What relationship building behaviors would the nurse use with a client who is distrustful of the health care system quizlet?

B, D

(Body language includes facial expressions, reflexes, body posture, hand gestures, eye movement, mannerisms, touch, and other body motions. Body posture and facial expressions, including eye movements, are two of the most important cues to determine how a person is responding to the message. This patients crossed-arm posture and sharp finger rapping are indicators of anger. Poor eye contract is recognized as poor self-esteem or guilt cues, whereas a quizzical expression is likely an indication of confusion. Leaning forward in the chair is generally viewed as a positive sign of interest and/or cooperation.)

Which issues should a nurse address during the first interview with a patient with a psychiatric disorder?
a.Trust, congruence, attitudes, and boundaries
b.Goals, resistance, unconscious motivations, and diversion
c.Relationship parameters, the contract, confidentiality, and termination
d.Transference, counter transference, intimacy, and developing resources

Bethany, a nurse on the psychiatric unit, has a past history of alcoholism. She has weekly clinical supervision meetings with her mentor, the director of the unit. Which statement by Bethany to her mentor would indicate the presence of countertransference?
A. "My patient, Miranda, is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again."
B. "My patient, Laney, has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!"
C. "My patient, Jack, started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA meetings five times a week after discharge."
D. "My patient, Gayle, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."

Sets with similar terms

1. Building trust
2. Warmth, interest, and concern
3. Clear communications
4. Confidentiality issues

Beginning assessment:
-Assess needs, coping, defenses, and adaptation
-Thoughts, feelings, and behaviors are clues to problem areas

Tentative goals:

This is also a time when communication styles of both the nurse and client are explored to facilitate rapport.

This includes assessing how verbal the client is including things such as speech patterns.

This is also a time to build the foundation for a trusting relationship by showing things listed above.

Always want to demonstrate acceptance, the client must feel accepted for trust to grow.

Remember at this point the nurse is still a stranger so it will be hard for the client to open up at first.

This phase also marks the beginning of assessment.

Looking at needs, coping skills used in the past/present, defense mechanisms in use, adaptation patterns, strengths and weaknesses. It is also a time to form nursing diagnosis and set tentative goals with the client.

Depressed affect, apathy, psychomotor retardation:

Provide patience, frequent contact, and empathy

Encourage patient to relate/interact with you to build trust (may have to just sit in silence)

Discourage rumination

Encourage ADLs and diversion activity

Postpone problem solving until depression subsides and thinking is more logical

*Depressed clients have a feeling of sadness, emptiness, worthlessness, lack of self respect, powerlessness, hopelessness.

*Behavior may include avoiding contact with others, changes in eating, sleep, and activity (posture, tone of voice, affect).

- The nurse-client relationship requires trust.
- Trust builds when the client is confident in the nurse and when the nurse's presence conveys integrity and reliability.
- Trust develops when the client believes that the nurse will be consistent in his or her words and actions and can be relied on to do what he or she says.
- Some behaviors the nurse can exhibit to help build the client's trust include caring, interest, understanding, consistency, honesty, keeping promises, and listening to the client
- A caring therapeutic nurse-client relationship enables trust to develop, so the client can accept the assistance being offered.
- Congruence occurs when words and actions match.
- For example, the nurse says to the client, "I have to leave now to go to a clinical conference, but I will be back at 2 PM," and indeed returns at 2 PM to see the client.
- The nurse needs to exhibit congruent behaviors to build trust with the client.
- Trust erodes when a client sees inconsistency between what the nurse says and does.
- Inconsistent or incongruent behaviors include making verbal commitments and not following through on them.
- For example, the nurse tells the client he or she will work with the client every Tuesday at 10 AM, but the next week, the nurse has a conflict with the conference schedule and does not show up.
- Another example of incongruent behavior is when the nurse's voice or body language is inconsistent with the words he or she speaks.
- For example, an angry client confronts a nurse and accuses her of not liking her.
- The nurse responds by saying, "Of course I like you, Nancy! I am here to help you." But as she says these words, the nurse backs away from Nancy and looks over her shoulder; the verbal and nonverbal components of the message do not match.

