Phases of Therapeutic Nurse - Patient Relationship

PHASES OF THERAPEUTIC NURSE - PATIENT RELATIONSHIP

DEFINITION

The nurse patient relationship is an end result of series of interaction between the nurse and patient over a period of time with the nurse focusing on need and problem of patient and his family while using the scientific knowledge and specific skills of nursing profession.Renjulal y 090504009 2

PHASES OF THERAPEUTIC NURSE- PATIENT RELATIONSHIPPre interaction phase Introductory / orientation phase Working phase Termination phase

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Pre-interaction phase

Pre interaction is a phase which a nurse goes through before actual interaction with the patient. This phase begins when the nurse is assigned a patient to develop therapeutic relationship with him till she goes to him for interactionRenjulal y 090504009 4

Pre-Interaction Phase..

The pre interaction phase begins before the nurses first contact with the patient. This involves preparation for first encounter with the client. This phase begins when the nurse is assigned a patient to develop therapeutic relationship with him or her till she goes him or her for interaction.Renjulal y 090504009 5

Task of pre-interaction phase Obtaining available information

about the client from his or her charts, significant others or other health team members. From this information the initial assessment are begun. This initial information may also allow the nurse to become aware of personal response to the knowledge about the client.Renjulal y 090504009 6

Task of pre-interaction phaseExamining ones feelings, fears

and anxieties about working with a particular patient. Set objective for the interaction phase. Take help of the clinical supervisor or co-workers to overcome fears.


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Reactions of Nurse in Pre-Interaction PhaseThe nurse thinks and feels about

the patient before interacting according to her knowledge, fears and miss concepts. She tries to collect information from secondary sources like the patients records, a resource person and other nurses working in the ward.


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Pre Interaction Phase .The nurse plans how she is going

to interact with the patient, what she is going to achieve from this interaction and how she is going to help the patient. She plans her objective for interaction phase.Renjulal y 090504009 9

The nurse may experience anxiety.

Pre Interaction Phase .

Anxiety may be manifested by standing in duty room and going through the records, talking with the clinical instructor.

Anxieties maybe,

will the patient talk to me? He may not accept me or like me? He may beat me?

Once she goes to the patient the anxiety reduces.Renjulal y 090504009

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How to overcome anxieties She can go through their record. Talk to the clinical supervisor or

other nurses about her fears. Can set her goals very clearly. Plan a brief interaction with the patient.


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INTRODUCTORY / ORIENTATION PHASE

Begins when the nurse goes to the patient, introduces herself and gets introduction about him. The nurse and client get acquainted. The orientation phase ends when the nurse and he patient begin to accept each other as a unique human being.Renjulal y 090504009 12

Task of introductory or orientation phasea) Establishment of Contact Nurse introduce herself to the

patient Build trust and rapport by demonstrating acceptance. Establishing a therapeutic environment ensuring safety and privacy


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Task of introductory or orientation phase..b) Making Agreement or Pact Initiating a therapeutic contract

by establishing a time, place and duration of each meeting as well as the length of time the relationship will be in effect.


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Task of introductory or orientation phase..c) Talking with the Patient While talking with the patient, shows trust in her behaviour. The patient may present a prepared spiel to the nurse when she asks, what is your problem? during this task the nurse should establish a mode of communication which is acceptable to both the client and theRenjulal y 090504009 15

Task of introductory or orientation phase..d) Assess the Clients Need,

Coping Strategies, Defense Mechanisms, Strengths and Weakness


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BARRIERS TO ORIENTATION PHASE1) Establishing an agreement or

pact.2) Social class of the patient or the

nurse.3) Status of the patient.Renjulal y 090504009 17

5) Transference

When the patient perceive the nurse as a significant individual from the past: for example the perceives the nurse as his daughter and starts behaving with her like a father 6) Counter transference When the nurse perceives a male patient like her father and gives him the same care that she would have given to her father


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WORKING PHASE

Working Phase starts when the nurse and the patient are able to overcome the barriers of orientation and introductory phase. During this phase the nurse and the patient actively work on meeting the goals which they had establish during the orientation phase.Renjulal y 090504009 19

WORKING PHASE.The characteristic feature of this

phase is that the nurse is able to overcome anxiety and the patients fear of un known is also decreased.


