Psych: nurse-cclient relationship

The Therapeutic Nurse-Client Relationship (NCR)

-essential for attaining positive behavioral change

Characteristics

• Goal Directed
• Focused on the need of the patient
• Planned
• Time limited
• Professional


Components of Therapeutic Relationships

• Trust
• Friendliness
• Caring
• Interest
• Understanding
• Consistency
• Treating the client as a human being
• Suggesting without telling
• Approachability
• Listening
• Keeping promises
• Providing schedules of activities
• Honesty

• Genuine interest
• Empathy
• Acceptance
• Positive regards


Self Awareness and Therapeutic Use of Self

- To be able to use self as a therapeutic agent, nurses should be aware of their own self.
- This includes values, beliefs, attitudes, motivations, prejudice, strengths and weaknesses
- A nurse who successfully evaluated and accepted self will have better relationship with clients
- One tool that is useful in learning oneself is Johari’s Window



PHASES OF NURSE- CLIENT RELATIONSHIP (NCR)


A. Pre-interaction/Pre-orientation (For the Nurse)

- the core value and major goal of a nurse is self awareness
- begins when the client is assigned to the nurse
- includes gathering of data, planning for interaction
- nurse may feel little anxiety like in planning an interview


B. ORIENTATION (INITIATION)

- Begins when the nurse meets the client
- The nurse establish roles, the purpose of the meeting, the parameters of the subsequent meeting, assess/identifies the client’s problem, needs and clarifies expectations
- Levels of anxiety of both the nurse and client are identified
- The major goal in this stage is establishing rapport
- Set goals of relationship. –Contracts-
- Define responsibilities of nurse and client. Stage of testing.
- Establish boundaries of relationship. Stress confidentiality.
- The start of termination phase: “Good morning, full name, RN, shift, session, date start & end.”

ESSENTIAL ELEMENTS OF A NURSE- CLIENT CONTRACT
1. Names of RN and patient 5. Purpose of a relationship
2. Roles of RN and patient 6. Meeting location / time
3. Responsibilities of RN and patient 7. Condition for termination
4. Goals / Expectations 8. Confidentiality




C. WORKING PHASE

 Highly individualize
 The most difficult and the longest phase
 Promote acceptance of each other
 Major task is identification and resolution of the client’s problem
 Accept client as having value and worth as a unique individual.
 Most problems encountered are resistance, transference and counter transference
 NCP is a continuing process
- Identification of the problem/exploration
- The Core Value is Consistency especially for manipulative patients
Be consistent to patient with: BAAAM COPS
B orderline C onduct d/o
A ntisocial O ral/eating disorder
A lzheimer’s P aranoid
A utistic S uicidal
M anic

TASK:

1. Maintaining the professional, therapeutic relationship
2. Gathering more data- recognize blocks to communications
3. Exploring perceptions of reality and keeping interactions reality oriented
4. Developing positive coping skills
5. Promoting positive self concept -reflection of feelings
6. Encouraging verbalization of feelings- by active listening
7. Facilitating behavior change
8. Working through resistance
9. Evaluating progress
10. Practice new coping behaviors
11. Promoting independence


D. TERMINATION
 Plan for termination of relationship: orientation phase
 Begins when problems are solved
 It is a weaning process
 Major task is to assist the client in reviewing what has learned and applying it to interpersonal relationships
- Separation Anxiety:
S/Sx: Regression: Temper tantrums, thumb sucking, apathy, fetal position when crying.

- Evaluation
 Maintain boundaries do not give address and telephone numbers
 Be firm and professional
 Don’t promise that relationship will continue
 Anticipate problems of termination:
 Dependency on the nurse
 Recalling of past negative experiences like rejection, depression, abandonment,
 Regressive behaviors may surface