100 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP
(including medications), and protecting the client’s
civil rights. The client needs to know the limits of
confidentiality in nurse–client interactions and how
the nurse will use and share this information with
professionals involved in client care.
Self-Disclosure.Self-disclosuremeans revealing
personal information such as biographical informa-
tion and personal ideas, thoughts, and feelings about
oneself to clients (Deering, 1999). Traditionally con-
ventional wisdom held that nurses should share only
their name, marital status, and number of children,
and perhaps should give a general idea about their
residence such as “I live in Ocean County.” Now,
however, it is believed that more self-disclosure can
improve rapport between the nurse and client (Deer-
ing, 1999). The nurse can use self-disclosure to convey
support, educate clients, demonstrate that a client’s
anxiety is normal, and even facilitate emotional heal-
ing (Deering, 1999).
Nurses should remember these therapeutic goals
of self-disclosure and use disclosure to help the client
feel more comfortable and more willing to share
thoughts and feelings. Sharing may help the client
gain insight about his or her situation or encourage
him or her to resolve concerns. The nurse should not
use self-disclosure to meet personal needs.
When using self-disclosure, the nurse must con-
sider cultural factors. For example, if the client is
from a culture that is stoic and noncommunicative,
he or she may deem self-disclosure inappropriate.
The nurse should keep self-disclosure brief and com-
fortable, respect the client’s privacy by making sure
the discussion takes place away from others, and un-
derstand that each experience is different. The nurse
must monitor his or her own comfort level. If the
nurse has unresolved feelings about the issue, he or
she should not share personal experiences.
Disclosing personal information can be harmful
and inappropriate for a client, so the nurse must giveTable 5-3
COMMUNICATIONDURING THEPHASES OF THENURSE–CLIENTRELATIONSHIP
Phase of
Relationship Sample Conversation Communication SkillOrientationOrientationOrientationWorkingWorkingWorkingTerminationNurse:“Hello, Mr. O’Hare. I am Sally Fourth, a nursing
student from Orange County Community College.
I will be coming to the hospital for the next 6 Mondays.
I would like to meet with you each time I am here to
help support you as you work on your treatment
goals.”
Nurse:“Mr. O’Hare, we will meet every Monday from
June 1 to July 15 at 11 AMin conference room #2. We
can use that time to work on your feelings of loss
since the death of your twin sister.”Nurse:“Mr. O’Hare, it is important that I tell you I will
be sharing some of what we talk about with my in-
structor, peers, and staff at clinical conference. I will
not be sharing any information with your wife or
children without your permission. If I feel a piece of
information may be helpful, I will ask you first if I
may share it with your wife.”
Client:“Nurse, I miss my sister Eileen so much.”
Nurse:“Mr. O’Hare, how long have you been without
your sister?”
Client:“Without my twin, I am not half the person I was.”
Nurse:“Mr. O’Hare, let’s look at the strengths you have.”
Client:“Oh, why talk about me. I’m nothing without my
twin.”
Nurse:“Mr. O’Hare, you are a person in your own
right. I believe working together we can identify
strengths you have. Will you try with me?”
Nurse:“Well, Mr. O’Hare, as you know I only have
1 week left to meet with you.”
Client:“I am going to miss you. I feel better when you
are here.”
Nurse:“I will miss you also, Mr. O’Hare.”Establishing trust; placing bound-
aries on the relationship and
first mention of termination in
6 weeksEstablishing specifics of the rela-
tionship time, date, place, and
duration of meetings (can be
written as a formal contract or
stated as an informal contract)
Establishing confidentialityGathering dataPromoting self-esteemOvercoming resistanceSharing of the termination experi-
ence with the client demon-
strates the partnership and the
caring of the relationship