Therapeutic relationships in healthcare settings facilitate fundamental provision of effective nursing care through utilisation of effective communication that promotes health and well-being of patients (Foster & Hawkins, 2015). Effective communication and active listening skills from both patient and health professionals promote emotional engagement between the two. This aspect ensures accurate assessment and understanding of patient’s needs and delivery of effective patient centered care by health professionals. Welch, 2015 also states that therapeutic relationships have several benefits on patients such as; provision of psychological support, effective communication of distressing thoughts and feelings, promotion of self-care as well as delivery of care at the right time of patient’s choice. This enables patients to take ownership of their care, promoting independence and positive health outcomes (Doherty and Thompson, 2014). Consequently, there has been renewed focus on the importance of how nurses interact with patients in practice, in order to promote positive health outcomes (Nursing and Midwifery Council, 2015; Sutcliffe, 2011.
The essay aims to discuss the process of building therapeutic relationships in clinical practices, demonstrating professional values that provide safe, effective and person centred care. Doherty (2014) defines therapeutic relationship as ‘one in which patients feel comfortable being open and honest with the nurse, which facilitates development of productive relationships that include empathy, genuineness, trust and valuing each other’s beliefs. The definition suggests that in order to develop therapeutic relationships, nurses have must be caring, open, warm and genuine. Canning, etal (2016) suggests that therapeutic communication displays empathy and warmth that helps patients to feel relaxed and secure. When patients are listened to, they feel respected and gain trust and confidence to discuss their anxieties and worries. In this instance nurses will also be strengthening positive patient-nurse relationship which also creates connectedness between nurse and patients. McCabe and Timmons, 2016 also suggest that listening is a vital component of building rapport with patients where personal judgements are not displayed. A hospital environment can be distressing for patients, therefore open communication nurtures trust, that creates harmony and healing (Watson, 2015). Hence, by showing empathy the patients get reassurance that nurses understand their emotions and feelings. When nurses identify with patients’ needs, they develop insight understanding of patients’ circumstances that’s facilitating holistic treatment of patient (Nursing and Midwifery Council, 2015; Sutcliffe, 2011).
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Effective therapeutic relationships develop over time through effective communication, listening and promoting compassionate care by health professionals. However, time constraints can be a barrier where staff shortages result in failure on the part of nurses to effectively listen and devote time to patients as nurses work rapidly providing medication on specific times (Foster and Hawkins, 2015). In this instance nurses cannot effectively engage with patients to promote therapeutic relationships, which also results in negative implications such as compassionate fatigue. When this happens, patients feel neglected and lose their independence which limits positive health outcomes. (Foster and Hawkins, 2015).
Staff shortages can also create negative staff attitudes as a result of tiredness from staff who have little time and therefore developing therapeutic relationships might then be viewed as irrelevant.
According to the Nursing and Midwifery Council Code of Conduct(2015), nurses must practice effectively and prioritize patients, putting them at the heart of their practice. In this instance, it rests and nurse’s responsibilities to address these mishaps through their managers and ensure their patients are not neglected as a result of mismanaging priorities by health officials.
There are several concepts of building therapeutic relationships that can be utilized by nurses which are communication, compassion, empathy, trust and respect. Nursing and Midwifery Council code of conduct (2015) underlies these key concepts with the principle of prioritizing individuals to facilitate maintenance of dignity while engaging with patients. I will reflect on three concepts which are empathy, compassion and communication as well as how my professional values supported developing and engaging in therapeutic relationships in my clinical placement. The Royal College of Nursing, (2014) defines reflection as a type of thinking associated with deep thought, aimed at achieving better understanding through recapture of day to day experiences and evaluating nursing practice. Throughout the essay pseudonyms names will be utilized to facilitate confidentiality.
John was admitted to the ward as a result of deterioration from the stroke he suffered a year earlier. My first encounter with John was to undertake some clinical observation and report to the nurse. I introduced myself to John, shaking his hand to quickly establish trust and respect, and ensure he feels at ease. I went on to tell him my role and then requested his consent to undertake a clinical observation procedure. Jones and Bartlett (2013) states that good communication is the cornerstone of nurse-patient relationship that empowers patients with trust and confidence to verbalize their insight feelings, preferences and needs. The goal of requesting patient’s permission before undertaking any procedure reassures them that they are respected, accepted as unique individuals who are valued in their own right.
By requesting John’s consent to take clinical observations, I was exercising compassion and empathy towards him. Therefore, displaying empathy to John ensured I am aware and understood his pain and grief as he also displayed understanding by being at ease while nodding his head with a smile on his face. Hobbs (2012) defines empathy as ability to put oneself into patient’s position and trying to understand the pain or grief in their terms. Understanding patient’s circumstances and their explanations is of paramount value to their positive emotional well-being and health outcomes.
Therefore, to facilitate this aspect, as a student nurse, I utilized my active listening skills to achieve this aspect and wrote this Therapeutic relationships in nursing essay. Research suggests importance of active listening skills that allow patient to legitimize their feelings and recognize that nurses have the ability to relate to their emotional experiences (Balzar-Riley 2013). Shipley, (2013) suggest that remaining silent and listening are essential techniques that build rapport with nurse-patient relationship.
Patients feel valued as persons of worth when listened to by clinicians as some would have lost their self-esteem, therefore listening to them boosts this aspect. In this way they also get encouragement to share their personal insight thoughts and feelings with confidence and trust while contributing to informed decisions relating to their care. During the insight conversation, I also displayed empathy by a light touch of the patients arm to support understanding of how the patient feels about their situations.
