AL-barrak 2008 15
King Saud University
College of nursing
Master program
Course number \ 520 NUR
Nurse-patient relationship
“People will forget what you say to them. They will never forget how you make them feel.”
Under supervision of \
Prof. Dr Elham Fayad
Prepared by \
Mofida AL-barrak
14 \ 4 \ 1429 H
Objective:
At the end of this session the student will be able to:
1. Define the Nurse-patient relationship.
2-Analyse importance of the Nurse-patient relationship
3. Differentiate between social and professional relationship.
4-Apply principles underlying nurse patient relationship.
5-Discuss phases of the Nurse-patient relationship.
6. Assisting patient to build trust relationship with others.
7. Compare and contrast between elements of effective therapeutic relationship.
Outline:
1. Definition of nurse-patient relationship.
2. Importance of the Nurse-patient relationship
3. Types of relationships.
4-Types of personal space
4. Principles underlying nurse patient relationship
5. Phases of the nurses patient relationship
6. Elements of effective therapeutic relationship
Introduction
The nurse–patient relationship is viewed as central or
Foundational to the practice of nursing.
The nature of the nurse –patient relationship its importance
in psychiatric nursing the principles behind it and the stages of it are going to be explored in the following part
Definition of the nurse –patient relationship
It is a relation that involves two persons a professional one (nurse) who has the ability to help and relieve patients discomfort and the other person (patient) who is seeking relief of some exiting condition
Definition of therapeutic relationship
The nurse's therapeutic relationship with a client is an interpersonal helping process based on theory:
a. Interpersonal:
Because the nurse reaches out as one human being to another to enable the client to experience being listened to having her personal worth affirmed.
b. Helping :
Because it is focused towards the client's care, well being, learning growth.
c. Theory based:
Because it requires knowledge and skill.
Therapeutic patient's relationship.
Therapeutic relationship involves planned & structured psychological, psychosocial & /or interpersonal interventions aimed at influencing a behavior, mood and/or thee motional reactions to different stimuli.
1- Failure in early relationships then in later life is one of the factors contributing to mental illness.
2- The nurse-patient relationship could be used to re-educate mental patients to relate properly to people.
3- Patients needs can only be assessed and met through this relationship.
4- It is one of the tools of psychotherapy.
5- It can be used to influence the patient towards participation in other forms of treatment.
6- It provides changes and growth the nurse and patient.
7- The patents ability to return to the community depends on this relationship.
Characteristic / Professional relationship / SocialConcern / 1.Concerned with helping the patients( regardless their sex religion race……. etc) / Interaction is primarily for reason of pleasure or
friendship
Responsibility / 2.Require the help of persons with scientific knowledge and special skills (the nurse) / No person is in the position of responsibility of helping the other
Intention / 3.There is intention of dealing with others problems / There is no this intention
Goal / 4.The relationship is purposeful directed toward a therapeutic end / The goal is more or less social
Content / 5.The relationship should not entail nurse personal matters or problems
i.e.
achieve patients needs not nurses need / It is up to the partners to share their personal affair
i.e.
achieve both persons needs
Length / 6. Time limited / Unlimited
Termination / 7. it can not finish until reach to its goal of patient recovery / It may be finish at any times any person can relief unpleasant situation
Types of relation ships
There are mainly tree types of relationships
1. Therapeutic relation ship (Helping)
2. Professional relationship (At work)
3. Social relationship (Friends)
Principles underlying the nurse –patient relationship
1- To follow the psychiatric nursing principles
2. To understand the patient's needs & his way to express it.
3-To develop awareness of the total client know his physical and psychosocial needs are sensitive to his way of expressing these needs.
4- To understand herself, her feelings motives needs prejudices etc and to develop awareness of what she is doing why she is doing it and how does this affect the relationship
5- To develop the ability to empathize with her patient empathy helps the nurse to understand not how she might feel in the situation but how the patient feels in the situation
6- To use appropriate limits and maintain consistency in setting it
7. To properly use communication techniques
8. To benefit from previous experience with other patients
5. Phases of nurse-patient relationship
Peplau (1952) described four phases of the nurse–patient relationship: orientation, identification, exploitation resolution.
Phases of the nurse – patient relationship:
1) Initiation (orientation) phase:
a) Description:
Partners (nurse –patient) are strangers to each other.
Both are lacking knowledge about the Situation, having high level of anxiety, lacking trust and having great need for dependency
Both are having mutual Expectations.
