Therapeutic Relationship in Psychiatric Nursing

Patient Nurse Relationship in Nursing

Therapeutic Relationship in Psychiatric  Nursing and in nursing practice is and its phases.

Building The Therapeutic Relationship

    A nurse who has confidence rooted in self-awareness is willing to form appropriate therapeutic relationships with clients. Because personal growth continues throughout life, the caregiver cannot expect full self-knowledge. However, knowing your strengths and limitations at any given time is a good start stages.

    Peplau has studied and written about interpersonal processes and the stages of the caregiver-client relationship for 35 years. Her work provides the nursing profession with a model that can be used to understand and document the progress of interpersonal interactions. Peplau's (1952) model has three phases: orientation, work, and solution or completion . In real life, these phases are not so clear cut; they overlap and intertwine.

Orientation

    The orientation phase begins when the caregiver and client meet and ends when the client begins to identify issues for investigation. During the orientation phase, the caregiver establishes the roles, the purpose of the meeting and the parameters of subsequent meetings; identifies customer problems; and clarify expectations.

    Before meeting the client, the nurse has an important task to perform. The nurse reads the client's available medical history, becomes familiar with the medications the client is taking, collects the necessary documentation, and maintains a calm, private, and comfortable environment. This is the time for self-assessment. The caregiver needs to consider their personal strengths and limitations when working with this client. Are there any areas that might indicate difficulties based on past experience? For example, if this client is an abusive spouse and the caregiver's father was one, the caregiver should consider the situation: How does he feel? What memories does it trigger and can he or she work with the client without those memories interfering? The caregiver needs to examine preconceived notions about the client and ensure they can let go of them and get to know the real person. 

    The nurse must approach each client without preconceived notions or prejudices. It may be helpful for the caregiver to discuss any potential problem areas with the trainer. During the orientation phase, the nurse begins to build trust with the client. It is the nurse's responsibility to create a therapeutic environment that promotes trust and understanding. 

    The nurse should provide appropriate information about herself at this point, including name, reason for being on the ward and level of education: For example: “Hello, James. My name is Miss Ames and I will be your nurse for the next six Tuesdays. I'm a nursing student at the University of Mississippi. The nurse must listen carefully to the client's story, perceptions and misconceptions. He or she needs to convey empathy and understanding. When the relationship starts off positively, you are more likely to be successful and achieve the goals you set.

    At the first meeting, the client may be suspicious if previous relationships with caregivers have been unsatisfactory. The client may use ramblings, episodes, or exaggerations to avoid discussing the real issues. It may take several sessions before the client believes that she can trust the caregiver.

    Nurse-client contracts. Although many clients have prior experience with the mental health system, the caregiver needs to rethink caregiver and client responsibilities. Initially, the caregiver and patient must agree to these responsibilities in an informal or verbal contract. In some cases, a formal or written contract may be appropriate; Examples of this are when a written contract with the client was required in the past or when the client “forgets” the verbal contract.

    The contract must include the time, place and duration of the meetings.When sessions end Who will be involved in the treatment plan (family members or members of the health care team) Client responsibilities (arrival on time and completion on time) Caregiver responsibilities (arrival on time, completion on time, confidentiality at all times, evaluation of client progress and document sessions).

Confidentiality. Confidentiality means respecting the client's right to keep all information about their physical and mental health and related care secret. It means that only those responsible for the care of the client have access to the information that the client discloses. Third parties can only access this information under precisely defined conditions; For example, in many states, employees are required by law to report suspected child and elder abuse.

Adult clients can decide which family members, if any, are present. they can participate in treatment and have access to clinical information. The ideal is to involve people close to the client and responsible for her care. However, the client must decide who gets involved. For the client to feel safe, the limits must be clear. The caregiver must clearly identify who has access to client assessment data and progress assessments. He or she should tell the client that members of the mental health team will share appropriate information with each other to ensure ongoing care and will only involve a family member with the client's permission. If the client has a designated guardian, that person may review the client's information and make treatment decisions that are in the best interest of the client. For a child, the designated parent or guardian has access to information and can make treatment decisions as determined by the health care team.

    The nurse must be vigilant when a client asks her to keep a secret, as this information may be related to the client's harm to themselves or others. The nurse must avoid any promise to keep secrets. If the nurse promised not to say anything until she heard the message, she could jeopardize the client's trust. Even if the caregiver refuses to keep the information secret, in most cases the client will still report the problems. The following is an example of a good response to a suicidal client who requests confidentiality: The nurse manager and treating physician can notify both the police and the victim. 

    The nurse documents the client's problems with planned interventions. The client must understand that the nurse collects data about him or her to help make a diagnosis, plan care (including medication), and protect the client's civil rights. The client needs to understand the limits of confidentiality in caregiver-client interactions and how the caregiver will use and share this information with the professionals involved in the care of the client.

