AVOIDING BEHAVIORS THAT DIMINISH THE THERAPEUTIC RELATIONSHIP
The nurse has power over the client by virtue of his or her professional role. That power can be abused if excessive familiarity or an intimate relationship occurs or if confi-dentiality is breached.
All staff members, both new and veteran, are at risk for allowing a therapeutic relationship to expand into an inap-propriate relationship. Self-awareness is extremely important: The nurse who is in touch with his or her feelings and aware of his or her influence over others can help maintain the boundaries of the professional relationship. The nurse must maintain professional boundaries to ensure the best thera-peutic outcomes. It is the nurse’s responsibility to define the boundaries of the relationship clearly in the orientation phase and to ensure those boundaries are maintained throughout the relationship. The nurse must act warmly and empatheti-cally but must not try to be friends with the client. Social interactions that continue beyond the first few minutes of a meeting contribute to the conversation staying on the sur-face. This lack of focus on the problems that have been agreed on for discussion erodes the professional relationship.
If a client is attracted to a nurse or vice versa, it is up to the nurse to maintain professional boundaries. Accepting gifts or giving a client one’s home address or phone num-ber would be considered a breach of ethical conduct. Nurses must continually assess themselves and ensure they keep their feelings in check and focus on the clients’ interests and needs. Nurses can assess their behavior by using the Nursing Boundary Index in Table 5.4.
The nurse must not let feelings of empathy turn into sympa-thy for the client. Unlike the therapeutic use of empathy, the nurse who feels sorry for the client often tries to compensate by trying to please him or her. When the nurse’s behavior is rooted in sympathy, the client finds it easier to manipulate the nurse’s feelings. This discourages the client from explor-ing his or her problems, thoughts, and feelings; discourages client growth; and often leads to client dependency.
The client may make increased requests of the nurse for help and assistance or may regress and act as if he or she cannot carry out tasks previously done. These can be sig-nals that the nurse has been “overdoing” for the client and may be contributing to the client’s dependency. Clients often test the nurse to see how much the nurse is willing to do. If the client cooperates only when the nurse is in attendance and does not carry out agreed-on behavior in the nurse’s absence, the client has become too dependent. In any of these instances, the nurse needs to reassess his or her professional behavior and refocus on the client’s needs and therapeutic goals.
The nurse–client relationship can be jeopardized if the nurse finds the client’s behavior unacceptable or distaste-ful and allows those feelings to show by avoiding the cli-ent or making verbal responses or facial expressions of annoyance or turning away from the client. The nurse should be aware of the client’s behavior and background before beginning the relationship; if the nurse believes there may be conflict, he or she must explore this possi-bility with a colleague. If the nurse is aware of a prejudice that would place the client in an unfavorable light, he or she must explore this issue as well. Sometimes by talking about and confronting these feelings, the nurse can accept the client and not let a prejudice hinder the relationship. If the nurse cannot resolve such negative feelings, how-ever, he or she should consider requesting another assign-ment. It is the nurse’s responsibility to treat each client with acceptance and positive regard, regardless of the cli-ent’s history. Part of the nurse’s responsibility is to con-tinue to become more self-aware and to confront and resolve any prejudices that threaten to hinder the nurse– client relationship.