02 Therapeutic Nurse Patient Relationship

7/16/2019 02 Therapeutic Nurse Patient Relationship

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By Sawiji, S.Kep. Ns., M.ScBy Sawiji, S.Kep. Ns., M.Sc..

EmailEmail::[email protected]@gmail.comPhone: +628!"28!#28!"""Phone: +628!"28!#28!"""

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N'(sing Basic Science )epa(*men*N'(sing Basic Science )epa(*men*

M'hammaiyah om-ong eal*hM'hammaiyah om-ong eal*h

Science /ns*i*'*eScience /ns*i*'*e

Men*al eal*h Se(iesMen*al eal*h Se(ies

Therapeutic Nurse- Ther

apeutic Nurse-

Patient RelationshipPatient Relationsh

ip

mailto:[email protected]





0 1he therapeutic nurse-patient relationship is a m'*'al lea(ning epe(ience an aco((ec*i3e emo*ional epe(ience 4o( *hepa*ien*.

0 /* is -ase on *he 'ne(lying h'mani*y o4

n'(se an pa*ien*, wi*h m'*'al (espec* anaccep*ance o4 socioc'l*'(al i44e(ences.

0 /n *his (ela*ionship *he n'(se 'ses

pe(sonal a**(i-'*es an clinical *echni5'esin wo(ing wi*h *he pa*ien* *o -(ing a-o'*insigh* an -eha3io(al change.



Characteristics of the relationshipCharacteristics of the relationsh

ip::

1he goals o4 a *he(ape'*ic (ela*ionship a(e i(ec*e *owa(achie3ing *he pa*ien*7s op*imal g(ow*h an incl'e *he4ollowing imensions:

0 Sel4!(ealia*ion, sel4 9accep*ance, an an inc(ease

gen'ine sel4!(espec*.0 clea( sense o4 pe(sonal ien*i*y an an imp(o3e le3elo4 pe(sonal in*eg(a*ion.

0 n a-ili*y *o 4o(m in*ima*e, in*e(epenen*, in*e(pe(sonal(ela*ionships wi*h a capaci*y *o gi3e an (ecei3e lo3e.

0 /mp(o3e 4'nc*ioning an inc(ease a-ili*y *o sa*is4ynees an achie3e (ealis*ic pe(sonal goals.



0 1his chap*e( eamines:

! *he pe(sonal 5'ali*ies o4 *he n'(se as helpe(,! *he phases o4 *he (ela*ionship,

! 4acili*a*i3e comm'nica*ion,

! (esponsi3e an ac*ion imensions,! *he(ape'*ic impasses,

! an *he *he(ape'*ic o'*come ;<ig'(e=.0

Each of these factors influences the nurse'seffectiveness.





I.I. Personal Qualities of the NursePersonal Qualities of the Nurse::

0 1he *he(ape'*ic *ool o4 *he psychia*(ic n'(se

is *he 'se o4 onesel4. 1h's sel4!analysis is

*he 4i(s* -'iling -loc in p(o3iing 5'ali*y

n'(sing ca(e.

0 >esea(ch s'gges*s *ha* some essen*ial

5'ali*ies a(e neee i4 one is *o help o*he(s.



11..Awareness of Self Awareness of Self

0 1he n'(se m's* -e a-le *o eamine

pe(sonal 4eelings, ac*ions, an (eac*ions.

0 goo 'ne(s*aning an accep*ance o4sel4 allow *he n'(se *o acnowlege a

pa*ien*7s i44e(ences an 'ni5'eness.



Campbell (1980) has identified a holistic nursing model of self-awareness that consists of four interconnected components:

• The psychological component includes nowledge of emotions! moti"ations!

self-concept! and personalit#$ %eing ps#chologicall# self-aware means beingsensiti"e to feelings and outside e"ents that affect those feelings$

• The physical component is the nowledge of personal and general ph#siolog#! as well as of bod# sensations! bod# image! and ph#sical potential$

• The environmental component consists of the sociocultural en"ironment!

relationship with others! and nowledge of the relationship between humansand nature$

• The philosophical component is the sense of life ha"ing meaning$ & personal philosoph# of life and death ma# or ma# not include a spiritual being! but itdoes tae into account responsibilit# to the world and the ethics of beha"ior$

• Together these components pro"ide a model that can be used to promote theself-awareness and self-growth of nurses and the patients for whom the# care$



22..Clarification of ValuesClarification of Values::

0 N'(ses sho'l -e a-le *o answe( *he 5'es*ion,

?ha* is impo(*an* *o me wa(eness o4 one7s

own 3al'es helps *he n'(se *o -e hones*, *o

-e**e( accep* i44e(ences in o*he(s, an *o a3oi*he 'ne*hical 'se o4 pa*ien*s *o mee* pe(sonal

nees.

