Mutual Helping Relationship

ADPIE - diagnosis

-Analyzing data -Validating interpretation of data with the client -Identifying nursing diagnoses -Validating the nursing diagnoses with the client

challenging behaviors

-Before confronting challenging behavior the nurse should anticipate outcomes -Focus on behavior not person -constructive confrontation

ADPIE - assessment

-Collecting data regarding the client, client-family system, or community -Identifying needs, problems, concerns, or human responses

Validation

-Consciously seeking out our clients' opinions and feelings at each phase of the nursing process -Unearthing any questions or concerns our clients have about plans for their healthcare and securing their understanding and willingness to proceed to the next step -Makes the difference between problem solving for clients and mutual problem solving with clients -Keeps us focused on the rights and obligations of clients to make their own decisions about their health -Must be incorporated at each step of the problem-solving process in nursing -Stops us from moving too quickly and "doing" to our clients

mutual problem solving to involve the client in the implementation of the nursing process - advantages

-Contributes to growth and development of clients and nurses -Nurses and clients gain trust in each other

ADPIE - evaluation

-Evaluating the outcomes of nursing care in consultation with the client -Ongoing evaluation to revise the nursing care plan

exercise to practice at mutual problem solving approach to the nursing process

-Explore your own beliefs about clients having an active part in their healthcare -The extent to which you uphold clients' responsibility for their health mirrors how you involve them in their care -Step back, listen, openly discuss the issue and focus on collaboration -Know that an environment where questioning, curiosity, risk taking and skepticism are tolerated and even encouraged supports critical thinking skills -Watch for "teachable moments" -Remember to evaluate with your clients -Keep in mind that validating is an assertive act

constructive confrontation requires

-Firm, trusting bond between client and nurse -Appropriate timing, circumstance and environment -Confrontation is private, non-judgmental and empathetic -Only behaviors capable of being changed are addressed -Support client's right to self-determination

ADPIE - implementation

-Implementing nursing actions with assistance from the client -Encouraging client participation in carrying out nursing actions to achieve the outcomes -Continuing to collect data about the client's condition and interaction with the environment

client response patterns

-Nurses must recognize differences in client response patterns to effectively provide individualized care -The nurse is responsible for planning and implementing care in a way that takes these individual differences into consideration -The nurse must help the client develop multiple strategies and successfully cope with setbacks

ADPIE - planning

-Setting priorities for resolution of identified problems with the client -Determining expected and desired outcomes of nursing actions in collaboration with the client -Writing nursing interventions to achieve these outcomes in collaboration with the client

self disclosure

-The intentional revealing of personal experiences or feelings to enhance the nurse/client relationship -Use personal information to help clients open up to you not to meet your personal needs -Keep disclosure brief -Do not imply your experience is the same as the client's -Answer client briefly and return the focus to the client

Incorporation of validation into the nursing process

-Validating interpretation of collected data -Identifying actual or potential problems and validating the nursing diagnoses with the client -Determining expected and desired outcomes of nursing actions in collaboration with the client -Deciding on the nursing strategies to achieve these outcomes in collaboration with the client -Implementing nursing actions with assistance from client and encouraging client participation in carrying out nursing actions -Evaluating the outcomes of nursing care in consultation with the client

Client Centered Care (CCC)

-an approach to practice established through the formation fostering of therapeutic relationships between all care providers -focuses on individual preferences, values, beliefs, and needs as fundamental considerations

ADPIE

-assessment -diagnosis -planning -intervention -evaluation

mutuality

-experience of real or symbolic commonalities of visions, goals, sentiments, or characteristics, including shared acceptance of difference that validates the person's worldview -Sharing of collective knowledge

guiding principles of CCC

-presence -purpose -positive regard -mutuality -authenticity -empathy -respect for the dignity of the person -confidentiality

therapeutic relationship

-professional interpersonal alliance based on mutuality -each interaction is unique because disease, response and context differ -facilitated by empathy

goals of therapeutic relationships

-support clients and families to understand the clients experience of an illness -provide support to help clients and families make health care decisions -assist clients to cope and find meaning in their illness -connect clients and families with other members of the team -empower clients with knowledge and tools they need to navigate and negotiate their care

Nursing Process

ADPIE

Mutuality in Nurse-Client Relationships

An on-going sharing of knowledge between healthcare professionals and shared decision making helps ensure patient satisfaction

Matheis-Kraft et al (1990)

Clients who take more active roles in their treatments recover faster

Preinteraction phase

No client participation; nurse selects concrete goals and specific nursing actions aligned with client needs

Phases of Therapeutic Relationships

Peplau

the only way to know if your clients are satisfied with the outcomes of care

ask and listen to their opinions

Orientation phase

assessment

resolution phase

evaluation

exploitation phase

implementation

identification phase

planning

facilitated by empathy

required an integration of the nurse's focus and the client's focus creating a common ground