The nurse-client relationship is an interaction aimed at improving the "client" welfare, which may be an individual, family, group, or community. The Peplau theory has high relevance to the nurse-client relationship, with one of the main aspects being that both nurses and clients become more knowledgeable and mature during their relationship. Peplau believes that the relationship depends on the interaction of each person's thoughts, feelings, and actions and that the patient will experience better health when all of their special needs are fully considered in the relationship. The nurse-patient relationship allows nurses to spend more time, to connect, to interact with their patients and to understand the needs of their patients. This helps nurses to establish a unique perspective on the patient's disease, beliefs, and preferences. Thus, the patient/family feels that they are being treated and they feel more motivated to open themselves to the nurse and work together to achieve better results/satisfaction.
Video Nurse-client relationship
Element
The nurse-client relationship consists of several elements.
Boundary
Limitations are an integral part of the nurse-client relationship. They represent invisible structures imposed by legal, ethical, and professional nursing standards that respect the rights of nurses and clients. These limits ensure that the focus of the relationship remains on the client's needs, not only with words but also by law. The College of Nurses of Ontario (CNO) standard identifies that it is the nurse's responsibility to establish the limits and limits of the relationship between nurses and clients. The boundaries have specific health goals and objectives, and the relationship ends when the identified objectives are met.
Any action or behavior in a nurse-client relationship that personally benefits the nurse at the expense of the client is a boundary violation. Some examples of border violations engage in romantic or sexual relationships with current clients, large unnecessary disclosures to clients, and receiving prize money from clients. Abuse and neglect are extreme examples. They involve betrayal of respect and trust in relationships. This includes retaining communication from clients because it is considered an example of negligence.
It is the duty of the nurse to be aware of the signs that professional boundaries can be crossed or crossed. The warning signs of crossing limits that can lead to breaches of limits include often thinking of clients in a personal way, keeping secrets with certain clients, supporting one client care at the expense of others and telling the client's personal things about yourself to make an impression. Anything that can consist of the welfare of the client if the relationship with a registered nurse is continued or terminated can be considered as a warning sign. Bound violations are never acceptable and it is the duty of nurses to handle any situation by paying attention to them professionally and therapeutically, regardless of who initiates.
Confidentiality
It establishes a secure relationship and builds trust. Patients should feel comfortable disclosing personal information and asking questions. The nurse is to share information only with professional staff who need to know and obtain written permission from the client to share information with others outside the care team.
Maps Nurse-client relationship
Therapeutic nursing behavior
Nurses are expected always to act in the best interests of the patient to maintain a genuine relationship with all intentions to only benefit the client. Nurses should ensure that their clients' needs are met when they become professionals. Extensive research and clinical observation have shown that the body, mind and emotions are in one unity. Therefore, to help others, one must consider all these aspects; this means not neglecting the person and just treating his illness. Caring for patients outside the treatment of diseases and disabilities.
The aspects of knowledge needed to nurture a therapeutic nurse-client relationship are: background knowledge, knowledge of interpersonal theory and development, knowledge of influence and determination, knowledge of people, knowledge of health/disease, knowledge of the broadest influence on health care policy and health care, and knowledge of the system.
Knowledge of the background is nurse education, and life experiences. Knowledge of interpersonal theory and development is the knowledge of theories of self-sense and self-influence on others. Specific theories are: Interpersonal Theory, Theory of object relation, development theory, and Gender/development theory. Knowledge of people explains that nurses should take time to understand clients, and their world; what that means to them, and their history. Knowledge of Health and Illness is the knowledge that nurses must reach on the health issues of their clients. Knowledge of the widespread influence on health care and health care policies explains that nurses should be aware of the effect of client care; social/political forces, health care system expectations, and accessibility changes, and resources. Knowledge of the System explains that nurses need to know about the health care system so they can help their clients access the service. Effective communication in nursing requires empathic, nonjudgmental, understanding, approachable, sympathetic, caring, and has a safe and ethical quality. The first statement of the CNO Standard is Therapeutic Communication, which explains that nurses should apply communication and interpersonal skills to create, maintain, and terminate nurse-client relationships.
All aspects of therapeutic relationships are interrelated. You can not efficiently use one aspect without the other; they all connect and work together to create a successful relationship. Nurses help clients to achieve goals related to their health including improving their relationships with others. "The help that nurses offer their clients is more than technical expertise.The connection between nurses and clients is a powerful healing power by itself.
