Therapeutic Nurse-Client Relationships Flashcards

An RPN is working with a client who has recently been diagnosed with diabetes. Together, they are setting realistic goals for blood sugar management and actively practicing insulin administration techniques. The client openly expresses their fears and challenges, and the RPN provides encouragement and health teaching. In which phase of the therapeutic nurse-client relationship are the RPN and client operating?

Answer: Working Phase

The working phase of the therapeutic nurse-client relationship is characterized by actively working towards achieving client goals, problem-solving, and continuous evaluation. The scenario describes goal setting, practice, and overcoming challenges, which are hallmarks of this active phase. [2, 3]

Which of the following statements by an RPN best demonstrates the concept of empathy in a therapeutic nurse-client relationship?

Answer: "This must be a very difficult and frightening experience for you."

Empathy involves understanding and acknowledging the client's feelings from their perspective without taking on those feelings (sympathy) or offering false reassurance. [10, 26] This option validates the client's experience and feelings without judgment or comparison, which is a core component of a therapeutic relationship. [13, 27]

A client asks their RPN for advice on non-health-related personal matters, stating, "You always know what's best, I can't make a decision without you." The RPN recognizes this as a potential issue. What is the primary concern the RPN should address?

Answer: The client is becoming overly dependent, indicating a power imbalance.

The nurse holds a position of power in the therapeutic relationship due to their knowledge, access to information, and authority. [8, 11] The primary concern is the client's over-dependence, which signals a blurring of boundaries and a misuse of the inherent power dynamic. The RPN's goal is to empower the client, not to foster dependence. [24, 30]

A client tells the RPN, "I'm just so fed up with all of this." To encourage the client to expand on their feelings, which response by the RPN demonstrates the therapeutic communication technique of clarification?

Answer: "I'm not sure I understand what 'all of this' refers to. Can you tell me more?"

Clarification is a technique used to ensure the nurse has understood the client's message correctly and to prompt the client to provide more specific information. [17] Asking "Why?" can be perceived as confrontational, while dismissing the feeling or giving advice is non-therapeutic.

A client who an RPN has been caring for over several weeks is preparing for discharge. Which nursing action is MOST crucial during the termination phase of the nurse-client relationship?

Answer: Reviewing the progress made towards goals and discussing feelings about the relationship ending.

The termination phase is an essential part of the therapeutic relationship that provides closure. [2, 7] It involves summarizing achievements, reviewing the goals met, and allowing both the client and nurse to express feelings about the relationship ending, which helps empower the client for independence. [4, 19]

An RPN is caring for an adolescent client who asks, "Did you ever feel insecure when you were my age?" Which of the following responses is the most therapeutic use of self-disclosure?

Answer: "Yes, it can be a challenging time for many people. Let's talk more about what you're experiencing."

Therapeutic self-disclosure should be brief, relevant, and used intentionally to benefit the client. [21, 28] This option briefly answers the question, normalizes the feeling, and skillfully redirects the focus back to the client's needs, which is the primary goal of the therapeutic relationship.