    Self-disclosure. Self-disclosure means the disclosure of personal information, such as B. biographical information and personal ideas, thoughts and feelings about a sale to customers. Traditionally, the conventional wisdom was that nurses should only share their first name and give a general idea of ​​where they live, such as: B. “I live in Ocean County. However, it is now believed that well-planned and targeted self-disclosure can improve the caregiver-client relationship. The caregiver can use self-disclosure to provide support, educate clients, and show that a client's anxiety is normal and that many people in deal with stress and problems in their lives.

    Self-disclosure can help the client feel more comfortable and more willing to share their thoughts and feelings, or help the client better understand their situation. When self-reporting, the caregiver must also consider cultural factors. Some customers may find the self-certification inappropriate or too personal, making the customer uncomfortable. Disclosure of personal information to a customer can be harmful and inappropriate and should be carefully planned and considered in advance. 

    The spontaneous self-disclosure of personal information can have negative consequences. For example, if you are working with a client whose parents are divorcing, the nurse says, "My parents divorced when I was 12 and it was a horrible time for me." The nurse took the focus away from the client and given her the idea that this experience will be terrible for the client. Even if the caregiver intended to express empathy, the result can be just the opposite.

Working

    The work phase of the nurse-client relationship is generally divided into two sub-phases: During problem identification, the client identifies the problems or concerns that are causing problems. During exploitation, the caregiver guides the client towards the subject's feelings and reactions and towards the development of better coping skills and a more positive self-rescue change and image development; this promotes the behavior: independence. (Note that Peplau's use of the word exploitation had a very different meaning from today's usage, which implies exploiting or unfairly exploiting a person or situation. 

    For this reason, this phase is best conceived as an intensive exploration and elaboration of previous issues that the client discussed.) The trust that has been built between the caregiver and client at this point allows them to examine the issues and work on them in the safety of the relationship. 

    The client must believe that the caregiver will not turn away or become upset if the client reveals experiences, problems, behaviors, and problems. Sometimes the client will use outrageous stories or exaggerated behaviors to test the nurse. Behavior tests challenge the caregiver to stay focused and not react or get distracted. When the client is uncomfortable with getting too close to the truth, she often uses test behaviors to avoid the topic. The nurse can respond by saying, "It seems we've reached an uncomfortable point for you. Would you like to let it go now?" This statement focuses on the real problem and distracts from the test behavior.

 

    The caregiver must remember that it is the client who examines and explores problematic situations and relationships. The nurse must not judge and not give advice; The caregiver must allow the client to analyze situations. The nurse can guide the client to observe patterns of behavior and determine whether or not the expected response is occurring. For example, a patient suffering from depression complains to the nurse about the lack of attention to her children. With the support and guidance of the nurse, the client may explore how she communicates with her children and may discover that her communication is complaining and critical. The caregiver can then help the client find more effective ways to communicate in the future. Tasks specific to the work phase include:

• Maintain the relationship Collect more data
• Explore perceptions of reality. • Develop positive coping mechanisms
• Promotion of a positive self-image
• Encourage the verbalization of feelings
• Facilitate behavior change. • Work through resistances
• Evaluate progress and refine goals as needed. • Provide opportunities for the client to practice new behaviors
• Promotion of independence.

As the caregiver and client work together, it is common for the client to subconsciously transfer feelings for loved ones to the caregiver. This is called a transfer. For example, if the client has had negative experiences with authority figures such as parents, teachers, or school principals, he or she may show similar negative reactions and resistance towards the caregiver, who is also viewed as an authority. A similar process can occur when the caregiver responds to the client based on personal unconscious needs and conflicts, this is known as counter transference. For example, if the caregiver is the youngest in their family and often felt unheard as a child, they may become annoyed with a client who does not listen or resists their help. Again, self-awareness is important so that the caregiver can recognize when transference and counter transference may be occurring. By being aware of these "hot spots," the caregiver is more likely to respond appropriately rather than allowing old unresolved conflicts to taint the relationship.

Termination

The termination or resolution phase is the final phase in the caregiver-client relationship. It starts when the problems are resolved and ends when the relationship ends. Both the caregiver and the client often have feelings about ending the relationship; in particular, the customer may perceive the termination as an imminent loss. Clients often try to avoid termination by acting angry or by pretending the problem hasn't been resolved. The caregiver can acknowledge the client's feelings of anger and reassure them that this reaction is normal in order to end a relationship. When the client attempts to reopen and discuss old resolved issues, the caregiver needs to avoid feeling that the sessions were unsuccessful; Instead, you should identify the client's decelerating maneuvers and refocus the client on the newly learned behaviors and skills to cope with the problem. It is appropriate to tell the client that the caregiver enjoyed being with them and that they will remember it, but it is inappropriate for the caregiver to agree to see the client outside of the therapeutic relationship.