Therapeutic Nurse Client Relationship

The Newfoundland and Labrador College of Nurses¹ is the regulatory body for all nurses² in the province. The mandate of the College is to protect the public through regulation of the nursing profession in accordance with the Nurses Act. This document articulates the expected behaviours of nurses before, during, and after the therapeutic nurse-client relationship. Practice scenarios are provided in Appendix A as a resource to help nurses understand the expectations related to the therapeutic nurse-client relationship.

A therapeutic nurse-client relationship is defined as a professional, interpersonal alliance in which the nurse and the client join together for a defined period to achieve health-related treatment goals. The interactions within each relationship are unique, because each nurse and client have a distinctive personality, and the health circumstances and context differ.

Every nurse-client relationship, regardless of circumstance, is based on trust, respect, and professional integrity. It requires the appropriate use of authority or power. Nurses must work with the client toward achieving the client’s goals and ensure that the client receives safe competent care. Nurses utilize a caring attitude and behaviors to meet the needs of the client.

Phases of a Therapeutic Nurse-Client Relationship

Hildegarde Peplau describes four sequential phases of a nurse-client relationship, each characterized by specific tasks and interpersonal skills: preinteraction; orientation; working; and termination. The phases are overlapping and serve to broaden and deepen the emotional connection between the nurse and client.

Preinteraction Phase

• The only phase of the therapeutic nurse-client relationship in which the client does not directly participate.
• During this phase, the nurse prepares to meet the client by gathering relevant client information and anticipating client concerns prior to the first interaction. Being aware of potential client concerns before meeting with the client is helpful; for example, the approach to a client whose baby is in ICU would be different than with a client whose baby is healthy and rooming in.

Orientation Phase

• Defines the purpose, roles, and rules of the process, and provides a framework for assessing client’s needs.
• The nurse begins to build a sense of trust by providing the client with basic information (name, professional status and essential information about the purpose and nature of the relationship). Introductions are important even when the client is confused, aphasic, unresponsive, or unable to respond. Nonverbal supportive communication such as a handshake, eye contact, a smile and appropriate body language reinforce spoken words.
• A client’s dignity, autonomy, and privacy are kept safe within the nurse-client relationship. It is important for the nurse to set the context of care by providing relevant information to the client; for example, “Hello, my name is Jane Smith, I am an LPN, and I will be taking care of you until 7:30 p.m. I will be in and out of your room frequently during the day; however, if you need assistance and I am not here, please ring your call bell.” This information would be presented by the nurse in a respectful manner.

Page 1 of 14