Week 1
Therapeutic relationship
- Purposeful, goal-directed, time limited and always with the intent of advancing in the best
interests & outcomes of the patient.
- The nurse estables & maintains this key relationship by using knowledge, skills as well
as applying caring attitudes & behaviors.
Patient/ client centered care
- Based on the belief that within them each person has the capacity to heal if given
support with respect and unconditional regard in a caring authentic, therapeutic
relationship.
- Focuses on each person's individual preferences, values, beliefs and needs as a
fundamental consideration in all nursing interactions and interventions.
- There is active involvement of the patient and family regarding the decision making
options for care and treatment.
Patient centered care relationships (PCC)
- Is categorized as a “therapeutic alliance” and is linked to helping people achieve
identifiable health goals.
- It begins with the expectation that people will take an active participatory role in
self-managing their health.
- PCC relationships are time limited.
Components
- Considers a patient as a person first and foremost, with distinctive personally
held values, beliefs and life goals
- Each relationship represents a unique relational encounter.
- Nurses support people's self management skills and problem solving, and help
build confidence in their ability to manage their own health.
- Caring is the component that is best remembered by patients, families, and
nurses.
Patient-centered vs social relationships
- Social relationships are established and maintained to meet a mutual need or
friendship.
WHILE
- Therapeutic patient-centered relationship are established for professional health
related purposes within a specific time setting
- Therapeutic relationships are subject to ethical and legal standards.
- Note: the focus of therapeutic relationships is always on patient health concerns, and
actions needed to help them identify and resolve issues related to health and wellbeing
What is relational practice ?
, - Relational practice is a respectful and reflective approach to inquire into patients’ live
experiences and health care needs.
- It is the skilled action of respectful, compassionate, and authentically interested inquiry
into another’s (and one 's) experiences.
Therapeutic relationship : implications for practise
1. Look beyond the surface of people, situations and relationships to understand
contextual factors that impact health
- Contextual factors include personal elements, such as gender, age and
ability, and sociopolitical elements, such as economic, cultural, historical
and geographical ones.
2. Take responsibility in articulating personal and / or societal biases and discrimnation in
order to provide culturally safe care.
3. Demonstrating respect for patients’ culture, age, sex, beliefs and values, health care
decisions and preferences
4. Abide by nursing codes and standards and engage in reflective practice.
5. Establish policies, provide education and engage in research that explores therapeutic
relationships between nurses, patients and their families.
CNO standards : Therapeutic relationships
5 key components include
- Professional intimacy, power, empathy, respect and trust
- Trust - Trust is critical in the nurse-client relationship because the client is in a
vulnerable position. If breached it can be hard to re-establish
- Respect - Respect is the recognition of the inherent dignity, worth and uniqueness of
every individual, regardless of socio-economic status, personal attributes and the nature
of the health problem
- Professional intimacy - Professional intimacy is inherent in the type of care and
services that nurses provide.
- Empathy - . Empathy is the expression of understanding, validating and resonating with
the meaning that the health care experience holds for the client
- Power - The nurse-client relationship is one of unequal power. Although the nurse may
not immediately perceive it, the nurse has more power than the client.
4 standard statements - describe what the nurse is accountable for in a therapeutic nurse
client relationship
1. Therapeutic communication
- This is used to establish, maintain, re-establish and terminate the client
relationship.
2. client -centered care
- Nurses work with the client to ensure that all professional behaviors and actions
meet the therapeutic needs of the client
3. Maintaining boundaries
, -Nurses are responsible for effectively establishing and maintaining the limits or
boundaries in the therapeutic nurse-client relationship and recognizing the
standards related to giving and accepting gifts.
4. Protecting the client from abuse
- Nurses protect patients from harm by ensuring that abuse is prevented or
stopped or reported
How do nurses maintain boundaries within the nurse-client relationship ?
- Boundaries within the relationship, and helping clients understand when their requests
are beyond the limits of the therapeutic relationship
- ensuring that she/he does not interfere with the client’s personal relationships
- abstaining from disclosing personal information, unless it meets an articulated
therapeutic need of the client
- continually clarifying her/his role in the therapeutic relationship
Peplau’s interpersonal nursing theory
- Dr Peplau emphasized patient nurse interactions and believed that shared experiences
with patients were fundamental to nursing practice.
- Her theory recognised a give and take nurse-client relationship that many thought to be
revolutionary
Peplau identified 4 sequential phases of a nurse-patient relationship
1. Pre-interaction
- Reviewing a patient’s chart or report ; affords greater interpersonal sensitivity
prior to meeting ; allows you to reflect and review your professional goals and
potential biases
2. Orientation
- Developing conversational ease with your patient and trust needed to deepen
communication
3. Working phase
- Working together to help your patient discover solutions that fit best and engage
them in determining and implementing activities to meet therapeutic goals.
4. Termination
- Evaluating together the patients responses to treatment and what goals have
been achieved; reviewing instructions and newly developed skills ; identifying
support systems. Termination of PCC should be final.
Peplau’s role of a nurse
- Stranger
, - Resource person
- Teacher
- Leader ‘
- Surrogate for significant others
- Counselor d
- Arbitrator
Program philosophies
1. Phenomenology
- Understanding the meaning of client’s lived experience of health and healing
- Actualised through nurse client relationship
2. Critical social theory
- Exposing underlying social relationships that are often concealed
- Addressing unequal social, economic and power relations within health care
society
Model of person centeredness
Week 2
Therapeutic relationship
- Purposeful, goal-directed, time limited and always with the intent of advancing in the best
interests & outcomes of the patient.
