F3: INTERPERSONAL RELATIONSHIP
- one’s conception of oneself or of one’s role
Interpersonal relationship (IPR)
- collection of notions, feelings and beliefs about ourselves
- Involves social associations, connections, or affiliations
between 2 or more people
- Interpersonal: means between persons
- ‘Therapeia”: greek word meaning care
- ‘Relatus’: latin word denoting connection
- Reciprocal: give and take
> Hildegard Peplau (1909-1999)
- saw the role of the nurse as a participant observer
- shifted focus from what nurses do to clients to what
nurses do WITH clients
Self- awareness
- Process of being aware of one’s own feelings, assets,
skills and abilities
- Can be used to help nurses recognize their own
stereotypes and biases about clients who are culturally
different
- Achieved through refelection
Therapeutic relationship
- relationship between a health professional and a patient
- dynamic, ever-changing relationship with another human
being whose welfare, needs, experiences, feelings and
ideas, are the focus of the interaction
- begins with examining, understanding, affirming of self
and individual life.
Body image
- how one views oneself physically and one’s view of
his/her appearance
Non- therapeutic relationship
- relationship that will not hold out the prospect of
direct health- related benefit for the participant but
results may be produced that significantly contribute to
generalizable knowledge about the participant’s
condition
Self-image
with which we relate and communicate with others and
interact with the environment
CORE of nursing
- caring relationship formed between the nurse and
those affected by the nursing practice
Nurse-Client interaction
- any process in which a nurse and a client exchange or
share information, verbally or nonverbally
- no emotional involvement
- essential component of the nursing assessment
Therapeutic nurse-client relationship
- built on a series of nurse-client interactions
- develops over time
- differs from a social relationship in that it is designed to
meet the needs only of the client.
Types of Relationship
- Social relationship
: primarily initiated for the purpose of friendship,
socialization, companionship, or accomplishment of a
task
: usually focuses on sharing ideas, feelings and
experiences
: meets the basic need for people to interact
: serious work that moves the client forward may not be
done
- Intimate relationship
: involves two people who are emotionally committed to
each other
: concern: meeting each other’s needs
: may include sexual or emotional intimacy as well as
sharing of mutual goals
: has no place in the nurse-client interaction
- Therapeutic relationship
: focuses on the needs, experiences, feelings, and ideas
of the client only
: nurse and client agree about the areas to work on and
evaluate the outcomes
: nurse is not concern whether or not the client likes him
or her or is grateful
: there is an explicit time frame, a goal-oriented
approach, and a high expectation of confidentiality
: nurse’s level of self-awareness can either benefit or
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 F3: INTERPERSONAL RELATIONSHIP
hamper the therapeutic relationship
- Professional relationship
: emphasizes on health promotion, illness prevention and
concern for the client as a whole.
: nurse applies knowledge, understanding of human
behavior and communication and commits to ethical
behavior
Characteristics of a Therapeutic (helping) relationship
- intellectual and emotional bond between the nurse and
the client
- focused on the client and his/ her well-being
- respects the client as an individual
- maximizes client’s decision making and treatment
- considers ethnic and cultural aspects, family
relationships and values
- respects client confidentiality
- mutual trust, respect, and acceptance
Types of therapeutic (helping) relationship
- Nurse- client relationship
- Nurse- family relationship
- Nurse-community relationship
- Nurse- health team relationship
Phases of a nurse-client relationship
- Main ingredient: RAPPORT (creating a sense of harmony
between individuals; finding common interest and
experiences
- Pre-interaction phase
: planning stage
: nurse must identify specific information to be discussed
in order to achieve positive outcome
: TASKS
> self-assessment: explore personal beliefs, values,
attitudes, and feelings
> analyze own strengths and limitations
> read and review available client history or data
> review on appropriate theoretical concepts
> plan for initial interaction
- Introductory/ Orientation/ Pre-helping phase
: begins when the nurse and client meet and ends when
the client begins to identify problems needing
examination
: sets the tone for the rest of the relationship
: observes one another
: getting to know each other and developing trust
(building rapport)
: 3 stages of introductory phase
> opening the relationship
> clarifying the problem
> structuring and formulating the contract
: by the end of the introductory phase, client should begin
to
> develop trust in the nurse
> view the nurse as a competent professional capable of
helping
> view the nurse as honest person, open and capable of
helping
> believe the nurse will try to understand and respect
their cultural values and beliefs
> expect the nurse to respect client confidentiality
> feel comfortable talking with the nurse about feelings
and other sensitive issues
