Article as PDF ( KB) · Article as EPUB; Print this Article; Email to a Friend A therapeutic nurse-patient relationship is defined as a helping relationship This caring relationship develops when you and your patient come together in the moment, which results in harmony and healing. . Readers Of this Article Also Read. Two of the articles were discovered via manual search. The article analysis developed. As trust appears to have a major influence on nurse-patient relationships and familiarized by repeatedly reading through the selected articles. Next. PDF | To review assumptions inherent in the nurse-patient relationship as historically described and practiced, and to propose an alternate.
Discussion This study will help to understand the process of change in a nursing team working in an inpatient psychiatric ward and will allow nurses to generate knowledge, identify difficulties, and establish strategies to implement change, as well as to assess whether the quality of the care they provide shows a qualitative improvement.
Indeed, the concept of the therapeutic relationship emerged in parallel to the professionalization of nursing care [ 1 ] and is considered the cornerstone of psychiatric and mental health nursing [ 2 ]. Adequate establishment of the therapeutic relationship increases the efficacy of any nursing intervention in the acute mental health setting [ 3 ]. Multiple terms are used to describe the same concept. The TR is also called the helping relationship, the nurse-patient relationship, the trusting relationship, and the therapeutic alliance.
Nevertheless, the central focus of all these concepts is the helping working relationship [ 4 ]. Likewise, the concept of the TR has been enriched by diverse perspectives and paradigms, including the psychodynamic perspective originating with Freud, the pantheoretical model, and the humanist or person-centred approach. Consequently, some authors have stated that personal qualities rather than theoretical orientation take centre stage in the TR [ 4 ].
Psychiatric nurses are aware of the concept of the TR and its importance [ 24 — 10 ]. However, they are also aware that specific skills are required to develop and maintain a TR with patients [ 7 ], which involves a huge effort and, moreover, implies difficulty in its achievement. Factors such as consistency, empathy, the ability to listen, making a positive first impression, a safe and comfortable environment, and teamwork are basic pillars, encouraging and aiding the development of a TR [ 10 ].
For their part, patients perceive attitudes, values and a trusting relationship as being more important than technical skills in the therapeutic relationship [ 4 ]. Service users expect to receive individual attention as part of their treatment plan [ 11 ].
Having a feeling of control and of self-determination is highly important, and this sense of meaning and control is provided by interpersonal relationships [ 12 ]. So much so, that what patients want most are empathetic nurses, ie, those able to identify what the patient expects or needs from the nurse at any given moment [ 4 ].
Patients value nurses who are patient and imaginative and have a sense of humour [ 9 ], who listen and are empathetic [ 4 ].
Nurse–client relationship - Wikipedia
The greater the chronicity, the more patients lose interest in their physical needs and the more they value relational aspects of care [ 13 ]. Despite evidence of the greater effectiveness of the TR and psychodynamic training in clinical practice [ 14 ], mental health nursing has been strongly influenced by the biomedical model and has become increasingly depersonalized [ 15 ].
There is no recognition of the need for the care of emotions, or of the importance of the emotional work required to develop and maintain a quality TR [ 13 ]. In this regard, routine tasks and administrative duties, as well as the time they consume, hamper the provision of individual attention and consequently the effectiveness of the TR [ 11 ].
Nevertheless, some evidence suggests that staff spend increasingly less time with patients, despite an increase in the staff-to-patient ratio in some units [ 16 ]. For some patients, inaccessibility and lack of communication-and therefore a lack of information provided by some staff-are factors that limit the TR [ 17 ]. Likewise, lack of availability, inequality, and differences in values and experience are factors that distance nurses from patients and hamper the development and maintenance of the therapeutic alliance.
Often, patients feel they are given little opportunity to collaborate in their care [ 17 ], perceive that they spend most of their time alone and that they have little relationship with the care team [ 16 ]. Some patients feel like prisoners and report that staff who are themselves insecure adopt intimidating and condescending attitudes [ 18 ].
In this regard, and although nurses are aware of the importance of the TR and how to foster such an alliance, the scientific evidence shows that theoretical knowledge of communicative and interpersonal skills alone is insufficient to develop these skills effectively, and hence to establish an effective therapeutic relationship and provide high-quality nursing care [ 3915 — 1720 — 23 ].
Attributes such as being genuine, warm and respectful are a few to mention. An aspect of respect is respecting an individual's culture and ensuring open-mindedness is being incorporated all throughout the relationship up until the termination phase. It is highly beneficial for the client to incorporate their family, as they may be the most effective support system. Revealing your whole self and being genuine with clients will accomplish the desired nurse client relationship.
