Psychiatric Mental Health Nursing by Videbeck

98 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP

Table 5-2

PHASES OF THENURSE–CLIENTRELATIONSHIP

Orientation Working Termination

Identification Exploitation

CLIENT

• Seeks assistance


• Conveys needs


• Asks questions


• Shares pre-
  conceptions and
  expectations of
  nurse based on
  past experience

NURSE

• Responds to client


• Gives parameters
  of meetings


• Explains roles


• Gathers data


• Helps client iden-
  tify problem


• Helps client plan
  use of community
  resources and
  services


• Reduces anxiety
  and tension


• Practices active
  listening


• Focuses client’s
  energies


• Clarifies precon-
  ceptions and
  expectations of
  nurse
  
  
  • Participates in identifying
    problems
  
  
  • Begins to be aware of
    time
  
  
  • Responds to help
  
  
  • Identifies with nurse
  
  
  • Recognizes nurse as a
    person
  
  
  • Explores feelings
  
  
  • Fluctuates dependence,
    independence, and inter-
    dependence in relation-
    ship with nurse
  
  
  • Increases focal attention
  
  
  • Changes appearance
    (for better or worse)
  
  
  • Understands continuity
    between sessions
    (process and content)
  
  
  • Testing maneuvers
    decrease
  
  
  • Maintains separate
    identity
  
  
  • Exhibits ability to edit
    speech or control focal
    attention
  
  
  • Shows unconditional
    acceptance
  
  
  • Helps express needs,
    feelings
  
  
  • Assesses and adjusts
    to needs
  
  
  • Provides information
  
  
  • Provides experiences
    that diminish feelings of
    helplessness
  
  
  • Does not allow anxiety
    to overwhelm client
  
  
  • Helps client focus on cues
  
  
  • Helps client develop
    responses to cues
  
  
  • Uses word stimuli
    
    
    • Makes full use of services
    
    
    • Identifies new goals
    
    
    • Attempts to attain new
      goals
    
    
    • Rapid shifts in behavior:
      dependent, independent
    
    
    • Exploitative behavior
    
    
    • Self-directing
    
    
    • Develops skill in interper-
      sonal relationships and
      problem-solving
    
    
    • Displays changes in
      manner of communication
      (more open, flexible)
    
    
    • Continues assessment
    
    
    • Meets needs as they
      emerge
    
    
    • Understands reason for
      shifts in behavior
    
    
    • Initiates rehabilitative plans
    
    
    • Reduces anxiety
    
    
    • Identifies positive factors
    
    
    • Helps plan for total needs
    
    
    • Facilitates forward move-
      ment of personality
    
    
    • Deals with therapeutic
      impasse
    
    
    
    
  
  
  
  

Adapted from Forchuck, C., & Brown, B. (1989). Establishing a nurse–client relationship. Journal of Psycho-
social Nursing, 27(2), 30–34.

• Abandons old needs


• Aspires to new goals


• Becomes independent of
  helping person


• Applies new problem-
  solving skills


• Maintains changes in
  style of communication
  and interaction


• Shows positive changes
  in view of self


• Integrates illness


• Exhibits ability to stand
  alone


• Sustains relationship
  as long as client feels
  necessary


• Promotes family inter-
  action to assist with goal
  planning


• Teaches preventive
  measures


• Uses community
  agencies


• Teaches self-care


• Terminates nurse –
  client relationship

fosters trust and understanding (Table 5-3). The
nurse should share appropriate information about
himself or herself at this time: name, reason for being
on the unit, and level of schooling: for example, “Hello,
James. My name is Miss Ames and I will be your
nurse for the next 6 Tuesdays. I am a senior nursing
student at the University of Mississippi.”
The nurse needs to listen closely to the client’s
history, perceptions, and misconceptions. He or she

needs to overcome nervousness and convey feelings

of warmth, expertise, and understanding. If the rela-

tionship gets off to a positive start, it is more likely

to succeed and to meet established goals (Forchuk

et al., 2000).

At the first meeting, the client may be distrustful

if previous relationships with nurses have been un-

satisfactory. The client may use rambling speech, act

out, or exaggerate episodes as ploys to avoid discussing