> understand the purpose of the relationship and the
roles
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> feel that they are active participants in developing a
mutually agreeable plan of care
- WORKING phase
: nurse and client begin to view each other as unique
individuals and work toward a goal
: client begins to overcome resistive behavior
: divided into two phases
(1) problem identification
- client identifies issues and concerns
: Transference- client unconsciously transfers to the
nurse feelings he or she has for significant others
: Countertransference: nurse to client
(2) exploitation
: facilitating and taking action
: nurse guides client to examine feelings and responses
and to develop better coping skills and a more positive
self-image
: responsibility for action belongs to the client
: nurse only provides support, collaborate in these
decisions and may offer options or information
: Tasks
> maintaining the relationship
>gathering more data
> facilitating behavior change
> developing positive coping mechanisms, self-concept,
and independence
> providing opportunities for the client to practice new
behaviors
> evaluating progress and redefining goals
- TERMINATION/ RESOLUTION
: begins when problems are resolved and ends when the
relationship has ended
: ending of the contract or termination of the relationship
: planning for termination is actually done during the
beginning of the relationship
: evaluation
Nurse in a therapeutic relationship
- The nurse uses communication skills, personal
strengths, and understanding of the human behavior to
interact with the client
Nursing attitudes
- Trust
: builds when the client is confident In the nurse and the
nurse’s presence conveys integrity and reliability
: CONGRUENCE: consistency in words and action
: maintaining confidentiality
- Genuine interest
: nurse is comfortable with himself or herself, aware of
one’s strength and limitations, and is clearly focused,
therefore able to show genuine interest
- Empathy
: ability of the nurse to perceive the meaning and feelings
of the client and to communicate that understanding to
the client
: putting oneself in another’s shoes
: does not mean that the nurse has had the same exact
experiences as the client
- Acceptance
: nurse does not become upset or respond negatively to
a client’s outbursts, anger, or acting out conveys
acceptance to the client
: avoid judgmental behavior
: does not mean acceptance of inappropriate behavior
but acceptance of the person as worthy
- Positive regard
: appreciate the client as a unique, worthwhile human
being can respect the client regardless of his or her
behavior, background, or lifestyle
- Self-awareness
: process of developing an understanding of one’s own
values, beliefs, attitudes, thoughts, feelings, motivation,
prejudices, strengths and limitations and how these
qualities affect others
: allows the nurse to observe, pay attention to, and
understand the subtle responses and reactions of clients
when interacting with them
internal evaluation of oneself and of one’s reactions to
emotionally charged situations, people, and places
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- Therapeutic use of self Tools used for IPR
: by developing self-awareness and understanding his or Self-awareness
her attitudes the nurse can begin to use aspects of his or - process of developing an understanding of one’s own
her personality, experiences, values, feelings, values, beliefs, thoughts, feelings, attitudes, motivations,
intelligence, needs, coping skills, and perceptions to prejudice, strengths, and limitations and how these
establish relationship with clients qualities affect others
- understanding that our own values and beliefs are not
necessarily right for everyone
Other nursing attitudes that promote therapeutic
relationship Values
- warmth - principles that influence the development of beliefs and
- respect attitudes and thus indirectly affects behavior
- hope - gives a person a sense of right and wrong and
- humor established a code of conduct for living
- compassion - CRUCIAL: may interfere with establishing positive
- effective listening (SOLER) relationship with those under our care
> sit - as nurses we not only understand and accept our own
> open posture values and beliefs but are sensitive to and accepting of
> lean forward the unique values of others
> eye contact 1. Are derived from a range of choices
> relax 2. Reflect our own culture
3. Are those we have chosen for ourselves from a variety
Factors in a therapeutic relationship of influences-role models
- age - Values clarification
- sex > PRIZING: person considers the value, cherishes it, and
publicly chooses the value that feels right
- appearance
> CHOOSING: person considers a range of possibilities
- diagnosis
and freely choose the value that feels right
- education
> ACTING: person puts the value into action
- values
- ethnic and cultural background Johari’s window
- personality - Psychological tool created by Joseph Luft and Harry
- expectations Ingham
- professional characteristicfs - used to help people better understand their
interpersonal communications and relationships
Roles of a nurse in a therapeutic relationship - “word of portrait” of a person with 4 areas and
- caregiver indicates how well a person knows oneself and
- teacher communicating with others
- advocate
- manager
- evaluator

