Therapeutic relationship

Therapeutic relationship in psychiatric nursing

1. THERAPEUTIC RELATIONSHIP MRS BINCY VARGHESE CLINICAL TUTOR

2. INTRODUCTION

3. “ The relationship between a healthcare professional and a client (patient). It is a mean by which the Therapist and a client hope to engage with each other and effect beneficial change in the client” DEFINITION OF THERAPEUTIC RELATIONSHIP

4. “ The interaction process in which the Nurse fulfills her role by using her professional knowledge and skill in such a way that she is able to help the patient physically, socially and emotionally” DEFINITION OF THERAPEUTIC NURSE PATIENT RELATIONSHIP

5. TYPES OF RELATIONSHIP

6. Social Relationship Intimate Relationship Therapeutic Relationship

7. SOCIAL RELATIONSHIP

8. A social relationship is primarily initiated for the purpose of friendship, socializations and companionship The communication is usually centered around sharing ideas, feelings and experiences and meets the basic needs of people. In Therapeutic Nurse patient relationship, the social relationship must be limited

9. INTIMATE RELATIONSHIP

10. A healthy intimate relationship involves two people who are emotionally committed to each other and both concerned about having their needs met and helping each other. The relationship may include sexual or emotional intimacy as well as sharing of mutual goals It has no place in the nurse patient relationship.

11. THERAPEUTIC RELATIONSHIP

12. It focuses on the needs, experiences, feelings and ideas of the client. The areas to be worked on are agreed on and the outcomes are continually evaluated. The nurse uses communication skills, personal strengths and understanding of human behaviour to interact with the client

13. GOALS OF NURSE PATIENT RELATIONSHIP

14. Help to understand his/her problems. Cope with present problems. Identify emerging problems.

15. Find out new alternatives to problems Communicate Try out new patterns of behaviour Socialize

16. FACTORS DETERMINING EFFECTIVE NURSE PATIENT RELATIONSHIP

17. Self Awareness Attitude towards the patient Ability of developing the rapport

18. Self Awareness Self awareness includes self concept, beliefs and values. If a nurse has a positive self concept about herself she will be confident in caring for the patient. But if she has developed a negative self concept, she will not be able to help the patient

19. Attitude towards the patient Nurse must develop an attitude of acceptance of the patient, tolerance of his/her disturbed behaviour and helping the patient She should avoid passing the judgement on the patient

20. Ability of developing the rapport It is defined as a relationship of mutual sympathy and understanding especially between patient and therapist. The essential qualities for developing rapport are warmth, genuineness and empathy

21. QUALITIES OF THERAPEUTIC NURSE PATIENT RELATIONSHIP

22. Genuineness (real and honest) Sincerity Respect Love and affection Concern Listen Empathy (ability to feel with patient) Good communication skills Exploration of problems Self discipline

23. PHASES OF THERAPEUTIC NURSE PATIENT RELATIONSHIP

24. Peplau’s Interpersonal Theory (1962). Preinteraction / Preorientation phase Get available information about the patient from his/her case file, significant others or other health care team members. Examine your own feelings, fears and anxieties

25. Orientation Phase Create an environment of trusting relationship Assessment Identify patient’s problems, strength Formulate nursing diagnosis Set goals which are mutually agreeable Develop plan of action

26. Working Phase Maintain the trust and rapport Solve the patient’s problems Continuously evaluate the progress towards goal attainment

27. Resolution phase/Termination Phase The mutually agreed goals may have been reached The patient may be discharged from hospital Review the progress made

28. THERAPEUTIC IMPASSES Obstacles or blocks which occurs in Therapeutic Nurse Patient relationship

29. Resistance occurs when patient consciously or unconsciously conceals the problems (acting out, forgetful, be silent) Nurse can help client to overcome resistance by pointing out their progress and strength

30. TRANSFERENCE Transference is an unconscious response whereby client identifies the nurse with some significant others. Feelings and attitudes about the other person are transferred to the nurse

31. Created by the nurse The nurse identifies the patient with someone significant to her life (reaction of intense love or caring, hostility) COUNTER TRANSFERENCE

32. GIFT GIVING

33. BOUNDARY VIOLATION

34. It occurs when a nurse goes beyond the established therapeutic relationship and enters into a social, economic or personal relationship with the patient. (patient takes nurse on lunch and dinner, nurse accepts gifts, nurse does business with patient, nurse talks about personal matters with patient, nurse meets patient outside hospital setting)

35. OVERCOMING THERAPEUTIC IMPASSES

36. Be prepared to be exposed to powerful emotional feelings Nurse must have knowledge about impasses The reason behind the behaviour must be explored Try to solve the problem

37. COMMUNICATION SKILL

38. SENDER MESSAGE RECEIVER FEEDBACK ELEMENTS

39. Accept the patient as he is Use self understanding as therapeutic tool Use consistent behaviour Give reassurance in subtle manner Change patient’s behaviour through emotional experience PRINCIPLES OF PSYCHIATRIC NURSING

40. Avoid unnecessary increase in patient’s anxiety Maintain nurse patient relationship Avoid physical or verbal force Provide care to the patient as a person PRINCIPLES OF PSYCHIATRIC NURSING

41. Give explanation at patient’s level of understanding Focus on strength of patient PRINCIPLES OF PSYCHIATRIC NURSING

42. Counsellor Surrogate parent Teacher Social agent Coordinator Client Advocate ROLE OF NURSE

43. Researcher Administrator Supervisor Case Manager ROLE OF NURSE (contd..)