REVIEWER Roles of the Nurse:
Chapter 5: Therapeutic Relationships (Page 194 – Teacher: Educates the client about their
230) condition and treatment.
Introduction Caregiver: Provides physical and emotional
care.
The ability to establish therapeutic relationships Advocate: Supports the client’s rights and
with clients is crucial for effective psychiatric needs.
care. Parent Surrogate: Occasionally assumes a
This chapter explores the necessary components nurturing role, especially when the client cannot
for establishing and maintaining these care for themselves
relationships, including trust, genuine interest,
acceptance, positive regard, self-awareness, and Factors Enhancing the Relationship:
therapeutic use of self
Open communication
Components of a Therapeutic Relationship: Active listening
Empathy
Trust: Essential for the nurse-client relationship, Respect for client autonomy
built through caring, consistency, honesty, Consistency and reliability
keeping promises, and listening. Trust erodes
with inconsistency between words and actions Factors Diminishing the Relationship:
Congruence: Ensures that the nurse's verbal
and non-verbal messages match, which is crucial Unclear or violated boundaries
for building trust Intimacy
Acceptance and Positive Regard: The nurse Abuse of power
must accept the client unconditionally,
demonstrating a non-judgmental attitude and KEY POINTS
respect for the client as an individual
Empathy and Genuine Interest: The nurse ► Factors that enhance the nurse–client relationship
should show an understanding of the client's includes trust and congruence, genuine interest,
feelings and exhibit a sincere interest in their empathy, acceptance, and positive regard.
well-being ► Self-awareness is crucial in the therapeutic
relationship. The nurse’s values, beliefs, and attitudes all
Phases of the Nurse-Client Relationship: come into play as he or she forms a relationship with a
client.
1. Orientation Phase: The nurse and client meet,
and the nurse provides explanations, information, ► Carper identified four patterns of knowing: empirical,
and answers questions. The client begins to aesthetic, personal, and ethical.
identify problems to address
► Munhall established the pattern of unknowing as an
2. Working Phase: Consists of two sub-phases:
openness that the nurse brings to the relationship that
o Problem Identification: The client
prevents preconceptions from clouding his or her view of
begins to express thoughts and feelings.
the client.
o Exploitation: The client makes full use
of the services offered, working on the ► The three types of relationships are social, intimate,
identified problems and therapeutic. The nurse–client relationship should be
3. Termination Phase: This phase begins when therapeutic, not social or intimate.
the client's problems are resolved, and the
► Nurse theorist Hildegard Peplau developed the
relationship ends as the client becomes more
phases of the nurse–client relationship: orientation,
independent
working (with sub phases of problem identification and
exploitation), and termination or resolution. These phases
are ongoing and overlapping.
► The orientation phase begins when the nurse and
client meet and ends when the client begins to identify
problems to examine.
► Tasks of the working phase include maintaining the
relationship, gathering more data, exploring perceptions
of reality, developing positive coping mechanisms,
promoting a positive self-concept, encouraging
verbalization of feelings that facilitate behavior change,
working through resistance, evaluating progress and
redefining goals as appropriate, providing opportunities
for the client to practice new behaviors, and promoting
independence.
► Termination begins when the problems are resolved
and ends when the relationship is ended.
► Factors that diminish the nurse–client relationship
include loss of or 229 unclear boundaries, intimacy, and
abuse of power.
► Therapeutic roles of the nurse in the nurse–client
relationship include teacher, caregiver, advocate, and
parent surrogate.
