Nursing: Phases of the Helping Relationship

Therapeutic Relationship

-a healing relationship between a nurse and a person in need of care

-nurse and client join together for a period of time to achieve health related treatment goals

-beginning & end

-boundaries

Client Centered

-goal is promotion of health and well-being

-client centered and focus on empowering the client

-each relationship is unique

Therapeutic Communication

-encourages self-direction

-goal setting

-problem solving

-enhances self-esteem

Self-Awareness

-taking time to examine your own values so that biases/prejudices are not placed on clients in your care

-eliminates stereotypes and unconscious rejection

-increases respect and empowerment

Professional Boundaries

-imposed by legal, moral, professional standards of nursing which promotes respect of nurse and client rights

-prevents injury

-increases trust

Level of Involvement

-compassion versus developing a relationship that is too close

-must maintain emotion objectivity

-over-involvement occurs when there are shared positive feelings about the relationship

-Disengagement occurs when nurses withdraw from clients

Signs of overinvolvement

-giving extra time to client

-visiting in off hours

-doing things for clients they could do for themselves

-putting down actions of other HCP

-feeling resentment toward other HCP's care of client

-always thinking of client

Disengagement

-clients left to cope alone

-fail to progress

-lingering death

-hostile

-depressed

-unclean

Empathy

-understanding experiences of client without losing self respect

-promotes client respect, understanding and validation

Self-Disclosure

-intentional revealing of personal experiences or feelings similar/different from the client

-nurse should be the regulator of disclosure and needs to refocus conversation on client and identify needs

Peplau's Phases of Nurse-Client Helping Relationship

1. Pre-interaction Phase (before meeting client)

2. Orientation Phase (nurse/client meet)

3. Working Phase (nurse/client work together)

4. Termination Phase (end of helping relationship)

Pre-Interaction Phase

-creating a psychological and physical environment

-psychological preparation (concerns/issues)

-develop professional goals based on situation

-timing of interactions

-physical setting preparation (lighting, seating, location, etc.)

Orientation Phase

-nurse meets client

-clarify purpose of relationship

-assess clients needs

-participant observation test (competence & commitment)

-communication strategies

-identify goals

-expect termination in relationship

Working Phase

-Interdependent role relationship: client assumes partnership to solve problems and accomplish goals

-express feelings of health

-mutual clarification of ideas and expectations

-develop goals

-define problems which may interfere with goals

Termination Phase

-The formal end to the relationship

-evaluation based on all phases of the nursing process

-discharge planning, referral, follow-up, smooth transition