0 Ane o4 *he many challenges 4acing psychia*(ic

n'(ses *oay is the need to provide care for

patients from diverse ac!"rounds.



##..$%ploration of &eelin"s$%ploration of &eelin"s::

0 /* is o4*en ass'me *ha* helping o*he(s (e5'i(es comple*eo-jec*i3i*y an e*achmen*. 1his is e4ini*ely no* *('e.omple*e o-jec*i3i*y an e*achmen* esc(i-e someonewho is 'n(esponsi3e, 4alse, 'napp(oacha-le, impe(sonal,

an sel4!aliena*e!5'ali*ies *ha* -loc *he es*a-lishmen*o4 a *he(ape'*ic (ela*ionship.

0 >a*he(, n'(ses sho'l -e open *o, awa(e o4, an /ncon*(ol o4 *hei( 4eelings so *ha* *hey can -e 'se *o helppa*ien*s.

0 <o( eample, espi*e *he pa*ien*7s s*a*emen* *ha* C*hingsa(e going (eal wellC, *he n'(se migh* pe(cei3e a s*(ongsense o4 espai( o( ange(.



''..Servin" as (ole )odelServin" as (ole )odel::

0 >esea(ch has shown *he powe( o4 (ole

moels in moling socially aap*i3e, as

well as malaap*i3e, *h's a n'(se has an

o-liga*ion *o moel aap*i3e an g(ow*h!

p(o'cing -eha3io(.



**..AltruismAltruism::

0 l*('ism is conce(n 4o( *he wel4a(e o4 o*he(s.

0 /* oes no* mean *ha* an al*('is*ic pe(sonsho'l no* epec* ae5'a*e compensa*ion

an (ecogni*ion o( m's* p(ac*ice enial o(sel4!sac(i4ice.

0 Anly i4 pe(sonal nees ha3e -eenapp(op(ia*ely me* can *he n'(se epec* *o -e

maimally *he(ape'*ic.

0



++..$thics and (esponsiilit,$thics and (esponsiilit,::

0 1he oe 4o( N'(ses (e4lec*s common

3al'es (ega(ing n'(se!pa*ien* (ela*ionships

an (esponsi-ili*ies an se(3es as a 4(ame

o4 (e4e(ence 4o( all n'(ses in *hei( j'gmen*s a-o'* pa*ien* wel4a(e an social

(esponsi-ili*y.

0 >esponsi-le e*hical choice in3ol3esacco'n*a-ili*y, (is, commi*men*, an

j's*ice.



Phases of the (elationshipPhases of the (elationship::

0 /* is impo(*an* *o is*ing'ish -e*ween social

s'ppo(* an p(o4essional s'ppo(*.

0 1he s'ppo(* (e5'es*e an 'l*ima*ely p(o3ie

sho'l -e wi*hin *he omain o4 *he n'(se7s (oleas a p(o4essional ca(egi3e(.

0 <o'( phases o4 *he n'(se!pa*ien* (ela*ionship

ha3e -een ien*i4ie: p(ein*e(ac*ion,

in*(o'c*o(y, o( o(ien*a*ion, phaseD wo(ing

phaseD an *e(mina*ion phase.



11..Preinteraction PhasePreinteraction Phase::

0 1he preinteraction phase -egins -e4o(e *hen'(se7s 4i(s* con*ac* wi*h *he pa*ien*s. 1he n'(se7sini*ial *as is one o4 sel4!eplo(a*ion.

0 1he sel4!analysis o4 *he p(ein*e(ac*ion phase is anecessa(y *as.

0 1o -e e44ec*i3e, n'(ses sho'l ha3e a (easona-lys*a-le sel4!concep* an an ae5'a*e amo'n* o4sel4!es*eem. 1hey sho'l engage in posi*i3e

(ela*ionships wi*h o*he(s an 4ace (eali*y *o helppa*ien*s o *he same.0 A*he( *ass o4 *his phase incl'e "atherin" data

a-o'* *he interaction wi*h *he pa*ien*s.



