapeutic Use of Self
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.
Who was the theorist that developed the concept of the therapeutic use of self
Peplau
Johari window
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.
Patterns of Knowing
Ways of observing, understanding client interactions.
List the patterns of Knowing
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.
Types of Relationships
social
intimate
therapeutic
Describe a social: type of relationship
Purpose of friendship, socialization, companionship, or task accomplishment.
Superficial communication; shifting roles; outcomes rarely assessed
Describe an intimate: type of relationship
Emotional commitment of two persons.
Individual needs met; assistance with helping each other meet needs
Describe a therapeutic: type of relationship
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.
Peplau’s model of establishing a therapeutic relationship includes three phases:
Orientation
Working
Termination
Overlapping, interlocking of phases
Orientation Phase: peplau model of establishing a therapeutic relationship
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
Working Phase: peplau model of establishing a therapeutic relationship
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.
Termination Phase: peplau model of establishing a therapeutic relationship
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.
Behaviors Diminishing Therapeutic Relationships
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).
Therapeutic Roles of the Nurse in a Relationship
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).
Self-Awareness Issues
- define
- helpful activities
- development of self awareness
Nurse’s self-awareness: crucial to developing therapeutic relationships.
Helpful activities: values clarification, journaling, group discussions, reading.
Development of self-awareness: continual, ongoing process.
