THERAPEUTIC NURSE PATIENT RELATIONSHIP Presenter

Mrs. Anita.F.Lopes

Learning Outcomes

• Define Communication and describe communication cycle

• Describe necessary components of Effective communication

• Implement steps for effective communication (Therapeutic use of Self)

• Describe Therapeutic communication

• Describe the goals of therapeutic relationship

• Describe factors affecting Nurse-patient relationship.

Learning Outcomes contd…..

• List the attributes of successful therapeutic nurse

• Acquire and Implement social manners and etiquettes

• Explain the characteristics of Nurse-patient relationship.

• Identify and use appropriate techniques while establishing Therapeutic Nurse Patient Relationship.

• Describe and implement the phases of Therapeutic Nurse Patient Relationship.

• List methods of follow up care

Communication

• Interaction between two people( individuals , groups etc.) to share & understand a message at the same level

Communication cycle

ParaphraseConfirm

Listen

Effective Communication

What is Therapeutic Communication?

It is an interpersonal interaction between the nurse and the patient during which the nurse focuses on the patient’s specific needs to promote an effective exchange of information

Goals of therapeutic relationship

Therapeutic relationship process that strives to achieve two goals:

• Assist client manage their own problems in living more effectively and develop unused opportunities.

• Assist clients become better at helping themselves in their everyday life.

Factors effecting the therapeutic relationship:

• Age,

• Gender,

• Appearance,

• Diagnosis,

• Education,

• Values and cultural, ethnic background,

• Personality,

• Expectations,

• And settings/ environment.

Ten Attributes of Successful Nurses  

• Passionate• Communication skills• Detail oriented • Competent• Committed• Intuitive• Compassionate• Flexible and Calm• Team player• Efficient 

Important steps for acquiring good communication skills:

1. Know what you want to say and why?

2. How will you say it?

3. Listen.

4. Reach understanding, agreement or

consensus.

Social manners & etiquettes

Entering the room

• Facial expressions (smiling face)

• Self introduction

• Acknowledging the presence of relatives/ people

• Voice modulation, tone & pitch of voice

Social manners & etiquettes

• Words & language used• Telephone manners (3 rings) • Imparting information to patients & relatives• Handling co-workers & other depts.• Use of Humor

Main/Key component:

• The development of trust and acceptance between

nurse and the client

• An underlying belief that the nurse cares and wants

to genuinely assist the client.

Characteristics of a Helping relationship:

1. Maximizing the client’s abilities to participate in

decision making and treatments

2. Considering the ethnic and the cultural aspects of

clients.

3. Considering family relationships and values.

4. Respects client’s confidentiality

5. Focuses on client’s well being

6. Is based on mutual trust, respect and acceptance.

Developing helping relationship:

• Listen actively

• Focus on feelings

• Empathize

• Be honest

• Be genuine and credible

• Be aware of cultural differences.

• Maintain confidentiality.

• Know your role and limitations

Techniques used for TNPR

• Restating• Reflecting• Clarification• Confrontation• Offering Alternatives• Voicing doubt• Use of Humor – use

cautiously/discretely

• Silence• Support/reassurance• Sharing Observations• Acknowledge feelings• Broad – open ended

statements• Information giving• Interpretation

Phases of Helping relationship:

• Pre interaction phase

• Introductory phase

• Working phase

• Termination Phase

Pre interaction phase

• TASKS The nurse reviews

pertinent data and knowledge, considers potential areas of concern and develops plans of interaction

• SKILLS Organized data

gathering, recognizing limitations and seeking assistance as required.

Introductory Phase: 1) Opening the relationship

TASKS• Identify each other by

name• Explains the nurses

role• Help client express

concerns and fears• Use open ended

questions..

SKILLS• A relaxed, attending

attitude to put the client at ease.

• It is not easy for all clients to receive help.

Introductory Phase: 2) Clarifying the problem

TASKS: • Helping the client to

identify the problem• Not all clients are

clear about their problems.

SKILLS: • Listening,

paraphrasing, clarifying, and other techniques should be used.

• Common error: Too many questions, instead focus on priorities.

Introductory Phase: 2) Structuring and formulating a contract

TASKS: The nurse and client

develop a degree of trust and verbally agree about:

a) Location, frequency and length of meetings.

b) Overall purpose of the relationship

c) How confidential material will be handled.

d) Tasks to be accomplishede) Duration and indications

for terminations of relationship.

SKILLS:Effective Communicationskills.

Achievement at the end of introductory phase:

Client should:

1. Develop trust in the nurse

2. View the nurse as a competent professional

capable of helping.

3. View the nurse as honest, open and concerned

about their welfare.

4. Believe that nurse will try to understand and

respect their cultural belief and values.

Achievement at the end of introductory phase: contd…..

5. Believe the nurse will respect client’s

confidentiality.

6. Feel comfortable talking to the nurse about their

feelings and other sensitive issues.

7. Understand the purpose of the relationships and

the roles.

8. Feel that they are active participants in

developing a mutually agreeable plan.

Working phase: 1) Exploring and understanding thoughts and

feelings:

TASKS:• Should assist the client to

explore thoughts and feelings to acquire an understanding of the client.

• The client explores thoughts and feelings associated with problems, develops the skills of listening and gains insight into personal behavior.

SKILLS:

• Decision making and goal setting skills.

Working phase: 2) Facilitating and taking action

TASK: The nurse plans a programs within the

client’s capabilities and considers long

term and short term goals.

The client needs to learn to take risks

(i.e. accept that either failure or success

may be the outcome). The nurse needs

to reinforce success and help the client

recognize failures realistically.

SKILLS:

Decision making and

goal setting skills.

Nurse: reinforcement

skills

Client: Risk taking

Working phase:

• In the working phase, the nurse must be acutely aware of two common elements that can arise:• Transference: when patients unconsciously transfer

feelings they have for significant persons in their life onto

the nurse

• Countertransference: when the nurse responds to the

patient based on his or her own unconscious needs and

conflicts

Termination phase

TASKS• The nurse and client

accept feelings of loss. • The client accepts the

end of relationship without feelings of anxiety or dependence

SKILLS:• The nurse needs to

summarize for the client, ability to handle problems independently.

Follow up:

• Phone calls.

• E mails.

• Or other community based interventions.

The Complete Nurse

Walk through those doors with pride,Who's life will i save tonight?Someone is waiting for me,Someone is alive today because of my duty.Sometimes we cry cause we can't save them all,God sometimes won't let us interfere when he calls.A baby's first breath when he looks at me,The joy of my first delivery.The tear i wipe a way with my own hands,The life ending of a gentle old man.The night seems so dark and the morning so bright.Being a nurse you see life in a different light.Who will i save tonight?Who will hold my hand during their last breath with no fright?Who will enter this world on my shift?How many mothers will greet their babies with a kiss?I don't know who these special people arebut i will meet them with every callI will hold them tight and help the painI will hold them up when they feel faint.I will be strong when i am neededThat is my job, I am a nurse..that is my duty.

THANK YOU