Building Therapeutic Relationships in Nursing Practice

Introduction

Therapeutic relation between nurse and patient is considered as trustworthy relationship which is based on respect, dignity, attention and loyalty. According to Nursing and Midwifery Council (NMC), professional values are important in the nursing practice which assists nurse to maintain quality, integrity and trust into the care process. This essay will discuss the methods of building a therapeutic relationship between a nurse and a patient, their importance, how professional values are included and how understanding of these will positively influence nursing practice This essay will discuss that how therapeutic relationship will improve patient experience and quality of the nursing care process. In this essay, different key areas that are associated with the therapeutic relationship will be discussed. The key areas are communication, compassion, competence and courage in nursing care framework. Moreover this essay will discuss barriers and facilitators that are associated with therapeutic relationship between patients and nurse. In addition, this essay will entail recommendations with the aim of improving future practice.

Main Body

Therapeutic relationship is definedby Crotty and Doody (2015)as an interpersonal relation: the link between nurse and patient Nicol(2011), and Dark (2011)also defines the therapeutic relationship as one that develops when a patient eventually feels like they can be honest, open and comfortable with the nurse. Thus, from the two explanations it is evident that collaborative working is key in building therapeutic relationship and, The Nursing and Midwifery Council (NMC) 2015) detailed that working in cooperation the nurses and patient allows effective nursing care. This interpersonal relationship can be done by recognizing the holistic care of the patient by considering the patient’s physical, social, emotional, cognitive and cultural needs which are suitable for a patient development Crotty and Doody, (2015). Therapeutic relationship agrees to the development of an effective relation between the nurse and service user with an increase of positive outcome.

As stated by Wiechula et al. (2016.), different key aspects are associated with therapeutic relations in nursing, such as empathy, respect, dignity and integrity. Through maintaining respect and dignity in the care process, nurse can assist patients to share their cultural, physical, relational and psychological needs. Based on the NMC guidelines, the NHS nurses need to maintain proper integrity and loyalty in her work, in order to improve the overall quality of their care process. As stated by Richardson et al. (2015), nurse and patient would maintain strong and transparent relationship between hem which is based on trust, love and respect. Through maintaining strong communication and cooperation with patients, nurse can improve care process by getting proper details of patents health, their mental status and their needs.

The importance of therapeutic relationship is associated with manifold positive impacts in to the nursing practice. In forming such relationship with patient, nurse can introduce themselves in better in front of patients and family (Castro et al. 2016). Through this process, patient can know what the responsibilities of nurse are and what type of care process they are going to apply in order to treat the patient. Therapeutic relations between nurse and patient assist the nurses to maintain proper privacy about patient’s professional and personal details, their mental and physical health status and the coverall care process. Through conducting therapeutic relationship, nurse can listen to the needs, problems and preference of patients regarding their health and wellbeing. On the other hand, therapeutic relations assist the nurse as well as patient to share their viewpoint, understanding and decisions about the ongoing treatment process, which assist the health professional to know preference and physical needs to patients.

Professional values are the completion standards that are prepare for by specialist group and professional (Schank&Weis, 2001). Values in general are based on the entire nursing achievement, cooperation with the clients, family and multi-disciplinary team (Leners, Rochers&Piccone, 2006). According to Blats & Janice (2010), professional values are related to person’s beliefs which derive from societal and personal values. Moreover, the Department of Health (DH 2012) published a statement of six values (6C’s), that nurses needed, including compassion, competence, communication, courage, care and commitment for developing professional value in a care setting.

There are different important factors that are associated with maintaining strong therapeutic relations between nurses and patients [NMC, 2014]. According to NMC, the factors or key aspects that support the therapeutic relationship are the six values such as competence, compassion, communication, care, commitment and courage.

Communication

Communication is vital in nursing practice and building a therapeutic relationship. McCabe (2006) describe therapeutic communication as showing warmth and empathy especially the feeling of being safe and tolerant to clients rather than preserving the illness. Arnold & Boggs (2015) describes Therapeutic communication as an impartial form of communication that is used in health care to promote patient’s well-being and the accomplishment of patient wishes. Cited in Bach and Grant (2014), Balzer-Riley (2004) defines communication as the reciprocal process in which messages are sent and received between two or more persons. According to Browie et al (2016) difficulties in communication can affect the therapeutic relationship between health care professional and patient. Alongside compassion, NMC (2010) explains that communication is an essential skill that nurses should complete and practice in providing holistic care and effective communication using a variety of verbal and non-verbal method of communication and skills which enables the nurses to engage with services users therapeutically.

