Therapeutic Use of Self in Nursing

Therapeutic Use of Self

• Therapeutic use of self is how a nurse uses their personality, experiences, and skills to build a relationship with the client.
• Interpersonal communication techniques are the tools used by nurses to provide psychosocial interventions.
• Nurse-client relationship is the foundation of psychiatric nursing.

Therapeutic Relationship

• Therapeutic relationship occurs when caregiver and care receiver work together in a healing environment.

Essential Conditions for a Therapeutic Relationship

• Rapport: A sense of harmony based on understanding and appreciating each person's individuality.
• Empathy: Ability to understand the situation from the client's perspective.
• Realness: Being honest and open in interactions with the client.
• Respect: Believing in the dignity and worth of the client regardless of their behavior.
• Trust: Demonstrated by providing caring and warm interventions to the client.

Phases of a Therapeutic Nurse-Client Relationship

• Pre-interaction phase:

  • Goal: Explore self-perception.
  • Tasks:
    • Gathering information about the client.
    • Examining personal feelings, fears, and anxieties about working with the client.

• Orientation (introductory) phase:

  • Goal: Establish trust and formulate a contract for intervention.
  • Tasks:
    • Creating an environment for trust and rapport.
    • Developing a contract for interventions.

• Working phase:

  • Goal: Promote client change.
  • Tasks:
    • Maintaining trust and rapport.
    • Promoting the client's insight and perception of reality.

• Termination phase:

  • Goal: Evaluate goal attainment and ensure therapeutic closure.
  • Tasks:
    • Evaluating progress towards mutually set goals.
    • Establishing a plan for continuing care during stressful life experiences.

Transference and Countertransference

• Transference: When the client unconsciously displaces (transfers) feelings toward someone from their past onto the nurse.
• Countertransference: The nurse's behavioral and emotional response to the client. Can be related to unresolved feelings towards significant others from the nurse's past, or a reaction to transference from the client.

Boundaries in the Nurse-Client Relationship

• Four issues associated with professional boundaries:

  • Material boundaries
  • Social boundaries
  • Personal boundaries
  • Professional boundaries

• Warning signs that professional boundaries are in jeopardy:

  • Keeping secrets with a client.
  • Spending free time with a client.

Comparison: Process Recordings, Feedback

• Process recording: A written record of verbal interactions with clients. Includes verbatim accounts of interactions, used to improve interpersonal communication techniques.
• Feedback: A method of communication that encourages clients to consider modifying their behavior.

Johari Window Model

• The Johari Window Model helps understand the dynamics of self-disclosure and awareness in relationships.

• Four areas of the Johari Window:

  • Facade: Known only to myself.
  • Arena: Known to all.
  • Unknown: Known to no one.
  • Blind Spot: Known to others.