The Nurse Client Relationship

The Nurse Client Relationship


Nurse-Client Relationship
What is the nurse-client relationship?
Main tool of psychiatric nursing
Anodyne
Confidential
Reliable
Consistent
With clear boundaries

Social Relationships
Initiated for the purpose of friendship, socialization or task accomplishment.
Mutual needs are met during interaction.
Communication includes giving advice and ask for or provide help with jobs.
Content of communication may be superficial, roles may shift.
No evaluation

Intimate Relationships
Individuals have an emotional
commitment
Often a partnership where mutual needs are met
Short and long term goals are mutual
Personal and intimate information are shared
Emotional satisfaction, security, sex, procreation, etc.

Therapeutic Relationships
Relationship consistently focused on the client s problems and needs
Potential solutions to problems discussed
Client chooses and implements plans
New coping skills develop
Behavioral change encouraged
Nurse’s Behaviors that Facilitated
Growth and Change in Clients
Genuineness “Being yourself”
Self-awareness of one s feelings
Ability to communicate one s feelings when appropriate
Key ingredient in building trust
Empathy
Understanding the client’s feelings and ideas accurately
Accurate understanding of client s communication
Communicating understanding to the client and check for accuracy
Acting on “this understanding” in a helpful way

Nurse’s Behaviors that Facilitated
Growth and Change in Clients
Positive self-regard
Respect communicated indirectly
by actions
Help client to develop own personal resources and actualize his living potential
Nonjudgmental focus on client s thoughts, feelings to understand behaviors
Cultural sensitivity

Boundaries of the
Nurse-Client Relationship

Client s needs are separated from the nurse s needs

Client s role is different from that of the nurse

Boundaries Blurred
Nurses’ actions are overly helpful, controlling, or narcissistic
Transference- Client’s feelings and behaviors from childhood are displaced onto another person (nurse).
Counter-transference- Nurse displaces onto client feelings related to people in the nurse’s past.
Phases of Nurse-Client Relationship

Orientation
Working
Termination
Orientation Phase
Establish
Trust
Parameters of the relationship
Formal or informal contract
Confidentiality
Termination begins
Assessment, nursing diagnosis, mutually agreed goals, plan of actions

Working Phase

Maintain relationship
Gather further data
Promote clients
Problem-solving skills
Self-esteem
Use of language

Working Phase - Continued

Facilitate behavioral change
Overcome resistant behaviors
Evaluate problems and goals
Redefine them as necessary
Promote practice and expression
of alternative adaptive behaviors

Termination Phase
Nurse and client express feelings about termination
Evaluating outcomes, goals and interventions
Summarize goals and objectives achieved
Review client s plans for future
Finalize termination


Factors Facilitating the
Nurse-Client Relationship


Consistent, regular, and private interactions with client
Being honest and congruent
Letting client set the pace
Listening to client s concerns
Factors Facilitating the
Nurse-Client Relationship

Positive initial attitudes and preconceptions
Promoting client comfort and balancing control
Client demonstrating trust and active participation in relationship


How to Begin Communication

Setting

Seating

Introductions

Helpful Guidelines
Speak briefly
When you do not know what to say,
say nothing
When in doubt focus on feelings
Avoid giving advice
Do not rely on asking questions
Pay attention to nonverbal clues
Focus on the client

Client’s Behaviors
Cries
Asks nurse to keep a secret
Leaves before a session is over
Interrupted by another client
Communicates thoughts of suicide

Client’s Behaviors

Does not want to talk
Seeks to prolong the interview
Gives the nurse a present
Asks the nurse a personal question

Factors that Affect Communication
Personal
Emotional
Social
Cognitive
Environmental
Physical
Societal determinants

Therapeutic Communication
Verbal- all words a person speaks
Communicates- Beliefs, values, perceptions
Convey- interest, understanding or the opposite, clear or distorted

Non-Verbal- 95% of a message
Kinesics - Proxemics - Verbal tracking
Silence - Touch - Paralanguage
Eye contact - Culture
Therapeutic Techniques
Silence
Accepting
Giving recognition
Offering self
General leads
Broad opening
Making observations
Restating
Reflecting

Focusing
Exploring
Giving information
Clarification
Presenting reality
Voicing doubt
Encouraging evaluation
Summarizing
See table 11-4 p.187
Detrimental Nurse-Client Relationship
Nurse tries to get his or her own needs met by wanting the client to like them
Nurse tries to solve the client s problems
Expects the client to do as suggested
Nurse takes the role of a friend or family member of the client
Lack of boundaries in the relationship

Factors Hindering
Nurse-Client Relationship

Lack of nurse availability or lack
of contact
Lack of nurse self-awareness
Nurse s negative feelings about client

Blocks to Therapeutic Communication

Obstructive techniques
Asking excessive questions
Giving approval or disapproval
Advising
Asking "why" questions

Blocks to Therapeutic Communication Table 11-5 p.191
Giving advice
Minimizing feelings
False reassurance
Showing non-verbal signs of boredom
Making value judgments
Changing the subject
Asking “Why” questions
Asking excessive questions
Giving approval, agreeing
Disapproving, disagreeing