Chapter 5 Therapeutic Relationships

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Chapter 5 Therapeutic Relationships
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Therapeutic Relationships-nurses responsibility

• The ability to establish therapeutic
  relationships with clients is one of the most
  important skills a nurse can develop.
• Elements include
• Trust (nurse is friendly, caring, understanding,
  consistent keeps promises listens is honest)
  Box 5-1 Know trusting behaviors
• Congruence (nurses words and actions match)

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Therapeutic Relationships (contd)

• Genuine interest
• Empathy (not sympathy)-ability of the nurse to
  perceive the meanings and feelings of the client
  and to communicate that the nurse understands the
  client. Note picture.
• Acceptance of person, not necessarily his or her
  behavior
• Positive regard (unconditional, nonjudgmental
  attitude)-the nurse who appreciate that clients
  are unique and worthwhile-regardless of behavior,
  background, lifestyle.

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Self-Awareness and Therapeutic Use of Self

• Self-awareness(ongoing) is essential on the
  nurses part. Self-awareness is a process of
  understanding ones own values, beliefs,
  thoughts, feelings, attitudes, motivations,
  strengths, and limitations and how ones thoughts
  and behaviors affect others. Nurse reevaluates
  and readjust to the above process as they gain
  wisdom and experience.
• VALUEs are abstract standards that give a
  person a sense of what is right and wrong and
  establish a code of conduct for living.
• Therapeutic use of self is when the nurse uses
  aspects of his or her personality, experience,
  values, feelings, intelligence, needs, coping
  skills, and perceptions to establish
  relationships with clients that are beneficial to
  clients.

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Self-Awareness and Therapeutic Use of
Self(contd)

• Joharis window is a self-awareness tool
  categorizes qualities of self as open/public
  blind/unaware hidden/private and unknown.

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Patterns of Knowing-Hildegard Peplau

• Preconceptions(ways one expects to behave or
  speak as a roadblock to therapeutic(authentic)
  relationships.
• There are four patterns of knowing (ways of
  observing and understanding client interactions)
• Empirical (derived from nursing science)
• Personal (from life experiences)
• Ethical (from moral nursing knowledge)
• Aesthetic (from art of nursing)
• Unknowing is when the nurse admits he or she
  does not know the client or understand the
  clients subjective world

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Establishing the Therapeutic Relationship

• Therapeutic relationships are focused on the
  needs, experiences, feelings, and ideas of the
  client, not the nurse. THERE IS NO PLACE FOR
  INTIMACY IN THE NURSE-CLIENT RELATIONSHIP.
• In the orientation phase, the nurse and client
  meet, roles are established, the purposes and
  parameters of future meetings are discussed,
  expectations are clarified, and (ENDS WHEN) the
  clients problems are identified.

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Establishing the Therapeutic Relationship(contd)

• The working phase involves problem
  identification, where the client identifies
  issues or concerns causing problems, and
  exploitation, when the nurse guides the client to
  examine his or her feelings and responses,
  develop better coping skills and a more positive
  self-image, change behavior, and develop
  independence.

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Establishing the Therapeutic Relationship(contd)

• Transference is when clients unconsciously
  transfer feelings they have for significant
  persons in their life to the nurse.
  Counter-transference is when the nurse responds
  to the client based on his or her own unconscious
  needs and conflicts.
• The termination or resolution phase begins when
  the clients problems are resolved and ends when
  the relationship is ended. It is important to
  deal with feelings of anger or abandonment that
  may occur.

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Behaviors That Diminish Therapeutic Relationships

• Inappropriate boundaries (relationship becomes
  social or intimate)
• Feelings of sympathy rather than empathy
• Encouraging client dependency rather than
  promoting independence
• Nonacceptance of client as a person because of
  his or her behaviors, leading to avoidance of the
  client.
• Nurse self-awareness is the way to avoid such
  problems.

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Therapeutic Roles of the Nurse in a Relationship

• Teacher
• Caregiver
• Advocate-PROVIDE privacy and dignity, promote
  informed consent, prevent unnecessary
  exams/procedures
• Parent surrogate

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Self-Awareness Issues

• Self-awareness on the nurses part is crucial to
  developing therapeutic relationships. Students
  may find that values clarification, journaling,
  group discussions, and reading will assist them
  in this process. Developing self-awareness is a
  continual, ongoing process the nurse needs to
  plan for self-growth.