5 THERAPEUTICRELATIONSHIPS 103
tive regard, regardless of the client’s history. Part of
the nurse’s responsibility is to continue to become
more self-aware and to confront and resolve any prej-
udices that threaten to hinder the nurse–client re-
lationship (Box 5-4).
ROLES OF THE NURSE IN A
THERAPEUTIC RELATIONSHIP
As when working with clients in any other nursing
setting, the psychiatric nurse uses various roles to
provide needed care to the client. The nurse under-
stands the importance of assuming the appropriate
role for the work that he or she is doing with the
client.
Teacher
The teacher role is inherent in most aspects of client
care. During the working phase of the nurse–client
relationship, the nurse may teach the client new
methods of coping and solving problems. He or she
may instruct about the medication regimen and
available community resources. To be a good teacher,
the nurse must feel confident about the knowledge he
or she has and must know the limitations of that
knowledge base. The nurse should be familiar with
the resources in the health care setting and commu-
nity and on the Internet, which can provide needed
information for clients. The nurse must be honest
about what information he or she can provide and
when and where to refer clients for further informa-
tion. This behavior and honesty build trust in clients.Caregiver
The primary caregiving role in mental health set-
tings is the implementation of the therapeutic rela-
tionship to build trust, explore feelings, assist the
client in problem solving, and help the client meet
psychosocial needs. If the client also requires physi-
cal nursing care, the nurse may need to explain to the
client the need for touch while performing physical
care. Some clients may confuse physical care with in-
timacy and sexual interest, which can erode the ther-
apeutic relationship. The nurse must consider the
boundaries and parameters of the relationship that
have been established and must repeat the goals that
were established together at the beginning of the
relationship.Table 5-4
NURSINGBOUNDARYINDEX
Please rate yourself according to the frequency that the following statements reflect your behavior, thoughts, or
feelings within the past 2 years while providing patient care.- Have you ever received any feedback about your behavior
for being overly intrusive with patients or their families? - Do you ever have difficulty setting limits with patients?
- Do you arrive early or stay late to be with your patient
for a longer period of time? - Do you ever find yourself relating to patients or peers as
you might a family member? - Have you ever acted on sexual feelings you have for a
patient? - Do you feel that you are the only one who understands
the patient? - Have you ever received feedback that you get “too
involved” with patients or families? - Do you derive conscious satisfaction from patients’
praise, appreciation, or affection? - Do you ever feel that other staff members are too critical
of “your” patient? - Do you ever feel that other staff members are jealous of
your relationship with a patient? - Have you ever tried to “match-make” a patient with one
of your friends? - Do you find it difficult to handle patients’ unreasonable
requests for assistance, verbal abuse, or sexual language?
NeverNever
NeverNeverNeverNeverNeverNeverNeverNeverNeverNeverRarelyRarely
RarelyRarelyRarelyRarelyRarelyRarelyRarelyRarelyRarelyRarelyPilette, P., Berck, C., & Achber, L. (1995). Therapeutic management. Journal of Psychosocial Nursing, 33(1), 45.
SometimesSometimes
SometimesSometimesSometimesSometimesSometimesSometimesSometimesSometimesSometimesSometimesOftenOften
OftenOftenOftenOftenOftenOftenOftenOftenOftenOftenAny item that is responded to with a “sometimes” or “often” should alert the nurse to a possible area of vulnera-
bility. If the item is responded to with a “rarely,” the nurse should determine if it was an isolated event or a possi-
ble pattern of behavior.