- When the nurse is comfortable with him or herself, aware of his or her strengths and limitations, and clearly focused, the client perceives a genuine person showing genuine interest.
- A client with mental illness can detect when someone is exhibiting dishonest or artificial behavior, such as asking a question and then not waiting for the answer, talking over him or her, or assuring him or her everything will be alright.
- The nurse should be open and honest and display congruent behavior.
- Sometimes, however, responding with truth and honesty alone does not provide the best professional response.
- In such cases, the nurse may choose to disclose to the client a personal experience related to the client's current concerns.
- It is essential, however, that the nurse is selective about personal examples.
- These examples should be from the nurse's past experience, not a current problem the nurse is still trying to resolve, or a recent, still painful experience.
- Self-disclosure examples are most helpful to the client when they represent common day-to-day experiences and do not involve value-laden topics.
- For example, the nurse might share an experience of being frustrated with a coworker's tardiness or being worried when a child failed an exam at school.
- It is rarely helpful to share personal experiences such as going through a divorce or the infidelity of a spouse or partner.
- Self-disclosure can be helpful on occasion, but the nurse must not shift emphasis to his or her own problems rather than the client's.

- The nurse who appreciates the client as a unique worthwhile human being can respect the client regardless of his or her behavior, background, or lifestyle.
- This unconditional nonjudgmental attitude is known as positive regard and implies respect.
- Calling the client by name, spending time with the client, and listening and responding openly are measures by which the nurse conveys respect and positive regard to the client.
- The nurse also conveys positive regard by considering the client's ideas and preferences when planning care.
- Doing so shows that the nurse believes the client has the ability to make positive and meaningful contributions to his or her own plan of care.
- The nurse relies on presence, or attending, which is using nonverbal and verbal communication techniques to make the client aware that he or she is receiving full attention.
- Nonverbal techniques that create an atmosphere of presence include leaning toward the client, maintaining eye contact, being relaxed, having arms resting at the sides, and having an interested but neutral attitude.
- Verbally attending means that the nurse avoids communicating value judgments about the client's behavior.
- For example, the client may say, "I was so mad, I yelled and screamed at my mother for an hour." If the nurse responds with, "Well, that didn't help, did it?" or "I can't believe you did that," the nurse is communicating a value judgment that the client was "wrong" or "bad." A better response would be "What happened then?" or "You must have been really upset."
- The nurse maintains attention on the client and avoids communicating negative opinions or value judgments about the client's behavior.

- Before he or she can begin to understand clients, the nurse must first know him or herself.
- Self-awareness is the process of developing an understanding of one's own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths, and limitations and how these qualities affect others.
- It allows the nurse to observe, pay attention to, and understand the subtle responses and reactions of clients when interacting with them.

- Are abstract standards that give a person a sense of right and wrong and establish a code of conduct for living.
- Sample values include hard work, honesty, sincerity, cleanliness, and orderliness.
- To gain insight into oneself and personal values, the values clarification process is helpful.
- The values clarification process has three steps: choosing, prizing, and acting.
- Choosing is when the person considers a range of possibilities and freely chooses the value that feels right.
- Prizing is when the person considers the value, cherishes it, and publicly attaches it to him or herself.
- Acting is when the person puts the value into action.
- For example, a clean and orderly student has been assigned to live with another student who leaves clothes and food all over the room.
- At first, the orderly student is unsure why she hesitates to return to the room and feels tense around her roommate.
- As she examines the situation, she realizes that they view the use of personal space differently (choosing).
- Next, she discusses her conflict and choices with her adviser and friends (prizing).
- Finally, she decides to negotiate with her roommate for a compromise (acting).

- Are general feelings or a frame of reference around which a person organizes knowledge about the world.
- Attitudes, such as hopeful, optimistic, pessimistic, positive, and negative, color how we look at the world and people.
- A positive mental attitude occurs when a person chooses to put a positive spin on an experience, a comment, or a judgment.
- For example, in a crowded grocery line, the person at the front pays with change, slowly counting it out.
- The person waiting in line who has a positive attitude would be thankful for the extra minutes and would begin to use them to do deep breathing exercises and to relax.
- A negative attitude also colors how one views the world and other people.
- For example, a person who has had an unpleasant experience with a rude waiter may develop a negative attitude toward all waiters.
- Such a negative attitude might cause the person to behave impolitely and unpleasantly with every waiter he or she encounters.
- The nurse should reevaluate and readjust beliefs and attitudes periodically as he or she gains experience and wisdom.
- Ongoing self-awareness allows the nurse to accept values, attitudes, and beliefs of others that may differ from his or her own.
- A person who does not assess personal attitudes and beliefs may hold a prejudice or bias toward a group of people because of preconceived ideas or stereotypical images of that group.
- It is not uncommon for a person to be ethnocentric about his or her own culture (believing one's own culture other to be superior to others), particularly when the person has no experience with any culture than his or her own.