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Task of working phaseThe nurse collects the data in detail

from primary and secondary sources and identifies the needs of the patent. The nurse assists the patient to identify his or her problem. She helps the patient to communicate. She encourages the patient toRenjulal y 090504009 21

Task of working phaseThe nurse helps the patient o find

an alternative solution to his or her problems She encourage the patients to use new patterns of behaviour. Helps the client to develop positive coping behaviors. Identifying available support system.Renjulal y 090504009 22

Task of working phaseThe nurse helps the patient to

understand that he has a significant role in his treatment. Exploring the clients perception of reality and provide constructive feed back. Developing and implementing plan of action with a realistic goals. Evaluating the results of plan ofRenjulal y 090504009 23

Task of working phaseThe nurse prepares the patient

for termination of relationship by reminding him during the interviews


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Working phaseThe working phase helps the nurse

to develop knowledge and skill in psychiatric nursing. She identifies her strengths and weakness as a nurse while interacting with patient. It enables the nurse to achieve the goals which they have plan for this phase. The end results lead the patient to verbalize, socialize, identify and faces the problems realisticallyRenjulal y 090504009 25

BARRIERS OF WORKING PHASETesting of the nurse

The patient tests the nurse for the ability and competence. Example: Patient: please continue talking I am very upset today. If the nurse gives in to his demand, it indicates manipulation. He may deliberately be aggressive to test whether he is ableRenjulal y 090504009 26

BARRIERS OF WORKING PHASEProgress of the patient

A mentally ill patient may not show a quick progress. He may progress then regress and remains stagnant before making further progress. In therapeutic relationship the nurse must understand the realistic progress in the clientRenjulal y 090504009 27

BARRIERS OF WORKING PHASEDifficulty in collecting and

interpreting the data The nurse is unwilling to engage in TDS task in collecting and interpreting the data, applying the knowledge and skills in helping the patient, she finds too hard to do this acts as a barrier in completing the task of working phase.Renjulal y 090504009 28

BARRIERS OF WORKING PHASEFear of closeness

The nurse feels that she is working closely with the patient she may find difficult to terminate the relationship. The patient may not like to discontinue the relationship. To avoid closeness she doesnt communicate freely and makes deliberate attempts to avoid going to the patient.Renjulal y 090504009 29

STRATEGIES TO OVERCOME BARRIERSLearn the subject in depth Taking help from supervisors and

expertsDiscussions with peer group


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TERMINATION PHASE

The final step of the therapeutic relationship is the termination phase. The nurse terminates the relationship when they mutually agreed: on goals are reached.Renjulal y 090504009 31

TERMINATION PHASE.The nurse discusses the termination

phase with the client encourages to identify the progress that the client has made and explores the necessity of any referral that may be beneficial to the patient. As separations occurs clients commonly exhibit regressive behaviour demonstrates hostility or experience sadness.Renjulal y 090504009 32

TERMINATION PHASE.The client may attempt to prolong

the relationship as clinical symptoms of separation anxiety are experienced however; termination needs to occur if a therapeutic relationship to be a complete process. Preparation for termination actually begins during the initiation phaseRenjulal y 090504009 33

CAUSES

The

client is transferred or discharge. The nurse is finished clinical rotation. The patient may go on parole and doesnt come back to hospital. The client has improved and no longer needs to have one to oneRenjulal y 090504009 34

TASK OF TERMINATIONBring a therapeutic end to the

relationship. Review feelings about relationship. Evaluate progress towards goal. Establish mechanisms for meeting future therapy needs. Summarize entire communication and follow up treatments.


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PREPARATION OF PATIENTExplain

whatever goals of therapeutic relationship where plans have been met. Allow the patient to talk about his or her fear and an individualistic approach has to be used. A psychiatric social worker can be contacted to meet to visit the office and family of the patient.


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PREPARATION OF PATIENTThe patient may sent on parole

before discharge, so that he gradually goes through the weaning of the phase. The patient may be sent through a half way home. The patient may be asked to attend the day care center for few days.


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BARRIERS OF TERMINATION PHASEThe patient may ask the nurse to

write to him or come back from duty and see him. The patient may ask the address and telephone number of nurse and ask permission to visit her in hospital Gift givingRenjulal y 090504009 38

BARRIERS OF TERMINATION PHASE.The nurse may withdraw earlier

from the patient due to her own anxiety she may not interact with the patient The nurse may not assess the patient which she could otherwise do


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STRATEGIES TO OVERCOMENurse needs to explore her own

feelings and thoughts about separation from the patient which will help her to accomplish the task of termination phase The patient should be explained that every relationship terminates Getting help from supervisors


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STRATEGIES TO OVERCOME.After discharge the patient comes

for intervention he or she should be referred to a second in charge. If the patient is giving some gifts: the patient need to be explained about the professional ethics, if he wants to give a gift he may be encourage to gift out something for the utilization of other patients.


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Thank youPresented by : Renjulal y M.Sc nursing Mental Health Nursing MCON


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Phases of Therapeutic Nurse - Patient Relationship