- The nurse estables & maintains this key relationship by using knowledge, skills as well
as applying caring attitudes & behaviors.
Patient/ client centered care
- Based on the belief that within them each person has the capacity to heal if given
support with respect and unconditional regard in a caring authentic, therapeutic
relationship.
- Focuses on each person's individual preferences, values, beliefs and needs as a
fundamental consideration in all nursing interactions and interventions.
- There is active involvement of the patient and family regarding the decision making
options for care and treatment.
Patient centered care relationships (PCC)
- Is categorized as a “therapeutic alliance” and is linked to helping people achieve
identifiable health goals.
- It begins with the expectation that people will take an active participatory role in
self-managing their health.
- PCC relationships are time limited.
Components
- Considers a patient as a person first and foremost, with distinctive personally
held values, beliefs and life goals
- Each relationship represents a unique relational encounter.
- Nurses support people's self management skills and problem solving, and help
build confidence in their ability to manage their own health.
- Caring is the component that is best remembered by patients, families, and
nurses.
Patient-centered vs social relationships
- Social relationships are established and maintained to meet a mutual need or
friendship.
WHILE
- Therapeutic patient-centered relationship are established for professional health
related purposes within a specific time setting
- Therapeutic relationships are subject to ethical and legal standards.
- Note: the focus of therapeutic relationships is always on patient health concerns, and
actions needed to help them identify and resolve issues related to health and wellbeing
What is relational practice ?
, - Relational practice is a respectful and reflective approach to inquire into patients’ live
experiences and health care needs.
- It is the skilled action of respectful, compassionate, and authentically interested inquiry
into another’s (and one 's) experiences.
Therapeutic relationship : implications for practise
1. Look beyond the surface of people, situations and relationships to understand
contextual factors that impact health
- Contextual factors include personal elements, such as gender, age and
ability, and sociopolitical elements, such as economic, cultural, historical
and geographical ones.
2. Take responsibility in articulating personal and / or societal biases and discrimnation in
order to provide culturally safe care.
3. Demonstrating respect for patients’ culture, age, sex, beliefs and values, health care
decisions and preferences
4. Abide by nursing codes and standards and engage in reflective practice.
5. Establish policies, provide education and engage in research that explores therapeutic
relationships between nurses, patients and their families.
CNO standards : Therapeutic relationships
5 key components include
- Professional intimacy, power, empathy, respect and trust
- Trust - Trust is critical in the nurse-client relationship because the client is in a
vulnerable position. If breached it can be hard to re-establish
- Respect - Respect is the recognition of the inherent dignity, worth and uniqueness of
every individual, regardless of socio-economic status, personal attributes and the nature
of the health problem
- Professional intimacy - Professional intimacy is inherent in the type of care and
services that nurses provide.
- Empathy - . Empathy is the expression of understanding, validating and resonating with
the meaning that the health care experience holds for the client
- Power - The nurse-client relationship is one of unequal power. Although the nurse may
not immediately perceive it, the nurse has more power than the client.
4 standard statements - describe what the nurse is accountable for in a therapeutic nurse
client relationship
1. Therapeutic communication
- This is used to establish, maintain, re-establish and terminate the client
relationship.
2. client -centered care
- Nurses work with the client to ensure that all professional behaviors and actions
meet the therapeutic needs of the client
3. Maintaining boundaries
, -Nurses are responsible for effectively establishing and maintaining the limits or
boundaries in the therapeutic nurse-client relationship and recognizing the
standards related to giving and accepting gifts.
4. Protecting the client from abuse
- Nurses protect patients from harm by ensuring that abuse is prevented or
stopped or reported
How do nurses maintain boundaries within the nurse-client relationship ?
- Boundaries within the relationship, and helping clients understand when their requests
are beyond the limits of the therapeutic relationship
- ensuring that she/he does not interfere with the client’s personal relationships
- abstaining from disclosing personal information, unless it meets an articulated
therapeutic need of the client
- continually clarifying her/his role in the therapeutic relationship
Peplau’s interpersonal nursing theory
- Dr Peplau emphasized patient nurse interactions and believed that shared experiences
with patients were fundamental to nursing practice.
- Her theory recognised a give and take nurse-client relationship that many thought to be
revolutionary
Peplau identified 4 sequential phases of a nurse-patient relationship
1. Pre-interaction
- Reviewing a patient’s chart or report ; affords greater interpersonal sensitivity
prior to meeting ; allows you to reflect and review your professional goals and
potential biases
2. Orientation
- Developing conversational ease with your patient and trust needed to deepen
communication
3. Working phase
- Working together to help your patient discover solutions that fit best and engage
them in determining and implementing activities to meet therapeutic goals.
4. Termination
- Evaluating together the patients responses to treatment and what goals have
been achieved; reviewing instructions and newly developed skills ; identifying
support systems. Termination of PCC should be final.
Peplau’s role of a nurse
- Stranger
, - Resource person
- Teacher
- Leader ‘
- Surrogate for significant others
- Counselor d
- Arbitrator
Program philosophies
1. Phenomenology
- Understanding the meaning of client’s lived experience of health and healing
- Actualised through nurse client relationship
2. Critical social theory
- Exposing underlying social relationships that are often concealed
- Addressing unequal social, economic and power relations within health care
society
Model of person centeredness
Week 2
