Psychiatric Mental Health Nursing by Videbeck

96 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP

qualities from quadrants 2, 3, and 4 into quadrant 1
(qualities known to self and others). Doing so indi-
cates that the nurse is gaining self-knowledge and
awareness. See the accompanying figure for an ex-
ample of a Johari window.

PATTERNS OF KNOWING

Nurse theorist Hildegard Peplau (1952) identified
preconceptions,or ways one person expects another
to behave or speak, as a roadblock to the formation
of an authentic relationship. Preconceptions often
prevent people from getting to know one another. Pre-
conceptions and different or conflicting personal be-
liefs and values may prevent the nurse from devel-
oping a therapeutic relationship with a client. Here
is an example of preconceptions that interfere with a
therapeutic relationship. Mr. Lopez, a client, has the
preconceived, stereotypical idea that all male nurses
are homosexual and refuses to have Samuel, a male
nurse, take care of him. Samuel has a preconceived,
stereotypical notion that all Hispanics use switch-
blades, so he is relieved that Mr. Lopez has refused
to work with him. Both men are missing the oppor-
tunity to do some important work together because
of incorrect preconceptions.

Carper (1978) identified four patterns of know-

ingin nursing: empirical knowing (derived from

the science of nursing), personal knowing (derived

from life experiences), ethical knowing (derived from

moral knowledge of nursing), and aesthetic knowing

(derived from the art of nursing). These patterns

provide the nurse with a clear method of observing

and understanding every client interaction. Under-

standing where knowledge comes from and how it

affects behavior helps the nurse become more self-

aware (Table 5-1). Munhall (1993) added another

pattern that she called unknowing:for the nurse to

admit she does not know the client or the client’s sub-

jective world opens the way for a truly authentic en-

counter. The nurse in a state of unknowing is open to

seeing and hearing the client’s views without impos-

ing any of his or her values or viewpoints. In psychi-

atric nursing, negative preconceptions on the nurse’s

part can adversely affect the therapeutic relation-

ship, thus, it is especially important for the nurse to

work on developing this openness and acceptance

toward the client.

TYPES OF RELATIONSHIPS

Each relationship is unique because of the various

combinations of traits and characteristics of and cir-

cumstances related to the people involved. Although

every relationship is different, all relationships may

be categorized into three major types: social, intimate,

and therapeutic.

Johari window

Table 5-1

CARPER’SPATTERNS OFNURSINGKNOWLEDGE

Pattern Example

Empirical knowing

(obtained from the

science of nursing)

Personal knowing

(obtained from life

experience)

Ethical knowing

(obtained from the

moral knowledge of

nursing)

Aesthetic knowing

(obtained from the art

of nursing)

Client with panic disorder

begins to have an

attack. Panic attack will

raise pulse rate.

Client’s face shows the

panic.

Although the nurse’s shift

has ended, she remains

with the client.

Although the client shows

outward signals now,

the nurse has sensed

previously the client’s

jumpiness and subtle

differences in the

client’s demeanor

and behavior.

Adapted from Carper, B. (1978). Fundamental patterns of knowing in

nursing. Advances in Nursing Sciences,13–23.