Relationship Development Review outline in the note CHAPTER OUTLINE/LECTURE NOTES I. Role of the Psychiatric Nurse independent members of the professional health care team. physician’s handmaiden to the present recognition of nurses as unique, A. Nursing has evolved through various roles from custodial caregiver and B. Hildegard Peplau identified six subroles within the role of the nurse. health care. 2. The Resource Person. The nurse provides information related to the client’s 1. The Stranger. In the beginning, nurse and client are strangers to each other. 3. The Teacher. The nurse identifies learning needs and provides information participant in planning his or her care. 4. The Leader. Democratic leadership allows the client to be an active required by the client or family to improve the health situation. 5. The Surrogate. The nurse fulfills for the client basic needs associated with to learn to adapt to difficulties or changes in life experiences. 6. The Counselor. The nurse uses “interpersonal techniques” to assist clients mothering. C. Peplau believed that the emphasis in psychiatric nursing is on the counseling relationship development in the provision of emotional care. D. Peplau and Sullivan, both interpersonal therapists, emphasize the importance of subrole. II. Dynamics of a Therapeutic Nurse–Client Relationship met by the relationship. other as a unique human being. When this occurs, both participants have needs A. A therapeutic nurse–client relationship can occur only when each views the B. Therapeutic relationships are goal oriented, and directed at learning and growth 1. Identify the client’s problem. C. Goals are often achieved through use of the problem-solving model. promotion. 3. Identify realistic changes. 2. Promote discussion of desired changes. 5. Discuss alternative strategies for creating changes the client desires to make. adaptively cope with them. 4. Discuss aspects that cannot be realistically changed, and ways to more 6. Weigh benefits and consequences of each alternative. 9. Provide positive feedback for the client’s attempts to create change. 8. Encourage the client to implement the change. 7. Assist the client to select an alternative. 10. Assist the client to evaluate outcomes of the change and make modifications A. Defined: The ability to use one’s personality consciously and in full awareness in III. Therapeutic Use of Self as required. an attempt to establish relatedness and to structure nursing interventions. IV. Gaining Self-Awareness about life, death, and the overall human condition. B. Nurse must possess self-awareness, self-understanding, and a philosophical belief A. Values clarification is one process by which an individual may gain selfawareness. b. Irrational—an individual holds the idea as true despite the existence of a. Rational—objective evidence exists to substantiate its truth. 1. Beliefs. A belief is an idea that one holds to be true. Beliefs may be: objective, contradictory evidence. d. Stereotypical—the belief describes a concept in an oversimplified or objective evidence exists. c. Held on faith—ideas that an individual holds as true for which no undifferentiated manner. a. Attitudes have an emotional component. They may be judgmental, organizes knowledge about his or her world. 2. Attitudes. Attitudes are frames of reference around which an individual selective, and biased. individual’s ideal mode of conduct and ideal goals. 3. Values. Values are abstract standards, positive or negative, that represent an b. Attitudes may be positive or negative. action producing. a. Values differ from attitudes and beliefs in that they are action oriented or c. Attitudes and beliefs flow out of one’s set of values. upon. b. Attitudes and beliefs become values only when they have been acted B. The Johari Window a. The Open or Public Self. The part of the self that is public; that is, to increase self-awareness. It is divided into four quadrants: 1. The Johari Window is a representation of the self and a tool that can be used aspects of the self about which both the individual and others are aware. c. The Private Self. The part of the self that is known to the individual, but remains hidden from the awareness of the individual. b. The Unknowing Self. The part of the self that is known to others but that the individual deliberately and consciously conceals from others. 2. The goal of increasing self-awareness by using the Johari Window is to individual and to others. d. The Unknown Self. The part of the self that is unknown to both the increase the size of the quadrant that represents the Open or Public Self. right to respect and dignity. comfortably, to accept differences in others, and to observe each person’s 3. Increased self-awareness allows an individual to interact with others V. Conditions Essential to Development of a Therapeutic Relationship a nonjudgmental attitude. based on acceptance, warmth, friendliness, common interest, a sense of trust, and A. Rapport—implies special feelings on the part of both the client and the nurse B. Trust—implies a feeling of confidence in another person’s presence, reliability, C. Respect—implies the dignity and worth of an individual regardless of his or her Trust is the basis of a therapeutic relationship. integrity, veracity, and sincere desire to provide assistance when requested. unacceptable behavior. Carl Rogers called this unconditional positive regard. felt and what is being expressed. interactions with the client. Genuineness implies congruence between what is D. Genuineness—refers to the nurse’s ability to be open, honest, and “real” in behavior, and sense accurately another’s inner experience at a given time. With E. Empathy—a process wherein an individual is able to see beyond outward feeling, and experiences a need to alleviate distress. sympathy in that, with sympathy, the nurse actually shares what the client is empathy the nurse’s feelings remain on an objective level. It differs from VI. Phases of a Therapeutic Nurse–Client Relationship other health team members. 1. Obtain information about the client from his or her chart, significant others, or A. The Preinteraction Phase 2. Examine one’s own feelings, fears, and anxieties about working with a 1. Create environment for trust and rapport. B. The Orientation (Introductory) Phase particular client. 2. Establish a contract for intervention. 5. Formulate nursing diagnoses. 4. Identify the client’s strengths and weaknesses. 3. Gather assessment data. 7. Develop a realistic plan of action. 6. Set mutually agreeable goals. 1. Maintain trust and rapport. C. The Working Phase 8. Explore feelings of both client and nurse. 2. Promote the client’s insight and perception of reality. 5. Continuously evaluate progress toward goal attainment. 4. Overcome resistance behaviors. 3. Use problem-solving model to work toward achievement of established goals. 6. Transference and countertransference: b. Countertransference refers to the nurse’s behavioral and emotional “transfers”) to the nurse feelings formed toward a person from the past. a. Transference occurs when the client unconsciously displaces (or response to the client. a. Progress has been made toward attainment of the goals. 1. Therapeutic conclusion of the relationship occurs when: D. Termination Phase has been established. b. A plan of action for more adaptive coping with future stressful situations c. Feelings about termination of the relationship are recognized and explored.