Acknowledging your Cultural Heritage
•To what ethnic group, socioeconomic class, religion, age group, and community do you belong?
•What experiences have you had with people from ethnic groups, socioeconomic classes, religions, age groups, or communities different from your own?
•What were those experiences like? How did you feel about them?
•When you were growing up, what did your parents and significant others say about people who were different from your family?
•What about your ethnic group, socioeconomic class, religion, age, or community do you find embarrassing or wish you could change? Why?
•What sociocultural factors in your background might contribute to being rejected by members of other cultures?
•What personal qualities do you have that will help you establish interpersonal relationships with people from other cultural groups? What personal qualities may be detrimental?

- By developing self-awareness and beginning to understand his or her attitudes, the nurse can begin to use aspects of his or her personality, experiences, values, feelings, intelligence, needs, coping skills, and perceptions to establish relationships with clients.
- This is called therapeutic use of self.
- Nurses use themselves as a therapeutic tool to establish therapeutic relationships with clients and help clients grow, change, and heal. Peplau (1952), who described this therapeutic use of self in the nurse-client relationship, believed that nurses must clearly understand themselves to promote their clients' growth and to avoid limiting clients' choices to those that nurses value.
- The nurse's personal actions arise from conscious and unconscious responses that are formed by life experiences and educational, spiritual, and cultural values.
- Nurses (and all people) tend to use many automatic responses or behaviors just because they are familiar.
- They need to examine such accepted ways of responding or behaving and evaluate how they help or hinder the therapeutic relationship.

- One tool that is useful in learning more about oneself is the Johari window (Luft, 1970), which creates a "word portrait" of a person in four areas and indicates how well that person knows him or herself and communicates with others. The four areas evaluated are as follows:
•Quadrant 1: Open/public—self-qualities one knows about oneself and others also know
•Quadrant 2: Blind/unaware—self-qualities known only to others
•Quadrant 3: Hidden/private—self-qualities known only to oneself
•Quadrant 4: Unknown—an empty quadrant to symbolize qualities as yet undiscovered by oneself or others

- In creating a Johari window, the first step is for the nurse to appraise his or her own qualities by creating a list of them: values, attitudes, feelings, strengths, behaviors, accomplishments, needs, desires, and thoughts.
- The second step is to find out others' perceptions by interviewing them and asking them to identify qualities, both positive and negative, they see in the nurse.
- To learn from this exercise, the opinions given must be honest; there must be no sanctions taken against those who list negative qualities.
- The third step is to compare lists and assign qualities to the appropriate quadrant.
- If quadrant 1 is the longest list, this indicates that the nurse is open to others; a smaller quadrant 1 means that the nurse shares little about him or herself with others.
- If quadrants 1 and 3 are both small, the person demonstrates little insight.
- Any change in one quadrant is reflected by changes in other quadrants.
- The goal is to work toward moving qualities from quadrants 2, 3, and 4 into quadrant 1 (qualities known to self and others).
- Doing so indicates that the nurse is gaining self-knowledge and awareness.

- Is primarily initiated for the purpose of friendship, socialization, companionship, or accomplishment of a task.
- Communication, which may be superficial, usually focuses on sharing ideas, feelings, and experiences and meets the basic need for people to interact.
- Advice is often given.
- Roles may shift during social interactions.
- Outcomes of this kind of relationship are rarely assessed.
- When a nurse greets a client and chats about the weather or a sports event or engages in small talk or socializing, this is a social interaction.
- This is acceptable in nursing, but for the nurse-client relationship to accomplish the goals that have been decided on, social interaction must be limited.
- If the relationship becomes more social than therapeutic, serious work that moves the client forward will not be done.