22..Introductor,- or rientation- PhaseIntroductor,- or rientation- Phase::

0 /* is '(ing *he in*(o'c*o(y phase *ha* *he n'(sean pa*ien* 4i(s* mee*. Ane o4 *he n'(se7sp(ima(y conce(ns is *o 4in o'* wh, the patientsou"ht help

0 n ai*ional *as is *o estalish "oalconsensus and collaoration.

0 <o(m'la*ing a con*(ac*. 1he *ass in *his phaseo4 *he (ela*ionship a(e *o es*a-lish a clima*e o4

*('s*, 'ne(s*aning, accep*ance, an opencomm'nica*ion an 4o(m'la*e a con*(ac* wi*h *hepa*ien*. Bo 2! lis*s *he elemen*s o4 a n'(se!pa*ien* con*(ac*.



1he iss'e o4 con4ien*iali*y is an impo(*an* one *o isc'sswi*h *he pa*ien* a* *his *ime. on4ien*iali*y in3ol3es *he

isclos'(e o4 ce(*ain in4o(ma*ion only *o ano*he(speci4ically a'*ho(ie pe(son.

A*he( *ass o4 *he n'(se in *he o(ien*a*ion phase o4 *he(ela*ionship a(e as 4ollows:

0 1o eplo(e *he pa*ien*7s pe(cep*ions. 1ho'gh*s, 4eelings,an ac*ions.

0 1o ien*i4y pe(*inen* pa*ien* p(o-lems

0 1o e4ine m'*'al, speci4ic goals wi*h *he pa*ien*.





##../or!in" phase/or!in" phase::

0 Mos* o4 *he(ape'*ic wo( is ca((ie o'* '(ing *he wo(ingphase. 1he n'(se an *he pa*ien* eplo(e s*(esso(s anp(omo*e *he e3elopmen* o4 insi"ht in *he pa*ien* -ylining pe(cep*ions, *ho'gh*s, 4eelings, an ac*ions.

0 1hese insigh*s sho'l -e *(ansla*e in*o ac*ion an achan"e in ehavior . 1hey can *hen -e in*eg(a*e in*o *heini3i'al7s li4e epe(iences.

0 Pa*ien*s o4*en isplay (esis*ance -eha3io(s '(ing *hisphase -eca'se i* in3ol3es *he g(ea*e( pa(* o4 *he p(o-lem!sol3ing p(ocess.

0 s *he (ela*ionship e3elops, *he pa*ien* -egins *o 4eel

close *o *he n'(se an (espon -y clinging *o ol e4ensesan (esis*ing *he n'(se7s a**emp*s *o mo3e 4o(wa(.



''..0ermination phase0ermination phase::

0 1e(mina*ion is one o4 *he mos* i44ic'l* -'* mos*impo(*an* phases o4 *he *he(ape'*ic n'(se!pa*ien* (ela*ionship.

0 1e(mina*ion is a *ime *o echange 4eelings an

memo(ies an *o e3al'a*e m'*'ally *he pa*ien*7sp(og(ess an goal a**ainmen*.

0 Fe3els o4 *('s* an in*imacy a(e heigh*ene,(e4lec*ing *he 5'ali*y o4 *he (ela*ionship an *he

sense o4 loss epe(ience -y -o*h n'(se anpa*ien*







II. &acilitative CommunicationII. &acilitative Communication::

0 omm'nica*ion, which *aes place on *wo

le3els ;3e(-al an non3e(-al=, can ei*he(

4acili*a*e *he e3elopmen* o4 a *he(ape'*ic

(ela*ionship o( se(3e as a -a((ie( *o i*.



Veral CommunicationVeral Communication::

0 Ge(-al comm'nica*ion occ'(s *h(o'gh

wo(s, spoen w(i**en.



Nonveral CommunicationNonveral Communication::

0 Non3e(-al comm'nica*ion incl'es all

(elaye in4o(ma*ion *ha* oes no* in3ol3e

*he spoen o( w(i**en wo(, incl'ing c'es

4(om all 4i3e senses.

0 /* has -een es*ima*e *ha* a-o'* $H o4

meaning is *(ansmi**e -y wo(s, "8H is

*(ansmi**e -y pa(aling'is*ic c'es s'ch as3oice, an %%H is *(ansmi**e -y -oy

c'es.



Types of Nonverbal BehaviorsTypes of Nonverbal Behaviors

0 Veral cues: incl'e all *he non3e(-al

5'ali*ies o4 speech.

0 Some eamples incl'e pi*chD *one o4

3oiceD 5'ali*y o4 3oiceD lo'ness o(

in*ensi*yD (a*e an (hy*hm o4 *alingD an

'n(ela*e non3e(-al so'ns, s'ch as

la'ghing, g(oaning.



