CNO - College of Nurses of Ontario Nurse-Client Relationships Questions and Answers — Questions and Answers
Question 1: A community health nurse has provided care to a client for several months. The client's health goals have been met, and services are being discontinued. According to the CNO's Therapeutic Nurse-Client Relationship standard, which action is essential during the termination phase of the relationship?
- Reviewing the client's progress and summarizing the goals achieved together. (Correct answer)
- Exchanging personal phone numbers to stay in touch socially.
- Promising the client that the nurse will visit them as a friend in the future.
- Abruptly stopping all communication to encourage client independence.
Correct answer: Reviewing the client's progress and summarizing the goals achieved together.
The termination phase is a planned and professional conclusion to the nurse-client relationship. It involves summarizing the client's progress, evaluating the achievement of goals, and ensuring a smooth transition to other services or to self-care. This provides closure and reinforces the client's accomplishments.
Question 2: A nurse is caring for a client newly diagnosed with a chronic illness who expresses feeling overwhelmed and alone. The nurse also has the same chronic illness. When considering the use of self-disclosure, what is the nurse's primary consideration?
- Whether the disclosure will make the nurse feel more connected to the client.
- Whether the disclosure will serve a therapeutic purpose for the client. (Correct answer)
- How much personal detail the nurse is comfortable sharing with the client.
- If the nurse's manager would approve of sharing personal health information.
Correct answer: Whether the disclosure will serve a therapeutic purpose for the client.
The CNO standards emphasize that self-disclosure should be used cautiously and only when it serves the client's therapeutic needs. The primary goal is to benefit the client by, for example, instilling hope or normalizing their experience, not to meet the nurse's own needs for connection or validation.
Question 3: A client is hesitant to ask questions about their diagnosis, stating, "You're the expert, I don't want to bother you." How should the nurse best respond to address the inherent power imbalance in this therapeutic relationship?
- Provide the client with a pamphlet about their diagnosis to read on their own time.
- Tell the client that it's their right to be informed and they must ask questions.
- Acknowledge the client's feelings and create a safe, collaborative environment for them to ask questions. (Correct answer)
- Document in the chart that the client is non-participatory in their care planning.
Correct answer: Acknowledge the client's feelings and create a safe, collaborative environment for them to ask questions.
The nurse-client relationship has an unequal power dynamic. The nurse's role is to empower the client and promote a partnership. Acknowledging the client's feelings validates their concern, while explicitly inviting questions creates a safe space for collaboration and shared decision-making, thereby reducing the power imbalance.
Question 4: Which of the following is the best example of appropriate professional intimacy within a nurse-client relationship?
- Sharing details about the nurse's own challenging family situation to build rapport.
- Asking a client for details about their romantic life to offer personal advice.
- Inviting a client to a personal social gathering after they are discharged.
- Gently holding a distressed client's hand while providing emotional support. (Correct answer)
Correct answer: Gently holding a distressed client's hand while providing emotional support.
Professional intimacy involves the psychological, spiritual, and physical aspects of care that create closeness but remain within professional boundaries. Holding a hand for comfort is a therapeutic action that serves the client's emotional needs, whereas the other options cross into a personal or social relationship.
Question 5: The CNO standards identify empathy as a key component of the therapeutic nurse-client relationship. How is empathy best described in this context?
- Feeling pity or sorrow for the client's unfortunate circumstances.
- Sharing the client's feelings and experiencing the same emotions.
- Maintaining a detached and purely objective professional distance from the client.
- Understanding the client's perspective and communicating that understanding back to them. (Correct answer)
Correct answer: Understanding the client's perspective and communicating that understanding back to them.
Empathy is the ability to understand what the client is experiencing from their point of view and to reflect that understanding back to them. This validates the client's feelings without the nurse taking on those feelings, which would be sympathy.
Question 6: A client in a long-term care facility asks a nurse for their personal social media profile to connect online. What is the nurse's most appropriate initial action to maintain professional boundaries?
- Gently explain that their relationship is professional, not personal, and therefore decline the request. (Correct answer)
- Accept the request to avoid hurting the client's feelings but limit interactions online.
- Report the client's request to the manager as an example of inappropriate behaviour.
- Ignore the request and change the subject to a different topic to avoid confrontation.
Correct answer: Gently explain that their relationship is professional, not personal, and therefore decline the request.
Maintaining professional boundaries is the nurse's responsibility. This response is direct, respectful, and clearly reinforces the professional nature of the relationship without being punitive. It educates the client on the boundaries of the therapeutic relationship while protecting the nurse's privacy and professional integrity.
CNO - College of Nurses of Ontario Nurse-Client Relationships Questions and Answers
A community health nurse has provided care to a client for several months.
The client's health goals have been met, and services are being discontinued.
According to the CNO's Therapeutic Nurse-Client Relationship standard, which action is essential during the termination phase of the relationship?