Therapeutic nurse patient relationship in psychiatry

1. 1
Therapeutic nurse patient relationship
A relationship is defined as a state of being related or a state of affinity between two individuals.
Nurse patient relationship
 Series of interactions between the nurse and the patient in which the nurse assists the patient to attain
positive behavioural change
Types of relationships
1. Social Relationships
 A social relationship is primarily initiated for the purpose of friendship, socializations and
companionship
 The communication is usually centered around sharing ideas, feelings and experiences and meets the
basic needs of people.
 In Therapeutic Nurse patient relationship, the social relationship must be limited
2. Intimate Relationships
 A healthy intimate relationship involves two people who are emotionally committed to each other and
both concerned about having their needs met and helping each other.
 The relationship may include sexual or emotional intimacy as well as sharing of mutual goals. It has
no place in the nurse patient relationship.
3. Therapeutic Relationships
 It focuses on the needs, experiences, feelings and ideas of the client. The areas to be worked on are
agreed on and the outcomes are continually evaluated.
 The nurse uses communication skills, personal strengths and understanding of human behaviour to
interact with the client
Qualities of therapeutic nurse patient relationship
 Genuineness (real and honest)
 Sincerity
 Respect
 Love and affection
 Concern
 Listen
 Empathy (ability to feel with patient)
 Good communication skills
 Exploration of problems
 Self discipline
Characteristic of nurse patient relationship
 Goal-directed
 Focused on the needs of the patient
 Planned
 Time-limited
 Professional
Basic elements of nurse patient relationship
 Trust
 Rapport
 Unconditional positive regard
 Setting limits
 Therapeutic communication

2. 2
Phases of nurse patient relationship
1. Pre-orientation phase
 Begins when the nurse is assigned to a patient
 Phase of Nurse-Patient Relationship in which the patient is excluded as an actual participant
 Nurse feels certain degree of anxiety. Includes all of what the nurse thinks and does before
interacting with the patient
 Tasks include data gathering, planning for the first interaction. Major task is to develop self-
awareness
2. Orientation phase
 Begins when the nurse and the patient interacts for the first time. Parameters of the relationship are to
be laid
 Nurse begins to know about the patient. Tasks include establishing rapport, developing trust,
assessment (and formulation of a nursing diagnosis).
 Major task is to develop a mutually acceptable contract
3. Working phase
 It is highly individualized. More structured than the orientation phase
 The longest and most productive phase of the nurse- patient relationship. Limit-setting is employed
 Tasks include planning and implementation
 Major task is identification and resolution of the patient’s problems
4. Termination phase
 It is a gradual weaning process. It is a mutual agreement
 It involves feelings of anxiety, fear and loss
 It should be recognized in the orientation phase. Tasks include evaluation
 Major task is to assist patient to review what has been learned and to transfer his learning to his
relationship with others
Problems affecting nurse patient relationship
Transference
 Occurs when the client displaces onto the nurse attitudes and feelings that the client originally
experience in other relationships
 These patterns are automatic and unconscious
 Example: A client falls in love with the nurse.
Counter transference
 Occurs when the nurse displaces onto the client attitudes or feelings from his or her past.
 Example: A female nurse who has teenage children and who is experiencing extreme frustration with
an adolescent client may respond by adopting a parental or chastising tone.
 The nurse is countertransfering her own attitudes and feelings toward her children onto the client.
Resistance
 Development of ambivalent feelings toward self-exploration
Principles of care in psychiatric settings
 The nurse views the patient as a holistic human being.
 The nurse accepts the patient as a unique human being.
 The nurse should focus on the patient’s strengths and assets.
 The nurse views the patient’s behavior non- judgmentally.
 The nurse has the potential for rapport.
Levels of interventions in psychiatric nursing

3. 3
1. Primary level of prevention
 Interventions aimed at the promotion of mental health and lowering incidences by altering the
stressors.
 Examples: Health education, Information dissemination, Counseling
2. Secondary level of prevention
 Interventions that limit the severity of a disorder.
 Has two components: Case finding & Prompt treatment.
 Examples: Crisis intervention, Administration of medications
3. Tertiary level of prevention
 Interventions aimed at reducing the disability after a disorder.
 Has two components: Prevention of complication &Active program of rehabilitation
 Examples: Alcoholics Anonymous groups. Occupational therapy
Chandni Narayan
15.4.2021