0 Action cues: a(e -oy mo3emen*s,

some*imes (e4e((e *o as kinetics.

>e4lees, pos*'(e, 4acial ep(ession,

ges*'(es.



0 ect cues: a(e *he speae(7s

in*en*ional an 'nin*en*ional 'se o4 all

o-jec*s. )(ess, 4'(nishings, an

possessions



0 Space: p(o3ies ano*he( cl'e *o *he

na*'(e o4 *he (ela*ionship -e*ween

*wo people.



0 0ouch: in3ol3es -o*h pe(sonal spacean ac*ion.

0 1he(ape'*ic *o'ch o( *he n'(se7s

laying hans on o( close *o *he -oyo4 an ill pe(son 4o( *he p'(pose o4

helping o( healing.





0herapeutic Communication 0echniues0herapeutic Communication 0echniues::

1he(e a(e *wo (e5'i(emen*s 4o( *he(ape'*ic

comm'nica*ion:

. ll comm'nica*ion m's* p(ese(3e *he sel4!(espec*

o4 -o*h ini3i'als.

2. Ane sho'l comm'nica*e 'ne(s*aning -e4o(e

gi3ing any s'gges*ions o( a3ice.

0 Activities are carried out with the patient- not for thepatient.



0 1. 3istenin": lis*ening is essen*ial *o

'ne(s*aning *he pa*ien*.0 1he(e4o(e *he 4i(s* ('le o4 a *he(ape'*ic

(ela*ionship is *o lis*en *o *he pa*ien*.

0 >eal lis*ening is i44ic'l*. It is an active-not a passive- process.



is *o omm'nica*ion is *o omm'nica*ion

0 c*i3e lis*ening

9Ep(ession o4 in*e(es*

9Feaning 4o(wa(

9Noing hea

9Ge(-alia*ions s'ch as IJh!h'h an Io

onL

9<(e5'en* 3alia*ion

9 **emp* *o 4'lly 'ne(s*an



0 2. 4road penin"s:0 B(oa openings, s'ch as:

! C?ha* a(e yo' *hining a-o'*C Can yo'

*ell me mo(e a-o'* *ha*I! C?ha* shall we isc'ss *oayC

0 enco'(age *he pa*ien* *o selec* *opics *o

isc'ss.



0 #. (estatin":0 >es*a*ing is *he n'(se7s (epea*ing

o4 *he main *ho'gh* *he pa*ien*has ep(esse.



0 '. Clarification:0 la(i4ica*ion occ'(s when *he n'(se

a**emp*s *o p'* in*o wo(s 3ag'e ieas o(

*ho'gh*s *ha* a(e implici* o( eplici* in *hepa*ien*7s *aling.

0 S'ch as C/7m no* s'(e wha* yo' mean. (e

yo' saying *ha* LC



0 *. (eflection:

0 >e4lec*ion o4 con*en* is also calle validation, which le*s *he pa*ien* now *ha* *he n'(se has

hea( wha* was sai an 'ne(s*ans *he con*en*.

/* consis*s o4 (epea*ing in 4ewe( o( i44e(en* wo(s

*he essen*ial ieas o4 *he pa*ien* an (esem-lespa(aph(asing. Some*imes i* helps *o (epea* a

pa*ien*7s s*a*emen*, emphasiing a ey wo(.

0 >e4lec*ion o4 4eelings consis*s o4 (esponses *o

*he pa*ien*7s 4eelings a-o'* *he con*en*.



0 +. &ocusin":

0 <oc'sing helps *he pa*ien*

epan on a *opic o4 impo(*ance.



0 5. Sharin" Perceptions:

0 Sha(ing pe(cep*ions in3ol3es asing *hepa*ien* *o 3e(i4y *he n'(se7s 'ne(s*aningo4 wha* *he pa*ien* is *hining o( 4eeling.

0 Pe(cep*ion checing is a way *o eplo(eincong('en* o( o'-le!-lincomm'nica*ion.

0Co'7(e smiling, -'* / sense *ha* yo'7(e(eally ang(y wi*h wha* happene.C



0 6. 0heme Identification:

0 *hemes a(e 'ne(lying iss'es o( p(o-lemsepe(ience -y *he pa*ien* *ha* eme(ge

(epea*ely '(ing *he co'(se o4 *he n'(se!pa*ien*

(ela*ionship.

