The Therapeutic Nurse-

Client Relationship
Use of Therapeutic
Communication
Self Awareness & Nurse - Client
Relationship
Quad I
Open to self/public
What you know about self
And what others also
know about you
Quad 2
Blind the unaware self
Qualities others know
about you but you are
unaware of.


Quad 3
The hidden /private self
Qualities only you know
Quad 4
Unknown self
EMPTY quad the
undiscovered self-
Qualities not known by
self/ others


Components of the Nurse-Client
Relationship
Trust
Genuine interest
Empathy
Acceptance
Positive Regard
Therapeutic Use of Self
Types of relationships
Social
Friendship
Companion
Use small talk
superficial
Intimate
Emotional
commitment
May be sexual/
emotional
Intimacy
Therapeutic
Focus on client
needs
Experiences,
Feelings, ideas
Goal oriented

Phases of the Nurse-Client
Relationship:
Pre-Orientation- Self assessment
examine own feelings, fears, anxieties.
Orientation Introductory Phase
establish trust, share information with
client; discrete self-disclosure.
convey support, facilitate healing
educate

Phases of Therapeutic Nurse-
Client Relationshipcontd.
The Working Phase Problems identified
Exploration- guide client to examine
feelings/responses, develop new coping
skills
Termination Phase Resolution phase
Examine goals achieved;
Explore feelings regarding termination
Establish plan for continuing assistance




Obstacles to the Therapeutic
Relationship:
Inappropriate Boundaries

Encouraging dependence

Non acceptance/Avoidance

Resistance


Roles of the Nurse:
Teacher

Caregiver

Advocate

Parent- Surrogate
Therapeutic Communication
Boundaries:
Intimate

Personal

Social

Public

Non Verbal Communication
Eye Contact
Body Language
Boundaries
Facial Expressions
Silence
Vocal cues

Non Verbal Communication
Space (comfort zone)
Touch ( action/personal space used
cautiously)
Appearance communicates a particular
image/ones mental status ( use of
clothing, make-up etc.)
Be aware of own non-verbal cues!!
Traits of Therapeutic
Communication
Genuineness
Positive Regard
Empathy
Trustworthiness
Clarity
Responsibility
Assertiveness
Active Listening!!
S Sit facing the client
O Open Posture
L Lean forward towards client
E Establish eye contact
R- Relax!!

Conditions Affecting
Communication
Values
Attitudes
Beliefs
Perceptions
Culture or Religion
Social Status
Gender
Age or developmental level
Environment
Enhancing Communication
Silence
Support/reassurance
Sharing Observations
Acknowledge feelings
Broad open ended statements
Information giving
Interpretation
Enhancing Communication
Restating
Reflecting
Clarification
Confrontation
Offering Alternatives
Voicing doubt
Role-playing
Use of Humor use cautiously/discretely

Non-therapeutic responses
Advising
Agreeing
Belittling feelings
Challenging
Defending
Disagreeing
Disapproving
Probing
Caring for clients from different
socio-cultural backgrounds
Important !! Analyze self! know your own
beliefs/values/customs/behaviors
Avoid being judgmental
Rules for communication vary since they arise
from cultural norms!
Understand differences in communication
among various cultures
Ask families for assistance re: their culture
Reflect on your emotions/journal write feelings
Therapeutic communication ?s
1. The nurse is meeting a new client on
the unit.Which action, by the nurse, is
most effective in initiating the nurse-
client relationship?
A. Introduce self and explain the purpose
and the plan for the relationship.
B. Describe the nurses family and ask the
client to describe his/her family.
C. Wait until the client indicates a readiness
to establish a relationship.
D. Ask the client why he/she was brought to
the hospital.
2. Mrs. F. has remained close to the nurse all
day. When the nurse talked with other
clients during dinner, Mrs. F. tried to regain
the nurses attention and began to shout,
Youre just like my mother. You pay
attention to everyone but me! The best
interpretation of this behavior is that
A. Mrs. F. is exhibiting resistance.
B. Mrs. F. has been spoiled by her family.
C. The nurse has failed to meet Mrs. Fs needs.
D. Mrs. F. is demonstrating transference.
3. The nurse is caring for a Native American
client who says, I dont want you to touch
me.Ill take care of myself. Which nursing
response is most therapeutic?
A. Okay, if thats what you want.Ill just leave
this cup for you to collect your urine.
B. If you dont want our care, why did you
come here?
C. Why are you being so difficult? I only want
to help you.
D. It sounds as though you want to take care
of yourself. Lets work together so you can
do things for yourself.
4. The client says to the nurse I am going to
die, I wish my family would stop hoping for a
cure! I get so angry when they carry on like
this! After all, Im the one whos dying. The
most therapeutic response is:
A. Youre feeling angry that your family
continues to hope for you to be cured.
B. I think we should talk more about your
anger with your family.
C. Well, it sounds like youre being
pessimistic. After all, years ago people died
of pneumonia.
D. Have you shared your feelings with your
family?

5. The nurse employed in a mental health clinic
is greeted by a neighbor in a local grocery
store. The neighbor says to the nurse,
How is Carol doing? She is my best friend
and is seen at your clinic every week. The
most appropriate nursing response is which
of the following?
A. Im not supposed to discuss this, but because
you are my neighbor, I can tell you that she is
doing great!
B. Im not supposed to discuss this, but because
you are my neighbor, I can tell you that she
really has some problems!
C. If you want to know about Carol, you need to
ask her yourself.
D. I cannot discuss any client situation with you.

6. The nurse is preparing the client for the
termination phase of the nurse-client
relationship. The nurse prepares to
implement which nursing task is most
appropriate for this phase?
A. Identifying expected outcomes
B. Planning short term goals
C. Making appropriate referrals
D. Developing realistic solutions
7. During the termination phase of the nurse-
client relationship, the clinic nurse observes
that the client continuously demonstrates
bursts of anger. The most appropriate
interpretation of the behavior is that the
client
A. Requires further treatment and is not ready to be
discharged.
B. Is displaying typical behaviors that can occur
during termination.
C. Needs to be admitted to the hospital.
D. Needs to be referred to the psychiatrist as soon
as possible.
8. A client looks at a mirror and cries out, I look
like a bird. This is not my face. The nurse
responds therapeutically by saying:
A. What kind of a bird do you think you are?
B. That must be very distressing to you, your
face does not look different to me.
C. Maybe the light is playing tricks on you.
D. Why do you think that you look like a bird?
9. A 32 year old mother of 2 young children diagnosed with
cervical cancer with metastacies, tells her nurse Im
going to die, arent I ? The nurses most appropriate
response would be:
A. No, you are not . After all you are receiving the latest
treatment available, and your doctor is one of the best
in this area.
B. We are all going to die sometime.
C. What did your doctor tell you?
D. I dont know. You have a serious illness. Do you have
feelings that you would like to talk about?
10. A client relates angrily to the nurse that
his wife says he is selfish. Which
response by the nurse would be most
helpful?
A. Thats just her opinion.
B. I dont think that you are selfish.
C. Everyone is a little bit selfish.
D. You sound angry tell me more about
what went on.
11. The most therapeutic response a nurse could
make to a student who begins to cry upon
learning that a failing grade was received on a
final exam is:
A. Youll make it next time.
B. Failing an exam is an upsetting thing to
happen.
C. How close were you to passing?
D. It wont seem so important 5 years from now.