Phases of Therapeutic Nurse - Patient Relationship - Free download as Powerpoint applying the knowledge and skills in helping the patient, she finds too hard to do this for intervention he or she should be referred to a second in charge. Start studying Phases of Helping relationship. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Introduction to the professional helping relationship with emphasis on the quality of focusing on the person then the two of you are meeting at the contact point.
Gillaspy has taught health science at University of Phoenix and Ashford University and has a degree from Palmer College of Chiropractic. A therapeutic nurse-patient relationship is a supportive interaction that moves a patient toward wellness. It's based on trust, respect, interest, and empathy. Learn how to use these components to move patients through each phase of the relationship. Nurse-Patient Relationship Even as small children, we learn that friends make the world feel safe and fun.
True friends are trusted with our secrets and respect our privacy. Through their actions and words, friends encourage us to reach our goals and comfort us when we have a setback. In a lot of ways, a therapeutic nurse-patient relationship is like a friendship. This professional interaction is a caring relationship that supports a patient's well-being. A successful nurse-patient relationship is based on trust and respect, much like a friendship.
In this lesson, we'll look at these components and others and show how they can be used to help a patient move through the different phases of a therapeutic nurse-patient relationship. Components There are many skills to learn when studying to become a nurse.
One of the most important skills is how to create a therapeutic relationship with patients. To do this, a nurse must master a few key components, including trust and respect. As a nurse, you should introduce yourself to your patients and refer to the patient by name.
Lesson 8: OVERVIEW OF THE FIVE-STEP HELPING PROCESS
These seemingly small gestures display an air of friendliness, caring, and approachability, which can go a long way toward making a patient feel safe. When you maintain eye contact with a patient, you continue to foster trust and respect as your relationship progresses. It's also important to respect a patient's boundaries. Data collection A focus group was conducted with six participant social workers and their manager. For the purpose of gathering data and for crystallisation, the themes established in the focus group were further explored in semi-structured interviews as suggested by Nieuwenhuis Semi-structured interviews were also conducted with the seven child participants identified by the social workers.
The focus group and semi-structured interviews with the social work participants explored their experiences in dealing with child clients in the initial phase of the helping process, while the child participants' semi-structured interviews focused on their initial contact with the social workers. Data analysis The data collected were analysed with thematic analysis as outlined by Wagner, Kawulich and Garner Data were transcribed, read and then coded.
The names of categories flowed from the data. The data revealed a pattern that became the themes. Relevant literature was linked to the themes. The themes were verified with the social work participants to ensure accurate reflection of their experiences. To prevent the reactivation of trauma in children, the interview schedule focused on the relationship experience of the child and not on the referral issue Creswell, If necessary, the social worker assigned to the case at the NGO in the rural Boland district was prepared to contract a colleague to debrief the child client after the one-on-one interview to ensure minimum harm to the client.
Trustworthiness This qualitative research was planned and implemented to ensure core criteria of trustworthiness as outlined by Lincoln and Guba as far back as To ensure credibility, interviews and focus groups were audio taped and social work participants checked the themes. The aim of the research was not to generalise findings; however, the descriptions of themes could be transferred by other social workers to their specific situations as suggested by Bertram and Christiansen To maintain dependability, the research process was clearly described and can be audited.
Introduction to the professional helping relationship with emphasis on the quality of the relation
This transparency also enhanced confirmability. The so-called crystallised reality Wagner et al. FINDINGS The data gathered from the social work and child participants through the focus group and semi-structured interviews were integrated and analysed until certain themes emerged as listed in Table 1. Rationale for relationship building with a child client According to social work participants, the key reasons for relationship building are to build trust and to create a platform from which support can be offered.
Spray and Jowett As participant 3 explained: According to the social work participants, the trusting helping relationship is present when child clients voluntarily attend sessions, show emotions and express inner thoughts. Participant 5 said the reason she wants to establish a relationship with the child is "because I want to have an influence on the child. Participant 1 stated that establishing a safe relationship with someone "is a primary human need" and can become a model for healthy relationships from which the child can operate in future relationships Seabury et al.