0 1hey can (ela*e *o 4eelings ;ep(ession o(anie*y=, -eha3io( ;(e-elling agains* a'*ho(i*y o(

wi*h(awal=, epe(iences ;-eing lo3e o( h'(*=,

o( com-ina*ions o4 all *h(ee.



0 7. Silence:

0 Silence on *he pa(* o4 *he n'(se has3a(ying e44ec*s epening on how *hepa*ien* pe(cei3es i*.

0 1o a 3ocal pa*ien*, silence on *he pa(* o4*he n'(se may -e welcome, as long as *hepa*ien* nows *he n'(se is lis*ening.

0 ?i*h a ep(esse o( wi*h(awn pa*ien*,*he n'(se7s silence may con3ey s'ppo(*,'ne(s*aning, an accep*ance.



0 18. 9umor :0 'mo( is a -asic pa(* o4 *he pe(sonali*y

an has a place wi*hin *he *he(ape'*ic

(ela*ionship.0 s a pa(* o4 in*e(pe(sonal (ela*ionships, i*

is a cons*('c*i3e coping -eha3io(.

0 By lea(ning *o ep(ess h'mo(, a pa*ien*may -e a-le *o lea(n *o ep(ess o*he(

4eelings.





0 11. Informin":

0 in4o(ming o( in4o(ma*ion gi3ing, is anessen*ial n'(sing *echni5'e in which *he

n'(se sha(es simple 4ac*s o( in4o(ma*ionwi*h *he pa*ien*.



0 12. Su""estin":

0 s'gges*ing is *he p(esen*a*ion o4 al*e(na*i3eieas, an is eplo(ing al*e(na*i3e copingmechanisms.

0 S'gges*ing o( a3ice, also can -e no

*he(ape'*ic, (ein4o(ces *he pa*ien*7s epenence.

0 1he n'(se7s in*en* in 'sing *he s'gges*ing*echni5'e sho'l -e *o p(o3ie 4easi-leal*e(na*i3es an allow pa*ien*s *o eplo(e *hei(3al'es in *hei( 'ni5'e li4e si*'a*ion.



III. ($SPNSIV$ I)$NSINSIII. ($SPNSIV$ I)$NSINS

0 1he n'(se m's* possess ce(*ain sills o(

5'ali*ies *o es*a-lish an main*ain a

*he(ape'*ic (ela*ionship.

0 Speci4ic co(e coni*ions 4o( 4acili*a*i3e

in*e(pe(sonal (ela*ionships can -e i3ie

in*o (esponsi3e imensions an ac*ion

imensions



0 1he (esponsi3e imensions incl'e

gen'ineness, (espec*, empa*hic'ne(s*aning, an conc(e*eness.

0 1he helping p(ocess can impee *he

pa*ien*7s g(ow*h (a*he( *han enhance i*,epening on *he le3el o4 *he n'(se7s

(esponsi3e an 4acili*a*i3e sills.



0 1he (esponsi3e imensions a(e c('cial in

a *he(ape'*ic (ela*ionship *o es*a-lish *('s*an open comm'nica*ion.

0 1he n'(se7s goal is *o 'ne(s*an *he

pa*ien* an *o help *he pa*ien* gain sel4'ne(s*aning an insigh*.

0 1hese (esponsi3e coni*ions *hen

con*in'e *o -e 'se4'l *h(o'gho'* *hewo(ing an *e(mina*ion phases.



11..;enuineness;enuineness

0 en'ineness means *ha* *he n'(se is an

open, hones*, since(e pe(son who is

ac*i3ely in3ol3e in *he (ela*ionship.

0 en'ineness is *he opposi*e o4 sel4!

aliena*ion, which occ'(s when many o4 an

ini3i'al7s (eal, spon*aneo's (eac*ions *o

li4e a(e s'pp(esse.



0 en'ineness means *ha* *he n'(se7s

(esponse is since(e, *he n'(se is no**hining an 4eeling one *hing an saying

some*hing i44e(en*.

0 /* is an essen*ial 5'ali*y -eca'se n'(sescanno* epec* openness, sel4!accep*ance,

an pe(sonal 4(eeom in pa*ien*s i4 *hey

lac *hese 5'ali*ies *hemsel3es



0 ?ha*e3e( *he n'(se shows m's* -e (eal

an no* me(ely a 7p(o4essional7 (esponse*ha* has -een lea(ne an (epea*e.

