The Standard of Professional Performance for Communication established by the American Nurses Association (ANA) is defined as, “The registered nurse communicates effectively in all areas of
professional practice.”[1] See the following box for the
competencies associated with the Communication standard. ANA’s Communication Competencies The registered nurse: Review basic communication concepts for nurses in the
“Communication” chapter in Open RN Nursing Fundamentals. Establishment of the therapeutic
nurse-client relationship is vital in nursing care. Nurses engage in compassionate, supportive, professional relationships with their clients as part of the “art of
nursing.”[2] This is especially true in psychiatric care,
where the therapeutic relationship is considered to be the foundation of client care and
healing.[3] The nurse-client relationship establishes trust and rapport with a specific purpose; it facilitates therapeutic communication and engages the client in decision-making regarding their plan of care. Therapeutic nurse-client relationships vary in depth, length, and focus. Brief therapeutic encounters might last only a few minutes and focus on the client’s immediate needs, current feelings, or behaviors. For example, in the emergency
department setting, a nurse may therapeutically communicate with a client in crisis who recently experienced a situational trauma. During longer periods of time, such as inpatient care, nurses work with clients in setting short-term goals and outcomes that are documented in the nursing care plan and evaluated regularly. In long-term care settings, such as residential facilities, the therapeutic nurse-client relationship may last several months and include frequent interactions focusing on
behavior modification. Read more about crisis and crisis intervention in the “Stress, Coping, and Crisis Intervention” chapter. Phases of Development of a Therapeutic RelationshipThe nurse-client relationship goes through three phases. A well-known nurse theorist named Hildegard Peplau described these three phases as orientation, working, and termination.[4] Orientation PhaseDuring the brief orientation phase, clients may realize they need assistance as they adjust to their current status. Simultaneously, nurses introduce themselves and begin to obtain essential information about clients as individuals with unique needs, values, beliefs, and priorities. During this brief phase, trust is established, and rapport begins to develop between the client and the nurse. Nurses ensure privacy when talking with the client and providing care and respect the client’s values, beliefs, and personal boundaries. A common framework used for introductions during patient care is AIDET, a mnemonic for Acknowledge, Introduce, Duration, Explanation, and Thank You.
Working PhaseThe majority of a nurse’s time with a client is in the working phase. During this phase, nurses use active listening and begin by asking the reason the client is seeking care to determine what is important to them. They use assessment findings to develop a nursing plan of care and plan patient education. If a care plan has already been established on admission, nurses use this time to implement interventions targeted to meet short-term outcomes and long-term goals. During the working phase, clients begin to accept nurses as health educators, counselors, and care providers. Nurses use therapeutic communication techniques to facilitate clients’ awareness of their thoughts and feelings and mutually develop goals and an individualized plan of care. Nurses provide reflective and nonjudgmental feedback to clients to help them clarify their thoughts, goals, and coping strategies.[5] Therapeutic communication techniques used during this phase, including motivational interviewing, are discussed later in this chapter. Termination PhaseThe final phase of a nurse-client relationship is the termination phase. This phase typically occurs at the end of a shift or on discharge from care. If the previous working phase has been successful, the client’s needs have been successfully met by collaboration among the client, nurses, and interprofessional health care team members. The nurse should be aware the client may try to return to the working phase to avoid termination of the relationship. During the termination phase, the nurse can encourage the client to reflect on progress they have made and review post-discharge goals. The nurse also makes community referrals for follow-up and continuation of support in meeting goals. What does a nurse do during the orientation phase of a helping relationship quizlet?In the orientation phase of building a helping relationship, the nurse should closely observe the patient and prioritize the patient's problems. The nurse should create a warm and empathetic conversation and work to understand the patient's behavior.
What is the orientation phase of the nurse patient relationship quizlet?Explanation: The orientation phase consists of introductions and an agreement between the nurse and the client about their mutual roles and responsibilities.
What actions should the nurse take during the orientation phase of developing a therapeutic relationship with a client?The priority nursing action during the orientation phase of the nurse-client relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client based on respect, acceptance, a sense of trust, and a nonjudgmental attitude.
What occurs during the working phase of the nurseWorking Phase:
The working or middle phase of the relationship is where nursing interventions frequently take place. Problems and issues are identified and plans to address these are put into action. Positive changes may alternate with resistance and/or lack of change.
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