therapeutic relation

1. Orientation…
• Barriers:
- Resistance
- Transference
- Counter transference
• Ways to overcome barriers:
- Adequate knowledge about therapeutic impasses
- Self evaluation
- Evaluation by seniors or coworkers and their feedback
- Limit setting
- Open and clear communication
- Encouraging independence

2. Working phase
• The time period between orientation and termination
• Nurses’ tasks:
- Maintain the relationship
- Gather further data
- Promote the client’s development
- Facilitate behavioral change
- Overcome resistance behavior
- Evaluate the problem and goals and redefine as
necessary

3. Working phase…
• Barriers:
- Testing of the patient by the patient
- Progress of the patient
- The nurses’ fear of closeness
- Life stresses of the nurse
- Resistance, transference and counter
transference
• Ways to overcome barriers: same as orientation
phase

4. Termination phase
• Giving therapeutic end to the nurse patient relationship
• Conditions for termination:
- Symptoms relieved; improved social functioning
- Greater sense of identity
- Accomplishment of goal/ or not at all achieved
- Death/ discharge
- Referral to other agencies
- Run away or LAMA
• Nurses’ tasks:
- Establish reality of separation
- Mutually explore feelings of rejection, loss, sadness, anger
and related behaviors
- Review progress of therapy and attainment of goals
- Formulate plans for meeting future therapy needs

5. 3.4 Process recording
• Process recording is a written account or
verbatim recording of all that transpired,
during and immediately following the nurse -
patient interaction
• The recording of the conversation during the
interaction or the interview between the
nurse and the patient in the psychiatric setup
with the nurse’s inference

6. Purpose
The process recording is intended to:
• Develop planning, structuring and evaluating
the interaction with patients
• Improve communication skills
• Identify nurse’s feelings and thoughts in
relation to self and others
• Develop ability to identify problems and solve
them

7. Components of process recording
• Introductory part
• Context of the interaction
• Record of interaction between nurse and the
patient
• Analysis of the interaction
• Summary

8. Process recording format
1. Patient’s Identification:
Name: Age: Sex:
Religion: Marital status: Education:
Occupation: Income/month: Language:
I.P. No: Ward: Diagnosis:
Address: Date and time of process recording
Date of admission:
Brief summary of the patient’s problem:
2. Place of interaction
3. Description of the environment
4. Reason for selecting the patient
5. Objectives:
-
-
-

9. Format…
Nurse’s Response Patient’s Response Technique Inference
Verbal Non- Verbal Verbal Non- Verbal
Conclusion:
- Fixing the time and place for next interview
Summary:
- List of inferences
- Care plans made according to inference
- Any special difficulties faced during the inference
- Techniques used to overcome difficulties
Signature