0 /n 4oc'sing on *he pa*ien*, many o4 *he

n'(se7s pe(sonal nees a(e p'* asie, aswell as some o4 *he 's'al ways o4 (ela*ing

*o o*he(s.



2. (espect

0 >espec* is also calle 'nconi*ionalposi*i3e (ega(.

0 /* oes no* epen on *he pa*ien*7s

-eha3io(.0 a(ing, liing, an 3al'ing a(e o*he( *e(ms

4o( (espec*.

0 1he pa*ien* is (ega(e as a pe(son o4wo(*h an is (espec*e as s'ch.



#. $mpath,

0 Empa*hy is *he a-ili*y *o en*e( in*o *he li4e o4

ano*he( pe(son, *o acc'(a*ely pe(cei3e *hepe(son7s c'((en* 4eelings an *hei( meanings, an*o comm'nica*e *his 'ne(s*aning *o *he pa*ien*.

0 cc'(a*e empa*hy in3ol3es mo(e *han nowing

wha* *he pa*ien* means. /* also in3ol3essensi*i3i*y *o *he pa*ien*7s c'((en* 4eelings an *he3e(-al a-ili*y *o comm'nica*e *his 'ne(s*aningin a lang'age a**'ne *o *he pa*ien*.



0 Empa*hy can signi4ican*ly p(omo*econs*('c*i3e lea(ning an change.

0 <i(s*, i* issol3es *he pa*ien*7s sense o4isola*ion -y connec*ing *he pa*ien* *oano*he( pe(son.

0 1he pa*ien* can pe(cei3e *ha* C/ maesense *o ano*he( h'man -eing. .. so / m's*no* -e so s*(ange. L an i4 / am in *o'ch

wi*h someone else, / am no* so alone.



'. Concreteness

0 onc(e*eness in3ol3es 'sing speci4ic*e(minology (a*he( *han a-s*(ac*ions whenisc'ssing *he pa*ien*7s 4eelings,epe(iences, an -eha3io(.

0 /* a3ois 3ag'eness an am-ig'i*y an is*he opposi*e o4 gene(aliing, la-eling, anmaing ass'mp*ions a-o'* *he pa*ien*7s

epe(iences.



IV. AC0IN I)$NSINIV. AC0IN I)$NSIN

0 1he ac*ion!o(ien*e coni*ions 4o( 4acili*a*i3e

in*e(pe(sonal (ela*ionships a(e con4(on*a*ion,

immeiacy, *he(apis* sel4!isclos'(e, ca*ha(sis,

an (ole playing.

0 ?i*h *he ac*ion imensions, *he n'(se mo3es *he

*he(ape'*ic (ela*ionship 'pwa( an o'*wa( -y

ien*i4ying o-s*acles *o *he pa*ien*7s p(og(essan *he nee 4o( speci4ic -eha3io( change.



11..ConfrontationConfrontation

0 on4(on*a*ion o4*en implies 3en*ing ange(

an engaging in agg(essi3e -eha3io(.

owe3e(, con4(on*a*ion as a *he(ape'*ic

ac*ion imension is an asse(*i3e (a*he(*han agg(essi3e ac*ion.



on4(on*a*ion is an ep(ession -y *he n'(se o4 pe(cei3e

isc(epancies in *he pa*ien*7s -eha3io(. 1h(ee ca*ego(ies o4

con4(on*a*ion incl'e *he 4ollowing:

0 discrepancies between the patient's expression of what heis (self-concept) and what he wants to be (self-ideal)

0 discrepancies between the patient's verbal self-expressionand nonverbal behavior.

0 Discrepancies between the patient's expressed experienceof himself and the nurse's experience of him

on4(on*a*ion is an a**emp* -y *he n'(se *o mae *he pa*ien*

wa(e o4 incong('ence in 4eelings, a**i*'es, -elie4s an

-eha3io(s.



0 on4(on*a*ion also m's* -e app(op(ia*ely *ime*o -e e44ec*i3e ;4ig'(e=. /n *he o(ien*a*ion phase

o4 *he (ela*ionship, *he n'(se sho'l 'secon4(on*a*ion in4(e5'en*ly an pose i* as ano-se(3a*ion o4 incong('en* -eha3io(.

0 simple mi((o(ing *he isc(epancy -e*ween apa*ien*7s ac*ions an wo(s is *he mos*non*h(ea*ening *ype o4 con4(on*a*ion. 1he n'(semigh* say, Cyo' seem *o -e saying *wo i44e(en**hings. C*his *ype o4 con4(on*a*ion closely

(esem-les cla(i4ica*ion a* *his *ime.