Role of the Psychiatric Nurse Nursing has evolved through various roles from custodial caregiver and physician’s handmaiden to recognition as a unique, independent member of the professional health care team. Peplau identified six sub-roles within the role of the nurse: The stranger. In the beginning, nurse and client are strangers to each other. The resource person. The nurse provides information related to the client’s health care. The teacher. The nurse identifies learning needs and provides information required by the client or family to improve the health situation

Goals are often achieved through use of the problem-solving model: Peplau believed that the emphasis in psychiatric nursing should be on the counseling sub-role. Peplau and Sullivan, both interpersonal therapists, emphasized the importance of relationship development in the provision of emotional care. Goals are often achieved through use of the problem-solving model: Identify the client’s problem. Promote discussion of desired changes. Discuss aspects that cannot realistically be changed and ways to cope with them more adaptively. Discuss alternative strategies for creating changes the client desires to make.

Therapeutic Use of Self Definition – ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions Nurses must possess self-awareness, self-understanding, and a philosophical belief about life, death, and the overall human condition.

Gaining Self-Awareness Values clarification is one process by which an individual may gain self-awareness. Beliefs – ideas that one holds to be true. May be Rational Irrational Held on faith Stereotypical

Attitudes – frames of reference around which an individual organizes knowledge about his or her world. Attitudes have an emotional component. They may be judgmental, selective, and biased. Attitudes may be positive or negative. Values – abstract standards, positive or negative, that represent an individual’s ideal mode of conduct and ideal goals. Values differ from attitudes and beliefs in that they are action-oriented or action-producing. Attitudes and beliefs become values only when they have been acted on. Attitudes and beliefs flow out of one’s set of values.

Conditions Essential to Development of a Therapeutic Relationship Rapport Trust Respect Genuineness Empathy