Nurse-Patient Relationship

Definition of relationship-

It is defined as a state of being related or state affinity(liking) between two individuals. Example- friendship and colleagues.

Therapeutic Relationship-

It is a relationship where the nurse and client work together towards the goal of assisting the client to regain the inner resources to meet life challenges and facilitate growth of health.

"The nurse – client relationship establishes from a series of interaction between a nurse and client over a period of time, with the nurse focusing on the needs and problems of the person family group while using scientific knowledge and special skills of the nursing profession."

Purposes of Nurse- Patient Relationship

Identify and explore patient's current needs.
Improve patient's Functioning.
Develop adaptive problem-solving approaches.
Promote patient's recovery.
Develop adaptive coping skills among patients.
Change maladaptive behavior to adaptive.

Types of Relationships

1. Social

Most common type
Between 2 individuals in every day life
No predetermined goal or focus
Continuation is not determined at the onset
May last for months or years

Eg: Platonic friends, work colleagues and neighbors.

2. Intimate

Between 2 individuals committed to one another, caring for, respecting and loving each other
According to Erickson. The ability to develop an intimate relationship with an adult of the opposite sex depends on completing developmental task.

Eg-Marriage and other partner type

3. Therapeutic

Professional relationship
N-P work together
Goal oriented

Elements of Nurse-Patient Relationship

Elements are the characteristics that influence the nurse's effectiveness in their therapeutic role. These elements include personal qualities of a nurse, their communication skills, responsive and action dimension, Therapeutic impasses and outcomes.

Altruism- A professional nurse should be passionate about her services to the patient, family or to community at large. She/he must be compassionate and have concern for the welfare of others.
Ethics and Responsibility- Nurse should practice in a professional manner where her behavior, decisions, activities should reflect professional ethics and accountability.
Communication Skills- Nurse should be skillful while communicating with the patients and should have adequate knowledge of verbal as well as nonverbal communication.
Genuineness- Nurse should be sincere and honest in therapeutic relation. She must have clear and concrete in communication with patient.
Respect- It is an unconditional positive regard to the patients and her behavior towards patient should not depend on the patient's behavior. There are different ways to promote respect and positive regard to the patient.
Empathy- It is the ability of a nurse to accurately understand the person's current feelings and their meanings, and to communicate this understanding to the patient. Empathy indicates a central focus on the patient's feelings.
Concreteness- Nurse must communicate information in a clear language using specific terms, according to the patient's level of understanding. Nurse should avoid vagueness while discussing the patient's feelings, experiences, and behavior.
Confrontation- It is a process of helping the patient become aware of inconsistencies in his or her feelings, attitudes, beliefs, and behavior. Effective confrontation is only possible with high levels of empathy and respect toward patient. It is to be done only after trust has been established, & should be done gently; with sensitivity (working phase of nurse-patient relationship is an ideal time for using confrontation).
Immediacy- Immediacy involves sensitivity to the patient's feelings and a willingness to deal with these feelings rather than ignore them. (Focus on here and now).
Nurse self-disclosure-Nurse intentionally reveals personal experiences about the self to the patient for the purpose of emphasizing both the similarities and the differences of experiences.

Phases of Nurse Client Relationship

Nurse client relationship is the end result of a series of planned purposeful interactions between nurse and client. It can be described in five phase-

Preinteraction phase
Introductory Phase
Orientation phase
Working phase
Termination phase

1. Preorientation/Preinteraction Phase –

Definition-This is a phase in which a nurse goes through before the actual interaction with the client.
This phase begins when the nurse is assigned a client to develop therapeutic relationship with him, till she goes to him for interaction.

Tasks Before meeting the client-

Explores own feelings and fears
Analyze own professional strengths and limitations
Gather data about client wherever possible
Plan for first meeting with client.
Set the objectives for interaction phase
Takes help of the clinical supervisor or co- worker to overcome fears.
Review available data, including the medical and nursing history.
Talk to other caregivers who have information about the client.
Anticipate health concerns or issues that arise.
Identify a location and setting that will foster comfortable, private interaction.
Plan enough time for the initial interaction.

2. Introductory Phase

In this phase nurse introduces herself and orients the patient about the hospital routine (if patient is indoor patient), how to call for the help, this reduces anxiety of patient.
Nurse collects general information about patient and seeks the ideal time to talk to the patient in detail. This will be the first step of nurse showing respect and helping patient to develop trust in her.
Pleasant greetings, eye-to-eye contact and acceptance of patient's behavior, also, being aware of patient's personal zone and not intruding into it will help to develop a good rapport.
This phase is short and concise but has a specific aim, but nurse should never show any hurried gesture or behavior during this phase.

3. Orientation Phase –

Definition- This is a phase which begins when the nurse goes to the client, introduces self and gets introduction about him.

The nurse and client who are strangers meet for the first time and become acquaintances.
This ends when the client and nurse accept each other as a unique human being.
One of the nurse’s primary concerns is to find out the client sought help. This forms basis for the nursing assessment and helps the nurse to focus on the client’s problem and to determine client’s level of motivation.

Tasks

Establishment of contact, rapport, trust and acceptance
Establish communication, assist in the verbal expression of thoughts and feelings
Gather data, including the client’s feelings, strengths and weaknesses
Define client’s problems, set priorities for nursing intervention
When the nurse and client meet and get to know one another
Set the tone for the relationship by adopting a warm, empathetic, caring manner
Recognize that the initial relationship is often superficial, uncertain, and tentative
Closely observe the client, and expect to be closely observed by the client
Begin to make inferences and form judgments about client messages and behaviours
Assess the client's health status
Prioritize the client's problems, and identify the client's goals
Clarify the clients and nurse's roles
Form contracts with the client that specify who will do what
Let the client know when to expect the relationship to be terminated

4. Working Phase – Working phase or phase of emerging identities of the nurse-client relationship starts when the nurse and the client are able to overcome the barrier of orientation or introductory (period) phase.

During this phase the nurse and client actively work on meeting the goals which they had established during the orientation phase. The characteristic features of this phase are that the nurse is able to overcome anxiety and the client’s fear of unknown is also decreased.

When the nurse and client work together to solve problems and accomplish goals-

The nurse collects the data in detail from primary and secondary sources and identifies the needs of the client
The nurse assists the client to identify his or her problems, share feelings and get socialize
Help the client to communicate
Encourage and help the client to express feelings about his or her health
Provide information needed to understand and change behavior Encourage and help the client to set goals
Take action to meet the goals set with the client
Use therapeutic communication skills to facilitate successful interactions
Use appropriate self-disclosure and confrontation
The nurse helps the client to find an alternative solution to his or her problem or development of insight and use of constructive coping mechanism
The nurse helps the client to understand that he has a significant role in his treatment
She prepares the client for termination of relationship by reminding him during the interviews
Provide him with opportunities for independent functioning
Evaluate problems and goals, refine as necessary

5. Termination Phase-when the set goals are achieved then the nurse-patient relationship must come to an end.

It is also called as resolution phase or end phase.

Goal- To bring a therapeutic end to the relationship.

Tasks

During the ending of the relationship-
Remind the client that termination is near
Evaluate goal achievement with the client
Separate from the client by relinquishing responsibility for his or her care
Achieve a smooth transition for the client to other caregivers as needed
Establish reality of separation
Mutually, explore feelings of rejection, loss, sadness, anger and related behavior, if attached
Review progress of therapy and attainment of goals
Formulate plans for meetings future therapy needs.