Nurse – Patient

Relationship
Hildegard Peplau (1952)
 OBJECTIVES:
 At the end of this lecture, students will be
able to:
1. Identify types of relationship.
2. Define Nurse-patient relationship.
3. List down the phases of a nurse-patient
relationship
4. Acknowledge the problems to be
encountered in every NPR phase.
5. Determine specific nursing responsibilities
with each phase.
 TYPES OF RELATIONSHIP:
  SOCIAL RELATIONSHIP - initiated for the
purpose of friendship, socialization,
companionship or accomplishment of task
 INTIMATE RELATIONSHIP – involves two
people who are emotionally committed to
each other. May include sexual or emotional
intimacy and sharing of mutual goals.
 THERAPEUTIC RELATIONSHIP – focuses on
the needs, experiences, feelings and ideas of
the client only. The nurse uses communication
skills, personal strengths and understanding of
human behavior to interact with the client.
Observe these in a Nurse-
Patient Relationship…
 CONFIDENTIALITY –means respecting the client’s
right to keep private any information about his/her
mental and physical health and related care.
Note: if a patient tells a secret about harming
oneself or others, avoid keeping a promise not to
tell the revealed information by the client.
  DUTY TO WARN – requires the nurse to notify
physicians, authorities, intended victims of a threat
  SELF-DISCLOSURE – nurses disclosing personal
information to the patient which the nurse think
can help in establishing rapport.
 The Nurse–Patient
Relationship
 This relationship forms the
basis of all psychiatric
nursing treatment
approaches.
 It is loosely defined as a
therapeutic relationship.
 Nursing is a healing art
(therapeutic)
 Stated that “human relationship
between an individual who is sick,
or in need of health services, and a
nurse especially educated to
recognize and to respond to the
need for help.
 Nursing is a “maturing force and
an educative instrument.”
P hases:
1. P rei nteracti on

2. Ori entati on

3. Worki ng

4. Termi nati on
Pre-Interaction Phase
 begins when the nurse is assigned/chooses
a patient
 patient is excluded as an active
participant
 nurse feels certain degree of anxiety
 includes all of what the nurse thinks and
does before interacting with the patient
 Goal: Self-disclosure

Major task of the nurse:

to develop SELF-AWARENESS

Other tasks:
data gathering,
planning for first interaction
Remember!
Self-awareness first before
TUOS…
Orientation phase
 first interaction
 establish of trust and rapport
 learn about the patient and his initial concerns
and needs
 establish contract with the patient
 encourage the patient to feel comfortable with
the meeting
 conduct initial interview and start termination
phase.
 manage present emotion of the patient
 provide support and empathy of the patient’s
feelings
 assure of confidentiality
 Goal: Establish TRUST, SET
WORKING / THERAPEUTIC PHASE:

 it is highly individualized
 more structured than the orientation phase
 the longest and most productive phase
 limit setting must be employed
 Personal questions may be expected

Major task: identification and resolution

of the patient's problems

Other tasks: planning and

implementation
Problems for Working
phase:
 Transference
– the development of an emotional
attitude towards the nurse
– positive or negative
 Counter transference –
experienced by the nurse /
therapist
Termination Phase
 Evaluate the summary of progress
 Reinforce change and strength of
patient
 Give rewards for the cooperation
during interaction
 Encourage expression of feelings
about termination of the relationship
 Terminate the relationship without
giving
 Goal: VALIDATION OF GOAL
Problems for termination
phase:
 SEPARATION ANXIETY
(BOTH Nurse and Patient)

 How to avoid these:

Must develop SELF-AWARENESS