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Learning Outcomes
• Describe necessary components in the nurse-patient
relationship.
• Explain the importance of values, beliefs, and attitudes
in the development of the nurse-patient relationship.
• Describe the importance of self-awareness and
therapeutic use of self in the nurse-patient
relationship.
• Describe the differences between social and
therapeutic relationships.
• Describe and implement the phases of the nurse-
patient relationship.
• Explain the negative behaviors that can diminish the
nurse-patient relationship.
Therapeutic Relationships
• The ability to establish therapeutic relationships with
patients is one of the most important skills a nurse can
develop
• The therapeutic relationship is especially crucial to the
success of interventions with clients requiring
psychiatric care because the therapeutic relationship
and the communication within it serve as the
underpinning for treatment and success
• Therapeutic nurse-client relationships:
– Trust
– Genuine interest
– Acceptance
– Positive regard
– Self awareness
– Therapeutic use of self
Therapeutic nurse-patient relationship
• Purposeful and goal-directed
– Directed towards the clients needs
• Has defined boundaries
– Clients know what they can do and the nurse defines these
boundaries
• Is structured to meet the patient’s needs
• Is safe, confidential, reliable, and consistent
– A social relationship between friends is subject matter, in a
therapeutic relationship there is no social relationship, its all
about the patient
• Nurse is responsible for initiating the nurse-patient
relationship
Therapeutic Relationships (cont’d)
• Components include:
– Trust
• Builds when the client is confident in the nurse and when the nurse’s
presence convey integrity and reliability
• Develops when the client believes that the nurse will be consistent in her
words and actions, can be relied on
• Congruence (when words and actions match)
– Ex. Nurse has to leave for a meeting and says she will be back at 2 pm, and she
is back by 2 pm
– Genuine interest
• When the nurse is comfortable with herself, aware of her strengths and
limitation, and is clearly focused
• Dishonest or artificial behavior: asking a question and not waiting for the
answer, talking over the client
• Revealing personal information (biographical data, ideas, thoughts,
feeling) can enhance openness and honesty and allow for the client to
share more information about themselves
– Empathy (not sympathy)
• The ability of the nurse to perceive the meaning and feelings of the client
and to communicate that understanding to the client
• Being able to put myself in the clients shoes (not poor you = sympathy)
• “gift of self”: client – by feeling safe enough to share feelings; nurse – by
listening closely enough to understand
Therapeutic Relationships (cont’d)
– Acceptance of person, not necessarily his or her behavior
• Nurse does not become upset or respond negatively to a client’s
outburst, anger or acting out
• Avoiding judgment of the person no matter what the behavior but be
clear and firm
– Unconditional positive regard
• Appreciates the client as a unique worthwhile human being can
respect the client regardless of his or her behavior, background, or
lifestyle
• Unconditional nonjudgmental attitude (don’t have to accept behavior)
• Calling the client by name, spending time with the client, listening and
responding openly
• Consider the client’s ideas and preferences
• Attending – uses nonverbal and verbal communication techniques to
make the client aware that he is receiving full attention
– Nonverbal: leaning toward the client, maintaining eye contact, being relaxed,
arms at side, interested but neutral attitude
– Verbal: avoids communicating value judgments or negative opinions about
the client’s behavior
– Self-awareness and therapeutic use of self
• Before the nurse can understand clients, the nurse must first know
herself
• (Next slide )
Self-Awareness and Therapeutic Use of Self
• Self-awareness: process of understanding one’s own values,
beliefs, thoughts, feelings, attitudes, motivations, strengths, and
limitations and how one’s thoughts and behaviors affect others
– Allows the nurse to observe, pay attention to and understand the subtle
responses and reactions of clients interacting with them
• Values: abstract standards that give a person a sense of right
and wrong and establish a code of conduct for living
– Hard work, honesty, sincerity, cleanliness, orderliness
– Choosing – when the person considers a range of possibilities and freely
chooses the value that feels right
– Prizing – when the person considers the value, cherishes it, and publicly
attaches it to herself
– Acting – when the person puts the value into action
• Beliefs: ideas that one holds to be true
– Ex. All old people are hard of hearing
• Attitudes: are general feelings or a frame of reference around
which a person organized knowledge about the world
Therapeutic Use of Self
• Therapeutic use of self: the nurse uses aspects of his or
her personality, experience, values, feelings, intelligence,
needs, coping skills, and perceptions to establish
relationships with clients that are beneficial to clients
– Nurses use themselves as a therapeutic tool to establish
therapeutic relationships with clients and to help clients grow,
change, and heal
– Nurse’s personal actions arise from conscious and unconscious
responses that are formed by life experiences and educational,
spiritual and cultural values
– Johari window
• Quadrant 1: open/public self – qualities one knows about self and others
also know
• Quadrant 2: blind/unaware self – qualities know only to others
• Quadrant 3: hidden/private self – qualities know only on oneself
• Quadrant 4: unknown – an empty quadrant to symbolize qualities as yet
undiscovered by oneself or others
Establishing the Therapeutic Relationship
• Therapeutic relationships are focused on the needs, experiences,
feelings, and ideas of the patient, not the nurse
• The therapeutic relationship consists of three phases:
– Orientation – begins when the nurse and client meet and ends
when the client begins to identify problems to examine
– Working – divided into 2 sub-phases:
• Problem identification: client identifies the issues or concerns causing
problems
• Exploitation: the nurse guides the client to examine feelings and
responses and to develop better coping skills and a more positive self
image, this encourages behavior change and develops independence
– Termination – final stage in nurse-client relationship, begins
when the problems are resolved, and it ends when the
relationship is ended
• Client may feel the termination as an impending loss, often try to avoid
termination by acting angry or as if the problem has not been resolved
Establishing the Therapeutic Relationship (cont’d)