Therapeutic Nurse-Patient Relationship - Essay Example

? Lecturer presentation a) Define and describe a therapeutic nurse patient relationship in a healthcare setting In nursing practice, establishing a therapeutic nurse patient relationship is imperative to promote the client’s recovery. CNO (2004) asserted that the “essence of professional nursing is the therapeutic relationship with the patient” (p. 12). Therapeutic nurse patient relationship is “a planned, time bound and goal oriented connection between a registered nurse and a patient, and sometimes the patient’s family for the purpose of meeting the healthcare needs of the client” (NANB, 2011). According to Wright (2006), the relationship is mutual, founded on trust, respect and professional intimacy. For a therapeutic patient nurse patient relationship to function effectively, the nurse should use his/her professional powers appropriately. Other people responsible for the patient’s wellbeing such as family members or friends also form an important component of the therapeutic nurse patient relationship. Duration of therapeutic nurse patient relationship varies, depending on the health needs of the patient and it expires once the patient recovers. Moreover, it also depends on the possibility of having to take care of the patient once again in future. However, the relationship between the nurse and the patient’s friends or family is not limited to the duration of care and may continue after the client is no longer under the care of the particular nurse. In therapeutic nurse patient relationship, the nurse is not only responsible for establishing the association with the client but also in maintaining it. According to Barry (1996), maintaining the relationship requires professional application of nursing knowledge, skills and behaviors. In healthcare setting, therapeutic nurse client relationship comprises four main elements, namely trust, power, respect and professional intimacy (DeLaune & Ladner, 2002). Professional intimacy is “the type of activities that registered nurses undertake for and with the patients, which result in establishment of private and more personal relationship between the two parties” (CNO, 2004). According to CNO (2004), professional intimacy could involve development of emotional, social, physical, and spiritual relationship but not sexual closeness. Power is the other defining element of the patient client relationship and NANB (2011) argues that it is tilted in favor of the nurse. The registered nurse possesses more power and authority than the patient due to the higher position he or she holds in the healthcare system and his/her inherent specialized skills in nursing practice. This places the nurse in a more influential position of determining the nature of relationships with the client and other healthcare providers in a healthcare setting. Moreover, the nurse is in a better position of accessing sensitive information relating to the patient under his or her care (CNO, 2004). The manner in which the nurse utilizes these powers determines the nature of relationship with the clients. Therefore, it is important for the nurse to apply these powers appropriately to promote good working relationship with the patient and attainment of expected health outcomes. This ensures that the relative powerlessness of the patient is not taken advantage of and the client’s healthcare needs are met. Trust is another element of a therapeutic nurse patient relationship and it is shown by the confidence and faith that the client has about the nurse ability to cater for his or her health needs. According to Hubert (1998), the patient expects the nurse to apply his or her professional skills appropriately and exhibit compassionate attitude so that the client can develop trust on the nurse ability to take care of him or her. Therefore, the ability of a nurse to win the trust of the client is very important, considering the relative powerlessness of the patient in the nurse patient relationship. In order for the nurse to gain the trust of the patient, the healthcare provider should be dependable in keeping his or her promises with the patient. Sundeen et al. (1998) argued that once the trust between client and the nurse is broken, restoring it becomes quite challenging and could jeopardize attainment of expected health goals. Finally, therapeutic nurse patient relationship should be based on respect for the patient’s uniqueness, culture, and other personal defining characteristics (McQueen, 2000). The nurse should be adequately informed on the culture and personality of the patient, to avoid breaking the trust and confidence while providing healthcare services. According to McQueen (2000), the nurse should be respectful by being nonjudgmental towards the patient and demonstrating curiosity of establishing the implications of the client’s verbal and non verbal cues. Moreover, making stereotypical comments and blaming the client undermines the respect between the concerned parties in therapeutic nurse patient relationship (Milton, 2008). b) Importance of developing therapeutic nurse patient relationship Developing a therapeutic nurse patient relationship is essential in health setting because it promotes effective communication between the two parties concerned. This provides the healthcare provider with good opportunity