Introduction, Types of Relationships, Therapeutic Nurse-Client Relationship and its Phases of N-P-R.

1. NURSE -
PATIENT
RELATIONSHIP ANAMIKA RAMAWAT
RNRM, MSN(OBG NURSING)
NURSING LECTURER
VYAS CON, JODHPUR

2. INTRODUCTION
The nurse-client relationship is the
foundation upon which nursing care is
established.
It is a relationship in which both
participants must recognize each other as
unique and important human beings.
It is also a relationship in which mutual
learning occurs.

3. NURSE
RELATION +
CLIENT
=
NURSE CLIENT RELATIONSHIP

4. THERAPEUTIC NURSE
CLIENT/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.
Definition 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.

5. TYPES OF
RELATIONSHIPS

6. Social
• most common
type
• btwn 2 individuals
in every day life
• no predetermined
goal or focus
• Continuation is
not determined at
the onset
• may last for
months or years
• Ex: Platonic
friends, work
colleagues and
neighbors.
Intimate
• btwn 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
• Ex:Marriage and other
partner type
Therapeutic
• professional
relationship
• N-P work together
• goal oriented

7. THERAPEUTIC RELATIONSHIP:
– It is goal oriented, interaction is
purposefully established, maintained
and carried out with the anticipated
outcome of the helping the client gain
coping and adaptation skills in living life.
– In this client regain the inner resources
to meet the challenges and facilitates
personal growth.

8. 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.
 First relationship defined between the client and
nurse. The relationship can emerge between a nurse and
client, client’s home, in the hospital.
 Second - Goal directed characteristic of one to one
relationship focuses the energies of the nurse and client.
 Third - It is the mutual collaboration with equal emphasis on mutual and
collaboration basic to this concept

9. GOALS OF THE THERAPEUTIC NURSE
CLIENT RELATIONSHIP
Travelbee joyce, in intervention in nursing care, has been discussed nine goals of one
to one relationship. They are:
 The nurse helps the client to cope with the present problems.
 The nurse the client to understand his problem.
 The nurse the client to understand his active participation in an experience.
 The nurse assists the Client realistically.
 The nurse helps the client to find out a new alternative for his or her problem
 The nurse the client to try out new patterns of behavior
 The nurse helps the client to communicate.
 The nurse helps the client to socialize
 The nurse helps the client to find a meaning in his illness

10. CONDITIONS ESSENTIAL TO DEVOLOPMENT OF A
THERAPEUTIC NURSE CLIENT RELATIONSHIP
N-P-R
RAPPORT
(IPR)
TRUST
EMPATHY
RESPECT

11. 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 four phase-

12. 1.
Preorientation
/Preinteraction
phase
2. Orientation
phase
3. Working
phase
4.
Termination
phase

13. 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.

14. 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 or
 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.

15. 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.

16. 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

17. 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.

18. 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

19. Termination Phase
It is also called as resolution phase or end phase.
Goal: To bring a therapeutic end to the relationship.

20. 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.

21. SUMMARY…

22. THANK YOU