Behavior that diminish a Therapeutic relationship

- lack of care
- inappropriate boundaries
- overinvolvement
- anxiety
- stereotyping
- feelings of sympathy
- encouraging client dependency
- nonacceptance and avoidance

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 F3: INTERPERSONAL RELATIONSHIP
- Creating a Johari’s window
1. Nurse to appraise his or her own qualities by creating a - ADULT (Neopsychic)
list of them: values, attitudes, feelings, strengths, : information, sensory perception, facts, no emotional
behaviors, accomplishments, needs, desires, and aspect
thoughts : objective appraisal of reality and the capacity to process
2. Find out perceptions of others by interviewing them data
and asking them to identify qualities, both positive and : perceptive skills, data processing, sociability, and
communicativeness
negative, that the see in a nurse
: has no emotion of its own, but pays attention to
3. Compare lists and assign qualities to the appropriate
feelings from the parent and child, logically deals with
quadrants them
- Q1 is the longest= nurse is open to others : the ability to see, hear, read, observe, collect
- Smaller than Q1= nurse shares little about himself or information, and evaluate them
herself with others : “it appears”, “I think”, “why”, “when”, “how”
- Q1 and G3 are both small= person demonstrates little
insight - CHILD (Archaeopsychic)
- any change in 1 quadrant will be reflected by changes in : creativity, play, self-expression, obedience, compliance,
other quadrants rebellion
- goal is to work toward moving qualities from q2, 3, and : responses of a little child to what he sees and hears
4 into Q1 (qualities known to self and others) : immature, need gratifying aspect
- doing so allows the nurse to gain self-knowledge and : full of bright ideas, spontaneous
awareness : part of me that wants what I want when I want it
: giggles, coyness, naïve, boisterousness, whining
Transactional analysis : “I want”, gosh!, “me”, “I dunno”
- Psychoanalytic theory of psychology and psychotherapy
developed by a psychiatrist named Eric Berne during late
1950’s
- Concentrated on the content of the people’s interaction
with each other rather than believing that increasing
awareness of the contents of unconsciously held ideas
was the therapeutic path
- IMPORTANCE
> improves communication
> shows how one communicates and behaves with
others
> helps us to understand what happens in human
interactions
> show whether a communication is destructive or
constructive
> increases self-awareness
Transaction
EGO STATES - unit of social intercourse
- PARENT (Exteropsychic) - exchange of interaction, verbal or nonverbal, between 2
: rules, judgments, decisions, counsel, care and or more persons
punishment
: incorporate the feelings and behaviors learned from
parents or authority figure
: resemble closely behavior of human parents
: all wise, all knowing, benevolent, prim, critical, or
righteous attitude
: part of me that feeds, cuddles and nurtures others
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2. Transverse (Crossed) transactions

- Sender: the one who initiates the “transaction” or the
- an individual sends a message to the person that is
communication interaction, there is always a “receiver”
contacted from any ego states, however, the other
of the communication
person replies from another wgo state than the ego state
- Transaction follow 3 rules:
that is targeted by the message sender
> The more comprehensive the transactions are, the
- transverse transactions generally result in
more chances of survival they have (such as adult-adult
misunderstanding
ego state transaction)
> If there is a change towards transverse transaction in a
communication (Parent ego state/child, child ego
state/parent), it is interrupted and a problem occurs
> The result of hidden transactions are determined at a
psychological level rather than social level

1. Complementary (Straight) Transactions

- occurs when a stimulus gets the expected response
from another person
- the response must go back from the receiving ego to
sending ego
- transactional vectors are parallel
- they are easy to understand and message is clear
- the messages are either straight or parallel
- best type
> parent-child
3. Ulterior transaction
> parent-parent
- 2 types:
> child-child
> Angular transaction
> adult-adult
: a two level transaction in which beyond the obvious
transaction, there is a hidden transaction between two
different ego-states of the person concerned
: a non verbal message is sent along with the spoken
words
: a message conveyed in the social level as adult ego-
state but it contains a hidden psychological message
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intended for the child ego-state of the recipient

> Duplex transaction

: beyond the obvious transaction, there is a hidden
transaction between the two ego states of the person
concerned

Psychological games
- Berne indicated that psychological games are formed as
a result of hidden transactions and play a role in the
unconsciousness of the adult ego state
- Games are learnt behaviors
- a person who is unconsciously overwhelmed with the
weight of an unsolved problem either faces one’s
problem or manipulates others in order to get support

Life positions
- refers to the specific behavior towards others that an
individual learns on the basis of certain assumptions
made very early in the life
1. “I’m not okay. You’re okay”
: the futility, helpless position
: depressive, helplessness
2. “I’m not okay. You’re not okay”
: the depressive, despair position
3. “I’m not okay. You’re not okay”
: the destructive, arrogant position/ paranoid
4. “I’m okay. You’re okay”
: the healthy, mature person

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