Therapeutic Nurse Patient
relationship (TNPR)
Meaning
Therapeutic nurse-patient
relationship is a professional relationship between a patient and a nurse based
on therapeutic communication; in which the skilled and trained nurse assists
the patient to solve his problems.
Definition
The nurse patient relationship is
result of series of interactions between the nurse and patient over a period of
time with the nurse focusing on need and problem of patient and his family
while using the scientific knowledge and specific skills of nursing profession
(Joyce Travelbee).
Purposes of TNPR
·
Helps to cope with the current problems.
·
Helps to understand the problems.
·
Helps to try out new patterns of behavior.
·
Helps to find out a new alternative for his or
her problem.
·
Helps to communicate.
·
Helps to socialize.
Phases
1. Pre interaction phase:
it begins before the nurse's first contact with the patient. A common fear of
nurse related to the stereotype of psychiatric patient as violent- Because this
is the picture portrayed by the media, many nurses are afraid of being
physically hurt by the patient's outburst of aggressive behavior. Other fear is
related to nurses questioning their own mental health status. Nurses may fear
mental illness and worry that exposure to psychiatric patients might cause them
to lose their own needs. Other tasks of this phase include gathering data about
the patient if information is available and planning for the first interaction
with the patient.
Tasks
·
Nurse explores his/her fear and anxiety.
·
Sets objectives for interaction.
·
Takes help of the supervisor or co-worker to
overcome the fear.
Barriers
·
Thinks about patient according to her knowledge,
fears and misconcepts.
·
Tries to collect information from secondary
sources.
·
Plans objectives
·
May experience anxiety and will try to reduce
it.
2.Introductory or orientation
phase: It is the introductory phase that the nurse and patient first
meet. One of the nurses concerns is to find out why the patient sought help and
whether it was voluntary.
Tasks
·
Establishment of contract
·
Making agreement or pact
·
Talking with the patient
·
Prepare the patient for termination of the
relationship
Barriers
·
Establishing an agreement or pact
·
Social class of the patient
·
Status or position
3.Working phase or therapeutic
phase: Most of the therapeutic work is carried out during the working
phase. The nurse helps the patient to master anxieties, increase independence
and self - responsibility and develops constructive coping mechanisms. Actual
behavior change is the focus of this phase. Patient often display resistance
during this phase. As the relationship develops the patient begins to feel
close to the nurse.
Tasks
·
Collect data in detail and identify the problems
·
Encourage to socialize
·
Help to find out alternative solution
·
Encourage to use new patterns of behavior
·
Help the patient to understand that he has a
significant role in his treatment
Barriers
·
Testing of nurse
·
Progress of the patient
·
Difficulty in collecting and interpreting the
data
·
Fear of closeness
4.Termination phase/resolution
phase or end phase: Termination is one of the most difficult but most
important phase of the therapeutic nurse-patient relationship. It is the time
to exchange feelings and memories and to evaluate mutually the patient's
progress and goal attainment.
Tasks
·
Bring a therapeutic end to the relationship
·
Review feelings about the relationship
·
Evaluate progress towards goals
·
Establish mechanism for meeting future therapy
needs
Barriers
·
Associated with a sense of disappointment and
feeling of sadness
·
Ask to give the address
·
Gift giving
·
Nurse may withdraw due to her anxiety
Preparation for termination of
the patient
·
Explain that set goals are met
·
Allow to talk about his or her fear
·
May be sent on "parole" before
discharge
·
Ask to attend a day care center for a few days
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