106 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP
- Munhall established the pattern of unknow-
ing as an openness that the nurse brings to
the relationship that prevents preconceptions
from clouding his or her view of the client. - The three types of relationships are social,
intimate, and therapeutic. The nurse–client
relationship should be therapeutic, not social
or intimate. - Nurse theorist Hildegard Peplau developed
the phases of the nurse–client relationship:
orientation, working (with subphases of
problem identification and exploitation), and
termination or resolution. These phases are
ongoing and overlapping. - The orientation phase begins when the nurse
and client meet and ends when the client be-
gins to identify problems to examine. - Tasks of the working phase include main-
taining the relationship, gathering more
data, exploring perceptions of reality, devel-
oping positive coping mechanisms, promot-
ing a positive self-concept, encouraging ver-
balization of feelings that facilitate behavior
change, working through resistance, evalu-
ating progress and redefining goals as ap-
propriate, providing opportunities for the
client to practice new behaviors, and pro-
moting independence.- Termination begins when the problems are
resolved and ends with the termination of
the relationship. - Factors that diminish the nurse–client rela-
tionship include loss of or unclear bound-
aries, intimacy, and abuse of power. - Therapeutic roles of the nurse in the
nurse–client relationship include teacher,
caregiver, advocate, and parent surrogate.
For further learning, visit http://connection.lww.com.
REFERENCES
Carper, B. (1978). Fundamental patterns of knowing in
nursing. Advances in Nursing Science,13–23.
Deering, C. G. (1999). To speak or not to speak? Self-
disclosure with patients. American Journal of
Nursing, 99(1), 34–39.
Forchuk, C., Westwell, J., Martin, M., Bamber-Azzapardi,
W., Kosterewa-Tolman, D., & Hux, M. (2000). The
developing nurse-client relationship: Nurses’ per-
spectives. Journal of the American Psychiatric
Nurses Association, 6(1), 3–10.
Hancock, C. (1998). How to decide about self-disclosure.
Nursing, 98(3), 12–13.
Hewitt, J. (2002). A critical review of the arguments
debating the role of the nurse advocate. Journal of
Advanced Nursing, 37(5), 439–445.
Hyland, D. (2002). An exploration of the relationship be-
tween patient autonomy and patient advocacy: Impli-
cations for nursing practice. Nursing Ethics, 9(5),
472–482.I NTERNET R ESOURCES
Resource Internet Address
◗Countertransference and the therapeutic
relationship http://psychematters.com/papers/hinshelwood.htm
◗Analysis: difficult relationship http://www.nursing.ouhsc.edu/N3034/Unit3/Module2/
Activity2_Analysis.htm
◗Hildegard Peplau home page http://www.uwo.ca/nursing/homepg/peplau.html
◗Boundaries and countertransference
in treatment http://www.abbington.com/cpi/6900.htmlCritical Thinking Questions
1.When is it appropriate to accept a gift from a
client? What types of gifts are acceptable?
Under what circumstances should the nurse
accept a gift from a client?
2.What relationship-building behaviors would
the nurse use with a client who is very dis-
trustful of the health care system?
3.What preconceptions do you have about mental
health clients?