Nurse-Client Relationship & Boundaries

Nurse–Client Relationship

A professional, therapeutic relationship focused on the patient's health, safety, and well-being.

Is the nurse–client relationship a friendship?

No. It is a professional relationship, not a friendship or personal relationship.

Primary goal of the nurse–client relationship

Promote the patient's health.

Another goal of the nurse–client relationship

Build trust.

Another goal of the nurse–client relationship

Provide safe, ethical care.

Another goal of the nurse–client relationship

Help the patient achieve health goals.

Trust in the nurse–client relationship

Be honest and dependable.

How does a nurse build trust?

Follow through on promises.

Example of trust in nursing

Telling a patient you'll return in 30 minutes to check their pain and returning as promised.

Respect in the nurse–client relationship

Treat every patient with dignity.

Respect includes

Respecting cultural beliefs and personal values.

Professional boundaries

Keep the relationship focused on the patient's needs.

Purpose of professional boundaries

Prevent the relationship from becoming personal.

Example of maintaining professional boundaries

Do not accept expensive gifts.

Example of maintaining professional boundaries

Do not lend money to patients.

Example of maintaining professional boundaries

Do not borrow money from patients.

Example of maintaining professional boundaries

Do not share excessive personal information.

Example of maintaining professional boundaries

Do not become friends with patients on social media.

Empathy

Understanding a patient's feelings without taking them on as your own.

Example of empathy

"It sounds like you're feeling overwhelmed after your diagnosis."

Confidentiality in the therapeutic relationship

Protect patient privacy.

Confidentiality requires

Following HIPAA and facility policies.

How many phases are in the nurse–client relationship?

Four.

First phase of the nurse–client relationship

Pre-Interaction Phase.

What occurs during the Pre-Interaction Phase?

The nurse reviews the medical record.

Another activity during the Pre-Interaction Phase

The nurse plans care.

Another activity during the Pre-Interaction Phase

The nurse reflects on personal feelings or biases.

Memory Trick for Pre-Interaction

Prepare.

Second phase of the nurse–client relationship

Orientation Phase.

Another name for the Orientation Phase

Introduction Phase.

What happens during the Orientation Phase?

The nurse introduces themselves.

Another responsibility during the Orientation Phase

The nurse explains their role.

Another responsibility during the Orientation Phase

The nurse establishes trust.

Another responsibility during the Orientation Phase

The nurse identifies the patient's concerns.

Another responsibility during the Orientation Phase

The nurse sets goals.

Memory Trick for Orientation Phase

Meet and build trust.

Third phase of the nurse–client relationship

Working Phase.

Which phase is the longest?

The Working Phase.

Responsibilities during the Working Phase

Provide nursing care.

Responsibilities during the Working Phase

Perform assessments.

Responsibilities during the Working Phase

Educate the patient.

Responsibilities during the Working Phase

Help solve problems.

Responsibilities during the Working Phase

Evaluate progress.

Memory Trick for Working Phase

Do the work.

Fourth phase of the nurse–client relationship

Termination Phase.

Purpose of the Termination Phase

End the professional relationship appropriately.

Responsibilities during the Termination Phase

Review the patient's progress.

Responsibilities during the Termination Phase

Discuss future care.

Responsibilities during the Termination Phase

Encourage independence.

Responsibilities during the Termination Phase

Say goodbye professionally.

Memory Trick for Termination Phase

End professionally.

Boundary Crossing

A minor departure from usual professional boundaries that may be appropriate depending on the situation.

Example of a boundary crossing

Attending a patient's graduation after thoughtful consideration and according to workplace policies.

Boundary Violation

A serious breach of professional boundaries that benefits the nurse instead of the patient.

Example of a boundary violation

Dating a patient.

Example of a boundary violation

Borrowing money from a patient.

Example of a boundary violation

Sharing intimate personal information with a patient.

Example of a boundary violation

Accepting expensive gifts from a patient.

Professional boundaries are intended to

Protect the patient and maintain a therapeutic relationship.

Therapeutic relationship focuses on

Meeting the patient's needs rather than the nurse's needs.

NCLEX Tip

If an action benefits the nurse more than the patient, it is usually a boundary violation.

NCLEX Tip

Nurses should avoid financial, romantic, or social relationships with current patients.

NCLEX Tip

Empathy means understanding the patient's feelings without becoming emotionally involved.

NCLEX Tip

Trust is built by honesty, reliability, and following through on commitments.

Quick Review: Therapeutic Relationship

Professional relationship focused on the patient's needs.

Quick Review: Trust

Be honest and reliable.

Quick Review: Professional Boundaries

Avoid personal, financial, or romantic relationships with patients.

Quick Review: Four Phases

Pre-Interaction → Orientation → Working → Termination.

Memory Trick for the Four Phases

Prepare → Meet → Work → End.