Nurse Patient Relationship

(NCM 117)
Prepared by: Ruth Abigail C. Valdez, RN
Types of Relationship
 1. Social Relationship
• A social relationship is primarily initiated for
the purpose of friendship, socialization,
companionship, or accomplishment of a task.
 2. Intimate Relationship
• A healthy intimate relationship involves two people who are
emotionally committed to each other.
• The relationship may include sexual or emotional intimacy as
well as sharing of mutual goals.
• The intimate relationship has no place in the nurse–client
interaction.
 3. Therapeutic Relationship
• The therapeutic relationship differs from the social
or intimate relationship in many ways because it
focuses on the needs, experiences, feelings, and
ideas of the client only.
 Nurse- Patient Relationship
• Nurse – Client Relationship

• Series of interaction between the nurse and the patient in which the nurse assists
the patient to attain positive behavioral change.

• The nurse’s words and actions should convey respect for the patient and
acknowledge the importance of feelings, thoughts and needs.

• The relationship should be goal-oriented, purposeful, time-limited and focused on

the patient’s needs and growth.

• An effective nurse-patient relationship empowers the patient.

• Establishment of an effective relationship requires gaining the patient’s trust.

 Phases of Nurse- Client
Relationship
• Nurse Patient Relationship

• Peplau’s model (1952) has three phases:

orientation, working, and resolution or
termination
 Before the NPR
• The nurse must develop
self-awareness.

• Data gathering planning

for first interaction.
 1. ORIENTATION “getting to know”

• The nurse establishes roles, the purpose of meeting, and the parameters
of subsequent meetings; identifies the client’s problems; and clarifies
expectations.
• The nurse begins to build trust with the client. It is the nurse’s
responsibility to establish a therapeutic environment that fosters trust and
understanding.
 1. ORIENTATION
Client
• Seeks assistance
• Conveys needs
• Asks questions
• Shares preconceptions and expectations of nurse based on past experience.

Nurse
• Responds to client
• Gives parameters of meetings
• Explains roles
• Gathers data
• Helps client identify problem
• Helps client plan use of community resources and services
• Reduces anxiety and tension
• Practices active listening
• Focuses client’s energies
• Clarifies preconceptions and expectations of nurse
 Nurse–Client Contracts
• Agreement between nurse and client on the responsibilities in an informal or
verbal contract.

The contract should state the following:

• Time, place, and length of sessions

• When sessions will terminate (psychotherapy)
• Who will be involved in the treatment plan (family members or health team
members)

Confidentiality- means respecting the client’s right to keep private any

information about his or her mental and physical health and related care.

Only those dealing with the client’s care to have access to the information that
the client divulges.
 2. Working (Identification)
Client
• Participates in identifying problems
• Begins to be aware of time
• Responds to help
• Identifies with nurse
• Recognizes nurse as a person
• Explores feelings
• Fluctuates dependence, independence, and interdependence in
relationship with nurse
• Increases focal attention
• Changes appearance (for better or worse)
• Understands continuity between sessions (process and content)
• Testing maneuvers decrease
 2. Working (Identification)
Nurse

• Maintains separate identity

• Exhibits ability to edit speech or control focal attention
• Shows unconditional acceptance
• Helps express needs and feelings
• Assesses and adjusts to needs
• Provides information
• Provides experiences that diminish feelings of helplessness
• Does not allow anxiety to overwhelm client
• Helps client focus on cues
• Helps client develop responses to cues
• Uses word stimuli
 2. Working (Exploitation)
Client

• Makes full use of services

• Identifies new goals
• Attempts to attain new goals
• Rapid shifts in behavior: dependent and independent
• Exploitative behavior
• Self-directing
• Develops skill in interpersonal relationships and problem-solving
• Displays changes in manner of communication (more open, flexible)
 2. Working (Exploitation)
Nurse
• Continues assessment
• Meets needs as they emerge
• Understands reason for shifts in behavior
• Initiates rehabilitative plans
• Reduces anxiety
• Identifies positive factors
• Helps plan for total needs
• Facilitates forward movement of personality
• Deals with therapeutic impasse
 3. Termination
• Client

• Abandons old needs

• Aspires to new goals
• Becomes independent of helping person
• Applies new problem solving skills
• Maintains changes in style of communication and interaction
• Shows positive changes in view of self
• Integrates illness
• Exhibits ability to stand alone
 3. Termination
Nurse

• Sustains relationship as long as client feels necessary

• Promotes family interaction to assist with goal planning
• Teaches preventive measures
• Uses community agencies
• Teaches self-care
• Terminates nurse–client relationship
 Interdisciplinary Team
• Different members of the team have expertise
in specific areas. By collaborating, they can
meet clients’ needs more effectively.

• Pharmacist, psychiatrist, psychologist,

psychiatric nurse, psychiatric social worker,
Occupational therapist, recreation therapist,
and vocational rehabilitation specialist.
• Pharmacist: The registered pharmacist is a
member of the interdisciplinary team when
medications, management of side effects,
and/or interactions with non-psychiatric
medications are complex. Clients with
refractory symptoms may also benefit from
the pharmacist’s knowledge of chemical
structure and actions of medications.
• Psychiatrist: The psychiatrist is a physician
certified in psychiatry by the American Board
of Psychiatry and Neurology, which requires a
3-year residency, 2 years of clinical practice,
and completion of an examination. The
primary function of the psychiatrist is
diagnosis of mental disorders and prescription
of medical treatments.
• Psychologist: The clinical psychologist has a
doctorate (Ph.D.) in clinical psychology and is
prepared to practice therapy, conduct
research, and interpret psychological tests.
Psychologists may also participate in the
design of therapy programs for groups of
individuals.
 Psychiatric nurse:
• The registered nurse gains experience in working with
clients with psychiatric disorders after graduation from an
accredited program of nursing and completion of the
licensure examination.
• The nurse has a solid foundation in health promotion,
illness prevention, and rehabilitation in all areas, allowing
him or her to view the client holistically.
• The nurse is also an essential team member in evaluating
the effectiveness of medical treatment, particularly
medications. Registered nurses who obtain master’s
degrees in mental health may be certified as clinical
specialists or licensed as advanced practitioners, depending
on individual state nurse practice acts. Advanced practice
nurses are certified to prescribe drugs in many states.
• Psychiatric social worker: Most psychiatric
social workers are prepared at the master’s
level, and they are licensed in some states.
Social workers may practice therapy and often
have the primary responsibility for working
with families, community support, and
referral.
• Occupational therapist: Occupational
therapists may have an associate degree
(certified occupational therapy assistant) or a
baccalaureate degree (certified occupational
therapist). Occupational therapy focuses on
the functional abilities of the client and ways
to improve client functioning, such as working
with arts and crafts and focusing on
psychomotor skills.
• Recreation therapist: Many recreation
therapists complete a baccalaureate degree,
but in some instances persons with
experience fulfill these roles. The recreation
therapist helps the client to achieve a balance
of work and play in his or her life and provides
activities that promote constructive use of
leisure or unstructured time.
 Vocational rehabilitation specialist:

• Vocational rehabilitation includes determining

clients’ interests and abilities and matching them
with vocational choices. Clients are also assisted
in job-seeking and job-retention skills as well as in
pursuit of further education, if that is needed and
desired. Vocational rehabilitation specialists can
be prepared at the baccalaureate or master’s
level and may have different levels of autonomy
and program supervision based on their
education.
 Reference

• Videbeck, S. L. (2017). Psychiatric- Mental

Health Nursing. Philadelphia: Wolters Kluwer.