of assessing the health needs of the patient and making accurate diagnosis. Conventional healthcare setting comprises nurses and patients from diverse cultural backgrounds. These differences normally create communication challenges between the patient and the healthcare providers, which undermine attainment of intended health outcomes (Barry, 1996). Desmond and Copeland (2000) indentified six common barriers that hinder effective patient-nurse communication in a healthcare setting. These impediments include language, culture, gender and health condition of the patient. In addition, the developmental stage of the patient and emotional state of the client are important barriers to communication in a healthcare setting. Language barrier does not only arise when two people use different dialects but also while speaking in the same language. In a healthcare setting, the patient and the nurse could be speaking in the same language but fail to understand one another because of using complicated vocabularies in form of medical jargon, poor listening skills and misconceptions. In such situations, developing therapeutic nurse patient relationship enables the care provider to indentify the barriers and formulate more appropriate method of communicating with the patient. This includes being more conscious of verbal and non verbal communication cues used by the patient. Differences in culture are also important barrier to communication between patient and nurses. Different cultures exhibit distinct communication patterns that unfortunately impede effective patient nurse interaction in healthcare setting. Sundeen et al. (1998) identified eye contact, physical closeness and contact as some of the most important elements of communication affected by cultural differences while attempting to establish therapeutic nurse patient relationship. Patients experiencing chronic pain often demonstrate communication difficulties while interacting with the healthcare providers (Hubert, 1998). Moreover, ability to communicate effectively in healthcare setting is affected by developmental level of the client. Young patients, for instance, do not have well developed information processing skills, and could create communication difficulties. In spite of these barriers to effective communication in healthcare setting, the nurse is under professional responsibility to establish a therapeutic relationship with the patient to achieve the desired health outcomes. The nurse should use his or her powers appropriately by treating patients with respect and dignity, in addition to maintaining trust and professional intimacy. Therapeutic nurse patient relationship is essential because it helps nurses conduct effective medical assessment of a patient. It provides a favorable environment that encourages the patient’s participation in indentifying and assessing health challenges affecting him or her. Therapeutic nurse patient relationship encourages participatory interaction between the healthcare provider and the client. While examining a patient, the nurse endeavors to comprehend the client by processing both verbal and nonverbal signs. In this case, therapeutic patient nurse relationship enhances the ability of the nurse to make accurate health assessment of the client (Desmond & Copeland 2000). Therefore, the nurse is able to make accurate diagnosis and execute relevant treatment and management intervention. Sundeen et al. (1998, p. 118) defined accurate diagnosis as “an art of communication that is perfected by the experience”. The precise diagnosis arises from therapeutic patient nurse relationship which occurs when the patient feels safe and secure under the nurse’s care. Consequently, the patient is able to tell the nurse all relevant information relating to his or her illness. Careful attention and correct interpretation of the patient’s verbal and nonverbal communication enables the nurse to decipher and indentify the patient’s needs which is essential for making accurate diagnostic decision. References Barry, P. (1996). Psychosocial nursing care of physically ill patients and their families. (3rd ed). Philadelphia: Lippincott. CNO (College of Nurses of Ontario). (2004). Therapeutic nurse client relationship. Retrieved from http://www.firsthealthcare.ca/docs/nursing_practice_standards/41033_Therapeutic.pdf DeLaune, S., & Ladner, P. (2002). Fundamentals of nursing. (2nd ed). Clifton Park, New York: Delmar Learning. Desmond, J., & Copeland, L. (2000). Communicating with today’s patient. San Francisco: Jossey-Bass. Hubert, P. (1998). Revealing patient concerns. American Journal of Nursing, 98(10), 12-19. McQueen, A. (2000). Nurse patient relationship and partnership in nursing care. Journal of Clinical Nursing, 9, 723-731. Milton, C. (2008). Boundaries: Ethical implications for what it means to be therapeutic in the nurse patient relationship. Nursing Science Quarterly, 21(18), 164-186. NANB (Nurses Association of New Brunswick). (2011). Practice standard: Therapeutic nurse client relationship. Retrieved from http://www.nanb.nb.ca/downloads/Practice%20Standard%20-%20Nurse- Client%20Relationship%20-%20E.pdf Sundeen, S., et al. (1998). Nurse client interaction: Implementing the nursing process. (6th ed). St Louis: Mosby. Wright, L. (2006). Violating professional boundaries caution. Nursing, 36(3), 50-54. Read More