In addition, the nurse may also reduce distance to demonstrate their desire in being involved, restating and reflecting to validate the nurse's interpretation of the client's message, directing the conversation towards important topics by focusing in on them. Furthermore, being polite and punctual displays respect for the client in addition to remembering to be patient, understanding, also to praise and encourage the client for their attempts to take better care of their health.
One of the non-verbal factors is listening. Listening behaviours are identified as S. R; S-sit squarely in relation to client, O-maintain an open position and do not cross arms or legs, L-lean slightly towards the client, E-maintain reasonable and comfortable eye contact, R-relax. These behaviours are effective for communication skills, and are useful for thinking about how to listen to another person.
Empathy Having the ability to enter the perceptual world of the other person and understanding how they experience the situation is empathy.
This is an important therapeutic nurse behaviour essential to convey support, understanding and share experiences.
Patients are expecting a nurse who will show interest, sympathy, and an understanding of their difficulties. When receiving care patients tend to be looking for more than the treatment of their disease or disability, they want to receive psychological consideration.
During hard times, clients are looking for a therapeutic relationship that will make their treatment as less challenging as possible. Many patients are aware that a solution to their problems may not be available but expect to have support through them and that this is what defines a positive or negative experience.
Past experiences can help the clinician can better understand issues in order to provide better intervention and treatment.
The goal of the nurse is to develop a body of knowledge that allows them to provide cultural specific care. This begins with an open mind and accepting attitude. Cultural competence is a viewpoint that increases respect and awareness for patients from cultures different from the nurse's own. Cultural sensitivity is putting aside our own perspective to understand another person's perceptive. Caring and culture are described as being intricately linked. It is important to assess language needs and request for a translation service if needed and provide written material in the patient's language.
As well as, trying to mimic the patient's style of communication e. Another obstacle is stereotyping, a patient's background is often multifaceted encompassing many ethic and cultural traditions.
In order to individualize communication and provide culturally sensitive care it is important to understand the complexity of social, ethnic, cultural and economic.
This involves overcoming certain attitudes and offering consistent, non-judgemental care to all patients. Accepting the person for who they are regardless of diverse backgrounds and circumstances or differences in morals or beliefs. By exhibiting these attributes trust can grow between patient and nurse. It includes nurses working with the client to create goals directed at improving their health status. A partnership is formed between nurse and client. The nurse empowers patient and families to get involved in their health.
To make this process successful the nurse must value, respect and listen to clients as individuals. Focus should be on the feelings, priorities, challenges, and ideas of the patient, with progressive aim of enhancing optimum physical, spiritual, and mental health. It is stated that it is the nurse's job to report abuse of their client to ensure that their client is safe from harm.
Nurses must intervene and report any abusive situations observed that might be seen as violent, threatening, or intended to inflict harm. Nurses must also report any health care provider's behaviors or remarks towards clients that are perceived as romantic, or sexually abusive.
Interviews were done with participants from Southern Ontario, ten had been hospitalized for a psychiatric illness and four had experiences with nurses from community-based organizations, but were never hospitalized. The participants were asked about experiences at different stages of the relationship. The research described two relationships that formed the "bright side" and the "dark side". The "bright" relationship involved nurses who validated clients and their feelings.
For example, one client tested his trust of the nurse by becoming angry with her and revealing his negative thoughts related to the hospitalization. The client stated, "she's trying to be quite nice to me For example, one client stated, "The nurses' general feeling was when someone asks for help, they're being manipulative and attention seeking ". One patient reported, "the nurses all stayed in their central station.
They didn't mix with the patients The only interaction you have with them is medication time". One participant stated, "no one cares. It's just, they don't want to hear it. They don't want to know it; they don't want to listen". These findings bring awareness about the importance of the nurse—client relationship.
Building trust[ edit ] Building trust is beneficial to how the relationship progresses. Wiesman used interviews with 15 participants who spent at least three days in intensive care to investigate the factors that helped develop trust in the nurse—client relationship.
Patients said nurses promoted trust through attentiveness, competence, comfort measures, personality traits, and provision of information. Every participant stated the attentiveness of the nurse was important to develop trust. One said the nurses "are with you all the time. Whenever anything comes up, they're in there caring for you".
They took time to do little things and made sure they were done right and proper," stated one participant. One client stated, "they were there for the smallest need. I remember one time where they repositioned me maybe five or six times in a matter of an hour". One said, "they were all friendly, and they make you feel like they've known you for a long time" Receiving adequate information was important to four participants.
One participant said, "they explained things. They followed it through, step by step". Emotional support[ edit ] Emotional Support is giving and receiving reassurance and encouragement done through understanding. Yamashita, Forchuk, and Mound conducted a study to examine the process of nurse case management involving clients with mental illness.