Nurse Patient

Relationship
Hildegard Peplau (1952)

OBJECTIVES:
At the end of this lecture, students will be
able to:
1. Identify types of relationship.
2. Define Nurse-patient relationship.
3. List down the phases of a nurse-patient
relationship
4. Acknowledge the problems to be
encountered in every NPR phase.
5. Determine specific nursing responsibilities
with each phase.

TYPES OF RELATIONSHIP:

SOCIAL RELATIONSHIP - initiated for the

purpose of friendship, socialization,
companionship or accomplishment of task
INTIMATE RELATIONSHIP involves two
people who are emotionally committed to
each other. May include sexual or emotional
intimacy and sharing of mutual goals.
THERAPEUTIC RELATIONSHIP focuses on
the needs, experiences, feelings and ideas of
the client only. The nurse uses communication
skills, personal strengths and understanding of
human behavior to interact with the client.

Observe these in a NursePatient Relationship

CONFIDENTIALITY means respecting the clients

right to keep private any information about his/her
mental and physical health and related care.
Note: if a patient tells a secret about harming
oneself or others, avoid keeping a promise not to
tell the revealed information by the client.
DUTY TO WARN requires the nurse to notify
physicians, authorities, intended victims of a threat
SELF-DISCLOSURE nurses disclosing personal
information to the patient which the nurse think
can help in establishing rapport.

The NursePatient
Relationship

This relationship forms the

basis of all psychiatric
nursing treatment
approaches.

It is loosely defined as a
therapeutic relationship.

Nursing is a healing art

(therapeutic)
Stated that human relationship
between an individual who is sick,
or in need of health services, and a
nurse especially educated to
recognize and to respond to the
need for help.
Nursing is a maturing force and
an educative instrument.

P hases:
1. P rei nteracti on
2. Ori entati on
3. Worki ng
4. Termi nati on

Pre-Interaction Phase

begins when the nurse is assigned/chooses

a patient
patient is excluded as an active
participant
nurse feels certain degree of anxiety
includes all of what the nurse thinks and
does before interacting with the patient
Goal: Self-disclosure

Major task of the nurse:

to develop SELF-AWARENESS
Other tasks:
data gathering,
planning for first interaction

Remember!
Self-awareness first before
TUOS

Orientation phase

first interaction
establish of trust and rapport
learn about the patient and his initial concerns
and needs
establish contract with the patient
encourage the patient to feel comfortable with
the meeting
conduct initial interview and start termination
phase.
manage present emotion of the patient
provide support and empathy of the patients
feelings
assure of confidentiality
Goal: Establish TRUST, SET

WORKING / THERAPEUTIC PHASE:

it is highly individualized
more structured than the orientation phase
the longest and most productive phase
limit setting must be employed
Personal questions may be expected

Major task: identification and resolution

of the patient's problems
Other tasks: planning and
implementation

Problems for Working

phase:

Transference
the development of an emotional
attitude towards the nurse
positive or negative

Counter transference
experienced by the nurse /
therapist

Termination Phase

Evaluate the summary of progress

Reinforce change and strength of
patient
Give rewards for the cooperation
during interaction
Encourage expression of feelings
about termination of the relationship
Terminate the relationship without
giving
Goal: VALIDATION OF GOAL

Problems for termination

phase:

SEPARATION ANXIETY
(BOTH Nurse and Patient)

How to avoid these:

Must develop SELF-AWARENESS