The Therapeutic Nurse-The Therapeutic Nurse-Patient RelationshipPatient Relationship

In a therapeutic relationship…In a therapeutic relationship…

There are specific goalsThere are specific goals The patient’s needs are the focus The patient’s needs are the focus

(relationship is client centered)(relationship is client centered) The nurse makes use of specific The nurse makes use of specific

communication and relationship skillscommunication and relationship skills

In a social relationship…In a social relationship…

There are not necessarily specific goals There are not necessarily specific goals beyond friendship and socializingbeyond friendship and socializing

The needs of both parties are the fociThe needs of both parties are the foci The information exchanged may remain The information exchanged may remain

superficialsuperficial The skills used are the general socialization The skills used are the general socialization

and communications skills everyone in the and communications skills everyone in the culture usesculture uses

In an intimate relationship…In an intimate relationship…

Mutual needs are metMutual needs are met Each party usually cares about meeting the Each party usually cares about meeting the

needs of the otherneeds of the other The parties have an emotional commitment The parties have an emotional commitment

to each otherto each other Mutual fantasies and desires may be Mutual fantasies and desires may be

satisfiedsatisfied Information shared may be personal and Information shared may be personal and

intimateintimate

Phases of a Therapeutic Phases of a Therapeutic RelationshipRelationship

Preorientation or preinteraction phasePreorientation or preinteraction phase Orientation phaseOrientation phase Working phaseWorking phase Termination phaseTermination phase

Preinteraction StagePreinteraction Stage

Self-explorationSelf-exploration Create the setting – comfortable, safeCreate the setting – comfortable, safe Prepare for the interaction/relationship –Prepare for the interaction/relationship –

review patient’s history, diagnosis, review review patient’s history, diagnosis, review nursing theorynursing theory

Anticipate obstacles, difficultiesAnticipate obstacles, difficulties Consider the timing of nurse/patient Consider the timing of nurse/patient

interactionsinteractions

Orientation or Introductory StageOrientation or Introductory Stage

IntroductionsIntroductions Discuss nurse’s role Discuss nurse’s role Gives patient information about the Gives patient information about the

purpose, possible goals, and the time frame purpose, possible goals, and the time frame of the relationshipof the relationship

Include the patient as a partner in the Include the patient as a partner in the relationshiprelationship

Assess the patient’s problems and needsAssess the patient’s problems and needs Plan goals and outcomes with the patientPlan goals and outcomes with the patient Develop trust and rapport with the patientDevelop trust and rapport with the patient Demonstrate caringDemonstrate caring Demonstrate that you see the patient as an Demonstrate that you see the patient as an

individualindividual

Working StageWorking Stage Implement the plan of careImplement the plan of care Evaluate intermediate outcomesEvaluate intermediate outcomes Re-plan if necessary; think of alternative Re-plan if necessary; think of alternative

solutionssolutions Implement alternative solutionsImplement alternative solutions Refer patient, if necessaryRefer patient, if necessary

Termination StageTermination Stage

Begins during the first interaction with the Begins during the first interaction with the patientpatient

Occurs when goals have been reached or Occurs when goals have been reached or referral is advisablereferral is advisable

Nurse and patient examine meaning and Nurse and patient examine meaning and value of the relationshipvalue of the relationship

Feelings are discussedFeelings are discussed

Termination Stage cont.Termination Stage cont.

Plans for follow-up are made, if necessaryPlans for follow-up are made, if necessary Anticipatory guidance and/or teaching Anticipatory guidance and/or teaching

should be done or repeatedshould be done or repeated Evaluation of outcomesEvaluation of outcomes Summarization of the relationship and the Summarization of the relationship and the

goals achievedgoals achieved Give this stage adequate time but do not Give this stage adequate time but do not

dwell on itdwell on it

BoundariesBoundaries

Psychological, communicationPsychological, communication– Be aware of the nurse’s roleBe aware of the nurse’s role– Limit self-disclosureLimit self-disclosure– Be aware of over involvementBe aware of over involvement– Confront/correct sexual innuendos or actionsConfront/correct sexual innuendos or actions

Boundaries cont.Boundaries cont.

PhysicalPhysical– Allow the patient his/her personal spaceAllow the patient his/her personal space– Use touch cautiously Use touch cautiously – Be aware of patient’s cultural patternBe aware of patient’s cultural pattern

Transference Transference

Transference – “…a person unconsciously Transference – “…a person unconsciously and inappropriately displaces onto and inappropriately displaces onto individuals in his or her current life those individuals in his or her current life those patterns of behavior and emotional reactions patterns of behavior and emotional reactions that originated with significant figures n that originated with significant figures n childhood.”(Varcarolis, 1998)childhood.”(Varcarolis, 1998)

CountertransferenceCountertransference

Countertransference – “…the tendency of Countertransference – “…the tendency of the therapist to displace onto the client the therapist to displace onto the client feelings caused by people in the therapist’s feelings caused by people in the therapist’s past.”(Varcarolis,1998)past.”(Varcarolis,1998)

Countertransference cont.Countertransference cont.

Dealt with best by self-examination and by Dealt with best by self-examination and by supervision by a more experienced supervision by a more experienced professional or by a peer.professional or by a peer.