Orientation: Nội dung chính Show
- In the beginning of the therapeutic relationship, the nurse and client are strangers to each other, yet each individual has preconceptions of what to expect – based on previous relationships, experiences, attitudes and beliefs
- The parameters of the relationship are established [e.g., place of meeting, length, frequency, role or service offered, confidentiality, duration of relationship]
- The client and nurse begin to learn to trust and know each other as partners in the relationship
- Trust, respect, honesty and effective communication are key principles in establishing a relationship
Working Phase:
- The working or middle phase of the relationship is where nursing interventions frequently take place
- Problems and issues are identified and plans to address these are put into action. Positive changes may alternate with resistance and/or lack of change
- It is important for the nurse to validate thoughts, feelings and behaviours
- The nurse assists the client to explore thoughts [e.g. views of self, others, environment, and problem solving], feelings [e.g. grief, anger, mistrust, sadness], and behaviours [e.g. promiscuity, aggression, withdrawal, hyperactivity]
- The content to be explored is chosen by the client although the nurse facilitates the process
- The nurse continues his/her assessment throughout all phases of the relationship
- New problems and needs may emerge as the nurse-client relationship develops and as earlier identified issues are addressed
- The nurse advocates for the client to ensure that the client’s perspectives and priorities are reflected in the plan of care
Resolution Phase:
- The resolution or ending phase is the final stage of the nurse-client relationship
- After the client’s problems or issues are addressed, the relationship needs to be completed before it can be terminated
- The ending of the nurse-client relationship is based on mutual understanding and a celebration of goals that have been met
- Both the nurse and the client experience growth
- Termination may be met with ambivalence
- The nurse and the client must recognize that loss may accompany the ending of a relationship
- Both should share feelings related to the ending of the therapeutic relationship
- Validating plans for the future may be a useful strategy
- Increased autonomy of both the client and the nurse is observed in this phase
The therapeutic nurse-patient relationship is at the core of nursing practice. When established properly, the relationship contributes to a patient’s health and well-being.
For this reason, nurses are accountable for establishing and maintaining therapeutic relationships with their patients, including maintaining appropriate professional boundaries.
It is also important to know that the relationship lasts as long as the patient needs nursing care. This means that no matter how short or long the time span, a therapeutic nurse-patient relationship is formed.
To make sure the patient’s needs are prioritized, nurses must understand that the following five components are always present in a therapeutic nurse-patient relationship:
Trust:
Trust is critical to the therapeutic relationship. It may be fragile at first, and you need continual effort to maintain it.
Respect:
To respect is to recognize that every individual has inherent dignity, worth and uniqueness, regardless of socio-economic status, personal attributes and the nature of their health problem.
Professional Intimacy:
When nurses provide intimate care activities to their patients, such as bathing, it creates professional closeness. Professional intimacy can also involve being privy to psychological, spiritual and social elements that are identified in patients’ plans of care.
Empathy:
A nurse shows empathy by understanding, validating and confirming what the health care experience means to the patient. Nurses must ensure that they maintain appropriate emotional distance from the patient to ensure objectivity and an appropriate professional response.
Power:
The nurse-patient relationship is one of unequal power. The nurse has more authority and influence in the health care system, access to confidential information and the ability to advocate for the patient. If a nurse misuses this power, it is considered abuse.
Nurses’ responsibility to establish and maintain the therapeutic nurse-patient relationship also includes maintaining proper boundaries. This means that nurses must not engage in any behaviour or activity that could be perceived as violating a boundary. Violating a boundary means a nurse is misusing their power and trust in the relationship to meet personal needs or is behaving in an unprofessional manner with the patient.
Page 11 of the Therapeutic Nurse-Client Relationshippractice standard has a decision tree which helps to determine whether an activity or behaviour is appropriate within the context of the nurse-patient relationship and meets a therapeutic purpose. For more information about nurses’ accountabilities to their patients, read the Code of Conduct.
It is also important to be aware of the differences between professional and social relationships. Nurses must make sure they set appropriate boundaries that prevent a professional relationship from becoming a social one. For more information, read the Ask Practice FAQ: Professional versus social relationships.
What is the importance of a therapeutic relationship in nursing?
Therapeutic interpersonal relationships between health care professionals and patients are associated with improvements in patient satisfaction, adherence to treatment, quality of life, levels of anxiety and depression, and decreased health care costs.
What is most effective when the nurse is developing a therapeutic relationship with a patient?
The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding one's own attitudes, values, and beliefs is called self-awareness.
What is a key component of the therapeutic nurse
The five key components of the therapeutic nurse-client relationship are professional intimacy, power, empathy, respect and trust. Regardless of the context, length of interaction and whether the nurse is the primary or secondary care provider, these components are always present.
What is the most important characteristic of a nurse
Compassionate One of the most important qualities of a good nurse is compassion. In their career, nurses will see patients suffer. Beyond simply offering a solution, they must be able to express compassion for patients and their families. This allows them to form meaningful relationships with their patients.