Nurse-Patient Therapeutic Relationship and Advocacy - Essay Example

Nurse-Patient Therapeutic Relationship and Advocacy Name Institution Date Instruction Caring for a patient takes more than just giving them the basic medicinal and personal care. It entails a careful establishment of the two key areas of professional nursing practice. These areas include the therapeutic nurse-patient relationship and patient advocacy. In order to improve quality and safety in nursing and patient care transitioning graduate registered nurses have first to understand the concepts behind these two topics and what standards underlie the same areas. This study describes therapeutic nurse-patient relationship and advocacy in the context of professional nursing practice and further justifies the importance of the same using critical reflections and arguments. Therapeutic Nurse-Patient Relationship The therapeutic nurse-patient relationship is the most fundamental aspect of the care of a patient as described by the famous psychotherapist Carl Rodgers. The therapeutic nurse-patient relationship refers to a helping relationship that exists between a nurse and patient. This relationship usually gets built on the basis of nurturing of faith and hope, mutual trust and respect and sensitivity to self and others. It also encompasses the act of assisting one’s patient’s physical, emotional and spiritual needs with gratification; through your knowledge, skill and expertise (Polit & Beck 2012). According to Rogers, therapeutic nurse-patient relationship qualifies as a helping relationship because one of the participants extends care to another and expects more appreciation or expression of gratitude from the other party. Other authors have come up with various definitions, but all definitions closely link to the concept of a helping relationship. This caring relationship develops gradually over time when the patient and the nurse come together in a harmonious moment of healing and care giving. The most important components of therapeutic nurse-patient relationship include effective verbal and non-verbal communication as they make up the basis of nurse-patient interaction. The other aspect that needs careful handling involves providing care in a manner that, enables the patient to become an equal partner in achieving his or her wellness. For example, introducing yourself to the patient, followed by a handshake, becomes one of the initial ways to gain trust and respect, in a therapeutic nurse-patient relationship before; getting to go into deeper communication (Vouzavali et al., 2011). In order for a therapeutic nurse-patient relationship to work effectively, nurses have to uphold and stick to certain elements and standards of caregiving. For example, they ought to express warmth towards their patients and remain respectful; by attending to patients as individuals and unique beings. Dignifying a patient puts the patient at ease as they feel more valued; hence tend to open up more to their nurse who acts as therapy in their treatment. A nurse demonstrating a high sense of professionalism would also assure the patient that they are in capable hands thereby building the nurse-patient trust about one's capabilities. In his definition of the therapeutic nurse-patient concept, Carl Rodgers highlighted the three core components of such a relationship. First, a nurse has to show empathy, which is a continuous process in caregiving. This component involves her putting aside her way of experiencing and perceiving reality and adjusts her preferences, sense and response to match the experiences and perceptions of her patient (Williams, 2008). A patient tends to feel isolated and neglected when the nurse caring for her lacks any sense of empathy, and this will result in a poor relationship between the two; thereby affecting their treatment plan. The second most crucial element involves having unconditional positive regard for your patients; exhibited through a given fundamental attitude of being a person-centered counsellor for your patients. A nurse who holds such an attitude provides care for their patients irrespective of what beliefs and values the patient holds (Williams, 2008). This element cultivates much deeper trust and mutual connection that defines the level of therapeutic relationship between a nurse and his patient. Thirdly, professional intimacy has to be inherent in any nursing care given to a patient. For example, it may involve bathing the patient and dressing them, this professional level of relating to the patient creates a level of closeness that build the therapeutic relationship; hence improving treatment. This element can also involve connecting with your patient on a psychological, spiritual and social point of view based on the standards of the care plan. The last component or element involves trust. Trust is the most critical element that lays the foundation for the nurse-patient relationship; because the patient exists in the most vulnerable position. Establishing initial trust can become very fragile. Therefore nurse ought to keep the promises they make to their patients. Other elements that constitute a nurse-patient therapeutic relationship include, power, maintaining high confidentiality standards and treating patients as individuals at all times (Perry, 2012). Standard statements guide and play as indicators on how nurse ought to behave and conduct themselves with their patients. These standard statements also describe the individual accountabilities for nurses and dictate how nurses can build and enhance the therapeutic nurse-patient relationship. They include: a) Therapeutic Communication Nurses are required to use a wide range of communication and interpersonal skills when communicating with their