Nurse patient relationship

Introduction, Types of Relationships, Therapeutic Nurse-Client Relationship and its Phases of N-P-R.

1. NURSE - PATIENT RELATIONSHIP ANAMIKA RAMAWAT RNRM, MSN(OBG NURSING) NURSING LECTURER VYAS CON, Jodhpur

2. INTRODUCTION The nurse-client relationship is the foundation upon which nursing care is established. It is a relationship in which both participants must recognize each other as unique and important human beings. It is also a relationship in which mutual learning occurs.

3. NURSE RELATION + CLIENT = NURSE CLIENT RELATIONSHIP

4. THERAPEUTIC NURSE CLIENT/PATIENT RELATIONSHIP Definition of relationship: It is defined as a state of being related or state affinity(liking) between two individuals. Example- friendship and colleagues. Definition therapeutic relationship: It is a relationship where the nurse and client work together towards the goal of assisting the client to regain the inner resources to meet life challenges and facilitate growth of health.

5. TYPES OF RELATIONSHIPS

6. THERAPEUTIC RELATIONSHIP: It is goal oriented, interaction is purposefully established, maintained and carried out with the anticipated outcome of the helping the client gain coping and adaptation skills in living life. In this client regain the inner resources to meet the challenges and facilitates personal growth.

7. The nurse – client relationship establishes from a series of interaction between a nurse and client over a period of time, with the nurse focusing on the needs and problems of the person family group while using scientific knowledge and special skills of the nursing profession. First relationship defined between the client and nurse.  The relationship can emerge between a nurse and client, client’s home, in the hospital. Second - Goal directed characteristic of one to one relationship focuses the energies of the nurse and client. Third - It is the mutual collaboration with equal emphasis on mutual and collaboration basic to this concept

8. GOALS OF THE THERAPEUTIC NURSE CLIENT RELATIONSHIP Travelbee joyce , in intervention in nursing care, has been discussed nine goals of one to one relationship. They are: The nurse helps the client to cope with the present problems. The nurse the client to understand his problem. The nurse the client to understand his active participation in an experience. The nurse assists the Client realistically. The nurse helps the client to find out a new alternative for his or her problem The nurse the client to try out new patterns of behavior The nurse helps the client to communicate. The nurse helps the client to socialize The nurse helps the client to find a meaning in his illness

9. CONDITIONS ESSENTIAL TO DEVOLOPMENT OF A THERAPEUTIC NURSE CLIENT RELATIONSHIP

10. PHASES OF NURSE CLIENT RELATIONSHIP Nurse client relationship is the end result of a series of planned purposeful interactions between nurse and client. It can be described in four phase-  

11. Preorientation/ Preinteraction Phase Definition: This is a phase in which a nurse goes through before the actual interaction with the client. This phase begins when the nurse is assigned a client to develop therapeutic relationship with him, till she goes to him for interaction.

12. TASKS Before meeting the client: Explores own feelings and fears Analyze own professional strengths and limitations Gather data about client wherever possible Plan for first meeting with client or Set the objectives for interaction phase Takes help of the clinical supervisor or co-worker to overcome fears. Review available data, including the medical and nursing history. Talk to other caregivers who have information about the client. Anticipate health concerns or issues that arise. Identify a location and setting that will foster comfortable, private interaction. Plan enough time for the initial interaction.

13. Orientation Phase Definition: This is a phase which begins when the nurse goes to the client, introduces self and gets introduction about him. The nurse and client who are strangers meet for the first time and become acquaintances. This ends when the client and nurse accept each other as a unique human being. One of the nurse’s primary concerns is to find out the client sought help. This forms basis for the nursing assessment and helps the nurse to focus on the client’s problem and to determine client’s level of motivation.

14. TASKS Establishment of contact, rapport, trust and acceptance Establish communication, assist in the verbal expression of thoughts and feelings Gather data, including the client’s feelings, strengths and weaknesses Define client’s problems, set priorities for nursing intervention When the nurse and client meet and get to know one another: Set the tone for the relationship by adopting a warm, empathetic, caring manner Recognize that the initial relationship is often superficial, uncertain, and tentative Closely observe the client, and expect to be closely observed by the client Begin to make inferences and form judgments about client messages and behaviours Assess the client's health status Prioritize the client's problems, and identify the client's goals Clarify the clients and nurse's roles Form contracts with the client that specify who will do what Let the client know when to expect the relationship to be terminated

15. Working Phase Working phase or phase of emerging identities of the nurse-client relationship starts when the nurse and the client are able to overcome the barrier of orientation or introductory (period) phase. During this phase the nurse and client actively work on meeting the goals which they had established during the orientation phase. The characteristic features of this phase are that the nurse is able to overcome anxiety and the client’s fear of unknown is also decreased.

16. When the nurse and client work together to solve problems and accomplish goals: The nurse collects the data in detail from primary and secondary sources and identifies the needs of the client The nurse assists the client to identify his or her problems, share feelings and get socialize Help the client to communicate Encourage and help the client to express feelings about his or her health Provide information needed to understand and change behavior Encourage and help the client to set goals Take action to meet the goals set with the client Use therapeutic communication skills to facilitate successful interactions Use appropriate self-disclosure and confrontation The nurse helps the client to find an alternative solution to his or her problem or development of insight and use of constructive coping mechanism The nurse helps the client to understand that he has a significant role in his treatment She prepares the client for termination of relationship by reminding him during the interviews Provide him with opportunities for independent functioning Evaluate problems and goals, refine as necessary

17. Termination Phase It is also called as resolution phase or end phase. Goal: To bring a therapeutic end to the relationship.

18. TASKS During the ending of the relationship: Remind the client that termination is near Evaluate goal achievement with the client Separate from the client by relinquishing responsibility for his or her care Achieve a smooth transition for the client to other caregivers as needed Establish reality of separation Mutually, explore feelings of rejection, loss, sadness, anger and related behavior, if attached Review progress of therapy and attainment of goals Formulate plans for meetings future therapy needs.

19. SUMMARY…  

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