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Lilik Supriati

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Trust
Respect
professional intimacy
empathy
power

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Trust.
Trust is critical in the nurse-client
relationship because the client is in a
vulnerable position. Initially, trust in a
relationship is fragile, so its especially
important that a nurse keep promises to a
client. If trust is breached, it becomes difficult
to re-establish.

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Respect.
Respect is the recognition of the inherent
dignity, worth and uniqueness of every
individual, regardless of socio-economic
status, personal attributes and the nature of
the health problem

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Professional intimacy.
Professional intimacy is inherent in the type of
care and services that nurses provide. It may
relate to the physical activities, such as bathing,
that nurses perform for, and with, the client that
create closeness. Professional intimacy can
also involve psychological, spiritual and social
elements that are identified in the plan of
care. Access to the clients personal information,
within the meaning of the Freedom of
Information and Protection of Privacy Act, also
contributes to professional intimacy.
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Empathy.
Empathy is the expression of understanding,
validating and resonating with the meaning
that the health care experience holds for the
client. In nursing, empathy includes
appropriate emotional distance from the
client to ensure objectivity and an
appropriate professional response
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Power.
The nurse-client relationship is one of unequal power.
Although the nurse may not immediately perceive it,
the nurse has more power than the client. The nurse
has more authority and influence in the health care
system, specialized knowledge, access to privileged
information, and the ability to advocate for the
client and the clients significant others. The
appropriate use of power, in a caring manner,
enables the nurse to partner with the client to meet
the clients needs. A misuse of power is considered
abuse
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Hubungan terapeutik perawat-klien
merupakan pengalaman belajar timbal balik
dan pengalaman emosional korektif bagi
pasien. Perawat menggunakan diri (self) dan
teknik teknik tertentu dalam bekerja dengan
pasien untuk meningkatkan penghayatan
dan perubahan perilaku pasien

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There are specific goals
The patients needs are the focus
(relationship is client centered)
The nurse makes use of specific
communication and relationship skills
There are not necessarily specific goals
beyond friendship and socializing
The needs of both parties are the focus
The information exchanged may remain
superficial
The skills used are the general socialization
and communications skills everyone in the
culture uses
Mutual needs are met
Each party usually cares about meeting the
needs of the other
The parties have an emotional commitment
to each other
Mutual fantasies and desires may be satisfied
Information shared may be personal and
intimate
Definition:
a series of goal-directed interactions

Peplau:
nursing as a significant, therapeutic, interpersonal
process

Characteristics - goals, stages, specific time


and place. It is different from a social
relationship
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Communication skills
Respect and a desire to help
Trust is based on confidentiality
Understanding
mental mechanisms
adaptation styles
coping strategies
therapeutic intervention skills

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To know the patient
To ascertain and meet the needs of the
patient
To fulfill the purpose of nursing
To develop self-awareness

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In-born nature
Happened at anytime, anyplace,
Multi-level
Verbal & Nonverbal
Proxemics - environmental, social, and
personal space
Kinesics - body movement
Can be learned

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Def:
It is an interpersonal interaction in which the
nurse used the self to focus on the clients
emotional issues, establish a therapeutic
relationships, identify client issues, discern the
most important topic at that time, and guide the
client toward identifying his/her own solutions to
problems

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Broad opening - start the conversation
Offering self - available, concern, interest
Active listening - content, emotion
Using silence - respect, anxiety
Asking questions - what, when, who
General leads - go on, Mm...
Restating - repeating

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Making observation - comment on what
have been seen
Verbalizing the implies - rephrasing,
reflecting
Clarification - restate, elaborate
Focusing - single, important topic
Exploring - getting more information
Interpreting

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Giving information - decision making
Presenting reality - but no argument
Voicing doubt - uncertainty about pts
interpretation/conclusion
Encouraging comparison - similarity &
difference
Summarizing - review the main points

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Preinteraction phase
self-awareness, self-exploration
Introductory or orientation phase
making a contract, building trust, setting goals
Working phase
explore stressors, promoting insight, reality testing,
problem-solving, coping, identifying past ineffective
behavior
Termination phase
goals, evaluation, referrals, separation, loss,
emotional responses

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Eksplorasi perasaan, fantasi dan ketakutan
perawat
Analisa kekuatan dan kelemahan
Dapatkan data klien (jika mungkin)
Rencanakan pertemuan awal
Kaji alasan klien dirawat
Bina rasa percaya
Kontrak:
- nama P_K
- peran dan tanggung jawab P-K
- harapan P-K
- waktu dan tempat
- rahasia
- terminasi sementara dan akhir
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Patient Nurse
seek assistance Actively listens
Identifies needs Establishes
commits to a boundaries of the
therapeutic relationship
relationship Clarifies
expectations
Uses empathy

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Mental status examination - orientation,
memory, calculation, attention, judgment
Fifth vital signs - Pain
Violence - domestic, history of
physical/sexual abuse
Substance abuse
Withdrawal symptoms, differential Dx, dual
Dx.
Holistic/ interdisciplinary team- realistic goals

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The process of learning - observation,
analysis, interpretation,
In-depth data collection,
Reality testing & cognitive restructuring
Supportive confrontation
Promoting change,
Teaching new skills social skills, problem
solving skills

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P-romote Positive Self concept
R-ealistic goal setting
O-rganize support system
V-erbalize feelings (encourage)
I-mplement action plan
D-evelop positive coping behaviors
E-valuate the results of plan of action

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Patient
Discusses problems underlying needs
Uses emotional safety of relationship to examine
personal issues
Test new ways of solving problems
Feels comfortable with nurse
May use transference
Nurse
Supports development of healthy problem solving
Identifies countertransference issues

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Evaluation;
summarize the objectives achieved
Referrals
Discussion of termination - emotional
responses; acceptance, denial, anger,
regression, acting-out...

