292 FINAL EXAM – BLUEPRINT SPRING 2018 Nurse -Client relationship: 2 <> Characteristics of Nurse -Client Relationship • Mutual respect • Client focused • Meets client’s needs • Emotional needs of nurse cannot interfere • Purposeful and goal oriented • Goals mutually established • Collaborative • Shared decision making • Promotes client’s independence • Agreement or contract is established • Boundaries are maintained Phases of the Nurse -Client relationship • Pre-interaction begins before nurse meets client, nurse reviews data, considers personal feelings and thoughts • Orientation phase introductory phase, initial encounter, develop trust, establish verbal contract and boundaries, collect data, formulate nursing diagnosis, develop goals, and initial plan of care • Working phase • Termination phase end of the relationship, evaluate outco mes, express feelings about ending the relationship Conditions essential to developing a therapeutic relationship • Rapport • Trust • Respect • Genuineness • Empathy Transference client transfers feelings and behavioral dispositions formed towards the nurse from past • Do you have a boyfriend? • Where do you live? Countertransference nurses behavioral and emotional responses to the client • Poor boundaries • Nurse begins to interfere with patient’s health decisions Conditions that influence the nurse -client relationship Communication & Defense Mechanism <> Active listening interactive process between nurse and client, understanding and being understood SOLER • Sit squarely facing client • Observe an open posture • Lean forward toward the client • Establish eye contact • Relax Verbal communication vocabulary, denotative/connotative meaning, clarity, timing, relevance, pacing, intonation of voice Non -Verbal techniques facial expression, eye contact, body posture, gestures, appearance, silence Religion and culture Communication varies across cultures Nurses Nurses needs to be sensitive and respectful Age/ Developmental level Communication must be appropriate Emotional maturity Self-awareness Emotional intelligence Boundaries Understand between professional and social relationships Limit self -disclosure “I am here to help you, this Use touch cautiously Inform clients touching them Assertive communication promotes use of I statements, allows client to own feeling, client encouraged to make clear what he or she wants. Passive communication personal need s are secondary to others, style is apologetic or complaining. Aggressive communication express needs but in a way that is disrespectful to others, hostile, angry, accusatory Therapeutic communication techniques Non -therapeutic communication techniqu es Silence reflecting Accepting focusing Recognition exploring Offering self clarifying Broad openings present reality General leads voice doubt Make observations state the implied Description of perceptions Comparisons Restating translate words into feelings Plan of action Reassurance clichés Rejecting denial Approving or disapproving interpreting Agree or disagree changing topic Giving advice Probing Defending Requesting explanations Indicate external source of power Minimize feelings ****** Assessment, mental status, interviewing: 1 <> Nursing Assessment: • Comprehensive and holistic o Physical o Psychological o Intellectual executive functionin g, illiteracy, capacity to intellectualize How far did you go in your education? Did you receive a GED? Can you read? o Social support system, social network o spiritual aspects • Evaluation ongoing; diagnosis and treatment plan evolve accordingly Preventive Intervention: • Primary focuses on reducing the incidence of mental disorders; identify causes o Ex: education
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