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Chapter 8: Therapeutic Relationships

Terms in this set (31)

Dignity and respect
Information sharing
Patient and family participation
Collaboration in policy and program development
Clear and appropriate boundaries
the core concepts of patient centered care:
Safe, confidential, reliable, and consistent
the first connections between nurse and patient are to establish an understanding that the nurse is .....
Therapeutic use of self
ability to use one's personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions
psychotherapy
an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties (talk therapy)
a combination of medication and psychotherapy
Best treatment for most psychiatric problems:
counseling
supportive face-to-face process that helps individuals problem-solve, resolve personal conflicts, and feel supported
Facilitate communication of distressing thoughts and feelings
Assist patient with problem solving
Help patient examine self-defeating behaviors and test alternatives
Promote self-care and independence
Provide education about disorders and treatments
Goals and Functions of a therapeutic nurse-patient relationship
promoting recovery
an additional goal of the nurse-patient relationship
Personal Relationships
Initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task
Mutual needs are met
Communication to give advice, give, or ask for help
Therapeutic Relationships
Needs of patient identified and explored
Clear boundaries established
Problem-solving approaches taken
New coping skills developed
Behavioral change encouraged
boundaries
The expected and accepted legal, ethical, and professional standards that separate nurses from patients
Provide a safe space for the patient
Professional and ethical boundaries
Maintaining a professional role helping meet patient goals and never personal goals of the nurse.
legal boundaries
Patient's right to confidentiality. Breach of confidentiality is a common law tort, which is a civil wrong. This wrong can result in a lawsuit resulting in monetary damages.
Sexual misconduct (this violates all three standards)
Boundary crossings
Boundary violations
Professional sexual misconduct
Blurring of roles
Over-involvement increases risk of:
Transference and Countertransference
two parts of blurring of roles
boundary crossing
(1) when the relationship slips into a personal context and (2) when the nurse's needs (for attention, affection, and emotional support) are met at the expense of the patient's needs
boundary violations
take advantage of the patient's vulnerability and are ethically; characterized by a reversal of roles where the needs of nurse are being met rather than the patient
Professional sexual misconduct
Physical or verbal breech of contract that may include expressions of feelings and thoughts or gestures that are sexual or could reasonably be interpreted by the patient as sexual
transference
Patient unconsciously and inappropriately displaces onto nurse feelings and behaviors related to significant figures in patient's past
Countertransference
Nurse unconsciously displaces feelings related to significant figures in the nurse's past onto the patient
overidentification with the patient
Common sign of countertransference in nurse is ....
Reflect own culture/subculture
Nurse's values and beliefs do what?
Preorientation phase
Preparing for your assignment
Researching the patient's history
Recognizing one's own thoughts and feelings about meeting this patient
Anticipating and setting ground rules before the first meeting
Preorientation phase
Orientation phase
Working phase
Termination phase
Peplau's Model of Nurse-Patient Relationship four phases?
Orientation phase
Establishing rapport
Parameters of the relationship
Formal or informal contract
Confidentiality
Terms of termination
Working phase
Maintain relationship
Gather further data
Promote patient's
Problem-solving skills
Self-esteem
Use of language
Facilitate behavioral change
Overcome resistant behaviors
Evaluate problems and goals
Redefine them as necessary
Promote practice and expression of alternative adaptive behaviors
Genuineness
Empathy (not sympathy)
Positive regard
Posture, eye contact, and body language
Suspending value judgments
Helping patients develop resources
Factors That Promote Patient Growth
Termination phase
Summarize goals and objectives achieved
Discuss ways for patient to incorporate new coping strategies learned
Review situations of relationship
Exchange memories
Posture, eye contact, and body language
nonverbal behaviors that reflect the degree of attending and are highly culturally influenced.
Attitudes
Actions
Attending
three parts of positive regard
attending
a special kind of listening that refers to an intensity of presence or being with the patient. At times, simply being with another person during a painful time can make a difference.
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