Unit 3 Nursing Process and Theraputic Communication

Unit 3: Nursing Process & Therapeutic Communication
Chapter 8: Therapeutic Relationships
1.) Social Relationship vs Therapeutic Relationship (Pg. 125-126)
 Social Relationship (personal relationship)–primarily initiated for
the purpose of friendship, socialization, enjoyment, or
accomplishment of a task.
o Mutual needs are met during social interaction (e.g.,
participants share ideas, feelings, and experiences).
o Communication skills may include giving advice and
sometimes meeting basic dependency needs, such as
lending money and helping with jobs.
o Often, the content of the communication is superficial.
 Therapeutic Relationship–the nurse maximizes communication
skills, understanding of human behaviors, and personal
strengths to enhance the patient’s growth.
o The relationship is consistently focused on the patient (e.g.,
their problems, needs, concerns, ideas, experiences, and
feelings), NOT THE NURSE!
 Therapeutic vs Non-Therapeutic Communication
Strategies?
 Therapeutic: Nurse Patient Relationship
o ID the needs of the patient and explore
them (orientation);
o Establish clear boundaries (orientation);
o Encourage alternate problem-solving
approaches (working);
o Help the patient develop new coping skills
(working);
o Support behavioral change
(working/termination).
 *This does not mean that the nurse is not
friendly toward the patient, and it does not mean
that talking about everyday topics is forbidden.


1

, o A small amount of self-disclosure on the
nurse’s part may strengthen the therapeutic
relationship (e.g., briefly sharing your
experience with nursing education, if the
patient asks).
2.) Peplau’s Theory of Interpersonal Relationships
 Foundation for the practice of psychiatric nursing.
 First nurse theorist to ID the nurse-patient relationship as the
foundation of nursing practice.
 Focuses on not what we do to the patient but with the patient.
3.) Goals and Functions of the Nurse-Patient Relationship (Pg. 125)
 Facilitating communication of distressing thoughts and feelings;
 Assisting with problem solving to help facilitate ADL’s;
 Examining self-defeating thoughts and behaviors and testing
alternatives;
 Promoting self-care and independence;
 Providing education about disorders, medications, and symptom
management;
 Promoting recovery;
 Modeling and respecting boundaries.
4.) Boundaries (Pg. 126-128)
 Exist to protect patients.
 Are the expected and accepted legal, ethical, and professional
standards that separate nurses from patients.
o This separation is essential, considering the power differential
between the nurse and the patient.
Blurring of Roles
 Transference–occurs when the patient unconsciously and
inappropriately displaces (transfers) onto the nurse feelings and
behaviors related to significant figures in the patient’s past.
1. Transference seems to be intensified in relationships where one
person is in authority.
2

,  Countertransference (transference in reverse)–occurs when the
nurse unconsciously displaces feelings related to significant figures
in the nurse’s past onto the patient.
1. Frequently, the intense emotions of transference on the part of
the patient bring out countertransference in the nurse.
2. One common sign is over-identification with the patient.
o E.g., a nurse who is struggling with a depressed family
member may feel disinterested or disgusted with a depressed
patient.
 Two common circumstances in which boundaries are
crossed are (Relationship is social):
1. when the relationship slips into a personal context and
2. when the nurse’s needs (for attention, affection, and emotional
support) are met at the expense of the patient’s needs.
5.) Peplau’s Model of the Nurse-Patient Relationship (Pg. 129-131)
 Peplau proposed that the nurse-patient relationship “facilitates
forward movement” for both the nurse and the patient.
o The four phases are:
 Pre-orientation–begins with preparing for your
assignment (the chart is a rich source of information).
 Includes:
o Recognizing your own thoughts and feelings
regarding the first meeting;
o Monitoring the unit atmosphere/milieu
(experienced faculty/staff have a sixth sense
for behaviors that indicate escalating tension).
 Orientation–it is the first time the nurse and the patient
meet and is the phase in which the nurse conducts the
initial interview (can last for a few meetings or extended
over a longer period of time).
 The patient may begin to express thoughts and
feelings, ID problems, and discuss realistic goals.
o Includes:
 Introductions;
 Establishing rapport;
3