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6.1 Nurse-Client Relationship

Therapeutic nurse-client relationships vary in depth, length, and focus. Some may be brief and others will be longer, depending upon the environment and the client’s needs. Regardless of length or client need, there are four stages to Peplau’s nurse-client relationship: pre-orientation, orientation, working, and termination. Each stage builds upon the one before it. These stages, as well as the boundaries placed and upheld by the nurse, help to build the rapport and trust between the client and the nurse.

6.2 Family Dynamics

Family dynamics have a large impact on a child’s emotional development. Some things that can affect family dynamics are being a single-parent family, divorce, poverty, addition of a stepparent, and parental mental health. Using Bowen’s family systems theory, mental health nurses can educate families on positive ways to interact and cope with mental illness in the family. Collaboration between the nurse, the client, the client’s family, and the interdisciplinary team increases the chances of positive outcomes.

6.3 Peer Support

Peer support services are led by a person or persons who have lived experience with mental illness. These services can be conducted in an inpatient, outpatient, or group setting, as part of an interdisciplinary treatment team, in a one-to-one format, and in a virtual setting. Peer support specialists can assist the individual with mental illness by helping them learn how to build better relationships with others, grow their self-esteem, increase their self-determination, access resources, empower themselves, and feel less lonely in their illness.

6.4 Client Engagement

Engagement is a term that describes both the client and the health-care team participating in the services provided. For recovery to work, clients must be engaged, so treatment options must be client-centered and appropriate based on age, culture, and stage of life. Nurses should assess clients for their potential level of engagement by looking at their therapeutic relationship, expectancy, attendance, clarity, and homework.

6.5 Trauma-Informed Care

According to Forkey et al. (2021), more than half of all U.S children under the age of eighteen have experienced some type of trauma in their lifetimes. Toxic stress (adverse events that keep activating the stress response) can lead to lifelong impairments. Focusing on the client’s strengths instead of just looking at what is “wrong” with them should be at the core of trauma-informed care. Involving the client in their own care provides them with a sense of autonomy and control over the treatment process. The first step to successful care is to create a safe, therapeutic nurse-client relationship. Effectively assessing and addressing a client’s family dynamics and its role in a child’s or adolescent’s mental health disorder requires an interprofessional team of health professionals, including nurses, physicians, social workers, and therapists. One type of therapy that has been found to help clients with PTSD is cognitive behavioral therapy. Support is critical during the trauma recovery process in order to achieve optimal outcomes of care.


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