As stated by Arnold and Boggs (2019), communication is one of the most important aspects that support therapeutic relationship building between nurse and the patients. Through maintaining the transparent and strong communication with patient and their family members, nurses are able to collect the correct information regarding health, mental status, needs and preference of patients. Communication with patient assists the nurses to build the clarity and trust into their relationship with patents. As stated by Wiechula et al. (2016), through conducting the verbal and non verbal communication with patient the nurses can understand individual perspectives of each patient regarding the treatment process. Through interacting with patient and their family members nurse are able to collect proper information about patient’s premedical history, previous psychological and physical status. In this aspect Pazargadi et al. (2015) mentioned that, nurses need to conduct communication based on their health status. For example, in case of patient with disability such as dementia patients, nurse need to use the non-verbal communication, In case of non-verbal communication, nurse needs to highly trained in using appropriate signs and activities which will assist patients to understand nurse’s instruction and advice. According to Richardson et al. (2015), in some cases nurses can use the written communication, in which y use hand written documents in order to make underhand patient about instruction and advice.

In a therapeutic relationship, communication is a corner stone for nurses to have a positive influence on a patients’ outcome including recovery process as described by Reynolds, (2009), Johnson &Cadwell, (2011) & Wright, (2010).

As described by McCormack & McCance (2010), communication is appropriate in the functioning of a human as it is practicing in nursing for meaning and sharing. More over McCormack & McCance (2010) explain that communicationwith clients is based on the information about them which would access the language that they use, what they say and the different communication plan of action. To expand it Bach & Grant (2011) state that nurses must be honest, authentic and caring by listening, giving support, providing accurate information and making sure that the care is patient centred. 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 one-side approach to conversation. Lewis and Kitchen (2010) suggestthat nurses engaging in good communication, will create a high-quality care for patients and their carers. 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.

Compassion

The concept of compassion plays a crucial role in building therapeutic relationship.

Peate et al (2014), andChochonov (2007) define compassion as accepting another person suffering and needs. The Department of health (2012) defined compassion as good care provision based on empathy, respect and dignity is essential to how people perceive their care and through this compassionate care a therapeutic relationship is developed (Nicol, 2015).

In order to conduct strong therapeutic relations between patients and nurses, it is important for the nurses be highly compassionate. As stated by Pazargadi et al. (2015), compassionate nurses are highly empathetic to patient’s needs, safety and security, which si important for improving the quality of care process. Based on Nursing and Midwifery Council (NMC) has made it obligatory for all the nurse and midwives under the national Health Service, will have proper skill and expertise to deal with service users in kind, friendly and polite manner. Based on the recent researches it can be stated that, compassionate nurse are able to provide the emotional support to patient during their pain and stress. Through being compassionate towards patients, nurses can improve the self confidence and self esteem of patients.

Benefits of being compassionate in nursing are associated with strengthening the overall therapeutic relations between the patients and nurse. Compassionate nurses are able to better understand the patients’ situation through which they are going. As stated by Castro et al. (2016), being compassionate nurses are able to better understand the needs and problems of the patients. Compassionate nurse have also the skill about how to make effectives and quality communication with the patient in order to provide the best emotional and social support. National Institute of Care and Excellence (NICE) assist the nurses to use positive voice as well as soft body language to improve the confidence level within patients. Through providing proper emotional support to patents, nurses are able to maintain strong relation with the patient. . Moreover compassionate nurses are able to understand actual psychology of their patient such as their preference, desire problem and expected needs.

Royal College of Nursing (RCN2015) implies that there are many factors which impact the quality of care on patients, although compassion will always play a crucial role in nursing. Compassion is important when developing therapeutic relationships as it allows a caring relationship to be built between clients and nurses. On the other hand,Peate et al (2014) also states that 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 ofthe patientbeing undervalued and perception ofan absence of emotional support.

