Unit – 4 THERAPEUTIC NURSE-PATIENT RELATIONSHIP

Definition:-

A series of interactions between a nurse and a patient in which the nurse helps the patient achieve positive behavior change. The therapeutic nurse-patient relationship is defined as an interaction in which the nurse uses her professional knowledge and skills and is based on trust and respect. Helps the patient physically, socially, emotionally.

★Some Types Of Therapeutic Relationship

• Social Relationships
• Intimate relationships

•Therapeutic relationship

~Social Relationships

The purpose of this relationship is friendship, socialization and support to each other. Their focus is on sharing ideas, feelings and experiences with each other and providing basic needs through interaction. This relationship is useful for individuals and families who are part of society.

For example, participating in work, giving advice and helping others.

~intimate relationship

An intimate relationship is seen between two individuals who have an emotional commitment to each other.

People in intimate relationships usually react naturally to each other. They set specific goals.

Individuals form intimate relationships to increase their economic security and reduce loneliness.

~Therapeutic Relationship

The therapeutic relationship focuses on the client’s needs, experiences, feelings, and thoughts. The nurse uses communication skills, personal strengths and understanding of human behavior to communicate with the client. She is goal oriented.

COMPONENTS OR ELEMENTS OF THERAPEUTIC RELATIONSHIP

Acceptance

To be accepted regardless of the patient’s social condition, background, or illness. They should be treated the same or treat them as equals and use the therapeutic aspect to maintain a relationship with them.

Trust

To trust another, one must feel confident in that person’s presence, reliability, honesty, truthfulness, and ability to provide help when requested.

Trust is an appropriate nursing intervention that provides warmth and a sense of caring to the client.

Rapport

A report is a relation or communication, especially when useful and harmonious. It is the core of the therapeutic relationship between nurse and patient. Rapport is a relationship of mutual understanding or trust and agreement between people. It implies a special emotional rapport of both client and nurse based on acceptance, warmth, friendliness, common interest and a sense of trust and critical attitude.

Empathy

Empathy is the ability to understand and recognize the meaning and feelings and emotions of others. It is considered an essential skill that a nurse must develop.

Empathy can be considered as feeling the emotions of another person within oneself.

Genuineness

Genuineness includes oneself.

This indicates that the nurse is aware of his thoughts, feelings, values ​​and their relevance in the immediate interaction with the client.

This includes the desire to express various feelings and attitudes in one’s behavior and within one’s self.

Respect

Respect means believing in a person’s dignity and worth regardless of their unacceptable behavior.

It helps in enhancing feelings of self-worth and self-esteem in psychiatric patients.

The nurse considers the mentally ill patient as a person deserving of respect and deeply cares for him as a person.

Warmth

Warmth means acceptance of the patient with his symptoms, willingness of the nurse to care for the patient, involvement in the patient’s happiness or enjoyment. Warmth is the ability to help the client feel cared for and comfortable.

PHASES OF THERAPEUTIC NURSE-PATIENT RELATIONSHIP

~Nurse patient relationship is the end result of planned purposeful communication between nurse and patient. Through which behavior, thought and feeling can be shared. Which has 4 phases.

1. Pre-Interaction Phase

2.Orientation Phase

3. Working Phase
4. Termination Phase

1.Pre-Interaction Phase

The pre-interaction phase begins before the nurse comes into contact with the patient for the first time. The nurse’s first task with the patient is investigation. This phase begins when the client is assigned.

Nurses may have misconceptions and prejudice about psychiatric patients, many nurses express feelings of inadequacy, fear of causing pain, fear of abusive and violent behavior of the patient. Nurses should also recognize feelings of insecurity, approval-seeking behavior.

Self-analysis that characterizes the pre-interaction phase is a necessary task. To make it effective, nurses must have a proper self-concept and self-esteem. They must have constructive relationships with others and the reality of helping patients in the same way. should be faced.

“NURSES TASK”

~ Identifying own feelings, fantasies and fears.

~Analyze your professional strengths and limitations.

~Retrieving patient no data.

Planning the first meeting with the client.

“PROBLEMS”

Difficulty in self-analysis and self-acceptance.

~Anxiety

~Depression

~Anger

~Boredom

“WAYS TO OVERCOME”

~ Seek help from colleagues and supervisors in self analysis and face reality.

~Analyze yourself and identify your limitations.