One social work participant stated that "experiencing this type of connection with a child is a wonderful experience and highly motivating" and participant 6 says it gives her "satisfaction" in a difficult profession. Pertinent contextual factors that influence relationship building The safety of the child client is paramount and requires gathering information The nature of social work in an NGO sometimes requires that immediate attention is given to the safety of child clients rather than focusing on establishing a helping relationship Glicken, Designated social workers are expected to establish within hours after referral whether a child client is a child in need of care and protection.
However, only after rapport is established will the child client engage in the social work intervention and lower his or her defences Ruch, Gathering information while the relationship is still tenuous might cause defensiveness or withdrawal from the client, who might not be ready to share difficult information Geldard et al.
Social worker participant 2 in this study reflected that once the relationship is established, information flows naturally. This created a dilemma for the social work participants. Participant 4 explained "I think the problem on the table requires you to give immediate attention to the problem while you have less chance to first build relationship, but we carry on because we need certain information from the child, while there is no relationship present causing you to gain no information and making no progress with the child.
Therefore one should understand the background of the child participants. Participant 2 asserts the importance of knowing the child's field. This is mirrored by Kroll's By starting where the child client is, the social worker respects the social work value of the client's sense of self-determination Seabury et al.
Participant 2 remarked on this phenomenon: You want to tell it to them the whole time, but that is the way they grow up. Participants 5 and 6 described the children of this study as being used to threats rather than praise. Child participant A also implied that aggression, eviction and drunkenness are part of her frame of reference.
Child participants D and F described being loved as "she loves me because she gives me food' and not as physical touch, words of affirmation or quality time. This was echoed in another article by Jackman, Kleijn specifically mentioned children being victims of crimes as a result of insufficient parental supervision. She explained that the experiences of children shape their perspectives and behaviours.
The problematic family relationships of a child cause insecure attachment styles that incapacitate the child's ability to develop healthy relationships Kroll, Participant 1 explained that this causes individual intervention to be time consuming, because relationship building with the children is strained as a result of their insecure attachment styles.
Parents as partners in the process Participant 4 noted that "The way in which the parent accepts the social worker also gives the child confidence. If the mother is negative, the children are also negative and scared. Parents can be a vital source of information Turney, Social work participants mentioned that parents or caregivers prescribe to children what to say to the social worker, which was highlighted in child participant C's comment "Then my grandmother says to me: If they ask what your name is or where you live, like that, then I must say I live with my grandmother, because I stay with hef'.
Parents might place the responsibility for change on the social worker. But they come with the expectation that we must do it. Other parents bring their children to the social worker as an authority figure who should scold the child for being naughty.
By informing parents, such unrealistic expectations can be addressed Kroll, Barriers to relationship-based practice Time and resources Individual intervention is not required for every child referred to the social worker. Social workers can address developmental areas through a family perspective.
Yet certain cases require the social work participants to intervene intensively with a child on individual level, for instance, removed, abused, molested, addicted, pregnant and foster children, as well as children who refuse to attend school. It is these cases that are often neglected by social workers because they are time consuming, and continuity and commitment are required from the social worker in order to build and maintain the relationship. The social work participants often struggle to find time for such interventions, even if it is only a few cases.
In this regard participant 3 stated that "I don't have the time to build relationship with a child.
If the child [in crisis] comes to my office then I have to do something immediately. This might prevent the social worker from engaging fully in the helping relationship Ruch, Demands on time can influence the social worker's connection with child clients and jeopardise the relationship Ruch, High caseloads force social workers to manage their time skilfully between the needed administrational duties and direct contact with clients.
All the participants agreed with participant 4 in saying, "We are so pressured for time.
The Nurse-Patient Relationship: Components, Phases & Outcomes
Now you have to do something quickly and you don't really have time. And that is the other thing, because it makes me feel guilty, because you don't work as you should. Participants 1 and 4 reflected that commitment and continuity are necessary in building a helping relationship, but difficult to acquire in social work practice.
