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Hildegaard Peplau
  • Nursing Theorist
  • Interpersonal Theory
  • Theorizes that healing occurs between persons
  • there are ways to promote a healing relationship
Therapeutic relationships
  • The ability to establish therapeutic relatioships is one of the most important skills a nurse can develop
  • Components include: trust, genuine interest, positive regard, self-awareness, therapeutic use of self (not for beginners)
Scope of the relationship
  • It can apply to a brief relationship or one that exists over time
  • CA treatment can go from dx all the way to hospice
  • The same staff magages care along the continuum
Mental Health Care
  • Mental health care goes from ER to indivudual counseling and med management
  • It is more likely to have different persons treating the pt in different settings
  • Due to this structure it is important that the pt be encouraged to detach when they leave the hospital
  • If pt maintains a relationship with inpatient caregivers they are less likely to follow-up with outpatient care including med management
Student's Role
  • The therapeutic relationship and all of it's components apply to pt contact, as brief as it is
  • The nurse is caring, friendly, understanding, consistent, keeps promises, listens, is honest
How to develop trust
  • Do what you say you will do
  • formalize your role
  • Keep your goal in mind: assessment, therapeutic communication
  • Your goal is not to investigate the pt's cause of their condition or satisfy your curiosity
Orientation Phase
  • check with staff for a reccomended pt
  • Do a brief chart review
  • spend time in public places or in group therapies to help assess the pt
  • intrduce yourself
  • set the parameters of the relationship, your goal, and work on communication
  • make an appointment for a specific time and length of time (15 minutes)
Working Phase and termination phase
  • Stay focused on therapeutic communication
  • It is not a social relationship focused on chit chat
  • It is not a time to share about yourself
  • wrap up the conversation at the designated time
  • thank them for their assistance in helping you learn how to really listen to a pt
  • I canot talk to you, you remind me of my mother
  • The pt may not be as direct or even aware that transferrence is occuring
Counter transference
  • Ocurs when you seek out working with pts who remind you of somone in your life
  • Eg: pt with anger issues, multiple affairs, pt with addiction issues
  • Who is the focus in the relationship? you or the pt?
  • Never appropriate in the mental health setting
  • It can feed paranoia
  • int can bring up experiences of abuse
  • it can be misundertstood by other pts
Genuine interest
  • set aside your personal values and opinions
  • this allows you to be open to the pt as they are
  • Congruence: nonverbal matches verbal communication
  • False reassurance lets the pt know you are not interested in hearing what they have to say
  • It may cause you to change the subject or focus on yourself
Research shows
  • Feeling understood is key to treatment
  • Feeling misunderstod is very common
  • staff can jump to conclusions about what the pt is saying
  • staff can interpret pt veralization as being solely part of their illness (dehumanizing the pt)
  • staff often stay behind the desk and seem rushed
Empathy, not sympathy
  • Empathy: perceiving what the pt means and letting them know you understand, the pt is comfortable sharing and the nurse is comfortable listening
  • Sympathy: Pity, over-identifying with pt and thinking about yourself
Professional Boundaries
  • Do not share about yourself except in very general terms (where you go to school, acknowledge marriage if wearing a ring, but not beyond that)
  • reinforce that this is a time for the pt, not you
  • do not accept contact information from a pt
  • do not keep secrets
  • make it clear that pertinent information will be shared with the entire team
  • make this clear before they tell you a secret
Setting boudnaries
  • You are not required to accept unacceptable behaviors
  • limits need to be set in a calm nonjudgemental manner
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