NURSE PATIENT RELATIONSHIP

What is the NURSE PATIENT RELATIONSHIP?

• Series of interaction between the nurse and the patient in which the nurse assist the patient to attain positive behavioral change.

What are the CHARACTERISTICS of the nurse-patient relationship?

• It is goal directed, focused on the needs of the patient, planned, time limited and professional.

What are the basic elements of a nurse patient relationship?

1. Trust
2. Rapport
3. Unconditional positive regard
4. Setting Limits
5. Therapeutic Communication

What are the PHASES OF THE NURSE PATIENT RELATIONSHIP?

1. Pre-Interaction Phase

• Begins when the nurse is assigned to a patient
• Phase of NPR in which the 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
• Major task of the nurse: to develop self-awareness
• Other task: data gathering, planning for the first interaction.

2. Orientation Phase

• Begins when the nurse and the patient interacts for the first time.
• Parameters of the relationship are laid.
• Nurse begins to know about the patient.
• Major task: to develop a mutually acceptable contract.
• Other task: Determine why the patient sought help. Establish rapport, develop trust, assessment.

3. Working Phase

• It is highly individualized.
• More structured than the orientation phase.
• The longest and the most productive phase of the NPR.
• Limit setting is employed.
• Major Task: Identification and resolution of the patients problems.
• Other task: Planning and implementation.

4. Termination Phase

• It is a gradual weaning process.
• It is a mutual agreement.
• It involves feeling of anxiety, fear, and loss.
• It should be recognized in the orientation phase.
• Major Task: To assist the patient to review what he has learned and transfer his learning to his relationship with others.
• Other Task: Evaluation.

When to terminate the NPR?

1. When the goals have been accomplished.
2. When the patient is emotionally stable.
3. When the patient exhibits greater independence
4. When the patient able to cope with anxiety separation, fear and loss.

How to terminate?

1. Gradually decrease interaction time.
2. Focus on future oriented topics.
3. Encourage expression of feelings.
4. Make a necessary referral.

COMMON PROBLEMS AFFECTING NPR:

1. Transference - the development of an emotional attitude of the patient either positive or negative towards the nurse.
2. Resistance - development of ambivalent feelings towards self exploration.
3. Counter-transference - transference as experienced by the nurse.