Therapeutic relationship refers to the professional relationship between a nurse and a client, it is the foundation on which a nurse and patient can work together to identify issues that are affecting the patient and requires change. The focus of this relationship is to bring about change in the person s health.
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Attributes of a nurse- patient relationship.
Being there–the patient likes the nurse to be there for them, that means being present for the patient when needed.
Self disclosure–patients sometimes think that they are the only ones who are having difficulties; by some self disclosure the patient is able to see that others share their difficulties. This also validates their feelings and provides perspective for their problems.
Being concerned–this enhances the nurse patient relationship, nurses recognize the need for the patient to make their own decision about their lives and their health as well as offering choice and alternatives to facilitate the patient in problem solving.
Components of the nurse ??“patient relationship includes trust, respect, empathy and rapport. In this relationship the nurses are trusted to assist change in patient by facilitating the understanding of the information. It requires the nurse to have active listening skills, be focused on the patient s needs, be led by the patient s issues and develop problem solving capacity and evaluate the change in the patient to identify progress towards maximum health.
Respecting a patient is all about caring, liking and valuing. The patient is regarded as a person of worth and respected. They are accepted for who they are or as they are, they are to be seen as individuals, people with lives beyond their mental illness.
Empathy forms a basis for a helping relationship between the nurse and the patient; it includes perceiving the patient s feelings and their meanings, sensing the patient??™s private world as if it were your own. When the nurse knows and understands the patient, the nurse assists the patient to understand themselves and thus empowering them to understand their treatment.
Rapport plays a significant part in developing therapeutic relationship, when two people talk on the same wavelength, share the same humour, pain and sorrow; it promotes productive relationship and better outcomes for all.
Stages of therapeutic relationship.
1. Preorientation ??“ this occurs prior to communicating with the patient, it allows the nurse to find out information from the patient s notes, MDT and possibly from family members. At this time the nurse explore his/her own feelings/fears and analyze own professional strengths and limitations.
2 .Orientation??”this is the first meeting point of the nurse and the patient. The nurse s primary concern is to find out why the patient sought help, This stage begins with exchanging of names, explanation of roles, responsibilities and expectations of the patient and nurse, with a description of what the nurse can and cannot do.
3. Working ??“at this stage the nurse enables the patient to safely explore current issues impacting on their lives. The nurse identifies behaviors that are resistant to change and provide a safe place for the patient to try new behaviors as well as beliefs. The nurse help the patient to master anxieties, increase independence and self responsibility, and to develop constructive coping mechanisms. At this stage it is important for the nurse to maintain the relationship, collect further information, and promote patient s solving skills and to evaluate problems and goals attained.
4 .Termination phase-this is the time to exchange feelings and memories and to evaluate the patient s progress and goals achieved. The reason behind termination should be clarified so that the patient does not interpret it as a rejection by the nurse. At this stage feelings are aroused in both the client and the nurse with regards to the experiences they have had. It is important for the nurse to work with the patient to bring into awareness any feelings and reactions the patient may be experiencing related to separations.
Summarizing goals and objectives achieved in the relationship is part of the terminal process. Reviewing situations that occurred during the time spent together and exchanging memories can help validate the experience for both the nurse and patient and facilitate closure for that relationship.
Stuart W GAIL and Laraia T Michele(2001)Principles and practice of Pychiatric Nursing ,7th ed.St Louis Mosby.
Brooker C and Waugh A(2007) Foundations of Nursing Practice.Fundamentals of holistic care.MosbyElservir.