Nurse Patient Relationship

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Nurse - Patient Relationship
• The general goal of nurse- client interaction is

to help the client to grow. All Nurses need
skills in therapeutic communication that
encourage the patient to express feelings and
ideas and that convey acceptance and respect.
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• Messages in therapeutic communication
involves the verbal (arrangement of words into
sentences, (content)) as well as the (context
which means the area where the conversation
takes place which might include the time and
the physical, social, emotional and cultural
environment).
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• Nonverbal communication body language, eye
contact, facial expression, the tone of the voice
and others.
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Goals of therapeutic communication in nursing
1. Establish a therapeutic nurse -patient

relationship.
2. Identify client’s most important needs
3. Assessing client’s problem and solving it.
4. Facilitate client’s expression of emotions or
feelings.
5. Clarifies the area of conflict and anxiety.
6. Identify client’s strengths and weaknesses.
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Characteristics Of Therapeutic
Communication in Nurse patient R/S
RESPONSIVE DIMENSIONS.
1. Genuineness‫ =ا لصدق‬nurse is open, honest,
sincere, person who is actively involved in the
relationship.
2. Respect = ‘Unconditional positive regard’ is
acceptance to someone, regardless of what they say or do
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Characteristics Of Therapeutic
Communication
3. Empathy understanding = Empathy is an
essential element of Inter Personal Relationship
“IPR”.
4. Concreteness‫= ا لواقعيه‬
avoids vagueness‫ غموض‬and ambiguity‫ ا==لتباس‬when
discussing the client’s feelings, experience and
behaviour.
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Characteristics Of Therapeutic Communication
• ACTION DIMENSIONS. Action dimensions must have a context

of warmth and understanding. With action dimensions, the nurse
moves the therapeutic relationship upward and outward by
identifying obstacles to the client’s progress and the need for both
internal understanding and external action.

• A) Confrontation – Usually implies venting‫ ا==لتنفيس‬anger and
aggressive behaviour. This has the effect of blaming and
embarrassing the receiver – all of which are harmful and
destructive in both social and therapeutic relationships.
• But confrontation in action dimension is an assertive rather than

aggressive action. Confrontation is an expression by nurse of
perceived discrepancies in the client’s behaviour
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Characteristics Of Therapeutic Communication
B) Immediacy‫– مباشر‬.Client describing what

he/she feels in the therapeutic relationship.
C) Nurse – self- disclosure. – Here the nurse

reveals information about himself/herself such as
ideas, values, feelings and attitudes. It involves a
particular kind of respect for the client.
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Components / Elements Of Nurse-Client Relationship
1.Rapport: Trust is critical in the nurse-client relationship because

the client is in a vulnerable position. trust in a relationship is
fragile, so it’s especially important that a nurse keep promises to
a client. If trust is breached, it becomes difficult to re-establish.
2.Respect: means dignity, worth and uniqueness of every

individual, regardless of socio-economic status, personal
attributes and the nature of the health problem.
3.Empathy:. When the nurse develops and utilizes this ability to

have empathy, clients tend to feel much better about themselves
and more understood.
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4. Genuineness:. For the nurse to do this, he or

she should be honest and congruent. Congruence
only occurs when the nurse’s words matches with
her actions.
5. Confidentiality: During the therapeutic

relationship the patient develops confidence and
trust in a nurse. She may talk about her personal
problems with the nurse. If a problem is such 'that
it requires intervention of a psychiatrist or social
worker the nurse should report it. However this
should be done with the consent of the patient.
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6. Warmth: is the ability to help the client feel

cared for & comfortable. It shows acceptance of
the client as a unique individual. calling his\her
name, accepting the patient with symptoms of
mental disorders
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Therapeutic Interpersonal Relationship – Phases
1. Pre-interaction phase = Explore self- perception of both

Nurse and client.
2. Orientation Phase = Establishment of trust and rapport

and formulate contract for intervention
3. Working phase = Promote client change
4. Termination phase = Evaluate goal attainment and

ensure therapeutic closure
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1) Pre-interaction Phase
• Pre-interaction phase = Involves preparation
for the first encounter with the client.
Nurse’s Tasks
1. Explore own feelingsand fears.
2. Analyse own professional strength & limitations.
3. Gather data about patient whenever possible.
4. Plan for first meeting with the patient.
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Problems found in pre-interaction phase
A. To effectively analyze self.
B. Anxiety
C. Anger
D. Depression
E. Boredom
•
Keys to overcome problems in preinteraction phase
• Nurses can take the help of senior experienced
nurses to overcome anxiety, analyze self and
identify the limitations.
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2. Orientation Phase/ Introductory Phase
2. Orientation Phase/ Introductory Phase = It is during that the

nurse and the client meet for the first time.
Nurse’s Tasks
1. Creating an environment for the establishment of trust and
rapport.
2. Gathering assessment information to build a strong client data
base.
3. Identifying client’s strength and weakness.
4. Formulating nursing diagnoses
5. Setting goals that are mutually agreeable to the nurse and client.
6. Exploring feelings of both nurse and client.
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Problems found in Orientation Phase
1. Both nurse and patient may have problems

