Nurse – Patient Nurse – Patient RelationshipRelationship

Hildegard Peplau (1952)Hildegard Peplau (1952)

OBJECTIVES:OBJECTIVES: At the end of this lecture, students will be At the end of this lecture, students will be

able to:able to:

1. Identify types of relationship.1. Identify types of relationship.

2. Define Nurse-patient relationship.2. Define Nurse-patient relationship.

3. List down the phases of a nurse-patient 3. List down the phases of a nurse-patient relationship relationship

4. Acknowledge the problems to be 4. Acknowledge the problems to be encountered in every NPR phase.encountered in every NPR phase.

5. Determine specific nursing responsibilities 5. Determine specific nursing responsibilities with each phase.with each phase.

TYPES OF RELATIONSHIP:TYPES OF RELATIONSHIP:   SOCIAL RELATIONSHIPSOCIAL RELATIONSHIP - initiated for the - initiated for the

purpose of friendship, socialization, purpose of friendship, socialization, companionship or accomplishment of taskcompanionship or accomplishment of task

INTIMATE RELATIONSHIPINTIMATE RELATIONSHIP – involves two – involves two people who are emotionally committed to people who are emotionally committed to each other. May include sexual or emotional each other. May include sexual or emotional intimacy and sharing of mutual goals.intimacy and sharing of mutual goals.

THERAPEUTIC RELATIONSHIPTHERAPEUTIC RELATIONSHIP – focuses on – focuses on the needs, experiences, feelings and ideas of the needs, experiences, feelings and ideas of the client only. The nurse uses communication the client only. The nurse uses communication skills, personal strengths and understanding skills, personal strengths and understanding of human behavior to interact with the client.of human behavior to interact with the client.

Observe these in a Nurse-Observe these in a Nurse-Patient Relationship…Patient Relationship…

CONFIDENTIALITYCONFIDENTIALITY –means respecting the client’s –means respecting the client’s right to keep private any information about his/her right to keep private any information about his/her mental and physical health and related care.mental and physical health and related care.

NoteNote: if a patient tells a secret about harming : if a patient tells a secret about harming oneself or others, avoid keeping a promise not to oneself or others, avoid keeping a promise not to tell the revealed information by the client.tell the revealed information by the client.

  DUTY TO WARN DUTY TO WARN – requires the nurse to notify – requires the nurse to notify physicians, authorities, intended victims of a threat physicians, authorities, intended victims of a threat

  SELF-DISCLOSURE SELF-DISCLOSURE –– nurses disclosing personal nurses disclosing personal information to the patient which the nurse think information to the patient which the nurse think can help in establishing rapport.can help in establishing rapport.

The NurseThe Nurse––Patient Patient RelationshipRelationship

This relationship forms the This relationship forms the basis of all psychiatric basis of all psychiatric nursing treatment nursing treatment approaches.approaches.

It is loosely defined as a It is loosely defined as a therapeutic relationship.therapeutic relationship.

NursingNursing is a healing art is a healing art (therapeutic) (therapeutic)

Stated that “human relationship Stated that “human relationship between an individual who is sick, between an individual who is sick, or in need of health services, and or in need of health services, and a nurse especially educated to a nurse especially educated to recognize and to respond to the recognize and to respond to the need for help.need for help.

Nursing is a “maturing force and Nursing is a “maturing force and an educative instrument.”an educative instrument.”

P hases:1. P rei nteracti on

2. Ori entati on

3. Worki ng

4. Termi nati on

Pre-Interaction PhasePre-Interaction Phase

begins when the nurse is begins when the nurse is assigned/chooses a patient assigned/chooses a patient

patient is excluded as an active patient is excluded as an active participant participant

nurse feels certain degree of nurse feels certain degree of anxietyanxiety includes all of what the nurse thinks and includes all of what the nurse thinks and

does before interacting with the patient does before interacting with the patient Goal: Self-disclosureGoal: Self-disclosure

Major task of the nurse:Major task of the nurse: to develop SELF-AWARENESS to develop SELF-AWARENESS

Other tasks: Other tasks: data gathering, data gathering, planning for first interaction planning for first interaction

RememberRemember!!Self-awarenessSelf-awareness first before first before TUOSTUOS……

Orientation phase Orientation phase first interactionfirst interaction establish of establish of trusttrust and and rapportrapport learn about the patient and his initial learn about the patient and his initial

concerns and needsconcerns and needs establish contract with the patientestablish contract with the patient encourage the patient to feel comfortable encourage the patient to feel comfortable

with the meetingwith the meeting conduct initial interview and start termination conduct initial interview and start termination

phase.phase. manage present emotion of the patientmanage present emotion of the patient provide support and empathy of the patient’s provide support and empathy of the patient’s

feelingsfeelings assure of confidentiality assure of confidentiality Goal: Establish Goal: Establish TRUST, SET TRUST, SET

CONTRACT/GOALCONTRACT/GOAL

WORKING / THERAPEUTIC PHASE:WORKING / THERAPEUTIC PHASE:

it is highly individualizedit is highly individualized more structured than the orientation more structured than the orientation

phasephase the longest and most productive phasethe longest and most productive phase limit setting must be employedlimit setting must be employed Personal questions may be expectedPersonal questions may be expected

Major taskMajor task: identification and resolution : identification and resolution of the patient's problems of the patient's problems

Other tasks: Other tasks: planning and planning and implementationimplementation

Problems for Working Problems for Working phase:phase:

TransferenceTransference – the development of an emotional the development of an emotional

attitude towards the nurseattitude towards the nurse– positive or negativepositive or negative

Counter transferenceCounter transference – – experienced by the nurse / experienced by the nurse / therapisttherapist

Termination PhaseTermination Phase

Evaluate the summary of progressEvaluate the summary of progress Reinforce change and strength of Reinforce change and strength of

patientpatient Give rewards for the cooperation Give rewards for the cooperation

during interactionduring interaction Encourage expression of feelings Encourage expression of feelings

about termination of the relationshipabout termination of the relationship Terminate the relationship without Terminate the relationship without

givinggiving Goal: Goal: VALIDATION OF GOALVALIDATION OF GOAL

Problems for termination Problems for termination phase:phase:

SEPARATION ANXIETYSEPARATION ANXIETY

(BOTH Nurse and Patient)(BOTH Nurse and Patient)

How to avoid these: How to avoid these:

Must develop Must develop SELF-AWARENESSSELF-AWARENESS