issues, the nurse must avoid feeling as if the sessions
were unsuccessful; instead, he or she should identify
the client’s stalling maneuvers and refocus the client
on newly learned behaviors and skills to handle the
problem. It is appropriate to tell the client that the
nurse enjoyed the time spent with the client and will
remember him or her, but it is inappropriate for the
nurse to agree to see the client outside the therapeu-
tic relationship.
Nurse Jones comes to see Mrs. O’Shea for the
last time. Mrs. O’Shea is weeping quietly.
Mrs. O’Shea: “Oh, Ms. Jones, you have been so
helpful to me. I just know I will go back to my old self
without you here to help me.”
Nurse Jones: “Mrs. O’Shea, I think we’ve had a
very productive time together. You have learned so
many new ways to have a better relationship with
your children, and I know you will go home and be
able to use those skills. When you come back for your
follow-up visit, I will want to hear all about how
things have changed at home.”
AVOIDING BEHAVIORS THAT
DIMINISH THE THERAPEUTIC
RELATIONSHIP
The nurse has power over the client by virtue of his
or her professional role. That power can be abused if
excessive familiarity or an intimate relationship oc-
curs or if confidentiality is breached.
Inappropriate Boundaries
All staff, both new and veteran, is at risk for allowing
a therapeutic relationship to expand into an inappro-
priate relationship. Self-awareness is extremely im-
portant: the nurse who is in touch with his or her feel-
ings and aware of his or her influence over others can
help maintain the boundaries of the professional re-
lationship. The nurse must maintain professional
boundaries to ensure the best therapeutic outcomes.
It is the nurse’s responsibility to define the bound-
aries of the relationship clearly in the orientation
phase and to ensure that those boundaries are main-
tained throughout the relationship. The nurse must
act warmly and empathetically but must not try to be
friends with the client. Social interactions that con-
tinue beyond the first few minutes of a meeting con-
tribute to the conversation staying on the surface.
This lack of focus on the problems that have been
agreed on for discussion erodes the professional rela-
tionship.
If a client is attracted to a nurse or vice versa, it
is up to the nurse to maintain professional bound-
aries. Accepting gifts or giving a client one’s home ad-
dress or phone number would be considered a breach
of ethical conduct. Nurses must continually assess
themselves and ensure that they keep their feelings
in check and focus on the client’s interests and needs.
Nurses can assess their behavior by using the Nurs-
ing Boundary Index in Table 5-4. A full discussion of
ethical dilemmas encountered in relationships is
found in Chapter 9.Feelings of Sympathy and
Encouraging Client DependencyThe nurse must not let feelings of empathy turn into
sympathy for the client. Unlike the therapeutic use
of empathy, the nurse who feels sorry for the client
often tries to compensate by trying to please him or
her. When the nurse’s behavior is rooted in sym-
pathy, the client finds it easier to manipulate the
nurse’s feelings. This discourages the client from
exploring his or her problems, thoughts, and feelings;
discourages client growth; and often leads to client
dependency.
The client may make increased requests of the
nurse for help and assistance or may regress and act
as if he or she cannot carry out tasks previously done.
These can be signals that the nurse has been “over-
doing” for the client and may be contributing to the
client’s dependency. Clients often test the nurse to
see how much the nurse is willing to do. If the client
cooperates only when the nurse is in attendance and
will not carry out agreed-on behavior in the nurse’s
absence, the client has become too dependent. In any
of these instances, the nurse needs to reassess his or
her professional behavior and refocus on the client’s
needs and therapeutic goals.Nonacceptance and Avoidance
The nurse–client relationship can be jeopardized if
the nurse finds the client’s behavior unacceptable
or distasteful and allows those feelings to show by
avoiding the client or making verbal responses or
facial expressions of annoyance or turning away from
the client. The nurse should be aware of the client’s
behavior and background before beginning the rela-
tionship; if the nurse thinks that there may be any
conflict, he or she must explore these with a colleague.
If the nurse is aware of a prejudice that wouldplace
the client in an unfavorable light, he or she must
explore such issues. Sometimes by talking about
and confronting these feelings, the nurse can accept
the client and not let a prejudice hinder the rela-
tionship. If the nurse cannot resolve such negative
feelings, however, he or she should consider request-
ing another assignment. It is the nurse’s responsi-
bility to treat each client with acceptance and posi-102 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP