A Focus On Nurses And Patients

Introduction

The therapeutic relationship is a relationship between healthcare professionals like doctors, nurses or any other professional in the healthcare department and the clients who are the patients. This kind of relationship helps both the therapist (who is the nurse/doctor) and the client (being the patient) through engaging each other. The relationship between the healthcare and the client is said to be interpersonal relationships because it involves a close association between two people. The nurse or the doctor should be able that he or she is gaining trust from the patient and also making him or her comfortable. The therapeutic relationship is important both for the patient and the doctor or the nurse since some of the values like empathy, trust and humility are involved in this case.

It is important for healthcare professionals to like the nurses to practices the therapeutic relationship because they attend to patients more than the doctors. Therefore a nurse should have the ability to make the patient comfortable enough for the patient to be open and honest with the nurse. Once the nurse has made the patient comfortable, the nurse should be able to give the patient empathy and hope. Since the therapeutic relationship is collaboration between two people, it allows effective nursing and care to the patient and also the nurse gets to have the easiest way to treat the patient. Department of health encourages the nurses and healthcare professionals to practice the therapeutic relationship.

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The key areas that would be explained in this research will show how important is the therapeutic relationship and it advantages. Therapeutic relationship agrees to the development of an effective relationship between the nurse and service user with an increase of positive outcome. There are institutes like the college of the nurse in Ontario explaining how hope, respect empathy, trust, and confidence play a major role in developing the therapeutic relationship. It is advisable to have and build a positive therapeutic relationship with the patients so that they can be offered the services and treatment they need. There are patients that are not easy to talk to and some cannot express how they feel and that is when the nurses come in by building up a relationship between him and the patient.

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For someone to be able to practice the therapeutic relationship he or she should be able to communicate, be friendly, should be a person who is ready to listen and many other interpersonal relationships skills. Since the therapy is important to both the patient and the nurse, it is considered to be psychiatric nursing treatment even if the nurse is aiming to analyze the patient psychologically. To achieve a therapeutic relationship one should be able to achieve goals like facilitating which includes communication, assisting which is helping the client with the problem and finding the solution, helping the clients through examining them and finally the promotion of self-care.

Communication

As a nurse, one should be able to have good communication skills because it is the cornerstone of the therapeutic nurse-client relationship. Having good communication skills helps in building trust between the nurse and the client who is the patient. Without showing the client that you are trustworthy as a nurse, it means that he or she will not be open enough since the approach through communication was not friendly or engaging to the client. As a nurse, you should be able to initiate a comfortable communication with the patient so that he or she can understand and be open as well. And through communication, the nurse should be able to show the client that there are warm welcome and empathy especially by making the client feel safe.

This type of communication between nurses and clients can be described as therapeutic communication. As explained earlier it makes the client feel comfortable enough to be open. Communication has more information that can help in knowing what and how to handle the patient. For example; a situation where the client has been going through abuse and she appears in an emergency room with bruises that describes that proves that she has been going through the abuse, she cannot be helped if the attending nurse was not able to communicate with her and make her feel safe. In such a situation the nurse should make sure that the person that has been abusing the patient is not in the room, communicate with the patient and show her that she is safe and the abusing will stop by convincing her to write a police statement. This example is one of the many ways through which a nurse can help the patient through communication that is therapeutic.

Communication will allow the client to feel free especially when talking about their feelings and the nurse will be able to understand the client and be able to know what kind of help the client needs. Therefore it is evident communication and understanding goes hand in hand with the therapeutic communication, meaning without communication there is no understanding. It is important that the therapeutic communication is administered to patients because it not only helps in identifying the problem with the patient but it also helps in the recovery process.

To expand it Bach & Grant (2011) explains that nurses must be honest, authentic and caring by listening, giving support, providing accurate information and making sure that the care is patient-centered. Having a verbal communication can be obtained by using words and sounds whereas having an open body posture, what is heard and speech and non-verbal communication including body language gestures, postures, facial, expressions touch, and eye contact and action are used to communicate.

Communication helps in establishing rapport and at the same time maintaining eye contact and prevent the distractions during conversations with clients can enhance the bond between nurse and patient (Brown & Bylund, 2015). Communication is also about sharing and receiving information. Therefore, healthcare professional should be able to obtain client concerns and use these carefully without stopping these communications with a one-sided approach to conversation. Lewis and Kitchen (2010) suggest that nurses engaging in good communication will create high-quality care for patients and their cares. Roberts, Fenton, & Bernard, (2015) state that using good verbal and non-verbal techniques when communicating with patients it can have a positive impact in gaining patients trust and the building of a trusting relationship.

Apart from normal communication, there are other ways through which a patient can be communicated especially people with a disability like deaf and blind. It does not matter how you talk to the client but how you communicate to them matter whether it is true brail or sign language the communication can still be done.

Compassion

The second goal is the assistance and through assistance is showing compassion and empathy. In a therapeutic relationship, it is important the nurse should be able to assist the client. Having compassion and empathy in the therapeutic relationship is essential because through compassionate therapeutic relationship can be easily developed. For someone to be compassionate about someone else it means that they can listen and understand their clients. The nurses can show how compassionate they are by trying to put themselves in their client's shoe and even give details to their experiences especially if it relates to the client.

According to the nursing and midwifery council, compassion is a necessary skill that a nurse must practice because it warms the client in a sensitive manner and it can be through touch. Compassion is important when developing therapeutic relationships as it allows a caring relationship to be built between clients and nurses. The key to compassionate care is about the quality of relationships between peoples; compassionate care requires an emotional link and interpersonal skills. Individually, care workers have the obligation to show kindness and a lack of compassion can lead to the feeling of the patient being undervalued and perception of an absence of emotional support. For example, in a hospital, people die every day and the most difficult thing to do that nurses find it hard is to deliver the message to the loved ones. When delivering this kind of message to the family of the deceased one should be able to be compassionate. The nurse will always be there when the doctor is delivering the message so that they can comfort the family and be compassionate.

So the compassionate care can be well delivered it was stated as a law by the department of health. This made the compassionate care be strong in the health department and that includes places like the holistic centers. In the holistic center, different people need different types of therapy and a compassionate nurse and physiotherapist should be able to show compassion and empathy to the patient so they can be encouraged.

Finally being compassionate as part of the therapeutic relationship that is advisable that it is practiced in any health facilities and every nurse should learn how to be compassionate. It is said to be one of the hardest parts since not everyone can have compassion and that is the reason why they had to make it a law in health departments.

The therapeutic relationship also needs someone that can be friendly to the client. There are clients can be hard to deal with especially the ones with mental cases. The nurse will offer therapeutic psychological test and know who to deal with such cases. The nurse should be friendly enough to make the patient comfortable and means reasoning with them. It can be hard to create a therapeutic relationship with that type of client and that is the reason why the health department has the nurses that deal with such cases. Being friendly is a type of interpersonal relationship that can be hard to deliver but it is important because it hands in hand with communication and compassionate.

Barriers and facilitators

Barriers and facilitators were recognised in building a therapeutic relationship, by accepting, barriers strategies need to be implicated to overcome them and the facilitators need to maintain in nursing practice which be essential in facilitating the development of therapeutic relationship. This is because one will be able to learn from the few barriers that they experience they would be learn and find solution for the barriers, some of these barriers include communication, time, under staff and lack of professionalism.

Even though communication is said to be the core of building a therapeutic relationship, it can also be a barrier. Not every patient or client that pops in the hospital can communicate and not all nurses can communicate either. As much as is considered one of the best ways to create a therapeutic relationship it is also one of the biggest barriers. For example, a client can be speaking a different language and the nurses would not be able to understand even though it is encouraged that every health department should have someone who can translate different languages. Secondly, A qualified nurse is one who can assess not only what a patient can say but also assess non-verbal signal displayed by a patient which may lead the nurse to conceive the patient feels and their needs.