- Differs from the social or intimate relationship in many ways because it focuses on the needs, experiences, feelings, and ideas of the client only.
- The nurse and client agree about the areas to work on and evaluate the outcomes.
- The nurse uses communication skills, personal strengths, and understanding of human behavior to interact with the client.
- In the therapeutic relationship, the parameters are clear; the focus is the client's needs, not the nurse's.
- The nurse should not be concerned about whether or not the client likes him or her or is grateful.
- Such concern is a signal that the nurse is focusing on a personal need to be liked or needed.
- The nurse must guard against allowing the therapeutic relationship to slip into a more social relationship and must constantly focus on the client's needs, not his or her own.
- The nurse's level of self-awareness can either benefit or hamper the therapeutic relationship.
- For example, if the nurse is nervous around the client, the relationship is more apt to stay social because superficiality is safer.
- If the nurse is aware of his or her fears, he or she can discuss them with the instructor, paving the way for a more therapeutic relationship to develop.

- Begins when the nurse and client meet and ends when the client begins to identify problems to examine. -
- During the orientation phase, the nurse establishes roles, the purpose of meeting, and the parameters of subsequent meetings; identifies the client's problems; and clarifies expectations.
- Before meeting the client, the nurse has important work to do.
- The nurse reads background materials available on the client, becomes familiar with any medications the client is taking, gathers necessary paperwork, and arranges for a quiet, private, and comfortable setting.
- This is the time for self-assessment.
- The nurse should consider his or her personal strengths and limitations in working with this client.
- Are there any areas that might signal difficulty because of past experiences?
- For example, if this client is a spouse batterer and the nurse's father was also one, the nurse needs to consider the situation. How does it make him or her feel? What memories does it prompt, and can he or she work with the client without these memories interfering?
- The nurse must examine preconceptions about the client and ensure that he or she can put them aside and get to know the person.
- The nurse must come to each client without preconceptions or prejudices.
- It may be useful for the nurse to discuss all potential problem areas with a mentor.
- During the orientation phase, the nurse begins to build trust with the client.
- It is the nurse's responsibility to establish a therapeutic environment that fosters trust and understanding
- The nurse should share appropriate information about him or herself at this time, including name, reason for being on the unit, and level of schooling.
- For example, "Hello, James. My name is Ms. Ames, and I will be your nurse for the next six Tuesdays. I am a senior nursing student at the University of Mississippi."
- The nurse needs to listen closely to the client's history, perceptions, and misconceptions.
- He or she needs to convey empathy and understanding.
- If the relationship gets off to a positive start, it is more likely to succeed and to meet established goals.
- At the first meeting, the client may be distrustful if previous relationships with nurses have been unsatisfactory.
-The client may use rambling speech, act out, or exaggerate episodes as ploys to avoid discussing the real problems.
- It may take several sessions until the client believes that he or she can trust the nurse.

- Means respecting the client's right to keep private any information about his or her mental and physical health and related care.
- It means allowing only those dealing with the client's care to have access to the information that the client divulges.
- Only under precisely defined conditions can third parties have access to this information; for example, in many states, the law requires that staff report suspected child and elder abuse.
- Adult clients can decide which family members, if any, may be involved in treatment and may have access to clinical information.
- Ideally, the people close to the client and responsible for his or her care are involved.
- The client must decide, however, who will be included. For the client to feel safe, boundaries must be clear.
- The nurse must clearly state information about who will have access to client assessment data and progress evaluations.
- He or she should tell the client that members of the mental health team share appropriate information among themselves to provide consistent care and that only with the client's permission will they include a family member.
- If the client has an appointed guardian, that person can review client information and make treatment decisions that are in the client's best interest.
- For a child, the parent or appointed guardian is allowed access to information and can make treatment decisions as outlined by the health care team.
- The nurse must be alert if a client asks him or her to keep a secret because this information may relate to the client's harming him or herself or others.
- The nurse must avoid any promises to keep secrets.
- If the nurse has promised not to tell before hearing the message, he or she could be jeopardizing the client's trust.
- In most cases, even when the nurse refuses to agree to keep information secret, the client continues to relate issues anyway.

