THE NURSE-PATIENT RELATIONSHIP (NPR )

THE NURSE-PATIENT RELATIONSHIP (NPR )

•Series of interaction between the nurse and the patient wherein the nurse assists the patient to attain positive behavioral change.

CHARACTERISTICS OF NPR

1.Goal oriented

2.Focused on the needs of the patient

3.Planned

4.Time-limited

5.Professional

BASIC ELEMENTS OF NPR

1.Trust

2.Rapport

3.Unconditional positive regard

4.Setting limit

5.Therapeutic communication

PHASES OF NPR

1. Pre-orientation phase

•Begins when the nurse is assigned to the patient.

•The patient is excluded as an active participant.

•The nurse feels a certain degree of anxiety.

•It includes all that the nurse thinks and does before interacting with the patient.

•MAJOR TASK of the nurse is self-awareness

•OTHER TASK of the nurse is data gathering and planning for the first interaction, read chart patient interview other health team involve in treatment.

2. Orientation Phase

•Begins when the nurse and the patient meet for the patient.

•Parameters of the relationship is done.

•Explanation of roles is done during this phase which includes the responsibilities and expectation of the patient and nurse, with the expectations of both parties of what they can and can’t do.

•The nurse begins to know the patient.

•MAJOR TASK of the nurse is to develop a mutually acceptable set contract.

•OTHER TASK of the nurse is to determine why the patients ought help, establish rapport, and develop trust and assessment physical examination

3. Working phase

•It is highly individualized.

•It is more structured than the orientation phase- meaning most of the therapeutic work is done during this phase.

•It is the longest and most productive phase of NPR. The nurse and the patient explore stressors and promote insight in the patient by linking perceptions, thoughts, feelings and actions. These insights should be translated into actions and a change in behavior.

•Limit setting is employed.

•MAJOR TASK of the nurse is identification and resolution of the patient’s problem. The nurse helps the patient master anxieties, increase his independence, self-responsibility and develop constructive coping mechanisms in short Goal setting

•OTHER TASK of the nurse is planning and implementation.

4. Termination phase

•It is the gradual weaning process since it is the most difficult and important phase of the NPR. During this phase, learning is maximized by the nurse and the patient.

•It is a mutual agreement. It is a time to exchange feelings and memories and to evaluate the patient’s progress and goal attainment.

•It involves feelings of anxiety, fear and loss.

•Termination should be recognized early during the orientation phase.

•MAJOR TASK of the nurse is to assist the patient to review what he has learned and transfer his learning to his relationship with others and end of contract.

•OTHER TASK is evaluation

WHEN TO TERMINATE NPR

•When goals have been accomplished.

•When the patient is emotionally stable.

•When the patient exhibits greater independence.

•When the patient is unable to cope with anxiety, separation, fear and loss.

HOW TO TERMINATE NPR

•By gradually decreasing interaction time.

•By focusing on future oriented topics.

•By encouraging expression of feelings.

•By making necessary referrals

COMMON PROBLEMS AFFECTING NPR

1. Transference

 —the development of an emotional attitude (either  positive or negative) of the patient towards the nurse.

2. Counter-transference

 —the development of an emotional attitude(either positive or negative) of the nurse towards the patient.

3. Resistance

 —development of ambivalent feelings towards self-exploration.