5 THERAPEUTICRELATIONSHIPS 105
limits. By retaining an open, easygoing, nonjudgmen-
tal attitude, the nurse can continue to nurture the
client while establishing boundaries. The nurse must
ensure that the relationship remains therapeutic and
does not become social or intimate (Box 5-5).
SELF-AWARENESS ISSUES
Self-awareness is crucial in establishing
therapeutic nurse–client relationships. For example,
a nurse who is prejudiced against people from a cer-
tain culture or religion but is not consciously aware of
it may have difficulty relating to a client from that
culture or religion. If the nurse is aware of, acknowl-
edges, and is open to reassessing the prejudice, the
relationship has a better chance of being authentic. If
the nurse has certain beliefs and attitudes that he
or she will not change, it may be best for another nurse
to care for the client. Examining personal strengths
and weaknesses helps one gain a strong sense of self.
Understanding oneself helps one understand and ac-
cept others who may have different ideas and values.
The nurse must continue on a path of self-discovery
to become more self-aware and more effective in car-
ing for clients.
Nurses also need to learn to “care for themselves.”
This means balancing work with leisure time, build-
ing satisfying personal relationships with friends, and
taking time to relax and pamper oneself. Nurses who
are overly committed to work become burned out,
never find time to relax or see friends, and sacrifice
their own personal lives in the process. When this
happens, the nurse is more prone to boundary viola-
tions with clients (e.g., sharing frustrations, respond-
ing to the client’s personal interest in the nurse). In
addition, the nurse who is stressed or overwhelmed
tends to lose the objectivity that comes with self-
awareness and personal growth activities. In the end,
nurses who fail to take good care of themselves also
cannot take good care of clients and families.Points to Consider about Building
Therapeutic Relationships- Attend workshops about values clarification,
beliefs, and attitudes to help you assess and
learn about yourself. - Keep a journal of thoughts, feelings, and
lessons learned to provide self-insight. - Listen to feedback from colleagues about
your relationships with clients. - Participate in group discussions on self-
growth at the local library or health center to
aid self-understanding. - Develop a continually changing care plan for
self-growth. - Read books on topics that support the
strengths you have identified and help to
develop your areas of weakness.
➤ KEY POINTS
- Factors that enhance the nurse–client rela-
tionship include trust and congruence, gen-
uine interest, empathy, acceptance, and
positive regard. - Self-awareness is crucial in the therapeutic
relationship. The nurse’s values, beliefs, and
attitudes all come into play as he or she
forms a relationship with a client. - Carper identified four patterns of knowing:
empirical, aesthetic, personal, and ethical.
Box 5-5
➤ METHODS TOAVOIDINAPPROPRIATERELATIONSHIPSBETWEENNURSES ANDCLIENTS
- Realize that all staff members, whether male or female, junior or senior, or from any discipline, are at risk of
over-involvement and loss of boundaries. - Assume that boundary violations will occur. Supervisors should recognize potential “problem” clients and
regularly raise the issue of sexual feelings or boundary loss with staff members. - Provide opportunities for staff members to discuss their dilemmas and effective ways of dealing with them.
- Develop orientation programs to include how to set limits, how to recognize clues that the relationship is
losing boundaries, what the institution expects of the professional, a clear understanding of consequences,
case studies, developing skills for maintaining boundaries, and recommended reading. - Provide resources for confidential and nonjudgmental assistance.
- Hold regular meetings to discuss inappropriate relationships and feelings toward clients.
- Provide senior staff to lead groups and model effective therapeutic interventions with difficult clients.
- Use clinical vignettes for training.
- Use situations that reflect not only sexual dilemmas but also other boundary violations including problems
with abuse of authority and power.