Aubrey Unique M.

Evangelista

BSN-3A

PHASES OF NURSE-PATIENT RELATIONSHIP

Orientation phase

 Problem defining phase

 Starts when client meets nurse as stranger
 Defining problem and deciding type of service needed
 Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of
past experiences
 Nurse responds, explains roles to client, helps to identify problems and to use available resources
and services

Identification phase

 Selection of appropriate professional assistance

 Patient begins to have a feeling of belonging and a capability of dealing with the problem which
decreases the feeling of helplessness and hopelessness

Exploitation phase

 Use of professional assistance for problem solving alternatives

 Advantages of services are used is based on the needs and interests of the patients
 Individual feels as an integral part of the helping environment
 They may make minor requests or attention getting techniques
 The principles of interview techniques must be used in order to explore, understand and
adequately deal with the underlying problem
 Patient may fluctuates on independence
 Nurse must be aware about the various phases of communication
 Nurse aids the patient in exploiting all avenues of help and progress is made towards the final
step

Resolution phase

 Termination of professional relationship

 The patients needs have already been met by the collaborative effect of patient and nurse
 Now they need to terminate their therapeutic relationship and dissolve the links between them.
 Sometimes may be difficult for both as psychological dependence persists
 Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated
and both becomes mature individuals
2. Therapeutic & Non-Therapeutic Communications

Therapeutic Non-Therapeutic
Technique Description Technique Description
Using Silence Accepting pauses or Stereotyping Offering generalized
silences that may extend and oversimplified
for several seconds or beliefs about groups of
minutes without people that are based on
interjecting any verbal experiences too limited
response. to be valid.
Providing general leads Using statements or Agreeing and Agreeing and
questions that encourage disagreeing disagreeing imply that
the client to verbalize, the client is either right
choose a topic of or wrong and that the
conversation, and nurse can judge this.
facilitate continued
verbalization.
Being specific and Making statements that Being defensive Attempting to protect a
tentative are specific rather than person or health care
general, and tentative services from negative
rather than absolute. comments.
Using open-ended Open-ended question Challenging These responses
question specify only the topic to indicate that the nurse is
be discussed and invite failing to consider the
answers that are longer client’s feelings.
than one or two words.
Using touch Providing appropriate Probing Asking for information
forms of touch to chiefly out of curiosity
reinforce caring rather than with the
feelings. The nurse must intent to assist he client.
be sensitive to the
differences in attitudes
and practices of clients
and self.
Paraphrasing This conveys that the Testing Asking questions that
nurse has listened and make the client admit to
understood the client’s something
basic message and
offers clients a clearer
idea of what they have
said.
Seeking Clarification A method of making the Rejecting Refusing to discuss
client’s broad overall certain topics with the
meaning of the message client. make clients feel
more understandable. that the nurse is
rejecting not only their
communication but also
the client
Seeking consensual A method similar to Changing topics and Directing the
validation clarifying that verifies subjects communication into
 the meaning of specific areas of self-interest
words rather than the rather than considering
overall meaning of a the client’s concerns
message.
Offering self Suggesting one’s Unwarranted Comforting statements
presence, interest, or reassurance of advice to reassure the
wish to understand the client
client without making
any demands or
attaching conditions that
the client must comply
with to receive the
nurse’s attention.
Giving information Providing in a simple Passing judgment Giving opinions and
and direct manner, approving or
specific factual disapproving responses,
information the client moralizing, or implying
may or may not one’s own values.
request.
Acknowledging Giving recognition, in a Giving common advice Telling the client what
non-judgmental way, of to do. These responses
a change in behavior, an deny the client’s right to
effort the client has be an equal partner.
made.
Clarifying time or Helping the client
sequence clarify an event,
situation, or happening
in relationship to time.
Presenting reality Helping the client to
differentiate the real
from the unreal.
Focusing Helping the client
expand on and develop
a topic of importance.
Reflecting Directing ideas,
feelings, questions, or
content back to clients
to enable them to
explore their own ideas
and feelings
Summarizing and Stating the main points
planning of a discussion to clarify
the relevant points
discussed.
3. Defense/ Mental mechanisms

Defense Mechanism

Denial – Refuse to accept a painful reality by pretending it does not exist

Displacement – Directing anger toward someone or onto another, less threatening (safer) substitute.

Identification – Taking on attributes and characteristics of someone admired.

Intellectualization – Excessive focus on logic and reason to avoid the feelings associated with a situation.

Projection – Attributing to others feelings unacceptable to self.

Reaction Formation – Expressing an opposite feeling from what is actually felt and is considered undesirable.

Sublimation – Redirecting unacceptable feelings or drives into an acceptable channel.

Undoing – Ritualistically negating or undoing intolerable feelings/ thoughts.