Another issue is a time which has been considered one of the barriers that hinder the therapeutic relationship. According to Dewar, using more time with the patients will develop a therapeutic relationship and making easy to know the patient, but there are so many patients to be attended especially in hospitals that are serving the poor and the middle-class people. It does not go deep enough as expected with the health department hence most people just end up not getting the help they need. People like Potter et al (2014) thinks time is a barrier of building a therapeutic relationship. Because nurses may be busy with paperwork and may not be able to get time to sit and talk with patients this bring down the chance of the patients having trust and open to the nurse about their concerns.

The final barrier that is well known is having fewer staffs in various health facilities. Shortage of staff is a barrier in building a therapeutic relationship because of a lack of staff on duty which impacts on the delivering the care of the patients. The nurses suffer from compassionate fatigue due to staff shortages which result in nurse delivering their care in hurry without compassion. There are more sick patients in the ward that require more time and attention from the staff but due to lack of staff, there is an only a limited thing a nurse can do for the patient.

Ellis (2015) states that due to the staff shortage the nurse will not be able to get more information to the patients because of covering staff who are off sick and unable to come to work to various matters. This can be a reason for poor communication between nurse and patient and shame of therapeutic nurse-patient relationship.

There are nurses who lack professionalism therefore they would not know how to handle their clients. Some of the nurses lack empathy and compassion naturally and that cannot be controlled because some are just wired like that or rather created like that. Some might say it is a disorder like autism but some might say it is ignorant. These kinds of barriers are experienced in under developed hospitals that have few staffs and few types of equipment that can be used in helping the patients.

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Conclusion

In summary, the therapeutic relationship is important both for the patient and the doctor or the nurse since some of the values like empathy, trust and humility are involved in this case. It is a relationship that needs two people both the client being able to understand each other. We have seen how communication plays a big role in building a therapeutic relationship. It has been emphasized how it is the core of the therapy and the nurses are required to know how to communicate and also understand their clients. Communication skills and compassion should be improved in the future to become more comfortable in managing potential hostility between nurse-patient therapeutic relationships. Through this nurse will be able to care for a patient from their view and empathy can be reflected.

Communication is a barrier to because it can lead to time consumption that other patient might not have. Lack of professionalism is also a barrier that is an issue in most of hospitals that over populated and underserved due to less staffs. In The holistic care was applied whilst building a therapeutic relationship which involved looking at a client, enabling the nurse to listen, respect and to understand patient’s needs. Through the understanding gained in communication, compassion, this concept will develop a good nurse-patient relationship in the future practice. The interpersonal relationship which leads to therapeutic relationship is important in health facilities like the nursing homes as well and that is why the nursing and midwifery council encourages that the nurses should be taught how to handle cases that needs them to build that kind of relationship. It has been discussed by various people how therapeutic can be used to help the patients.

References

  • BACH, S & GRANT, A., 2014. Communication and Interpersonal skills in nursing. 2nd ed. United Kingdoms: Learning matters.
  • DEPARTMENT OF HEALTH, 2013. A Promise to Learn-A Commitment to Act: Improving the Safety of patients in England[online]. Department of Health. [viewed 01November 2017]. Available:
  • DEPARTMENT OF HEALTH., 2012. Compassion in practice nursing, midwifery and care staff: Our vision and strategy [online]. Department of health. [Viewed 20th November 2016]. Available from: available from:
  • DEWAR, B., E. ADAMSON, S, SMITH, J, SURFLEET & L KING 2014, Clarifying Misconceptions about Compassionate Care, Journal of Advanced Nursing, 70(8) pp.
  • ELLIS, P.,2015. Understanding ethics for nursing students. London: Learning Matters.
  • NURSING AND MIDWIFERY COUNCIL., 2010. Standards for competence for registered nurses [online]. Nursing and Midwifery Council. [Viewed 20th November 2016]. Available from:
  • NURSING AND MIDWFERRY COUNCIL., 2015. The code: Professional standards of practice and behaviour for nurses and midwives[online]. Nursing and Midwifery Council. [Viewed 15th November 2016]. Available from:

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