Lecture 4b: The Therapeutic Relationship & Boundary Management

mental health notes Lecture 4B: 1/27 Concepts of the Nurse-Patient Relationship The nurse-patient relationship is the basis of all psychiatric nursing treatment approaches and an important part of all nursing care The Therapeutic Relationship & Boundary Management Phases and Tasks of the Therapeutic Relationship Establishing a Therapeutic Relationship Preorientation Kenuineness The Art of Nursing Provide care, compassion, and advocacy Enhance comfort and well-being Oecoming self-aware about thoughts and feelings or fear about saying the wrong thing Ability to be honest, open, and authentic Seeking support from clinical faculty Uey to establishing rapport and building trust :rientation Initial meeting The Science of Nursing Apply knowledge IntroductionW xhat pt refers to be called Intervene in patients' suBering to promote growth and facilitate healing Establishing rapport EGplaining conDdentiality xorking Phase Kathering information Social vs. Therapeutic Relationships Identifying problems Social Felationships Providing education PurposeW Mriendship, socialiCation, enRoyment, or accomplishment of a task Termination Phase FesponsibilityW /utual OeneDtW /utual Involves listening to and communicating clearly Empathy Attempt to understand the pt's perspective without Rudgment Associated with improved pt satisfaction and outcomes Hnconditional Positive Fegard Attitude that conveys respect Paying attention jiscuss in advance Suspending Rudgment :ccurs when pt is discharged or when clinical rotation ends zelping pts to develop resources YommunicationW Kiving advice, asking for help, general support, mutual back and forth Therapeutic Felationships PurposeW Identifying and eGploring the needs of the pt in developing new coping skills or working toward a behavioral change Establishing Boundaries qou are responsible for setting and maintaining boundaries in the nurse-patient relationship Physical OoundariesVPersonal Space jetermine a comfortable and safe physical distance between yourself and the pt FesponsibilityW Nurse Oe mindful of the setting OeneDtVMocusW Patient YommunicationW Hse of therapeutic communication strategies Emotional Ooundaries qou, as the student or nurse, should always keep clear boundaries around your emotional space .erbal Ooundaries Yontent of your discussions should be client-focused Blurring of Boundaries :ccurs when the relationship slips into social contentW eG) what you do on the weekends, your relationship status, your home life, your friendships, your thoughtsVfeelings, recommendations ;non-clinical qou do not have to engage in appropriate conversation even if the pt does Yonsistency Pts may not have been eGposed to healthy relationships with well-deDned boundaries Yonsistently model good boundaries Successful Ooundary Setting FecogniCe an appropriate amount of self-disclosure The nurse's needs are met at eGpense of the pt's needs The focus of the interaction and therapeutic relationship needs to be the patient Fe(uires an honest and open conversation with yourself about your thoughts, feelings, and behaviors Never forget to check your countertransference Seek guidance, especially when starting out as a nurse Blurring of Roles Transference Pt unconsciously and ;sometimes inappropriately displaces feelings and behaviors related to signiDcant Dgures of their past onto the nurse Potential to be helpful or hurtful to the situation cannot be controlled Yountertransference Nurse unconsciously and inappropriately displaces feelings related to people in their past onto pt Patient's transference to nurse often results in countertransference in nurse Yommon signsW Strongly positive or negative feelings Ketting involved in power struggles with the pt Oecoming overly involved with the pt :ver-identifying with the pt