The patient may behave in a manner to test the nurse , the whole situation, may resist sharing his feelings.
b) Nurse's aim:
· To establish contract.
· To collect information.
· To maintain rapport.
· To gain patient acceptance and trust.
c) Tasks involved:
· Orient the patient to herself, hospital personnel, facilities, rules, & routines.
· Collect data through observation & Interviews and identify problems.
· Hold neutral attitude towards patient's beliefs and actions.
· Allow for some degree of dependency.
· Be honest and consistent to build up trust and security in patient.
· Establish a clear contract with the patient (state the goal of the relationship, behavioral changes required, expected
Limits, etc.)
· Make a tentative care plan, carry it out & modify it as more data are gathered.
2) Continuation (Active Working) phase:
a) Description:
Lowering of anxiety level, increased feeling of trust, however some patients may continue to test the nurse.
Nurse patient are more knowledgeable about the situation
Both are working on patient's problems, the patient usually look forward for the nurse's visit, & vacillate between dependency independency.
b) Nurse's aim:
· To plan on clear basis.
· To enhance patient's acceptance and trust.
· To encourage patient's participation in his care.
· To solve patients' problems.
· To encourage patient's independency.
c) Tasks involved:
· Encourage patient to verbalize, extend his discussion and give emotional support to continue verbalization.
· Promote attitude of acceptance to decrease anxiety.
· Examine patient,s problems and deal with it directly with
The patient.
· Focus on increasing patient,s independence.
· Encourage the client to confront and work on identified
Problems.
3) Termination (Concluding) phase:
a) Description:
Patient is almost cured, or at least integrated functioning up to his abilities, fairly independent & ready for discharge.
Feelings about separation may arouse in both patient nurse.
Sometimes problems of termination occur in the form of relapsing symptoms, regressive behavior \ or feelings of rejection Depression.
b) Nurse's aim:
To make the process of termination and discharge as easy and non – traumatic ton the patient as possible.
b) Tasks involved:
· Plan for the conclusion of therapy early in the development of relationship.
· Wean the patient's from the relationship gradually by decreasing her visits, encouraging patient's socialization, allow frequent temporary leaves before final discharge allowing patient to drop inform time to time visit the staff.
· Anticipate problems of termination.
· Encourage patient to become independent.
· Discuss patient's previous experience with separation.
· Discuss patient's feelings about termination.
6. Elements of effective therapeutic relationship
1. Respect:
The nurse respects the patient through:
1. Recognize the client's feeling, beliefs experiences.
2. Actively listen to the patient.
2. Genuineness
Genuineness in a relationship means real, i.e. the nurse believes or feels what is expressed.
This is congruence and is basic to establishment of interpersonal trust.
The nurse's genuineness encourages the patient to:
1. Self disclose.
2. Communicate information or emotions.
3. Differentiate between social relationship and authentic therapeutic relationship
3. Hope:
When people face the repeated negative experiences and have thus lost respect for themselves, trust in their abilities and faith in their potentials, so the nurse should help the patient to:
1. Recognize her beliefs in these potentials.
2. Realize that she should continue taking the medication.
3. Convey to the patient any small changes and success and communicate them to the patient.
4. Assist the patient in seeing the self as confronting problems.
5. Help the patient to make changes that he wishes to make and are right for her.
4. Empathy (objectivity)
Empathy is significant in the nurse-client relationship.
Empathy means: that the nurse comprehend what the client is experiencing, the nurse will undergo this through:
1. Observe the patient's physical demands and listening to content and the style of what is said.
2. Develop spontaneous, emotional awareness of the patient.
3. Develop the ability to alternate between effectively participating with the patients and intellectually observing the patient.
4. Differentiate between sympathy and empathy.
Sympathy (subjectivity)means that the nurse feels sorry for the patient.
Conclusion
Nurses attempt to understand and meet the many needs of a diverse client population. In order to do so, nurses must establish therapeutic relationships with their clients, and the quality of those relationships is directly related to the quality of communication between nurse and client
References
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Morse J. (1991) Negotiating commitment and involvement in
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DeLaune, S., & Ladner, P. (2002). Fundamentals of Nursing
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Desmond, J., & Copeland, L. (2000). Communicating with
today’s patient. San Francisco: Jossey-Bass.
Giger, J. N., & Davidhizar, R. E. (1999). Transcultural nursing:
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Web Resources
Administration on Aging
http://www.aoa.gov
Center for the Advancement of Health
http://www.cfah.org
Gordon Training International
http://www.activelistening.com
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