Competence:

Competence is considered as the attainment of skill, expertise, knowledge, integrity, intellectual capacity and professional and ethical values (Arnold and Boggs, 2019). According to NMC, registered nurses and midwives need to be competent in order to build the strong relationship with patient and their family. Competency of nurse and midwives would assist the, to maintain the quality of their care process. Moreover, through maintaining their competency level, nurses and midwives are able to build trust, respects and ethics in the therapeutic relationship.

Care:

Based on the NICE guidelines, important and high quality care process is associated with supporting the building of therapeutic relationship between the patients and nurses (Wiechula et al. 2016). Through maintaining the high quality of the care process, nurses are able to provide the best emotional, physical and mental support to the patients. Moreover high quality care process also assists make perfect communication with each patent ad his or her family members which build trustworthy and strong relationship between the patients and the nurses.

Commitment:

Commitment is one of the most important aspects that support the building of therapeutic relations between patient and nurses. As stated by Pazargadi et al. (2015), nurses would be highly committed towards their work and responsibilities. They should understand the importance of patent values, needs and preference in order to maintain proper ethics and morality within the care process. Based on the NICE guidelines, nurses and midwives need to be highly committed to their responsibilities in order to maintain the quality of their care process.

Courage:

Courage is important for nurse in order to hold their interest in their work. As based on NMC, nurses and midwives needs to maintain their courage and the interest in order to provide high quality service to service users [NMC, 2019]. Through maintaining strong therapeutic relation with the patients, nurses can be motivated towards their work and ethics (Wiechula et al. 2016). Proper training, appreciating from eth higher staffs and rewards from their organisation, assists nurses to hold their courage in order to deal with challenging task within the organisation.

Barriers and facilitators

The barriers using whilst developing a therapeutic relationship were communication, time, and staff shortage.

According to Doherty and Thompson (2014) communication is a barrier whilst building a therapeutic. Communication is a big barrier in achieving to build a therapeutic relationship. This is because some nursing staff is unable to use a good verbal and non-verbal interaction such as gestures, postures, facial expressions and eyes contact (Brownie et al (2016). A qualify 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.

According to Potter et al (2014) time is a barrier of building a therapeutic relationship. Because nurses may be busy with paper work and may not be able to get time sit and talk with patients this bring down the chance of the patients having trust and open to the nurse about their concerns. Thompson (2014) and Ryan and Mckenna (2015) explains that nursing spending more time with patient contributes to maintain and build a caring relationship.

Shortage of staff is a barrier in building therapeutic relationship because of lack of staff on duty which impacts on the delivering the care of the patients Black (2014).

According to Foster and Hawkins (2015) 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 only limited thing a nurse can do for 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.

Understanding, person centred care and trusts are the facilitators who were identified whilst developing a therapeutic relationship.

Delvas-Yates (2015) describes person-centred care as the exclusivity of value and respects a person hold and preserves their personhood. The person- centred care is used to refer to many different principle and activities and there is no single agreed definition of the concept. Compassion and dignity are the main principles of person-centred care explained by the health foundation (2014). Person-centred care is important because many people want to play a more active role in their health care.

Person –centred care is about value and worth with large complex needs that leads to a happy living (Hogston, 2011). To maintain person- centeredness in nursing practice healthcare professional are required wherever possible to work with patient’s needs beliefs and values; to show empathy whilst engaging with client; deliver holistic care making share decision (Mc Cormack & Tanya McCance 2010.p37).

Foster & Hawker 2015) states that when a relationship is established, the nurse can perform professional practice which allows the relationship between the nurse and the patient to become a therapeutic relation. Nurse must try to build relationship of trust with patients to facilitate the development of a therapeutic relationship. This will help the patient to become trusted, open and excited. Understanding patient’s thoughts and their feeling facilitates the development of a therapeutic relationship. According to Doherty & Thompson (2014) therapeutic relationship is essential in building trust between nurse and patient

Therefore, a nurse needs to listen to the patient feeling and views regarding their care which will help to make person centred care being listening to their thoughts and feelings.

