THE NURSE CLIENT RELATIONSHIP

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THE NURSE CLIENT RELATIONSHIP
Mercedes A. Perez-Millan MSN, ARNP
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ROLES OF THE PSYCHIATRIC NURSEPaplau (1991)

• Nurse care of the ill a unique, independent
  member of the health care team
• Many Sub-roles
• Resource person
• Teacher
• Leader
• Counselor
• Levels of Practice

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Nurse Client Relationship

• is
• a series of purposeful, goal directed
  interactions that focus on the clients needs
• The client may be an individual, a family, a
  group, or a community

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TYPES OF RELATIONSHIPS

• Social- Friendship, enjoyment, or task oriented
• Intimate- Emotional commitment
• Therapeutic- The focus is on the clients
  problems and needs

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DYNAMICS OF NURSE-CLIENT ELATIONSHIP(Problem
Solving Approach)

• Identify Problem
• Discuss possible solutions
• Explore feelings/ alternate solutions
• Discuss strategies for change
• Explore and -
• Assist to select alternative
• Give positive feedback for efforts
• Evaluate outcome

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THERAPEUTIC NURSE BEHAVIORS

• Self-awareness
• Rapport
• Trust
• Respectful, warm, genuine and caring
• Empathy

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THERAPEUTIC NURSE BEHAVIORS(cont.)

• Positive regard
• Collaborative goal setting
• Responsible ethical practice
• Cultural sensitivity

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RELATIONSHIP ISSUES

• Establishing boundaries
• Professional vs social
• Transference
• Counter-transference
• Confidentiality

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PHASES OF THE THERAPEUTIC RELATIONSHIP

• Pre- Orientation Phase
• Obtain information
• Examine own feelings

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PHASES OF THE THERAPEUTIC RELATIONSHIP

• Orientation Phase
• Establishes trust and rapport
• Discusses parameters of the relationship
• Establishes a contract
• Termination, confidentiality
• Assessment, nursing dx. establish mutually agreed
  goals, develop plan of action
• Explore feelings

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PHASES OF THE THERAPEUTIC RELATIONSHIP

• Working Phase
• Maintains trust and rapport
• Promotes clients insight, overcomes resistance
• Uses problem solving in collaboration with the
  client to meet goals
• Teaches coping mechanisms
• Encourages to practice adaptive behaviors
• Evaluates effectiveness of interventions

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PHASES OF THE THERAPEUTIC RELATIONSHIP

• Terminating Phase
• Evaluates outcomes, reassessing the problems,
  goals, and interventions if needed
• Review plans for the future and referrals
• Nurse and client express feelings about
  termination
• Observe client for regressive behaviors
• Evaluates the entire nurse client relationship

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THERAPEUTIC COMMUNICATION
Definition- Therapeutic communication is composed
of verbal and non-verbal techniques that the
nurse uses to focus on the clients
needs. Non-verbal component- Kinetics Touch
Proxemics Paralanguage Silence
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THERAPEUTIC COMMUNICATION TECHNIQUES (see
textbook)

• Using Silence
• Accepting
• Giving recognition
• Offering self
• Broad opening
• General leads
• Placing event in sequence
• Making an observation

• Restating
• Clarification/Validation
• Reflecting
• Focusing
• Exploring
• Presenting reality
• Voicing doubt
• Formulating plan of action

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BLOCKS TO THERAPEUTIC COMMUNICATION

• Giving advice
• Minimizing feelings
• False reassurance
• Asking Why questions
• Asking excessive questions
• Making value judgments
• Giving approval or disapproval
• Changing the subject
• Showing non-verbal signs of boredom or
• resentment