accepting each other as a unique individual.
2. They may have trust issues between them.
3. The problem may occur in mutually setting a
goal.
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Keys to overcome problems in Orientation Phase
1. The nurse may find similarities and can relate

to an incident of her own. In this case, she
might consult her senior supervisor.
2. The nurse must share her feelings freely
without having fear of criticism.
3. During a discussion with the client, a nurse
may have an emotional attachment with the
client. A wise supervisor can identify it and
help the nurse to overcome it.
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3. Working Phase
3. Working Phase = The therapeutic work of

relationship is accomplished during this phase.
• Maintaining the trust and rapport that was

established during the orientation phase.
Promote the client’s insight & perception of
reality. Here nurses must continuously evaluate
the process towards goal attainment.
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Nurses responsibility in working Phase
1) Gather more and more data of the patient to explore

the stressors.
2) Help the patient to promote coping mechanisms and
develop insight.
3) Let the patient understand his behavioral change by
evaluating himself.
4) Facilitate individual functioning, If the required nurse
can modify it by discussing with the client.
5) The nurse can evaluate the problems and redefine
them.
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Problems found in working Phase
1. Sometimes patients test the nurse.
2. Making an unrealistic goal can give frustration
to both nurse and patient.
3. Nurses’ live problems.
4. Transference: is when someone redirects their feelings about one
person onto someone else, when you observe characteristics of your father
in a new boss
5. Countertransference: which occurs when a nurse lets their

own feelings shape the way they interact with or react to their client
in therapy
6. Resistance behavior: it caused by mistrust, boring and
unpleasant message
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Keys to overcome problems in working phase
• Discussion with supervisors and other staff

regarding the problem faced in this phase.
• Nurses may find sometime that she is not
having progress enough.
• Handing the resistances effectively.
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Case Scenario
• The psychiatric nurse care-manager has been seeing a 32-year
old male client for the past two years. The client was diagnosed
with schizophrenia and has experienced a reduction in symptoms
over the past year. The nurse and the client are working on the
goal of greater independence. The client’s priority is to move from
the group home to an apartment. The nurse responds by
1. Supporting the client’s problem solving by examining with the
client, alternatives and criteria for the new accommodation
2. Discussing the skills required for independent living and how
these skills may be enhanced/developed
3. Encouraging the client to do “homework” by seeking out
information and then discussing this with the nurse
4. Being aware of his/her own desire to be a “helper” and the
potential conflict with the client’s need to help himself
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4. Termination Phase
4. Termination Phase = This is the most difficult to
nurse and client, but most important phase of the
therapeutic nurse-patient relationship. The goal of
this phase is to bring a therapeutic end to the
relationship. The client may be discharged from the
hospital.
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Nurses responsibility in termination phase
• Put reality of separation in front of the patient.

• Nurse and patient should mutually explore the
feelings, emotions and related behavior.
• Evaluate the effectiveness of therapy and
achievement of goals.
• Discuss future plans for meetings if required.
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Problems found in termination phase
• Anger
• Punitive behavior.
• Depression
• Nurses unwillingness to implement any plan.
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Keys To Overcome Problems In Termination Phase
• Nurses should be aware of patient feelings and

capable of managing the situation.
• Encourage the patient to share his thoughts
regarding the termination phase.
• Nurses can take the help of the supervisor to
help the nurse preparing for the discharge of a
patient.
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Case Scenario
A 72-year-old male client is being discharged from a stroke
rehabilitation in-patient program. The nurse has worked with
the client & his family over the past couple of months.
A pressing concern is planning for in-house supports and

discussing community resources that have now been accessed.
The final meeting is planned between the nurse and client to
review the progress that has been made and the future plans.
Both use this opportunity to say their good-byes. They are both
aware of ambivalent feelings-happiness at the progress made
and return to home, yet some sadness at the loss of a
comfortable
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and familiar relationship 28
12/19/22 12:13 PM 29

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12/19/22 12:13 PM 1

Nurse - Patient Relationship

• The general goal of nurse- client interaction is

1. Establish a therapeutic nurse -patient

• ACTION DIMENSIONS. Action dimensions must have a context

• But confrontation in action dimension is an assertive rather than

B) Immediacy‫– مباشر‬.Client describing what

C) Nurse – self- disclosure. – Here the nurse

1.Rapport: Trust is critical in the nurse-client relationship because

2.Respect: means dignity, worth and uniqueness of every

3.Empathy:. When the nurse develops and utilizes this ability to

4. Genuineness:. For the nurse to do this, he or

5. Confidentiality: During the therapeutic

6. Warmth: is the ability to help the client feel

1. Pre-interaction phase = Explore self- perception of both

2. Orientation Phase = Establishment of trust and rapport

3. Working phase = Promote client change

4. Termination phase = Evaluate goal attainment and

2. Orientation Phase/ Introductory Phase = It is during that the

1. Both nurse and patient may have problems

1. The nurse may find similarities and can relate

3. Working Phase = The therapeutic work of

• Maintaining the trust and rapport that was

1) Gather more and more data of the patient to explore

5. Countertransference: which occurs when a nurse lets their

• Discussion with supervisors and other staff

• Put reality of separation in front of the patient.

• Nurses should be aware of patient feelings and

A pressing concern is planning for in-house supports and

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