Nurse-Patient Relationship PDF

NURSE - PATIENT RELATIONSHIP  INTRODUCTION  The nurse-client relationship is the foundation upon which nursing care is established.  It is a relationship in which both participants must recognize each other as unique and important human beings.  It is also a relationsh...

NURSE - PATIENT RELATIONSHIP  INTRODUCTION  The nurse-client relationship is the foundation upon which nursing care is established.  It is a relationship in which both participants must recognize each other as unique and important human beings.  It is also a relationship in which mutual learning occurs.  NURSE RELATION + CLIENT = NURSE CLIENT RELATIONSHIP What is the purpose of nurse – patient relationship?   THERAPEUTIC NURSE CLIENT/PATIENT RELATIONSHIP  Definition of relationship: It is defined as a state of being related or state affinity(liking) between two individuals. Example- friendship and colleagues.  Definition therapeutic relationship: It is a relationship where the nurse and client work together towards the goal of assisting the client to regain the inner resources to meet life challenges and facilitate growth of health. TYPES OF RELATIONSHIPS  Intimate most btwn 2 individuals professional Social Therapeutic common committed to one relationship type another, caring for, N-P work btwn 2 respecting and together individuals in loving each other goal oriented every day  According to life Erickson. The ability no to develop an predetermin intimate relationship ed goal or with an adult of the focus opposite sex Continuation depends on is not completing determined developmental task at the onset Ex: Marriage and may last for other partner type months or years THERAPEUTIC RELATIONSHIP:  It is goal oriented, interaction is purposefully established, maintained and carried out with the anticipated outcome of the helping the client gain coping and adaptation skills in living life.  In this client regain the inner resources to meet the challenges and facilitates personal growth. GOALS OF THE THERAPEUTIC NURSE CLIENT RELATIONSHIP Travelbee joyce, in intervention in nursing care, has been discussed nine goals of one to one relationship. They are:  The nurse helps the client to cope with the present problems.  The nurse helps the client to understand his problem.  The nurse helps the client to understand his active participation in an experience.  The nurse assists the Client realistically.  The nurse helps the client to find out a new alternative for his or her problem  The nurse helps the client to try out new patterns of behavior CONDITIONS ESSENTIAL TO DEVOLOPMENT OF A THERAPEUTIC NURSE CLIENT RELATIONSHIP RAPPORT (IPR) RESPECT N-P- TRUST R EMPATHY Requisites for Nurse-Patient Relationship CAREFUL THINKING ENERGY SENSITIVENESS TIME NURSES’ ROLES IN NURSE-PATIENT RELATIONSHIP CAREGIVER EDUCATOR COUNSELOR CONSULTANT  Characteristics of good nurse-patient relationship – Relationship is therapeutic – Exist until patient have fulfilled the health care needs – Nurses’ work is to attain, maintain, and restore the patients’ health – Patients are satisfied – Based on nurses’ competent care derived from skills and knowledge – Provide holistic care – Patient/client is an active participant – Nurse uses patients’ knowledge, attitudes, values, and thoughts to plan interventions – Reciprocal relationship influenced by professional and personal characteristics of both parties PHASES OF NURSE CLIENT RELATIONSHIP Nurse client relationship is the end result of a series of planned purposeful interactions between nurse and client. It can be described in four phase- PHA 1. SES Preorientatio 2. OF n/ Engagement NPR Phase/ Pre- Orientation interaction phase phase 3. Active 4. Intervention/ Termination Working phase phase  Preorientation/Pre-interaction Phase – Definition: This is a phase in which a nurse goes through before the actual interaction with the client. This phase begins when the nurse is assigned a client to develop a therapeutic relationship with him, till she goes to him for interaction.  During this Phase: 1. Nurse assesses the environment in which the nurse meets with patient 2. Explain the professional goals and set priorities 3. Both parties enter the relationship with expectations 4. Patients develop uncertainties and hesitate to comply with care and treatments 5. Patients and nurses become oriented to overall  TASKS Before meeting the client:  Explores own feelings and fears  Review available data, including the medical  Analyze own professional strengths and and nursing history. limitations  Talk to other caregivers who have  Gather data about client wherever possible information about the client.  Anticipate health concerns or issues that  Plan for first meeting with client or arise.  Set the objectives for interaction phase  Identify a location and setting that will foster  Takes help of the clinical supervisor or co- comfortable, private interaction. worker to overcome fears.  Plan enough time for the initial interaction.  Orientation Phase – Definition: This is a phase which begins when the nurse goes to the client, introduces self and gets introduction about him. – The nurse and client who are strangers meet for the first time and become acquaintances. – This ends when the client and nurse accept each other as a unique human being. – One of the nurse’s primary concerns is to find out the client sought help. This forms basis for the nursing assessment and helps the nurse to focus on the client’s problem and to determine client’s level of motivation. 1. Begin to develop the relationship 2. Nurse create a supportive environment 3. Establish a therapeutic contact with patients 4. Nurse introduce herself and the role functions 5. Trust and empathy are basic qualities here 6. Develop strong bond and feels less anxiety 7. Nurse plays the key role with expertise on illness 8. Nurse act as a coordinator. 