Self-awareness
Self-awareness is an internal evaluation of one's self and one's reaction to situations, people, and places of emotion. It offers an opportunity to recognize how attitudes, perceptions, past and present experiences, and relationships framing or altering interactions with others. An example of self-awareness will recognize that showing anger is not a sign of weakness, because there are emotions out of your control. Self-awareness allows you to fully engage with clients and attendance; with the client at the time, allowing the nurse to know when to provide assistance and when to withdraw. Until the individual can fully understand themselves, they can not understand others. Nurses need self-awareness in this connection to be able to relate to the patient's experience to develop empathy. Self-awareness may be the most important aspect of nurses in their professional practice
Original, warm and respectable
A highly skilled and experienced nurse must have certain attributes or skills to successfully establish a nurse client relationship. Attributes like sincere, warm, and respectful are some of them. An aspect of respect is to respect individual cultures and ensure that open-mindedness is being incorporated throughout the relationship until the termination stage. Nurses work to empower clients together with their families to be more involved in learning about their health and ways that can be improved. It is very beneficial for clients to combine their families, as they are probably the most effective support system. Expressing your whole self and being sincere with clients will achieve the desired nurse client relationship.
Therapeutic behavior may require staying silent at times to display acceptance, incorporating open questions to allow client control of the conversation and encouragement to proceed. In addition, nurses can also reduce the distance to indicate their desire to engage, reiterate and reflect to validate the nurse's interpretation of the client's message, directing the conversation to important topics by focusing on them. Nurses also seek clarification to demonstrate a desire to understand, summarize to help assist clients in separating relevant information from irrelevant ones. Nurses should make their clients feel confident that they will be treated with courtesy and that their nurses show a genuine interest in them.
A strong connection between the client and the nurse is made by presence, touch and listening. In addition, being polite and timely honors clients in addition to remembering to be patient, understanding, as well as to praise and encourage clients for their efforts to pay more attention to their health. The main factor in building a nurse client relationship is non-verbal messages or behaviors that you send unconsciously, generating negative perceptions and can distort your efforts to effectively help the client to achieve optimal health. One non-verbal factor is listening. Listening behavior is identified as S.O.L.E.R; S-sit is precisely in relation to the client, O-maintains an open position and does not cross arms or legs, L-lean slightly toward the client, E-maintains reasonable and comfortable eye contact, R-relax. This behavior is effective for communication skills, and useful for thinking about how to listen to others.
Empathy
Having the ability to enter the perceptual world of others and understand how they experience the situation is empathy. It is the therapeutic nurse's essential behavior to convey support, understanding, and sharing experiences. A client to a nurse in the general sense of seeking help. Patients expect nurses who will show interest, sympathy, and understanding of their difficulties. When receiving treatment patients tend to seek more from the care of their illness or disability, they want to receive psychological considerations. This happens through good communication, communication with the client is the foundation of care.
During difficult times, clients seek a therapeutic relationship that will make their treatment less challenging. Many patients are aware that solutions to their problems may not be available but hope to gain support through them and this is what defines a positive or negative experience. Empathy is used as a tool to improve communication between nurses and clients. Past experience can help doctors better understand the problem to provide better intervention and treatment.
Cultural sensitivity
Health care is a multicultural environment and nurses should expect that they will treat patients from a variety of cultural and ethical backgrounds. The cultural background affects people's perceptions of life and health. The aim of the nurse is to develop a body of knowledge that enables them to provide special care culture. It starts with an open mind and accepting attitude.
Cultural competence is a point of view that raises respect and awareness for patients from different cultures from their own nurses. Cultural sensitivity puts aside our own perspective to understand the perceptions of others. Concern and culture are described as complex relationships. This is believed to be because there is no drug without care and concern involving knowledge of the values ​​and behaviors that are different from one's culture. It is important to assess the language requirements and request translation services if necessary and provide written materials in the patient's language. And, try to imitate the communication style of the patient (eg little direct eye contact, slow, calm).
The main obstacle to cultural sensitivity and good communication is ethnocentrism, which is the belief that ethical groups are higher than others; this causes prejudice and stops the nurse to fully understand the patient. Another obstacle is stereotypes, the patient's background is often diverse that includes many ethical and cultural traditions. To communicate individually and provide culturally sensitive care, it is important to understand the social, ethnic, cultural and economic complexities. This involves overcoming certain attitudes and offering consistent and nonjudgmental care for all patients. Accept people for whom they are detached from diverse backgrounds and circumstances or differences in morals or beliefs. By demonstrating this attribute trust can grow between the patient and the nurse. Nurses need to know the outcomes of social, cultural, and racial differences, and how they can affect therapeutic relationships. Nurses must recognize the cultural impact of practicing health in a way that respects one's beliefs and values.
Collaborative destination settings
Therapeutic nurse-client relationships are established for the client's interests. This includes nurses working with clients to create goals directed to improve their health status. Goals are centered on the values, beliefs, and needs of the client. Partnerships are formed between nurses and clients. Nurses empower patients and families to get involved in their health. This relationship has three phases, beginning (first contact/introduction), middle (developing relationship to provide care) and end (patient no longer dependent on nurse). To make this process work, nurses should respect, respect, and listen to clients as individuals. The focus should be on patient feelings, priorities, challenges, and ideas, with a progressive goal of improving optimal physical, spiritual and mental health.