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P-romote self care
R-ecognize increasing anxiety
I-ncrease independence
D-emonstrate emotional stability
E-environmental support

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Patient Nurse

May express Avoids returning to


ambivalence about the patients initial
relationship and its problems
termination Encourage patient to
Uses personal style to prepare for the future
say good bye Encourage
independence
Promotes positive
family interactions
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1. Resistance
2. Transferens
3. Kontertransferens
4. Boundary violations
Psychological, communication
Be aware of the nurses role
Limit self-disclosure
Be aware of over involvement
Confront/correct sexual innuendos or actions
Physical
Allow the patient his/her personal space
Use touch cautiously
Be aware of patients cultural pattern
Transference is the "transference" of past
feelings, conflicts, and attitudes into present
relationships, situations, and circumstances.
An unconscious response in which the patient
experineces feelings and attitudes toward the
nurse that were originally associated with other
significant figures in his or her life
According to psychoanalytic theory,
transference evolves from unresolved or
unsatisfactory childhood experiences in
relationships with parents or other important
figures (Wilson & Kneisl, 1996)
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Ada dua jenis utama reaksi transference yaitu reaksi bermusuhan
dan tergantung.
Reaksi transference Bermusuhan
Contoh :
Klien yang dirawat di rumah sakit karena dbd, tanpa sebab yang
jelas klien marah-marah kepada perawat, setelah dikaji ternyata
perawat mirip dengan mantan pacarnya yang pernah menyakiti
hatinya. Hal ini dikarenakan klien mengalami perasaan dan sikap
terhadap perawat yang pada dasarnya terkait dengan tokoh
kehidupan yang lalu.
Contoh reaksi transference : Tergantung
Seorang klien dirawat oleh seorang perawat, perawat itu
mempunyai wajah dan suara mirip ibu klien, sehingga dalam
setiap tindakan keperawatan yang harus dilakukan selalu meminta
perawat yang melakukannya.

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Created by nurses specific emotional
response to the qualities of the patient
Include 3 type:
1. Reactions of intense love or caring
2. Reactions of intense disgust or hostility
3. Reactions of intense anxiety, often in
responses to resistance by the patient
Ketidakmampuan untuk berempati terhadap klien dalam area masalah tertentu.
Menekan perasaan selama / sesudah sesi.
Kecerobohan dalam mengimplementasikan kontrak dengan datang terlambat, atau
melampau waktu yang telah ditentukan.
Mengantuk selama sesi.
Perasaan marah/tidak sabar karena ketidakinginan klien untuk berubah.
Dorongan terhadap ketergantungan, pujian / afeksi klien.
Berdebat dengan klien.
Mencoba untuk menolong klien dalam segala hal, tidak berhubungan dengan tujuan
keperawatan.
Keterlibatan dengan klien dalam tingkat, personal dan sosial.
Melamunkan atau memikirkan klien.
Fantasi seksual atau agresi yang diarahkan kepada klien.
Perasaan cemas, gelisah atau perasaan bersalah terhadap klien.
Kecenderungan untuk memusatkan secara berulang, hanya pada satu aspek.
Kebutuhan untuk mempertahankan intervensi keperawatan dengan klien.

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Reaksi yangat mencintai caring
Reaksi sangat bermusuhan
Reaksi sangat cemas, seringkali digunakan
sebagai resopons terhadap resistensi

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Countertransference the tendency of the
therapist to displace onto the client feelings
caused by people in the therapists
past.(Varcarolis,1998)
Dealt with best by self-examination and by
supervision by a more experienced
professional or by a peer.
Created by nurses specific emotional
response to the qualities of the patient
Include 3 type:
1. Reactions of intense love or caring
2. Reactions of intense disgust or hostility
3. Reactions of intense anxiety, often in
responses to resistance by the patient
Want to help
Open to learn about self and others - Process
recording
Respect & privacy
Communication - verbal/nonverbal
Insight - defense mechanisms, adaptation,
and coping

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Putting yourself in the others shoes
Being there
Listening
Assumption - as if
Interpretation and validation

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Stress
Lack of time
High acuity, high workload
New employee
Caring for difficult patients
Limited opportunities to spend time with
patients

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emotional/verbal abuse,
Physical abuse,
sexual abuse,
neglect,
financial abuse
and insensitivity to religious andcultural
beliefs.

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The nurse must not use verbal and non-verbal behaviours that may reasonably be
perceived to demonstrate disrespect for the client and which are perceived by the
client or others to be abusive.
Such verbal and non-verbal behaviours include but are not limited to:
sarcasm;
revenge;
intimidation, including threatening gestures/actions;
manipulation;
teasing or taunting;
insensitivity to the clients preferences with respect to sex and family
dynamics;
swearing;
cultural slurs; and
inappropriate tone of voice such as expressing impatience.
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The nurse must not neglect the client. Neglect occurs
when nurses fail to meet the basic needs of clients who are
unable to meet them themselves. Such behaviours include
but are not limited to the withholding of care needs such
as:
clothing;
food;
fluid;
needed aids or equipment;
medication;
communication;
confining, isolating or ignoring the client; and
client privileges.

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The nurse must not take advantage of the power in the nurse-
client relationship to engage in activities that could result in either
monetary, personal or other material benefit, gain or profit to the
nurse or monetary or personal loss for the client. Such behaviours
include but are not limited to:
borrowing money or property from a client;
soliciting gifts from a client;
withholding of finances through trickery or theft;
influence, pressure or coercion to obtain the clients money or
property;
influence over the clients will;
abuse of trusteeship, bank accounts, power of attorney or
guardianship; and
assisting with the financial affairs of a client without the health teams
knowledge

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People will forget what you say to them.
They will never forget how you make them
feel.

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