2. Orientation Phase Orientation phase is also called introductory phase. This phase starts when the nurse goes to the patient, gives his introduction and gets an introduction about him. Nurse and patient who are strangers meet for the first time and become acquainted. The orientation phase ends when the nurse and patient begin to accept each other as unique human beings. In this phase, the client and the nurse come face to face for interaction. In this phase, the termination of the therapeutic relationship begins. Goals of the therapeutic relationship are also discussed during this phase. During this phase, the nurse and patient meet for the first time. One of the nurse’s primary concerns is to find out why the patient sought help. It helps the nurse to focus on the patient’s problems and determine the patient’s level of stimulation.

“NURSES TASK”

~ Building trust and rapport.

~Help verbal expression of thoughts and feelings.

~Creating a therapeutic environmemt.

~Collect data including patient’s feelings, strengths and weaknesses.

~Establish acceptable communication method for both patient and nurse.

~Set priorities for nursing intervention.

~ Establishing a therapeutic contract by determining the time, place, and duration for each meeting, as well as how long the relationship will be in effect.

• Identifying the patient’s problems.
• Set specific goals.

“PROBLEMS”

~ Don’t think of each other as a single person.

~Problems related to establishing agreement between nurse and patient.

~Social class

~Anxiety

“WAYS TO OUTCOME”

The nurse shares the data collected from the patient with the supervisor. The supervisor should provide an environment in which the nurse feels free to express herself without any fear of criticism.

3.Working Phase

This phase begins when the nurse and patient are able to overcome the barriers of the orientation phase. During this phase the nurse and patient actively work to meet the goals they set during the orientation phase. The characteristic of this phase is that the nurse is able to overcome anxiety and the patient’s fear of the unknown is also reduced. Reactions like transference and counter transference are also reduced.

Therapeutic work is done in this working phase. The goals set in the orientation phase are accomplished in this phase. Actual behavior change is the focus of this phase.

By linking perceptions, thoughts, feelings, and actions, the nurse helps the patient reduce anxiety, increase independence, and develop coping mechanisms.

The patient usually shows resistance during this phase. The patient relaxes, trusts the nurse, and discusses mutually agreed upon goals with the nurse as the assessment process continues and the care plan is developed.

~”NURSES TASK”

~Collecting patient data and identifying need.

~Helping to identify the patient’s problems.

~Using coping mechanisms.

~Promoting a positive self-concept.

~Facilitate behavior change.

~Giving them opportunities to act on their own.

~ Developing a realistic plan of action.

~Implementation of action plan.

~ To evaluate the result of the action plan.

~Nurses giving information about the patient’s role for the treatment.

“PROBLEMS”

~The nurse is tested by the patient.

~ Patients with mental illness may not progress quickly.

~Difficulty to collect data.

~Fear Of Closeness (The nurse works closely with the patient so she has fear.

~Nurses Life Stress

~Resistance Behaviour

“WAYS TO OUTCOME”

~ The supervisor should communicate with the expert and the help of other group members will be useful, and help in the interpretation of the data collected.

4. Termination Phase. Termination phase is called resolution phase or end phase. The termination phase begins with the orientation phase. This is the most important and most difficult phase of a therapeutic relationship. Termination of the therapeutic relationship takes place in this phase. The main goal of this phase is to give a therapeutic end to the relationship. This is the time to exchange feelings and memories and to evaluate the patient’s progress and whether the goal has been met or not.

“CRITERIA FOR TERMINATION”

~ The present problems of the patient are relieved.

~ Patient’s social function improves.

~Patient’s “ego” function is strengthened.

~ Patient planned treatment goala achieved.

“CAUSES OF TERMINATION”

~ The patient leaves the ward on his own.

~Nurse may terminate the relationship due to some reasons.

~When the patient goes on “parole” and returns to the hospital.

~The therapeutic relationship is terminated when the patient is discharged.

~When duty of nurses changes.

“PREPARATION OF PATIENT”

~ To explain whether the Goal of Nurse Patient Relationship has been achieved or not.

~Deciding on termination.

~ Inform the patient.

~Nurse should encourage the patient to talk about anxiety and fear.

~Patient should be sent on “parole” before discharge.

“NURSES TASK”

~Give the relationship a therapeutic end.

~ To establish the reality of separation.

~Reviewing feelings about relationships.

~ To review progress of therapy and achievement of goals.

~Exploring behavioral feelings related to rejection, loss, sadness and anger.

“PROBLEMS”

~ Patient’s Angry Behaviour.

~Nurse tries to punish.

~Ignore termination.

~Try to eliminate faults of nurses.

“WAYS TO OUTCOME”

~Nurse should be aware of the patient’s feeling and deal properly.

~Nurse should encourage the patient to tell the feeling of termination.