Social work participant 4 said "I have loads of work. It causes me to lie awake at night. In addition to these difficulties, social work participants 1 and 6 consider travelling distances in rural communities as hampering regular contact with child clients. In contrast, Ruch Work milieu and play material The physical setting of the counselling session contributes to a client's feeling of comfort Bedi, Three social work participants agreed that play material is important in establishing a relationship with children, but also admit to not having sufficient play material available during initial contact with a child.
As participant 3 said, "How do you build a relationship with a child if you don't even have a toy in your office" and participant 7 said that "just you behind your table is not good enough. The children in the study outlined play materials and games they would prefer in the social worker's office.
A few applicable toys identified by the participants were puppets, clay and colouring utensils. The child participants are not used to the idea of play as a therapeutic tool and thus suggested toys that do not fall within the categories mentioned by Landreth A few children mentioned food as an effective ice breaker.
It is evident from these suggestions that the child clients are not used to play as intervention technique.
The participant social workers delineated two impediments to the play setting. Participants 1 and 6 experienced that the children in their work area do not know how to play or engage with structured toys or play material because they had not been exposed to play material. The other impediment was the fact that social workers travel to external locations to meet children and these external settings are often not child- and or intervention-friendly.
A typical example would be the school environment where aspects such as intercom notifications, small working spaces or interventions in tea rooms interrupt sessions and impact on privacy. Stigmatisation and role confusion It seems as if children are uninformed about the roles of the social worker.
Child participants in the study thought correctly that a social worker is someone to talk to, who asks questions, someone to play with, monitor parental responsibilities and remove children. However, child participant A thought social workers are there to teach children mathematics, while participants B and C did not know what social workers do.
This links with the social work participants' notion that preconceptions based on stories about social workers raise anxiety during initial contact. Preconceptions are normally based on two elements: Participant 1 noted that if the child client remains anxious during the social work session, she explores his conception of social workers to arrive at the conclusion that she is there to help the child client.
Child participant B reported that they do not talk about visits to the social worker because "then they [the other people who came to the social worker with their children] tell us that it isn't fun. Participant 1 experienced this to be beneficial in encouraging compliance, whilst participant 2 experienced the power inherent to social work to be detrimental because children can be scared of admonishment by the social worker.
Social work participants assumed that children hear dreadful stories about social workers and those children feel ashamed to be associated with welfare agencies. In contrast, the child participants described social workers as helpful, bragging to their friends about the visit, looking forward to proposed meetings and feeling important if the social worker wants to see them.
However, child participants are aware of the statutory element in social work as clearly demonstrated by participant A saying "She [her friend] doesn't have to be scared. Then I tell her they [the social worker] won't send her away. Social workers feel inept Seabury et al. Social workers sometimes work with sensitive issues and traumatic events that have serious ramifications for children. The social workers in this study expressed fear that they "might do more damage than good" as a result of their lack of knowledge and skills in working directly with children in distress.
The participating social workers mentioned that they felt so out of depth in these difficult circumstances that they would rather refer the client if possibleor only address the practical issues involved rather than the emotional impact the difficult life circumstances have on the child. Participants 2 and 3 admitted to feeling despondent because of their experience of inadequacy. Previous cases that did not have positive outcomes confirm to participants 2 and 3 the notion that "I don't know what I am doing.
Reluctant child clients Engle and Holiman Children rarely refer themselves to the social worker and thus are probably involuntary participants in any form of intervention Hepworth et al. The social work participants experience the resistance of child clients to manifest as running away, missed appointments, being lethargic or non-talkative within the session, an aggressive attitude and refusal to take part in activities.
The first author had a similar experience with child participant E, who did not speak even after an hour of ice-breaking activities. Social work participants describe frustration, despondence, anger, impatience, powerlessness and anxiety about occurrences of resistance. They speculate that resistance is caused by many factors including influence from parents, pre-session occurrences, mistrust in people, shyness, stigmatisation of the profession, reason for referral and the social worker's personality type.