- Means revealing personal information such as biographical information and personal ideas, thoughts, and feelings about oneself to clients.
- Traditionally, conventional wisdom held that nurses should share only their name and give a general idea about their residence, such as "I live in Ocean County."
- Now, however, it is believed that some purposeful, well-planned self-disclosure can improve rapport between the nurse and the client.
- The nurse can use self-disclosure to convey support, educate clients, and demonstrate that a client's anxiety is normal and that many people deal with stress and problems in their lives.
- Self-disclosure may help the client feel more comfortable and more willing to share thoughts and feelings, or help the client gain insight into his or her situation.
- When using self-disclosure, the nurse must also consider cultural factors.
- Some clients may deem self-disclosure inappropriate or too personal, causing the client discomfort.
- Disclosing personal information to a client can be harmful and inappropriate, so it must be planned and considered thoughtfully in advance.
- Spontaneously self-disclosing personal information can have negative results.
- For example, when working with a client whose parents are getting a divorce, the nurse says, "My parents got a divorce when I was 12, and it was a horrible time for me." The nurse has shifted the focus away from the client and has given the client the idea that this experience will be horrible for him or her. Although the nurse may have meant to communicate empathy, the result can be quite the opposite.

- The working phase of the nurse-client relationship is usually divided into two subphases.
- During problem identification, the client identifies the issues or concerns causing problems.
- During exploitation, the nurse guides the client to examine feelings and responses and develop better coping skills and a more positive self-image; this encourages behavior change and develops independence.
- (Note that Peplau's use of the word exploitation had a very different meaning than current usage, which involves unfairly using or taking advantage of a person or situation. For that reason, this phase is better conceptualized as intense exploration and elaboration on earlier themes that the client discussed.)
- The trust established between the nurse and the client at this point allows them to examine the problems and to work on them within the security of the relationship.
- The client must believe that the nurse will not turn away or be upset when the client reveals experiences, issues, behaviors, and problems. Sometimes, the client will use outrageous stories or acting-out behaviors to test the nurse.
- Testing behavior challenges the nurse to stay focused and not to react or to be distracted.
- Often, when the client becomes uncomfortable because he or she is getting too close to the truth, he or she will use testing behaviors to avoid the subject.
- The nurse may respond by saying, "It seems as if we have hit an uncomfortable spot for you.
- Would you like to let it go for now?" This statement focuses on the issue at hand and diverts attention from the testing behavior.
- The nurse must remember that it is the client who examines and explores problem situations and relationships.
- The nurse must be nonjudgmental and refrain from giving advice; the nurse should allow the client to analyze situations.
- The nurse can guide the client in observing patterns of behavior and whether or not the expected response occurs.
- For example, a client who suffers from depression complains to the nurse about the lack of concern her children show her.
- With the assistance and guidance of the nurse, the client can explore how she communicates with her children and may discover that her communication involves complaining and criticizing.
- The nurse can then help the client

•Maintaining the relationship
•Gathering more data
•Exploring perceptions of reality
•Developing positive coping mechanisms
•Promoting a positive self-concept
•Encouraging verbalization of feelings
•Facilitating behavior change
•Working through resistance
•Evaluating progress and redefining goals as appropriate
•Providing opportunities for the client to practice new behaviors
•Promoting independence

- As the nurse and client work together, it is common for the client to unconsciously transfer to the nurse feelings he or she has for significant others.
- This is called transference.
- For example, if the client has had negative experiences with authority figures, such as a parent, teachers, or principals, he or she may display similar reactions of negativity and resistance to the nurse, who is also viewed as an authority.
- A similar process can occur when the nurse responds to the client based on personal unconscious needs and conflicts; this is called countertransference.
- For example, if the nurse is the youngest in her family and often felt as if no one listened to her when she was a child, she may respond with anger to a client who does not listen or resists her help.
- Again, self-awareness is important so that the nurse can identify when transference and countertransference might occur.
- By being aware of such "hot spots," the nurse has a better chance of responding appropriately rather than letting old unresolved conflicts interfere with the relationship.