0 N'(ses also migh* ien*i4y isc(epancies-e*ween how *hey an pa*ien*s a(eepe(iencing *hei( (ela*ionship, poin* o'*'nno*ice pa*ien* s*(eng*hs o( 'n*appe(eso'(ces, o( p(o3ie pa*ien*s wi*h

o-jec*i3e -'* pe(haps i44e(en* in4o(ma*iona-o'* *hei( wo(l.

0 <inally, *o -e e44ec*i3e, con4(on*a*ion(e5'i(es high le3els o4 empathy andrespect.



22..Immediac,Immediac,

0 /mmeiacy in3ol3es 4oc'sing on *he c'((en*in*e(ac*ion o4 *he n'(se an *he pa*ien* in *he(ela*ionship. /* is a signi4ican* imension-eca'se *he pa*ien*7s -eha3io( an 4'nc*ioning

in *he (ela*ionship a(e inica*i3e o4 4'nc*ioning ino*he( in*e(pe(sonal (ela*ionships.

0/mmeiacy in3ol3es sensi*i3i*y *o *he pa*ien*7s4eelings an a willingness *o eal wi*h *hese4eelings (a*he( *han igno(e *hem.



##..Nurse self<disclosureNurse self<disclosure

0 Sel4!isclos'(es a(e s'-jec*i3ely *('e, pe(sonals*a*emen*s a-o'* *he sel4, in*en*ionally (e3eale *oano*he( pe(son. 1he n'(se may sha(e epe(iences o(4eelings *ha* a(e simila( *o *hose o4 *he pa*ien* an mayemphasie -o*h *he simila(i*ies an i44e(ences.

0 1his in o4 sel4!isclos'(e is an ine o4 *he closenesso4 *he (ela*ionship an in3ol3es a pa(*ic'la( in o4(espec* 4o( *he pa*ien*. /* is an ep(ession o4gen'ineness an hones*y -y *he n'(se an is an aspec*o4 empa*hy.

0 1he (esea(ch li*e(a*'(e p(o3ies signi4ican* e3ience *ha**he(apis* sel4!isclos'(e inc(eases *he lielihoo o4pa*ien* sel4!isclos'(e. Pa*ien* sel4!isclos'(e isnecessa(y 4o( a s'ccess4'l *he(ape'*ic o'*come.



''..$motional catharsis$motional catharsis

0 a*ha(sis occ'(s when *he pa*ien* is enco'(age

*o *al a-o'* *hings *ha* a(e mos* -o*he(some.

a*ha(sis -(ings 4ea(s, 4eelings, an epe(iences

o'* in*o *he open so *ha* *hey can -e eaminean isc'sse wi*h *he n'(se.

0 1he ep(ession o4 4eelings can -e 3e(y

*he(ape'*ic in i*sel4D e3en i4 -eha3io(al changeoes no* (es'l*



**..(ole pla,in"(ole pla,in"

0 >ole playing in3ol3es ac*ing o'* a pa(*ic'la(si*'a*ion. /* inc(eases *he pa*ien*7s insigh* in*oh'man (ela*ions an can eepen *he a-ili*y *osee *he si*'a*ion 4(om ano*he( pe(son7s poin* o4

3iew.0 ?hen (ole playing is 'se *o 4acili*a*e a**i*'e

change, one ey elemen* o4 *he ee(cise is (ole(e3e(sal. 1he pa*ien* may -e ase *o ass'me*he (ole o4 a ce(*ain pe(son in a speci4ic si*'a*iono( *o play *he (ole o4 someone wi*h opposing-elie4s.



0 4*e( epe(iencing (ole (e3e(sal, pa*ien*s

may -e mo(e (ecep*i3e *o moi4ying *hei(own a**i*'es.

0 Jse as a me*ho o4 p(omo*ing sel4!

awa(eness an con4lic* (esol'*ion, (oleplaying may help *he pa*ien* Cepe(ienceC

a si*'a*ion, which can -e mo(e help4'l

*han j's* *aling a-o'* i*.



0 Ane o4 *he ways in which (ole playing can -e'se *o (esol3e con4lic*s an inc(ease sel4!

awa(eness is *h(o'gh a ialog'e *ha* (e5'i(es*he pa*ien* *o *ae *'(ns speaing 4o( eachpe(son o( each sie o4 a p(o-lem.