9. Nurse observe and assess patients 10. Develop an impression and validate with patients 11. Patients come to know their health issues and feel fear, discomfort, or insecure feelings and expect help 12. Nurses realize patients through their body languages and help them 13. Therapeutic relationship is well  TASKS  Establishment of contact, rapport, trust  Closely observe the client, and expect to and acceptance be closely observed by the client  Establish communication, assist in the  Begin to make inferences and form verbal expression of thoughts and feelings judgments about client messages and  Gather data, including the client’s behaviours feelings, strengths and weaknesses  Assess the client's health status  Define client’s problems, set priorities for  Prioritize the client's problems, and nursing intervention identify the client's goals  When the nurse and client meet and get  Clarify the clients and nurse's roles to know one another:  Form contracts with the client that specify  Set the tone for the relationship by who will do what adopting a warm, empathetic, caring  Let the client know when to expect the manner relationship to be terminated  Recognize that the initial relationship is often superficial, uncertain, and tentative  Working Phase – Working phase or phase of emerging identities of the nurse-client relationship starts when the nurse and the client are able to overcome the barrier of orientation or introductory (period) phase. – During this phase the nurse and client actively work on meeting the goals which they had established during the orientation phase. The characteristic features of this phase are that the nurse is able to overcome anxiety and the client’s fear of unknown is also decreased. 1. The sense of mutuality is developed between nurse and patient. 2. Discuss the conflicting situations deeply 3. Nurse and patient work with commitment 4. Nurse sort out problems and solve them 5. Collaboration and equal participation is seen, 6. Aware of the differences of rights, roles, and responsibilities. 7. Nurse acknowledge the patients’ feelings,show genuine interest, and honesty. 8. Nurse should be congruent 9. Nurse convinces the patient of equal rights to make decision. 10.Nobody will play dominant or submissive role. 11. No violation of patient’s rights 12. Patients become independent decision makers. When the nurse and client work together facilitate successful interactions to solve problems and accomplish goals:  Use appropriate self-disclosure and  The nurse collects the data in detail confrontation from primary and secondary sources  The nurse helps the client to find an and identifies the needs of the client alternative solution to his or her  The nurse assists the client to identify problem or development of insight and his or her problems, share feelings and use of constructive coping mechanism get socialize  The nurse helps the client to  Help the client to communicate understand that he has a significant role  Encourage and help the client to in his treatment express feelings about his or her health  She prepares the client for termination  Provide information needed to of relationship by reminding him during understand and change behavior the interviews  Encourage and help the client to set  Provide him with opportunities for goals independent functioning  Termination Phase It is also called as resolution phase or end phase. Goal: To bring a therapeutic end to the relationship. 1. Start at the time of explaining plans and goals. 2. Patient should be informed of the phase at the beginning otherwise patient s develop strong feeling of separation at this phase. 3. Nurse work on education, health advises preparing discharge plan  TASKS During the ending of the relationship: client to other caregivers as needed  Establish reality of separation  Remind the client that termination  Mutually, explore feelings of is near rejection, loss, sadness, anger and  Evaluate goal achievement with the related behavior, if attached client  Review progress of therapy and  Separate from the client by attainment of goals relinquishing responsibility for his or  Formulate plans for meetings future her care therapy needs.  Achieve a smooth transition for the Nurse-professional relationship WHY ? – To get advice – To educational support – To work related achievements – To self support  How?  Collaboratively  Cooperatively  With acceptance and self worth  With appreciation  With respect  Barriers for effective professional relationship 1. Role stress 2. Lack of inter professional understanding 3. Autonomy  ROLE STRESS a. The stress arises from role conflict or role confusion. b. Role conflict is a situation that you happen to play a role different from what you expected to play. c. Role stress occur when you are expected to do than what you can do. d. Result in stress and communication is disturbed.  Prevention of role stress – Experienced persons are responsible – Understand individual capabilities – Identify the individual weaknesses – Assign tasks accordingly – Kindly and duly respond against inexperienced behaviors or faults What are the disadvantag es of role conflicts?  Autonomy struggles What is Autonomy?  is one’s ability to be one’s own person directed by own desires, not imposed by others. When this ability is threated by others autonomy struggles are arose. People with higher level of autonomy Why do nurses need a relationship with the family? VIRTUES, VICES AND HABITS OF THE HEALTH CARE PROVIDER OBJECTIVE: Identify virtues of a health care provider in the context of the goals of medicine – Goals of Medicine – 1. Promote health, prevent disease – 2. Alleviate pain and suffering – 3. Cure diseases – 4. Improve/maintain function – 5. Prevent untimely death – 6. Education of the patient and family – 7. Do not harm (Latin: virtus, Greek: "arete") moral excellence. A virtue is a trait or quality subjectively deemed to be morally excellent and thus is valued as a foundation of principle and good moral being. Personal virtues are characteristics valued as promoting individual and collective wellbeing. The opposite of virtue is vice – Finds meaning in the circle of thinkers. Especially moralists and ethicists. – Virtue is understood as the faculty of the human person to choose what is good against what is deemed to be bad or evil. – Virtue involves a habit, a constant effort to do things well despite obstacles and difficulties. – According to St Agustine, virtue is a good quality of the mind by which one lives rightly, which no one badly and which God works in us but without us. – a practice or a behavior or habit considered immoral, depraved, and/or degrading in the associated society. In more minor usage, vice can refer to a fault, a defect, an infirmity, or merely a bad habit. Synonyms for vice include fault, depravity, sin, iniquity, wickedness, and corruption. The modern English term that best captures its original meaning is the word vicious, which means "full of vice". In this sense, the word vice comes from the Latin word vitium, meaning "failing or defect". Vice is the opposite of virtue – In contradiction to habit, a vice is considered an immoral, depraved or degrading act at all members in a given society. – Taken to mean a defect, infirmity, fault, iniquity, offense, wickedness or corruption. SUMMARY… THANK YOU