patients. For example, verbally introducing yourself to the patient, using their names when communicating, sharing with them information about their health and being aware how they perceive verbal or non-verbal communication, carries significant effect in the nurse-patient relationship (Pullen & Mathias, 2010). If necessary, modifying the communication style to meet the patient needs, listening and refraining from disclosing harmful information can contribute immensely to building trust and mutual respect hence enhancing the nurse-patient relationship; for better treatment. b) Client-Centered Care By working with the patient and professionally ensuring that all the actions undertaken meet the patient's therapeutic needs; the nurse tends to build the level of trust and respect faster. This development comes about because the patient gets assured of their capability and feels safe under their care. A nurse can accomplish client-centered care through understanding the patients’ limitations and abilities, discussing expectations with them and recognizing how their actions affect the patients’ well-being. c) Maintaining Boundaries Nurses are responsible for the initial establishment and maintenance of boundaries in therapeutic nurse-patient relationships. Nurses can only meet this standard and enhance the therapeutic relationship by ensuring that the existing relationship doesn’t undermine the judgment and objectivity of the new nurse-patient relationship. They should also understand the limits of patients’ requests follow the comprehensive care plan, get a team involved in any approach that seems to cross the boundary and keeping off patients’ personal relationships. Considering the patients’ values and constantly clearing their role in the therapeutic relationship may also save and enhance the relationship more, among other indicators that stay within the comprehensive care plan. d) Shielding the client from abuse As a nurse and a caregiver, the nurse should protect the patient from any harm by ensuring that they stop, avoid and prevent any abuse, and abusive language directed to patients. Through intervening, reporting, counselling and avoiding behaviors that patients may perceive as abusive, the nurse will build a stronger bond with the patient; based on trust, respect and professionalism ethics. Advocacy The definition of the concept of advocacy got derived from the Latin word advocate which means someone who is summoned to give evidence. However, the synthesis of advocacy in nursing is defined as the patients’ right to information and self-determination (Zomorody & Foley, 2009). Therefore, the philosophical definition of advocacy is fighting for patients’ right to information and self –determination. Patients are at their most vulnerable point when under the care of a nurse in hospitals or nursing homes; therefore they may require an advocate. History of nursing defines advocacy as a philosophical nursing principle that got utilized in the practice, as it involved interceding on behalf of patients; in different ethical dilemmas (Gosselin et al., 2007). Advocacy in nursing can take different dimensions, for instance, a nurse participating in determining the health, suffering and dying of a patient as well as providing the necessary information to the client as well as supporting the patient’s decisions. Nursing has incorporated the concept of advocacy in the practice to stand as a whistleblowing medium that protects the patients from unethical behavior and neglect (Davis & Konishi, 2007). Based on prominent nursing theories the patient and the nurse share a common humanity bond; a close, caring relationship that mostly translates to advocacy. Researchers have also proposed that the nurse-patient therapeutic relationship is central to nursing advocacy and dictates the basis on which nurse primarily advocates a patient. Using Kohnke’s theory, every patient has a right to self-determination; that includes the right to make freely decisions as they wish. On the other hand, nurses are obligated to inform the patients of their rights and support the decisions they make without maliciously interfering. This way patient find meaning in their personal illness, suffering, and dying experiences; hence they end up trusting their nurses more; enhancing the therapeutic relationship. There exist core attributes of advocacy that nurses synthesize in the nursing advocacy. These attributes include protecting the patient’s autonomy, acting on behalf of the patients especially in legal rights’ issues and thirdly championing social justice in the provision of healthcare to patients. The importance of nurse-patient therapeutic relationship and advocacy for all transitioning graduate registered nurses. Based on the standard statements of therapeutic nurse-client relationship, nurses are held accountable for the nurse-patient relationship and any decisions they undertake based on the same. This is why it is critical for transitioning graduated registered nurses to comprehend which behaviors and activities qualify as appropriate within the nurse-patient therapeutic relationship context. The transitioning graduate registered nurses also needs to understand that therapeutic nurse-patient relationship, and advocacy are somehow connected; and that without a well -established nurse-patient relationship there is no way advocacy can successfully take place. This knowledge is important to these graduates because they are now entering the real world of professional nursing, and they would, therefore, need this knowledge if they are to dispense their services effectively. Advocacy and therapeutic relationship between nurses and patients and patients are topics that directly apply to the field; that the new graduates are intended