Who Are Nursings clients

1
Who Are Nursings clients?

• the Therapeutic
• Nurse-Client
• Relationship

Heather Krohn
2
CNO definition of client

• may be an individual, family, group or
  community.
• CNO Standard for the Therapeutic Nurse-Client
  Relationship (pp. 4)
• Health promotion activities may be
• focused on an individual, family, group or
  community in a variety of settings

3
Client as Individual

• Caring for an individual can take place in a
  variety of settings including the
• Hospital
• Long-term care facility (nursing home, retirement
  facility, etc.)
• Home or other private residence (e.g. group home)
• Community-based agencies (e.g. school, clinic,
  etc.)

4
Client as Family

• Nurses carry out family-centered care in a
  variety of settings
• What settings other than the home environment can
  you think of where the nurse might focus on
  family-centred care?

5
Client as Community

• Beyond the geographical boundaries that may
  define a community, the community client can be
  composed of any group of clients with similar
  needs, values or other common characteristics
  that identify them as a distinct group.

e.g. faith center, school, ethic group, employee
group, etc.
6
Regardless of the type of client,

• Health Promotion requires the nurse to focus on
  being client-centered.
• One way of defining health promotion
• a process of enabling people to increase
  control over and to improve their health
• (WHO, 1986)

7
The Pillars of Health Promotion based upon this
definition are

• Primacy of the person
• Empowerment
• Enabling

8
1. Primacy of the Person

• Valuing the uniqueness and diversity of each
  person
• Respect for differences ways of thinking
• Viewing the client as a whole rather than a
  group of component parts
• Implies the existence of a relationship between
  the nurse and the client that is of utmost
  importance

9
2. Empowerment

• The nurse
• encourages the client to have power and control
  over his/her life
• assists the client to assume responsibility over
  his/her life
• It is an essential aim of every nurse-client
  relationship
• It is a purposeful act

10
2. Empowerment (continued)

• The appropriate use of power in a caring manner
  enables the nurse to work with the client towards
  the clients goals and to ensure that the
  clients vulnerable position in the nurse-client
  relationship is not taken advantage of.
• CNO Standard for the Therapeutic Nurse-Client
  Relationship (pp. 4)
• It is the combination of the nurses knowledge
  with the clients understanding and experience
  that creates the bases for care planning and
  decision making.
• (Young Hayes 2002)

11
3. Enabling

• Is closely related to empowerment (in addition to
  possessing power, one must also be able to act)
• To enable, the nurse assumes that the client has
  the innate ability to identify his/her own needs,
  problem solve, and to act in his/her own best
  interests.
• To enable then, the nurse needs to develop a
  collaborative relationship with the client, and
  begin from where the client is.
• (Young Hayes 2002)

12
3. Enabling (continued)

• Within this collaborative relationship, the nurse
  becomes a facilitator
• The nurse enables by supporting/assisting the
  client in acquiring the necessary knowledge,
  skills, and related resources to achieve the
  clients chosen goal(s)

13
Therapeutic Nurse-Client Relationship

• Established and maintained by the nurse and the
  client through the use of professional nursing
  knowledge, skill and caring attitudes and
  behaviours in order to provide nursing services
  that contribute to the clients health and
  well-being
• Five components are trust, respect,professional
  intimacy, empathy, and power
• CNO Standard for the Therapeutic Nurse-Client
  Relationship

14
Therapeutic Nurse-client relationship (continued)

• Other characteristics
• Interdependent
• Healing relationship
• Shares many characteristics of a social
  relationship
• Includes developmental phases
• Involves complex communication patterns
• Involves ethical decision making

15
Final Notes on Trust, Respect, Intimacy and
Appropriate Use of Power

• The client entrusts his/her care to a nurse based
  on the assumption that the nurse possesses
  knowledge, skills and attitudes that will assist
  him/her in seeking optimum health.
• This trust is fragile and if breached becomes
  very difficult to re-establish

16

• The nurse must
• Respect the dignity and worth of the client
• Know and understand the culture and other aspects
  of the clients uniqueness
• Incorporate knowledge of the clients individual
  characteristics when providing care/service
• Be aware of his/her own beliefs and values and
  provide non-judgemental care
• Recognize the existing intimacy within the
  relationship that creates personal and private
  closeness on many levels.

17

• The Therapeutic Nurse-client Relationship
• is a privileged relationship
• and is defined by the
• Standard For the Therapeutic Nurse-Client
  Relationship under the
• College of Nurses of Ontario