Therapeutic Nurse Patient relationship (TNPR)
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.
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.
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.
· Nurse explores his/her fear and anxiety.
· Sets objectives for interaction.
· Takes help of the supervisor or co-worker to overcome the fear.
· 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.
· Establishment of contract
· Making agreement or pact
· Talking with the patient
· Prepare the patient for termination of the relationship
· 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.
· 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
· 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.
· Bring a therapeutic end to the relationship
· Review feelings about the relationship
· Evaluate progress towards goals
· Establish mechanism for meeting future therapy needs
· 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