THERAPEUTIC RELATIONSHIPS Patient nurse relationship Building rapport Professional

THERAPEUTIC RELATIONSHIPS Patient -nurse relationship Building rapport Professional Boundaries Communication skills Interviewing

Types of relationships • Social • Intimate • Therapeutic

Therapeutic Relationship An interaction between two people in which input from both participants contributes to a climate of healing, growth promotion and/or illness prevention

Nurse client relationship • Therapeutic nurse client alliance – Takes time – requires skill – Focus is on the client – Early phase focuses on establishing an understanding that the nurse is safe, confidential reliable, and consistent

Goals include • Facilitating communication of distressing thoughts or feelings • Assisting clients with problem solving • Helping clients examine self defeating behaviors and test alternatives • Promoting self care and independence including coping skills • Focus is consistently on clients problems and needs » And potential solutions

Factors that promote growth in a client • Genuineness • Empathy (much different than sympathy) – Maintain objectivity, emotionally separate • Positive regard (attitude and action)

DETRIMENTAL NURSE-CLIENT RELATIONSHIP • nurse tries to get his or her own needs met • nurse tries to solve the client’s problems • nurse takes the role of a friend or family member of the client • lack of boundaries in the relationshi. P

Factors Hampering Nurse-Client Relationship • Lack of nurse availability or lack of contact • Lack of nurse self-awareness • Nurse's negative feelings about client (counter transference? ) Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Establishing boundaries • Blurred boundaries – Overhelping – Controlling – Narcissism • Recognizing – Transference • Client unconsciously transfers or displaces feelings formed toward a person in the past to the nurse – Countertransference

Understanding ourselves • Acknowledging values, feelings – Reflects our own culture, experiences

Relationship phases • Preorientation (preliminary preparation) • Orientation (get know meeting, housekeeping) • Working phase – Assessment and explore solutions • Termination phase

INTRODUCTORY/ORIENTATION PHASE • • • Climate Of Trust Expectations and Responsibilities Purpose Of Relationship Meeting, Location, and Time Confidentiality

WORKING PHASE • • explore Identify Stressors Coping Abilities Problem Solving

TERMINATION PHASE • • Evaluate Client’s Progress Decrease Length Of Appointments Focus On The Future Community Links and Referrals

How to Begin the client Interview • Setting that enhances a feeling of security • Seating • Introductions Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Helpful Guidelines • Speak briefly • When you do not know what to say, say nothing • When in doubt focus on feelings • Avoid giving advice • Do not rely on asking questions • Pay attention to nonverbal clues • Focus on the client Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Effective strategies • • Use of silence Active listening Clarifying Open ended questions

Not effective strategies • Asking to many closed ended questions • Asking why questions (implies criticism) • Giving approval or disapproval

Process recording • A tool for self evaluation of interview skill

Clinical supervision refers to a formal, structured process of professional support, learning and reflective practice. It assists with: * understanding issues associated with practice * developing new insights and perspectives * improving knowledge, skills and competence * professional accountability and autonomy.