~Discuss with supervisor so that they can help.

DISCUSSION ABOUT IMPORTANCE OF THERAPEUTIC NURSE-PATIENT RELATIONSHIP

(Importance of Therapeutic Nurse Patient Relationship)

Assists the nurse in assessing the patient’s needs and meeting the needs.

•Provides growth opportunities for both nurse and patient.

• It is helpful in communicating client’s distressing thoughts and feelings.
• The patient learns how to accept and relate to others.
• Their importance is to help clients in solving their day-to-day problems.
• It can reduce the time of admission in the hospital. Valuable resources and time can be saved.

•The patient’s return to the community depends on the therapeutic relationship.

• Can increase the quality of patient care and overall job satisfaction for nurses.
• It promotes client self-care and independence.
• Increases self acceptance and self respect.

•It makes the communication process easy.

• Clears the sense of personal identity.

DEFINITION OF COMMUNICATION SKILLS

Communication is the process of expressing thoughts and feelings or giving information and instructions to people. It usually involves the exchange of “Thoughts, ideas, feelings, information, opinion and knowledge” by one another. It is the exchange of information through symbols, signs and behavior. -le) is.

Communication skills are a set of skills that enable a person to convey information so that information is received and understood.

ELEMENTS OR COMPONENTS OF COMMUNICATION (-SMCR MODEL)

A person named “Berlo” described 4 elements of communication called the SMCR model.

S=SOURCE

M=MESSAGE(message)

C=CHANNEL

R=RECEIVER (Receiver)

1. SOURCE They are also called senders or encoders. The person who sends the message is called the sender. He decides to send the message and it is the most effective way to send the message. All this is done with the receiver in mind. The message is verbal or non verbal. The sender needs the same communication skills, attitudes, knowledge, and understanding abilities as the receiver. A symbol or sign is used to transmit a message.

MESSAGE

The message is the information that the sender sends to the receiver. The message is another element of communication. The content or information sent by the sender should be clear. The thought and feelings in the message can be expressed verbally or non-verbally with the aim of conveying information to the receiver. to deliver.

3. CHANNEL The medium used to deliver the message is the channel. Channels convey the message to the receiver through any sense like seeing, hearing, touching, smelling and testing. Face to face communication is more effective than telephonic or written messages. Communication recorded by tape recorder or television is effective for long time audience. Depending on the message, some channels are more useful than others. It is often beneficial to use several channels simultaneously. Post office, internet, radio etc. are examples of channels.

4.RECEIVER

The receiver is called the decoder who receives the message or the listener. He receives the information and interprets the received message. For effective communication, it is necessary to have equality in knowledge, attitude and communication skills of both the sender and the receiver. It is the responsibility of the receiver to provide feedback to the sender.

VARIOUS TYPES OF COMMUNICATION

(Different Types of Communication)

1.Formal Communication

Generally this includes all types of business communication or corporate communication. Official conferences, meetings and written memos and corporate letters are used for communication. Formal communication is official, for example communication between a superintendent of nursing and a staff nurse.

2.Informal Communication

In informal communication, communication takes place freely between friends and family. Informal communication has no strict rules and guidelines. Informal communication can happen anytime and anywhere.

3. Verbal communication

Verbal communication includes oral and written communication.

~Oral Communication

Oral communication is information spoken through the mouth. Example: Face to face communication, telephonic communication, speech, radio, TV, and lectures etc.

~Written Communication.

Communication by means of written symbols (printed or handwritten). E.g. Orders, Instructions, Letters, , Reports, etc

3.NonVerbal Communication

Written or spoken words should not be used in Non-Verbal. Non-verbal communication includes overall body language or behavior which includes person’s body posture, hand gesture and overall body movement. Can also be in the form of photographs and sketches. In it, the message is conveyed through five senses.

“OTHER TYPES OF COMMUNICATION”

Intra-Personal Communication

(Intra-Personal Communication)

In intra-personal communication, a person talks to himself and a person does imagination and self-visualization.

Interpersonal Communication

(Interpersonal Communication Skills)

This communication is direct, this communication takes place between two or more persons, and share ideas and thoughts with each other. Includes phone calls, video conference etc. It is an essential communication of two or more persons. There are two types of them

~Focused Communication

This means that the two people involved are fully aware of the communication taking place between them. Communication is the focus of both people.

~Unfocused Communication

This is when neither person is fully aware. This happens when a person only observes or listens to someone they are not communicating with. This usually happens at stations and bus stops.

Mass Communication

The information that is received and communicated through print, digital media, Internet, social media, radio, and television is called mass communication.