to work. Therefore, for them to provide quality care and ensure the safety of patients they need to understand these concepts. For instance, when faced with a problematic patient or a legal issue caused by the patient; the new nurse would have the necessary knowledge to handle the problem in an ethical manner (Granados, 2009). The nursing practice has had long debates regarding reflective care and client-centered care but with the latest knowledge and advanced research into this topic the transitioning nurses can now practice the same without any fear. As long as they remain within the comprehensive care plan, these topics are critically important in ensuring that the transitioning graduates observe the ethics and standards of therapeutic nurse-patient relationship as well as advocacy principles. Justification of nurse-patient therapeutic relationship and advocacy Several arguments have emerged regarding the justification of nurses as being in the best position to advocate for patients. Reviewing the overall structure of professional in the nursing practice, nurses indeed occupy the middle ground in patients care; compared to doctors or any other nursing professional. Therefore, this proximity allows them a unique relationship and emotional bond with the patients. It is only logical that they would best suit being the advocates for patients in any circumstance (Evans, 2007). Critiques have also argued that two powerless parties cannot necessarily join to become an empowered unit. Nonetheless, advocacy still continues to reflect and embed itself in the current nursing practice as a way of maintaining ethics and patients’ rights. For instance, the American Nurses Association Code of Ethics has continuously stated its commitment to patient advocacy (Hanks, 2008) and so is the United Kingdom Central Council for Nursing Midwifery. The professional application of advocacy indicates that the attributes of this concept were borrowed from the legal and moral rights and induced into the nursing practice. This concept has matured, and the obvious theoretical models are slowly being assimilated into practical nursing practice. The important roles of power and politics, in advancing policy options has seen the Canadian Nurses Association and other partners develop a range of resources; to enable their nurses mix decisions and maximize the support of the outcomes of advocacy. The justification for the advocacy being globally recognized means that the transitioning graduates have an ample opportunity of speaking out against inequity and inequality in their nursing practice profession (Kibble, 2012). Currently, in the field of psychiatric nursing, the therapeutic nurse-patient relationship remains the basis and the core by which psychiatric nursing programs and patient training rely on to succeed. Looking at the area of mental health, the therapeutic interpersonal relationship between the nurse and the patient has led to tremendous results in the implementation of the psychosocial intervention for mental health treatment. Nurses have reaffirmed the benefits of using self and the therapeutic relationship as a tool for the effective implementation of the psychosocial intervention. Therefore, such an advancement in psychiatric nursing and therapeutic communication justifies these two topics being incorporated in the field of professional nursing practice. The transitioning graduates learn can also learn through these topics that communication remains a primarily fundamental tool when it comes to the establishment of therapeutic nurse-patient relationship (Scanlon, 2010).Additionally, the UK and Ireland have advanced the mental health nurses training programs to include the specific caring for mental patients using the concept of nurse-patient therapeutic relationship and advocacy. This is because the duty of a psychiatric nurse also entails maintaining a positive therapeutic relationship with their patients in a clinical setting. The key elements of mental health care revolving around the therapeutic relationship established between nursing professionals and patients, therefore, justify the workability and success of the two concepts mentioned above, (Dziopa & Ahern, 2009) Despite the above justification that therapeutic nurse-patient relationship and advocacy has a significant impact on different aspects of the nursing practice, people still argue about the concept of empathy in nursing. Recent debates on the concept of empathy in the establishment of therapeutic nurse-patient relationship reveal questions as to whether empathy can lead to the abuse of patient trust instead of building the same. Empathy has nothing to with sharing and breaking the patient’s trust because empathy is more of an emotional attribute compared to communication. Conclusion In conclusion, trust in patient care and reciprocity remains the most important elements that constitute the nurse-patient therapeutic relationship for improved treatment. Without such a relationship nurses would never have discovered or successfully implemented the concept of advocacy. Even now with the emerging changes in Medicare and Medicaid, healthcare reforms, mental health parity, workplace safety, ethics and health care consumer rights, there is the urgent need for nurses to continue with advocacy. This is where the transitioning graduate registered nurses come in; as these topics put them at a better position of successfully establishing nurse-patient therapeutic relationships for better advocacy. References Center for Caregiver and Patient Advocacy. (2000). Revolution: The journal for RNs and patient advocacy. Oakland, CA: Center for Caregiver and Patient Advocacy. College of Nurses of Ontario (2006). 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