All seven social work participants agreed that they do not know how to handle resistance in child clients. Professional attributes Values in approaching the client The quality of the social work relationship is influenced by aspects such as the attitude, qualities and social work values Seden, Social work participants 1 and 5 commented on how their opinion of the importance of the case and natural appeal to the child client influence their ability to establish a positive relationship with a child.
Simultaneously, social work participants acknowledge that hope and respect are inherent in approaching a child client. Respect is the foundation on which all helping relationships and consequent interventions are built Egan, According to a study done by Russell in Holland, While respect is inherent in approaching the client, hope contributes to initial relationship building with a client Seabury et al. In order to instil hope in a client, the social worker needs to believe in the value of self-determination and the ability of people to grow and change Reyneke, Social workers also respect the intrinsic dignity and worth of their clients, being attentive to the differences in personalities Hepworth et al.
Social work participants listed shyness, the child's age, concentration span and spontaneity as influencing the helping relationship. In a study done by Bedi Participant 6 made the point that as a child she looked towards positive body language before opening up to an adult.
Non-verbal messages should convey warmth towards the client Egan, Social work participants sensed that child clients might prefer a social worker whom they perceive as present, available, accessible and who carries their best interests at heart. Presence conveys to clients that the social worker is with them and it enables the social worker to listen carefully Egan, Being available to the child client can simply entail making time for the child and not being hasty.
Participant 5 mentioned the detrimental effect haste has on relationship building by stating that "sometimes I am in such a hurry that nobody would want to talk to me, I need to be calmer, beaming warmth, friendliness and interest. The underlying principle in the Children's Act 38 of is the child's best interest. Social work participant 1 touched on this phenomenon by saying that if she was a child client, she would prefer a social worker who was on her side. The above-mentioned values of non-judgement, openness, presence, hope, respect and warmth will create the atmosphere for a calm, safe, relaxed and comfortable setting, as described by social work participants, where individual intervention with a child can take place.
Personality of the social worker Ackerman and Hilsenroth On the other hand, Holland In line with Ackerman and Hilsenroth's findings It is part of my personality He views these as strengths, because they enable the social worker to better understand the difficulties of clients. This links to Seabury et al. Social workers thus enhance the intervention by bringing their own personality to their work Geldard et al.
A child can identify a person who is not authentic, as participant 7 elucidated: Appropriate self-disclosure is used by participant 1 and 6 to demonstrate the social worker's humanness.
Participant 1 illustrated this by saying that "I search for something communal between me and the child, in order for the child to see me as a human being, not only as a social worker.
Another skill that increases the "humanness" of the social worker is empathy Glicken, Participants 1 and 2 mentioned the importance of soft, empathic responses in establishing a helping relationship. Empathic listening is important to building a strong helping relationship Bedi, Participant 1 uses humour to put the child at ease and to establish the initial connection, while participant 5 uses positive reinforcement. There is a fine line between complimenting the child and reinforcing strengths.
This means that positive reinforcement should not be founded on approving or disapproving of the client's behaviour, because the client might change behaviour to please the social worker and cover other behaviour to avoid the disapproval of the social worker Geldard et al. Social work participants concurred that questioning a child is not beneficial towards engaging the child in dialogue.
As participant 4 stated that "you cannot just ask children direct questions the whole time, because they clamp up. They don't want to talk. In this regard participant 4 said: Considerations for initial contact sessions with a child client It is advisable for social workers to establish their own pattern for introductory sessions with children. A well-established but adjustable pattern for introductory sessions allows the worker to focus on the child rather than the next activity.
According to participant 5, this "makes the process easier" and more fluent. Yet one should guard against becoming rigid in a specific pattern, as participant 6 stated "what works with the one, does not work for the next child. In the next section a few patterns are discussed that emerged from the data regarding initial individual sessions with child clients.
Pre-meeting stage Kroll During this stage Geldard et al. Child participant F contributed to the premeeting stage by requesting that social workers should notify him of an intended visit.