NCM 117 RLE - THERAPEUTIC RELATIONSHIPS unconditional and nonjudgmental; implies

respect
the ability to establish therapeutic relationships
self-awareness – developing an understanding
with clients is one of the most important skills a
of one’s own values, beliefs, thoughts feelings,
nurse can develop
attitudes, motivations, and behaviors affect
all intentional interaction with clients that are
others
helpful are therapeutic
therapeutic use of self – nurse uses aspects of
a relationship exists between the client and a
his/her personality, experience, values, feelings,
nurse only exist when they are significant to each
intelligence, needs, coping skills, and
other
perceptions to establish relationships that are
the opinion of another makes a difference on
beneficial to clients
how one views oneself
the potential for corrective emotional The Johari Window
experiences exists, if achieved, the relationship
tool for learning about oneself
becomes therapeutic
self-awareness tool that categorizes qualities of
boundaries are critical in maintaining a
self as:
professional relationship
 open/public
at the beginning of the relationship, an
 blind/unaware
agreement or contract should be established
 hidden/private
 excellent opportunity to establish rules,
 unknown
behaviors, and relationship
creates a word portrait of a person in 4 areas
 time and frequency of meetings,
first step – appraise his/her own qualities by
reimbursement of services, contact with
creating a list
family and SOs and other therapists, and
 values, attitudes, feelings, strengths,
prohibition against socializations
accomplishments, behaviors, needs,
many factors can enhance the NC relationship
desires, and thoughts
and it is our responsibility to develop them
second step – find out other’s perceptions by
Components or Factors which Enhance Nurse-Client interviewing them and asking them to list
Relationship qualities they see in the nurse (positive and
negative)
trust – caring, openness, objectivity, respect,
the opinions given must be honest and no
interest, understanding, consistency, treating as
sanctions must be taken against those who list
a human being, suggesting without telling,
negative qualities
listening, keeping promises, and honesty
third step – compare lists and assign qualities to
genuine interest – when the nurse is
the appropriate quadrants
comfortable with oneself and aware of strength
if the first quadrant is the longest, this means
and limitations and clearly focused the client
that the nurse is open to others
perceives a genuine person showing genuine
if the first quadrant is smaller, this means that
interest
the nurse shares little about oneself
empathy – ability of nurse to perceive the
if quadrants 1 & 3 are both small, the person
meanings & feelings of the client and to
demonstrates little insight
communicate that understanding to the client;
any change in 1Q is reflected by changes in other
essential skill to develop; being able to put
quadrants
oneself in another’s shoes
the goal is to work toward moving qualities from
acceptance of person – the nurse who does not
Q234 towards Q1 (qualities known to self and
become upset or respond negatively to client’s
others, indicates self-knowledge and awareness)
outburst, avoiding judgement no matter what
the behavior Patterns of Knowing
unconditional positive regard – appreciate the
ways of observing and understanding client
client as a unique being, can respect regardless
interactions
of behavior, background, and lifestyle;
 empirical – from nursing science

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  personal – from life experiences nurse must be acutely aware of 2 common
 ethical – from moral nursing knowledge elements that can arise
 aesthetic – from art of nursing  transference: happens when the client
 unknowing – when the nurse admits unconsciously transfer feelings they
he/she does not know the client or have for significant persons in their life
understand the client’s subjective world onto the nurse
 countertransference: when the nurse
Establishing the Therapeutic Relationship
responds to the client based on his/her
therapeutic relationships are focused on the own unconscious needs and conflicts
needs, experiences, feelings, and ideas of the
The Termination/Resolution Phase
client, not the nurse
the therapeutic relationship consists of 3 phases: goal: client and nurse to integrate helpful
 orientation experiences so that what has been learned may
 working be used in future relationships
 termination the more successful the relationship, the more
painful is the termination
Orientation Phase/Getting Acquainted
as a result, both are tempted to deny the
the nurse and client agree on a mutually inevitable and pretend that their parting is only
acceptable contract that establishes the temporary
relationship’s parameters these strategies are comforting in the short term
the goals of this phase are to develop trust and but do not help in the long run
establish the nurse as a significant other to the a therapeutic relationship remains the most
client useful tool when working with mentally ill clients
consistency and acceptance are desirable, these and the effectiveness depends on the nurse’s
behaviors are essential during the OP self-awareness
client learns to trust the nurse if one conveys begins when the client’s problem is resolved
acceptance of the client and exhibit consistent ends when the relationship is ended
behavior deals with the feelings of anger or abandonment
once client begins to trust the nurse, he/she may that may occur
engage in behaviors designed to test the nurse’s
Behaviors that Diminish Therapeutic Relationships
sincerity
during this stage, clients commonly arrive late inappropriate boundaries (relationship becomes
for an appointment social or intimate)
it is important to consistently convey acceptance feelings of sympathy and encouraging
of the client as a valued, worthwhile individual dependency
non-acceptance of the client as a person
Working Phase
because of his/her behaviors, leading to
problem identification avoidance of the client
 the client identifies issues/concerns nurse’s self-awareness is the way to avoid such
causing problems problems
 highly-individualized nature of the
Therapeutic Roles of the Nurse in a Relationship
client’s problems
 examination of client’s feelings and teacher – teach new methods of coping and
responses solving problems
nurse assumes roles of socializing agent, caregiver – implementation of therapeutic
counselor, or teacher as the nurse and client relationship to build trust, explore feelings, assist
tackle the issues facing the client in problem solving, and help meet psychosocial
exploitation needs
 development of better coping skills and advocate – nurse informs client and supports
a more positive self-image, behavior him/her in whatever decision he/she makes
changes, and independence

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 parent surrogate – when the nurse is required to
provide personal care such as feeding/bathing;
as evidenced in choice of words and non-verbal
communication

Self-Awareness Issues

self-awareness on the nurse’s part is crucial to

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