- In the advocate role, the nurse informs the client and then supports him or her in whatever decision he or she makes.
- In psychiatric-mental health nursing, advocacy is a bit different from medical-surgical settings because of the nature of the client's illness.
- For example, the nurse cannot support a client's decision to hurt him or herself or another person.
- Advocacy is the process of acting on the client's behalf when he or she cannot do so.
- This includes ensuring privacy and dignity, promoting informed consent, preventing unnecessary examinations and procedures, accessing needed services and benefits, and ensuring safety from abuse and exploitation by a health professional or authority figure.
- For example, if a physician begins to examine a client without closing the curtains and the nurse steps in and properly drapes the client and closes the curtains, the nurse has just acted as the client's advocate.
- Being an advocate has risks. In the previous example, the physician may be embarrassed and angry and make a comment to the nurse.
- The nurse needs to stay focused on the appropriateness of his or her behavior and not be intimidated.
- The role of advocate also requires the nurse to be observant of other health care professionals.
- At times, staff members may be reluctant to see what is happening or become involved when a colleague violates the boundaries of a professional relationship.
- Nurses must take action by talking to the colleague or a supervisor when they observe boundary violations.
- State nurse practice acts include the nurse's legal responsibility to report boundary violations and unethical conduct on the part of other health care providers.
- There is debate about the role of nurse as advocate.
- There are times when the nurse does not advocate for the client's autonomy or right to self-determination, such as by supporting involuntary hospitalization for a suicidal client.
- At these times, acting in the client's best interest (keeping the client safe) is in direct opposition to the client's wishes.
- Some critics view this as paternalism and interference with the true role of advocacy.
- In addition, they do not only see advocacy as a role exclusive to nursing but also relevant to the domains of physicians, social workers, and other health care professionals.

•Realize that all staff members, whether male or female, junior or senior, or from any discipline, are at risk for overinvolvement and loss of boundaries.
•Assume that boundary violations will occur. Supervisors should recognize potential "problem" clients and regularly raise the issue of sexual feelings or boundary loss with staff members.
•Provide opportunities for staff members to discuss their dilemmas and effective ways of dealing with them.
•Develop orientation programs to include how to set limits, how to recognize clues that the relationship is losing boundaries, what the institution expects of the professional, clearly defined consequences, case studies, how to develop skills to maintain boundaries, and recommended reading.
•Provide resources for confidential and nonjudgmental assistance.
•Hold regular meetings to discuss inappropriate relationships and feelings toward clients.
•Provide senior staff to lead groups and model effective therapeutic interventions with difficult clients.
•Use clinical vignettes for training.
•Use situations that reflect not only sexual dilemmas but also other boundary violations, including problems with abuse of authority and power.

- Self-awareness is crucial in establishing therapeutic nurse-client relationships.
- For example, a nurse who is prejudiced against people from a certain culture or religion but is not consciously aware of it may have difficulty relating to a client from that culture or religion.
- If the nurse is aware of, acknowledges, and is open to reassessing the prejudice, the relationship has a better chance of being authentic.
- If the nurse has certain beliefs and attitudes that he or she will not change, it may be best for another nurse to care for the client.
- Examining personal strengths and weaknesses helps one gain a strong sense of self.
- Seeking feedback from colleagues and others is another essential component of developing self-awareness.
- How one is perceived by others may be different from oneself-perception or intentions.
- Understanding oneself helps one understand and accept others who may have different ideas and values. - The nurse must continue on a path of self-discovery to become more self-aware and more effective in caring for clients.
- Nurses, like others in helping professions, may experience compassion fatigue, a type of secondary traumatic stress or burnout that comes from working through traumatic experiences with clients.
- The nurse "takes on" the burden of those experiences and may be unable to "leave work" at the end of the day.
- Time outside work can be consumed by worries and concerns about clients and their situations.
- Cetrano and colleagues (2017) found that several factors could have a positive impact on mental health workers and thus decrease compassion fatigue and burnout.
- These factors included ergonomic work conditions, relief from undue time pressures, trusting relationships with management, and training and education.
- Nurses also need to learn to "care for themselves."
- This means balancing work with leisure time, building satisfying personal relationships with friends, and taking time to relax and pamper oneself.
- Nurses who are overly committed to work become burned out, never find time to relax or see friends, and sacrifice their personal lives in the process.
- When this happens, the nurse is more prone to boundary violations with clients (e.g., sharing frustrations or responding to the client's personal interest in the nurse).
- In addition, the nurse who is stressed or overwhelmed tends to lose the objectivity that comes with self-awareness and personal growth activities.
- In the end, nurses who fail to take good care of themselves also cannot take good care of clients and families.

How do nurses build client relationships?

What behaviors help patients develop trust in the nurse?

What are three critical behaviors to a positive nurse

Which situations may cause the nurse to violate boundaries with a patient?