Conclusion:

Reflecting in my experience of building a therapeutic relationship between a nurse and patient, nurse should produce a suitable action plan, they should engage with patients in a more professional manner and ensuring that they maintain an empathy and understanding approach to care while maintaining boundaries. The concepts used in this essay were communication and compassion which enable to build therapeutic relationship. The concepts are very important for professional values which can impact patient’s needs like emotional, cultural and cognitive needs. Person centred care was applied which facilitated the development of a therapeutic relationship between the client and the nurse which help to promote best quality of care.

Understanding the concepts of communication, compassion, barriers and facilitator relating to patient enables nurse to develop and improve attributes.To achieve this, communication skills and compassion should be improved in the future to become more comfortable in managing potential hostility between nurse-patient therapeutic relationships. Throughthis nurse will be able to care for a patient from their view and empathy can be reflected.

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.

Prioritising people’s needs,and respect is the centre of developing and building therapeutic relationship between nurse and client. The NMC Code of conduct needs to be followed by nurses to prioritise needs, preserve safety, and promote professionalism and trust.

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.

Dig deeper into Building Effective Communication and Collaboration with our selection of articles.

Reference list:

ARNOLD, E. & BOGGS, K.,2015. Interpersonal relationship: communication Skills for nurses. 7th ed. St. Louis, Missouri: Elsevier.

Arnold, E.C. and Boggs, K.U., 2019. Interpersonal Relationships E-Book: Professional Communication Skills for Nurses. Saunders.

BACH, S & GRANT, A., 2014. Communication and Interpersonal skills in nursing. 2nd ed. United Kingdoms: Learning matters.

BLACK, B.P., 2014. Professional nursing: Concepts and challenges. 7th ed.Missouri: Elsevier

BROWN RF, BYLUND CL., 2015Communication skills training:describing a new conceptual model.Acad Med. 2008 ; 83 (1): 37-44.

BROWNIE, S. ET al., 2016 Therapeutic communication and relationship in chronic and complex care. Nursing standard. 31(6), pp. 54-61.

DEWAR, B., E. ADAMSON, S, SMITH, J, SURFLEET & L KING 2014, Clarifying Misconceptions about Compassionate Care, Journal of Advanced Nursing, 70(8) pp.

LENERS, D W., ROCHERS, C. V., &PICCONE, A. 2006. Tracking the development of professional values in undergraduate nursing students. Journal of Nursing Education [online]. 45(12), pp. 504-511. [viewed 01 November 2017]. Available from:

MACCBE, C, & TIMMONS, F., 2006. Communication Skills for NursingPractice. Palgrave Macmillan, Hampshire.

MACCORMARK, B. & MCCANCE, T., Person-Centred Nursing: theory and Practice.

NICOL, J., 2011. Nursing adults with long term conditions. London, Exeter, Devon: Learning

NICOL, J.,2015. Nursing adults with long term conditions. London, United Kingdom: Sage Publications.

Pazargadi, M., Fereidooni Moghadam, M., Fallahi Khoshknab, M., Alijani Renani, H. and Molazem, Z., 2015. The therapeutic relationship in the shadow: Nurses’ experiences of barriers to the nurse–patient relationship in the psychiatric ward. Issues in mental health nursing, 36(7), pp.551-557.

Richardson, C., Percy, M. and Hughes, J., 2015. Nursing therapeutics: Teaching student nurses care, compassion and empathy. Nurse Education Today, 35(5), pp.e1-e5.

ROBBERTS. J., FENTON, G., & BARNARD, M. 2015. Developing effective therapeutic relationships with children, young people and their families [online]. 27(4), pp. 30-35.

RYAN, A.A. & MCKENNA, H., 2014. It’s the little thing that count’. Families experience of roles, relationships and quality of care in rural nursing home. International journal of older people nursing [online]. 10, pp. 38-47. [Viewed 1st December 2017]. Available from:

Wiechula, R., Conroy, T., Kitson, A.L., Marshall, R.J., Whitaker, N. and Rasmussen, P., 2016. Umbrella review of the evidence: what factors influence the caring relationship between a nurse and patient?. Journal of Advanced Nursing, 72(4), pp.723-734.

WRIGHT,K., 2010. Therapeutic relationship: Developing a new understanding for nurses and care workers within an eating disorder unit. International Journal of Mental Health Nursing [online].19(3), pp. 154-161. [01november 2017]. Available from: