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Therapeutic nurse patient relationship in psychiatry
1. 1
Therapeutic nurse patient relationship
A relationship is defined as a state of being related or a state of affinity between two individuals.
Nurse patient relationship
Series of interactions between the nurse and the patient in which the nurse assists the patient to attain
positive behavioural change
Types of relationships
1. Social Relationships
A social relationship is primarily initiated for the purpose of friendship, socializations and
companionship
The communication is usually centered around sharing ideas, feelings and experiences and meets the
basic needs of people.
In Therapeutic Nurse patient relationship, the social relationship must be limited
2. Intimate Relationships
A healthy intimate relationship involves two people who are emotionally committed to each other and
both concerned about having their needs met and helping each other.
The relationship may include sexual or emotional intimacy as well as sharing of mutual goals. It has
no place in the nurse patient relationship.
3. Therapeutic Relationships
It focuses on the needs, experiences, feelings and ideas of the client. The areas to be worked on are
agreed on and the outcomes are continually evaluated.
The nurse uses communication skills, personal strengths and understanding of human behaviour to
interact with the client
Qualities of therapeutic nurse patient relationship
Genuineness (real and honest)
Sincerity
Respect
Love and affection
Concern
Listen
Empathy (ability to feel with patient)
Good communication skills
Exploration of problems
Self discipline
Characteristic of nurse patient relationship
Goal-directed
Focused on the needs of the patient
Planned
Time-limited
Professional
Basic elements of nurse patient relationship
Trust
Rapport
Unconditional positive regard
Setting limits
Therapeutic communication
2. 2
Phases of nurse patient relationship
1. Pre-orientation phase
Begins when the nurse is assigned to a patient
Phase of Nurse-Patient Relationship in which the patient is excluded as an actual participant
Nurse feels certain degree of anxiety. Includes all of what the nurse thinks and does before
interacting with the patient
Tasks include data gathering, planning for the first interaction. Major task is to develop self-
awareness
2. Orientation phase
Begins when the nurse and the patient interacts for the first time. Parameters of the relationship are to
be laid
Nurse begins to know about the patient. Tasks include establishing rapport, developing trust,
assessment (and formulation of a nursing diagnosis).
Major task is to develop a mutually acceptable contract
3. Working phase
It is highly individualized. More structured than the orientation phase
The longest and most productive phase of the nurse- patient relationship. Limit-setting is employed
Tasks include planning and implementation
Major task is identification and resolution of the patient’s problems
4. Termination phase
It is a gradual weaning process. It is a mutual agreement
It involves feelings of anxiety, fear and loss
It should be recognized in the orientation phase. Tasks include evaluation
Major task is to assist patient to review what has been learned and to transfer his learning to his
relationship with others
Problems affecting nurse patient relationship
Transference
Occurs when the client displaces onto the nurse attitudes and feelings that the client originally
experience in other relationships
These patterns are automatic and unconscious
Example: A client falls in love with the nurse.
Counter transference
Occurs when the nurse displaces onto the client attitudes or feelings from his or her past.
Example: A female nurse who has teenage children and who is experiencing extreme frustration with
an adolescent client may respond by adopting a parental or chastising tone.
The nurse is countertransfering her own attitudes and feelings toward her children onto the client.
Resistance
Development of ambivalent feelings toward self-exploration
Principles of care in psychiatric settings
The nurse views the patient as a holistic human being.
The nurse accepts the patient as a unique human being.
The nurse should focus on the patient’s strengths and assets.
The nurse views the patient’s behavior non- judgmentally.
The nurse has the potential for rapport.
Levels of interventions in psychiatric nursing
3. 3
1. Primary level of prevention
Interventions aimed at the promotion of mental health and lowering incidences by altering the
stressors.
Examples: Health education, Information dissemination, Counseling
2. Secondary level of prevention
Interventions that limit the severity of a disorder.
Has two components: Case finding & Prompt treatment.
Examples: Crisis intervention, Administration of medications
3. Tertiary level of prevention
Interventions aimed at reducing the disability after a disorder.
Has two components: Prevention of complication &Active program of rehabilitation
Examples: Alcoholics Anonymous groups. Occupational therapy
Chandni Narayan
15.4.2021