FACTORS INFLUENCING COMMUNICATION

Factors Affecting Communication)

Many factors affect the communication process.

~Perceptions

~Values

~Emotions

~ Socio-cultural background

~Knowledge

~Role and relationships

~Environment

~Space and territoriality

DISCUSS ABOUT THERAPEUTIC IMPASSES

Definition Of Therapeutic Impasses

Therapeutic impasse blocks the progress of the nurse-patient relationship. Strong emotions develop in both nurse and patient, which can range from anxiety and apprehension to depression, love, or even anger. This prevents the nurse-patient relationship from progressing.

Types Of Therapeutic Impasses

(1). Resistance

(2).Transference

(3).Counter Transference

(4).Boundary Violations

(1). Resistance

Resistance is the patient’s attempt to remain unaware of the anxiety-producing factors within himself.

Resistance is the patient’s reluctance or verbal defiance. The patient feels bad.

“TYPES OF RESISTANCE”

~Primary Resistance

It is often due to the patient’s unwillingness to make changes when changes are needed.

~Secondary Resistance

Rejects unpleasant situations.

Resistance is more common during the working phase of the nurse-patient relationship, as problem solving occurs mostly during this phase.

“CAUSES OF RESISTANCE”

• Nurses who are moved too quickly or too deeply into the patient’s feelings.
• Lack of respect in communication.

•Resistance occurs when the nurse is an inappropriate role model for the therapeutic relationship.

“MANAGEMENT OF RESISTANCE”

~ Goals, purposes, and roles of the nurse-patient relationship should be reset.

~The nurse should listen to the patient properly.

~Maintain open communication and provide clarification.

(2).Transference

Transference is an unconscious response in which the patient experiences feelings and attitudes toward the nurse that are originally associated with other significant persons in his life. It involves unconsciously comparing the image of one person to another, such as the height and age of the nurse to his own daughter. If she comes, the patient considers the nurse as his daughter and treats her like his daughter.

•These reactions are an attempt to reduce the patient’s anxiety.

• The nurse may be seen as an authority figure from the past, such as a parent figure, or a lost loved one, such as a former spouse.

•Transference reactions are detrimental to the therapeutic relationship if ignored and misunderstood.

• Transference reactions when ignored and not properly explained are harmful to the therapeutic relationship.

“MANAGEMENT OF TRANSFERENCE”

~Do not end the relationship unless there is a serious barrier to therapy.

~The patient should be helped to recognize the transference.

~Psychiatric nurse should be prepared to come in contact with such powerful positive and negative emotional reactions.

(3). Counter Transference

They are therapeutic impasses created by the nurse’s specific emotional response to the quality of the patient. In this knowingly – unknowingly, the nurse builds an emotional relationship with the patient. Transference applies to the nurse. The nurse transfers her personal thoughts and feelings to the client and enters personal needs into their therapeutic relationship.

Counter transfer reactions are of three types:

~A reaction of more Love or Care

A reaction of hostility or hatred.

~More Anxiety.

“VARIOUS EXAMPLES”

• Personal or social involvement with the patient.
• Sexual or aggressive fantasies about the patient.
• There is difficulty in expressing empathy with the patient in some problem areas.

•Feelings of depression during or after the session.

• Drowziness (lethargy) during the session.

“MANAGEMENT OF COUNTER TRANSFERENCE”

~Experience of working with psychiatric patients.

~Continuous attention should be paid to counter transference.

~Hold (suspend) countertransferences or use them to promote therapeutic goals.

~Doing Self Examination.

(4). Boundary violation

Whenever a nurse thinks of doing something special, different or unusual for a patient, it is called a boundary violation. Here the nurse goes beyond the boundaries of the therapeutic relationship and establishes a personal, economic and social relationship with the patient, which may involve sexual relationships which are immoral and often illegal.

“Possible Situations of Boundary Violation”

~Maintains personal or social relationship with patients.

~The patient takes the nurse out to lunch or dinner.

~The nurse regularly gives personal information to the patient.

~The nurse attends to the patient’s social function.

A nurse does business with or purchases services from a patient.

~Nurse accepts free gifts from patients.

~The nurse agrees to see the patient for treatment outside of the normal therapeutic setting without therapeutic support.

~Difficulty setting limits with the patient.

“MANAGEMENT OF BOUNDARY VIOLATIONS”

~The nurse should be open and clear about their actual reactions when the patient misperceives the behavior.

~Limitation setting is useful when patient misbehaves with nurse.

~ Having open communication with the supervisor who will guide to handle the situation.