THERAPEUTIC NURSE-PATIENT RELATIONSHIP
- a helping relationship that's based on mutual trust
and respect, the nurturing of faith and hope, being
sensitive to self and others, and assisting with the
gratification of your patient's physical, emotional,
and spiritual needs through your knowledge and
skill.
- an end result of series of interaction between the
nurse and patient over a period of time with the
nurse focusing on need and problem of patient and
his family while using the scientific knowledge
and specific skills of nursing profession.
Five Components of the nurse-client relationship:
POWER: The therapeutic nurse-client relationship is one
of unequal power. Although RNs may not perceive
themselves as having power in the relationship, they have
more power than the client. The power of the RN comes
from the authority associated with her position in the health
care system, specialized knowledge, influence with other
health care providers and the client’s significant others, and
access to privileged information. In any professional-client
relationship, there is an imbalance of power in favor of the
professional, and is reinforced in health care services by
the inherent vulnerability of a client needing care.
TRUST: Clients expect the RN to have the knowledge and
skills to provide safe competent care, and to demonstrate
caring attitudes and behaviours, and so entrust their care to
the RN. Trust is critical, as the client is in a vulnerable
position in the relationship. Part of trust is keeping one’s
word. If trust is breached, then it becomes very difficult to
re-establish it.
RESPECT: Respect for the dignity, worth, rights and
uniqueness of the client is fundamental to the therapeutic
nurse-client relationship. RNs demonstrate respect by
acknowledging and taking into account a client’s culture
and other aspects of the client’s individuality when
providing care. Being respectful means being non-
judgemental of the client, and seeking to discover the
meaning
behind the client’s behaviours.
PROFESSIONAL INTIMACY: This does not refer to
sexual intimacy. Professional intimacy relates to the kinds
of activities registered nurses perform for and with the
client which create personal and private closeness on many
levels. This can involve physical, emotional and spiritual
elements.
EMPATHY: Empathy is the expression of understanding,
validating and resonating with the
meaning that the health care experience holds for the client.
In nursing, empathy includes
appropriate emotional distance from the client to ensure
objectivity and an appropriate
professional response.
Phases of Nurse-Client Relationship:
1. PRE-ORIENTATION PHASE
- Self-awareness (understanding one’s own beliefs,
motivations, biases and limitations and recognizing
how they affect others)
Ω Carrying out self-examination.
Ω Increasing self-awareness through:
role play, introspection,
discussion, enlarging one’s
experience)
2. ORIENTATION PHASE
- Involves nurses learning about patients and their
initial concerns and needs.
Ω Building trust
Ω Beginning assessment
Ω Managing emotions
Ω Providing support
Ω Providing structures (e.g. Limit
setting)
- Establishing therapeutic environment.
- The roles, goals, rules and limitations of the
relationship are defined, nurse gains trust of the
client, and the mode of communication are
acceptable for both nurse and patient is set.
- Acceptance is the foundation of all therapeutic
relationship. Acceptance of others requires
acceptance of self first.
- Rapport is built by demonstrating acceptance and
non-judgmental attitude.
- Acceptance of patient means encouraging the
patient verbally and non-verbally to express both
positive and negative feelings even if these are
divergent from accepted norms and general
viewpoint.
- The nurse can encourage the client to share his/her
feelings by making the client understand that no
feeling is wrong.
- Trust of patient is gained by being consistent.
3. WORKING PHASE
- at this point, the client’s problems are identified
and solutions are explored, applied and evaluated.
- The nurse uses the techniques of communication
and assumes different roles to help the client.
4. TERMINATION/ RESOLUTION PHASE
- the nurse terminates the relationship when the
mutually agreed goals are met, the patient is
discharged or transferred or the rotation is finished.
- The focus of this stage is the growth that has
occurred in the client and the nurse helps the
patient to become independent and responsible in
making his own decisions. The relationship and the
growth or change that has occurred in both the
nurse and the patient is summarized.
- The nurse should be firm in maintaining
professionalism until the end of the relationship.
She should not promise the client that the
relationship will be continued.
- The time parameters should be made early in the
relationship and meetings are set further and
further apart near the end to foster independence of
the patient and prepare the latter gradually for the
separation.
- The nurse should not give her address or telephone
numbers to the patient.
THERAPEUTIC USE OF SELF ❖ Johari Window: Joseph Luft and Harry Ingham -
- refers to the ability to use our personality describes us in terms of us and others
consciously and in full awareness in an attempt to relate
with clients and perform nursing interventions
- Self- concept: one’s mental image of oneself;
involves all of the self- perceptions (appearance, values,
beliefs) → influence behaviour
- dimensions:
1. Self- knowledge – insight into one’s abilities,
nature & limitations
2. Self- expectation – what one expects of oneself
(realistic or unrealistic)
3. Social self – how one person is perceived by
others
4. Social evaluation – appraisal in relationship to
others, events, situations
- components: personal identity, body image, role
performance, self- esteem
❖ Personal identity - internal sense of individuality,
wholeness and consistency of a person over time and in
various circumstances.
- develops over time → being whole and
unique
- necessary for intimate rel’ps
❖ Body image - mental picture a person has of his or her
own body (involves person’s conscious & unconscious
attitudes related to the body including physical
appearance, structure or function)
- mental images may or may not be
consistent with actual physical structure or
appearance.
- affected by cognitive growth and
physical dev’t
❖ Role performance - method by which an individual
perceives his or her ability to carry out significant roles
→ perception of competence.
❖ Self- esteem – individual’s overall judgment of one’s
own worth (sense of self- worth) or the emotional • Leads to ease in the practice of:
appraisal of self- concept. 1. Empathy and sympathy - empathy is the ability
- types: global self- esteem – how to mutually experience the thoughts, emotions, and
much one likes one’s self as a whole direct experience of others without them being
: specific self- esteem – how directly communicated intentionally
much one approves of a certain part of - sympathy is a feeling of
one’s self care and understanding of a suffering being. It
implies a desire to help an individual in order to
relieve his distress
 Nurse must develop a clear understanding & awareness 2. Cross cultural sensitivity - refers to the
of self awareness and acceptance of other cultures
→ show respect to others & avoid projecting his or her 3. Responsible, ethical practice
own beliefs to others
~~> purposes: know & accept self, improve self,
respect others, use self therapeutically, be confident
about self

* Self awareness - capacity to focus attention to self.

When we focus on ourselves, we can evaluate our selves
based on the standards that specify how we ought to think,
feel and behave. The process of self evaluation allows us to
experience pride or dissatisfaction with the self and
consequently either continue or change behavior.
Therefore, self awareness is a major mechanism of self
control
- requires time and energy AND
it is never complete
- includes the recognition of our
personality, our strengths and weaknesses, our
likes and dislikes.