0 /4 *he con4lic* is in*e(nal, *he ialog'e occ'(s in

*he p(esen* *ense an al*e(na*es -e*ween *hepa*ien*7s con4lic*ing sel3es 'n*il one pa(* o4 *hecon4lic* o'*weighs *he o*he(.

0 /4 *he con4lic* in3ol3es a secon pe(son, *hepa*ien* is ins*('c*e *o Cimagine *ha* *he o*he(

pe(son is si**ing in *he chai( ac(oss 4(om yo'.C



V. 0herapeutic impassesV. 0herapeutic impasses

0 1he(ape'*ic impasses a(e -locs in *he p(og(ess o4 *hen'(se!pa*ien* (ela*ionship.

0 1hey come a-o'* 4o( a 3a(ie*y o4 (easons, -'* allimpasses c(ea*e s*alls in *he *he(ape'*ic (ela*ionship.

0 /mpasses p(o3oe in*ense 4eelings in -o*h *he n'(se an*he pa*ien*, which may (ange 4(om anie*y anapp(ehension *o 4('s*(a*ion, lo3e, o( in*ense ange(.

0 <o'( speci4ic *he(ape'*ic impasses an ways *oo3e(come *hem a(e isc'sse he(e: (esis*ance,*(ans4e(ence, co'n*e(!*(ans4e(ence, an -o'na(y3iola*ions.



11..(esistance(esistance

0 >esis*ance is *he pa*ien*7s (el'c*ance o(

a3oiance o4 3e(-aliing o( epe(iencing

*(o'-ling aspec*s o4 onesel4.

0 >esis*ance is o4*en ca'se -y *hepa*ien*7s 'nwillingness *o change when

*he nee 4o( change is (ecognie.



22..0ransference0ransference

0 1(ans4e(ence is an 'nconscio's (esponse inwhich pa*ien*s epe(ience 4eelings an a**i*'es*owa( *he n'(se *ha* we(e o(iginally associa*ewi*h o*he( signi4ican* 4ig'(es in *hei( li4e.

0 1(ans4e(ence (e'ces sel4!awa(eness -yallowing *he pa*ien* *o main*ain an inacc'(a*e3iew o4 *he wo(l in which all people a(e seen insimila( *e(ms.

0 1he 4i(s* is *he hos*ile *(ans4e(ence. /4 *he pa*ien*in*e(nalies ange( an hos*ili*y, *his (esis*ancemay -e ep(esse as ep(ession anisco'(agemen*.



0 secon i44ic'l* *ype o4 *(ans4e(ence is

*he epenen* (eac*ion *(ans4e(ence.

0 1his (esis*ance is cha(ac*e(ie -y

pa*ien*s who a(e s'-missi3e, s'-o(ina*e,an ing(a*ia*ing an who (ega( *he n'(se

as a golie 4ig'(e.



##..Counter transferenceCounter transference

o'n*e( *(ans4e(ence is a *he(ape'*ic impasse

c(ea*e -y *he n'(se7s speci4ic emo*ional

(esponse *o *he 5'ali*ies o4 *he pa*ien*.

o'n*e( *(ans4e(ence (eac*ions a(e 's'ally o4 *he4ollowing *h(ee *ypes:

. >eac*ions o4 in*ense lo3e o( ca(ing

2. >eac*ions o4 in*ense isg's* o( hos*ili*y

". >eac*ions o4 in*ense anie*y, o4*en in (esponse

*o (esis*ance -y *he pa*ien*.



''..4oundar, violations4oundar, violations

0 ?hich occ'( when a n'(se goes o'*sie

*he -o'na(ies o4 *he *he(ape'*ic

(ela*ionship an es*a-lishes a social,

economic, o( pe(sonal (ela*ionship wi*h apa*ien*.



Possible boundary violations related to psychiatric nurses

•The patient takes the nurse out to lunch or dinner.

•The professional relationship turns into a social relationship.

•The nurse attends a party at a patient's invitation.•The nurse regularly reveals personal information to the patient.

•The patient introduces the nurse to family members, such as a son

or daughter, for the purpose of social relationship.

•The nurse accepts free gifts from the patient's business.

•The nurse agrees to meet the patient for treatment outside the usual

setting without therapeutic justification.•The nurse attends social functions that include the patient

•The patient gives the nurse an expensive gift.

•The nurse routinely hugs or has physical contact with the patient

•The nurse does business with or purchases services from the patient.

VI 0h

i



VI. 0herapeutic outcomeVI. 0her apeutic outcome

Documents

02 Therapeutic Nurse Patient Relationship