Therapeutic

Relationships
Tracy C Brennan MSN -Ed, RN-BC

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Social Relationships
• Friendships
• Socialization &Enjoyment
• Accomplishment of a task
• Communication content maybe
superficial, not evaluating the
interactions

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Patient-Centered Care/ Interactions

Communication skills aimed at

understanding of human behaviors
personal strengths in order to promote
patient’s growth.
 Foundation for the practice of psychiatric
nursing

*Peplau’s First nurse theorist to identify the nurse-patient

relationship as the foundation of nursing
Theory of practice.

Interpersonal Focuses on not what we do to the patient but

with the patient.
Relationships
Illness offers opportunities for experiential
learning, personal growth, and to improve coping
strategies.

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 Goals and Functions of the Nurse-Patient
Relationship
To facilitate expression of distressing thoughts and feelings.*

To assist patients with problem solving.

To help facilitate activities of daily living.

To help patients identify and examine self-defeating behaviors and

practice alternatives.
 • To promote self-care and
independence.
Goals and • To provide education about
Functions of medications and symptom management.
the Nurse-
Patient • To promote recovery.
Relationship
To model and respect boundaries.
 Nurse who brings skills and expertise

Patient who wants to alleviate suffering,

Peplau’s find solutions to problems,
Model of
Improve quality of life, or find an advocate
Nurse-
Patient =
Relationship
Forward movement for both the nurse
and the patient
Nurse Patient Relationship
• Identify the needs of the patient and explore them (orientation)
• Establish clear boundaries (orientation)
• Encourage alternate problem-solving approaches (working)
• Help the patient develop new coping skills (working)
• Support behavioral change (working)>((termination)
Boundaries

Exist to protect patients.

Expected and accepted.

There are social, physical, and psychological boundaries that separate

nurses from patients.

Consider the power differential between the nurse and the patient.

Transference and Counter-transference.

Transference
Unconscious feelings a patient has towards a healthcare worker
that were originally connected to a significant relationship in
childhood.
Countertransference

Unconscious feelings the healthcare worker has towards a patient. Strong reactions to a patient
maybe a signal that the healthcare worker may be experiencing countertransference.
Boundary Blurring

Relationship is social
Nurse needs are met not the
patients

• Attention
• Affection
• Emotional Support
See table 8.1 on page 127 & table 8.2on
Page 128
Values, Beliefs, Self-Awareness
 Pre-orientation phase: Patient assignment and
review of the medical record.

Phases of
Peplau’s Orientation phase: Interview, expression
of feelings, determine goals .

Model
Working phase: Gather more data, work on
problem solving, manage symptoms, education,
and evaluation of progress
.

Termination phase:
Pre-
• Self reflection, attitudes
• Prepare for your assignment

orientation • Chart review

• Monitoring milieu
 • Introductions
• Establish Rapport

Orientation
• Contract
• Identifying Goals
• Reviewing Confidentiality
 • Reassessment through data gathering
• Teaching and Identifying problem solving skills

Working • Education
• Evaluating progress towards goals
 • Happens at discharge

Termination
• Review of outcomes of goals
• Review of the treatment
• Close discharge instructions
 Values: Standards either positive or negative
Values and Beliefs about what is important in life.
Beliefs:
Opinion
Trust or faith in something
Religious

Know thy self:

Reflect on your own culture or subculture
What values and beliefs your have come to on
your own and those related to culture.
 Factors that
Encourage and
Promote Patient’s
Growth
• Genuineness- ability to be open and
honest
• Empathy- attempt to understand feeings
• Positive Regard- respect
Hinders and
Helping the •
•
Pacing
Listening
Nurse- •
•
Initial impressions
Promoting patient comfort and balancing
Patient control
• Patient factors
Relationship