what the nurse brings to a nurse client relationship
- Client and nurse alike come to the relationship with unique, cognitive, affective, and psychomotor abilities that they use in a mutual way to enhance client well being
- Nurses are responsible for encouraging this interchange of ideas, values, and skills
Outcome of a good nurse client relationship
- Client satisfaction with the care
- Nurses feel a sense of accomplishment when their interventions have had a positive impact on client health
Components of Nurse Client Relationship
- Trust
- Empathy
- Respect
- Power (balance)
- Relational intimacy
CNO: standard statements
The therapeutic nurse client relationship includes 4 standard statements that describe the nurses accountability:
- Therapeutic communication
- Client centered care
- Maintaining boundaries
- Protecting the client from abuse
Kinds of abuse
- Neglect (failing to provide the necessities of life)
- Physical (striking a client or causing discomfort)
- verbal/emotional (shouting at or insulting a client)
- Financial (soliciting gifts from a client)
- Sexual (inappropriately touching a client)
Maintaining Boundaries
- Nurses are responsible for effectively establishing and maintaining the limits or boundaries in the therapeutic nurse client relationship
- A boundary crossing is the point at which the relationship changes from professional and therapeutic to unprofessional and personal
- Maintaining and establishing a professional relationship
- Establishing
- Self reflection
- Plan of care
- Confidentiality
- Type of relationship - Maintaining
- Constantly reflect on your practice and care
- Needs of the client are always the focus of your care
co-existing relationship
when a nurse has a relationship with a client prior to providing nursing care (friend, family)
Strategies for co-existing and ensuring objectivity and judgement
- Reflecting on your practice
- Talking with colleagues
- Team meetings
- Ethical framework
- Asking yourself questions after seeing a client
LISTEN
Look at the person Show Interest Stop talking...listen Think about what the person is saying Empathy Never assume
FOCUS
Feel Observe Connect Understand Share
Barriers to therapeutic nurse client relationships
- Anxiety
- Stereotyping and bias
- Overinvolvement
- Under Involvement
- Violation of personal space
- Time limitations
- Cultural issues
- Gender differences
Bridges to therapeutic nurse client relationships
- Caring and respect
- Trust and veracity
- Empathy
- Mutuality
- Confidentiality
- Ethical behaviour
Anxiety: Strategies to Cope
- Slow down breaths
- Explore medications with a doctor
- Challenge negative thoughts
- Talk to someone
reducing client anxiety
- Active listening
- Honesty and integrity
- Explain what’s going on clearly
- Be calm and unhurried
- Teach deep breathing and other relaxation techniques
- Using therapeutic touch as appropriate for the client
- Suggest diversional activities
Safe(r) space
safe(r) spaces, means zero tolerance for discrimination, prejudicial behaviour, bullying, harassment, or any other disruptive or negative behaviours
Gender vs Sex
- Sex is typically defined as the biological characterisitcs that describes a person (meaning do they have a penis or vagina)
- Gender is typically known as the state of being male or female; typically used as reference to social and cultural differences, rather than biological one. It is related to self identity
Gender Identity
- Gender identity is each person’s internal and individual experience of gender
- It is a person’s sense of being a women, a man, both, neither or anywhere along the gender spectrum
- A persons gender identity may be the same as or different form their birth assigned sex
Reducing Barriers
- Establish trust
- Demonstrate caring and empathy
- Empower the client
- Recognize and reduce client anxiety
- Maintain appropriate personal distance
- Practice cultural sensitivity and work to be multilingual
- Use therapeutic relationship building activities such as active listening
- Avoid medical jargon
Steps in the caring process - CARE
Connect with your client
Appreciate the client situation
Respond to client needs
Engage the client in collaborative care
what does inclusive health care mean?
The practice or policy of including people who might otherwise be excluded or marginalized on the basis of difference such as physical or mental disabilities or belonging to minority groups
Communicating with people with disabilities
1) Talk directly to the patient, not to anyone else with them - even if the patient has cognitive disabilities or difficult speech
2) Avoid assumptions based on a patient’s condition or disability. For example, if a patient has severe anxiety and presents stomach pain many health care professionals will assume that their stomach pain is due to their anxiety. But this is not necessarily the case
3) Use person first language. For example instead of saying “the MS patient” say “the patient with MS”
4) Repeat back to patients what you understood them to say. Have them repeat your directions or explanations back to you, in their own words
5) Don’t finish patients’ sentences. If a patient has speech that’s difficult to understand, ask them to repeat themselves until you get their meaning
culture
A complex social concept that encompasses socially transmitted communication styles, family customs, political systems, and the ethnic identity held by a particular group of people
communicating with culturally diverse clients
- Pronounce the clients name right
- Speak clearly and do not rush
- Avoid assumptions or interpretations without validating
- Consider adding more time to your n-ct interaction
- Show interest in learning about the client
- Seek to learn if there are cultural meanings that guide the clients health practices
- Ask about cultural practices that can become part of the plan of care
- Seek permission with physical skills
Communication Principles - LEARN
Listen carefully Explain what the client needs to understand Acknowledge cultural differences Recommend what the client should do Negotiate mutually agreeable strategies