However, touching the patients arm may be misconstrued by some, yet evidence suggests its value in maintaining a helpful approach while developing therapeutic relationships (Playfair, 2012). In this instance nurses have to reflect on their practice that includes self-knowledge and awareness of professional boundaries and maintain limits of the professional role. Thus also understanding the current phase of the relationship with the patient as therapy aims to be a purposeful, goal oriented relationships directed at advancing the best interest and positive health outcome of the patient.
Another concept I used to support therapeutic relationship at my clinical placement was displaying compassion. Nyatanga,(2013) defines compassion as ‘showing feelings towards the plight of others through relationships based on empathy, respect and dignity – it can also be described as intelligent kindness, central to how people perceive their care. Being in a hospital environment can be a distressing experience, therefore displaying compassion to patients ensures them to adjust to their circumstances at that stage.
Chochinov, 2016). Department of Health (2014) states that compassion entails emotional response that goes beyond acts of basic care, going extra mile to offer kindness, and displaying interest without stereotyping. Nurses have to provide compassionate care by respecting, listening and treating patients with dignity. This aspect is crucial to patient recovery and positive health outcomes, also being supported by the Nursing and Midwifery Code of Conduct (2015) that all nurses have to adhere to. The element of compassion demands searching for anything that could offer and relieve the patients suffering, even a glass of water resembles a sense of care (Chochinov, 2016).
Phil, was admitted to the ward after an accident which resulted in severe head injuries. Phil was of albino statue and I felt he could be conscious of being judged against his colour or stereotyped by staff. His body was covered in blood as a result of several bleeds from his self and he was just lying in his bed under extreme shock about the whole incident. I noticed Phil had not touched his food and went to him to introduce myself, requesting if l could warm his meal which was cold at that time. He displayed a smile, looked pleased about this and while eating his meal, I sat next to Phil and tried having a non – clinical dialogue about his family, work and hobbies.
Jones and Ballert (2013) suggests that encouraging patients to share their life stories makes them feel valued as people of worth not just as diagnoses or procedures. Sharing information with Phil enabled me to understand his life, priorities and challenging adjustments he had to go through as a result of the accident as a result I changed his care plan to involve Phil’s preferences of care. I asked him if there was anything else I could do to make him feel better to display understanding of the pain Phil was going through, seeking consent to help him with washing the blood on his self although he was capable of doing this. Jones and Ballert (2013) also states that several ways of displaying compassionate care by nurses is displaying insight awareness of the patients suffering with desire to relieve pain while responding with humanity and kindness to the person’s pain, distress or anxiety. From the patients point of view, this can facilitate holistic healing where co- ordination of interpersonal and professional skills contributes to successful patient-nurse relationship.
Good communication as well has been put at the core of developing positive therapeutic relationships with patients that promote positive feelings of self – worth from patients and feelings of achievement from nurses. Lewis, (2014) defines communication as a two-way process, where patients gain confidence to verbalize their needs and wishes in relation to their care as well as insight fears and hopes, while nurses exercise active listening that facilitate understanding of message conveyed.
Communication can also require use of non-verbal techniques to be applied where individuals have verbal communication challenges. Mast, (2011) defines non-verbal communication as behaviour in the absence of linguistic content and where nurses might fail to recognize cues, promoting risk of no development of a meaningful therapeutic encounters. While communication is meant to establish relationship through information shared with nurses, some patients who come into hospital environment may have speaking challenges. It is important in such cases that specialist support has to be sourced from nurses or families to ensure appropriate delivery of care for individuals. Purtilo and Haddard (2013) state that in these circumstances body language can be used to build rapport with patients such as warmth expressed through friendly facial expression, maintaining comfortable eye contact and smiling which helps the patient to relax and feel at ease.
By being open and sensitive to their language, nurses develop endanger trust in patients thereby promoting therapeutic relationship (McCabe and Timmins, 2013. The nursing and Midwifery Council (2015) advocates communication, trust, dignity and respect as fundamental aspects of care delivery that facilitate effective therapeutic relationships. Respect involves accepting other individual’s beliefs despite nurse’s personal feelings as patients come from a variety of backgrounds. Jones and Bartlett (2012) puts emphasis on the importance of non- judgmental attitudes about patients and accepting everyone as unique human beings in their own right.
As nurses, being an effective communicator with culturally diverse patients, it is important to be aware of different cultures and norms that affect values and behaviors in different societies and maintain professional boundaries. Therefore, in order to achieve this, as a student nurses, I made sure I spend time communicating with patients with a focus to establishing information to facilitates effective person centered care. Promoting dialogue also facilitates understanding of people’s cultures, respecting their boundaries thereby acting as professionals rather than personal friend (Rushton, 2014). This kind of relationship promotes dignity and gives patients confidence to share their concerns and be involved in their care to support holistic healing of patient. This therapeutic relationships in nursing essay was my goal of to facilitate development of therapeutic relationships in a professional manner.
In addition to this, there are facilitators that contribute to development of therapeutic relationships when nurses listen to patients in order to build trust from patients. Arnold, (2014) states that building trust involves values and emotions that results from interacting with patients and acting in trust. therapeutic relationships in nursing essay. In this way, nurses understand patients’ values. This aspect also helps to raise patient’s self-esteem and feelings of worth as respected individuals. The concept promotes prioritizing people as underpinned by Nursing and Midwifery Council code of conduct (2015).
The therapeutic relationships in nursing essay demonstrates that therapeutic relationships can only be effective when underpinned by gaining patients co-operation and encouraging patients involvement in all stages of assessment and care planning purposes. These aspects facilitate tailoring care towards patient’s preferences and needs while valuing them as people of worth. Effective communication, recognizing and maintaining professional boundaries also facilitate comprehensive development of therapeutic relationships that promote positive health outcomes for all patients.
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