BUILDING THERAPEUTIC RELATIONSHIPS

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social role

nurses have roles and responsibilities in advocating for mental wellness at the individual and community level; nurses serve as client advocates when participating in policymaking that directly and indirectly affects quality levels of care. they participate in a variety of leadership roles in health care organizations and local governing bodies, such as community health boards.

occupational role

nurses consider mental health across the health care spectrum. the nurse promotes the client’s functioning in socialization, self-esteem, and self-actualization. promoted by the nurse serving as an educator, facilitator, and manager.

therapeutic role

involves establishing the nurse-client relationship, which is built upon trust, respect, and professionalism. nurse considers the client as a whole: body, mind, and spirit. this role can include identifying factors that aggravate or alleviate s/s, coordinating spiritual leaders, encouraging emotional expression, or reinforcing CBT.

pre-interaction phase

provides the nurse an opportunity to recognize the needs of the client. nurse performs a self-evaluation of their beliefs and behavior before engaging with the client in order to improve the quality of care and improve a sense of fulfillment.

orientation phase

nurses goal in this phase is to establish the professional nurse-client relationship. the client presents a need they feel is not being met and the nurse helps the client identify barriers to wellness.

working phase

the nurse and client have established a mutual level of trust and comfort and develop progress toward established goals. client is more accepting of the nurse’s interventions and sees the nurse as a source of aid. nurse should affirm the client’s knowledge, skills, and attitude toward treatment.

termination phase

the goal established in the orientation phase have been met, and new goals are developed. client continues to build confidence in achieving goals and experiences an improvement in self-reliance. nurses goal is to ensure continuity of care and integrity of the professional relationship.

transference

the unconscious effort on behalf of the client to redirect their previously-experienced feelings or emotions towards the nurse. can result in feelings of affection or hostility toward the nurse.

countertransference

the unconscious effort on behalf of the nurse to redirect their previously experienced feelings or emotions toward the client.

congruence

when a client’s expected mood matches their facial expressions.

SOLER

square with your client, open posture, lean forward, eye contact, and relax

SURETY

sit at an angle, uncross legs and arms, relax, eye contact, touch, and intuition

nonverbal cues

affect (frowning; lack of expression, grimacing, biting, nose scrunching), appearance (sudden disrobing; clothing incongruent to current temperature), autonomic response (visible brow or palm sweat, pupil dilation, facial flushing), body behaviors (gait, posture, hand clenching), and eye movement (squinting, open with minimal blinking).

open-ended statements

allow the client to elaborate on what is important to them in their own words, an open invitation to share feelings and information.

affirmations

a therapeutic communication technique that is used to empower client behavior and decision making. nurse should not use these if they do not feel genuine about it.

simple reflection

technique used to clarify client emotions or statements using some element of what the client says.

complex reflection

technique where the nurse infers client emotion or thoughts in an effort to portray engagement and clarity. take practice to master, but are an effective therapeutic communication technique to move the conversation forward.

summaries

technique to restate major key concepts in a conversation about change. also an effective transitional technique to move on to the next phase of treatment planning.

LISTEN

look interested, involve by responding, stay on task, test understanding, evaluate the message, and neutralize feeling

pre-contemplation stage

characterized by the client lacking insight into their issue or demonstrating the defense mechanism of denial. the client does not recognize the benefit of change or may have previously attempted change and failed to maintain healthy behaviors. aim to raise awareness of the positive and negative impact the client’s current behaviors have on their life.

contemplation

characterized by ambivalence. client may be able to see themselves making a change or understand the change’s importance. the client may feel that the change can be difficult to achieve and can choose to seek comfort in current behaviors. aim to explore positives and negatives of current and proposed behavior changes.

preparation

characterized by the client demonstrating adjustments or minor changes to their current habits. client may have yet to fully commit to a changed lifestyle or is having difficulties overcoming barriers to change. aim to identify the client’s current coping skills and possible support systems.

action

characterized by the client experiencing changed behaviors. a behavior can be classified as changed when the previous behavior has not been experienced for more than 180 days. aim to help the client identify positive outcomes of making the behavior change and develop contingencies if planned coping or support systems fail.

maintenance

characterized by the client feeling like the change is second nature and actively working to prevent relapse. client has been practicing the new behavior for more than 6 months and no longer feels like a change is necessary. aim to help the client identify triggers for relapses like people, places, or objects that are associated with the old behavior.

therapeutic window

a psychological state in which therapeutic interventions are believed to be the most beneficial.

cultural preservations (maintenance)

care considerations to retain the client’s core cultural beliefs and values related to health care.

cultural accommodations (negotiation)

care considerations that help the client adapt or negotiate with other cultures while in treatment.

cultural repatterining (restructuring)

a direct therapeutic intervention performed by the nurse that supports the client who is changing a culturally related behavior in an effort to improve health outcomes.

organizational culture

refers to the values, attitudes, beliefs, psychology, and experiences that influence daily operation within an organization.

cultural formulation interview (CFI)

a clinical tool developed by the APA that is designed to elicit culturally relevant information on the client’s life context, social support, resources, and resilience.