Responsible, ethical practice
It is a communication-based relationship, therefore, the responsibility for interacting, educating, and sharing information is actually placed on the nurse. The fourth statement of the CNO Standard is, Protecting the Client from Abuse. It is stated that it is the duty of nurses to report abuse of their clients to ensure that their clients are safe from harm. Nurses should intervene and report the abusive situation observed that may be considered violent, threatening, or intended to be harmful. The nurse must also report the behavior or comment of any health care provider to a client who is considered romantic, or sexual abuse.
Client perspective
Coatsworth-Puspoky, Forchuk, and Ward-Griffin conducted research on the client's perspective in nurse-client relationships. The interview was conducted with participants from Southern Ontario, ten had been hospitalized for psychiatric illness and four had experience with nurses from community-based organizations, but had never been hospitalized. Participants were asked about experiences at various stages of the relationship. This study describes the two relationships that make up the "bright side" and the "dark side".
A "bright" relationship involves nurses who validate clients and their feelings. For example, one client tests her trust in a nurse by becoming angry with her and revealing her negative thoughts regarding hospitalization. The client states, "She tries to be nice to me... if she can tolerate this sometimes venomous attack, which she has done well until now, it will probably be a very lucrative relationship".
The "dark" side of the relationship results in nurses and clients moving away from each other. For example, one client states, "The nurse's general feeling is that when someone asks for help, they are manipulative and seek attention." The nurse does not recognize the client who has the disease with the need for it; the client avoids the nurse and considers the nurse avoid it. One patient reported, "All the nurses live in their central station, they do not mix with the patient... The only interaction you have with them is the time of treatment". Both trust and attention are not exchanged so that perceptions avoid each other and ignore the results. One participant stated, "nobody cares, it does not matter, they just do not want to hear it, they do not want to know, they will not listen". The growing relationship depends on the personality and attitude of the nurse. This finding brings awareness of the importance of nurse-client relationships.
Build trust
Building trust is helpful for how relationships work. Wiesman used interviews with 15 participants who spent at least three days in intensive care to investigate factors that helped develop trust in nurse-client relationships. Patients say nurses promote trust through attention, competence, measure of comfort, personality, and provision of information. Each participant stated that the nurse's attention was important for developing trust. One says that the nurses "are always with you all the time, and whenever there is something, they are there looking after you." Competence is seen by seven participants as important in the development of trust. "I trust nurses because I can see them doing their work, they take time to do small things and make sure they are done right and right," said one participant. Relief of pain was seen by five participants as promoting trust.
A client stated, "they are there for the smallest needs, I remember once where they repositioned me maybe five or six times in an hour". A good personality is expressed by five participants as important. One said, "they're all friendly, and they make you feel like they've known you for a long time" (61). Receiving sufficient information is important for four participants. One participant said, "They explain things, they follow, step by step". The findings of this study show how trust is beneficial to lasting relationships.
Emotional support
Emotional support is to give and receive certainty and encouragement through understanding. Yamashita, Forchuk, and Mound do research to examine the nurse case management process involving clients with mental illness. Nurses in hospitalization, transition, and community settings in four Canadian cities were interviewed. Interviews show the importance of providing emotional support to patients. A nurse declares that if the client knows "Someone really cares to see how they do it once a week... by going shopping with them or to an appointment with a doctor, for them it means the world".
Interviews show it is important to include families as therapeutic allies. A nurse stated that "We are with the family, we can be with them as opposition and get too involved and elsewhere in between, and we connect with them as much as they want." With frequent contact, nurses can discuss possibilities with the family. This study reaffirms the importance of emotional support in relationships.
Humor
Humor is important in developing lasting relationships. Astedt-Kurki, Isola, Tammentie, and Kervinen asked readers to write about experience with humor while at the hospital through patient organization bulletins. Letters selected from 13 clients who are chronically ill from Finland. Clients were also interviewed in addition to their letters. Interviews reported that humor plays an important role in health. A paralyzed woman said, "You must have a sense of humor if you want to live and survive, you have to defend it, no matter how painful it is."
Humor helps clients accept what happens by finding a positive outlook. One of the participants stated, "... when you are sick because you can and do nothing but lie down and other people do everything in their power to help, humor really makes you feel good". Humor also serves as a defense mechanism, especially in men. One participant said, "For male patients, humor is also a way to hide their feelings, it is very difficult for them to admit that they are afraid". Patients find it easier to discuss difficult things when the nurse has a sense of humor. "A nurse who has a sense of humor, that's the kind of nurse you can talk to, that's the kind of nurse you can go to and ask for help..." reports one participant. This research provides the support that if humor is generally important to people, then the change will remain important.
References
Source of the article : Wikipedia
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