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The Concept of Therapeutic Nursing and the Importance of Nurse-Patient Relationship

Discuss about the Therapeutic Practice in Nursing for Medical Care.

Caring is the fundamental aspect of nursing and develops with the therapeutic use of self, a process between the nurse and the patient. Nurses are responsible for making patient satisfied, while ensuring appropriate and adequate quality of medical care. For this, a positive and trustworthy relationship is needed to be developed within the patient and nurse, which is known as the therapeutic relationship or therapeutic alliance. In this context, the nurse needs to consist several important skills and competencies for achieving the standards of therapeutic care aligning with their nursing skills and regulations (Arnold and Boggs 2015). In this context, this essay will focus upon nursing the concept of therapeutic nursing and the characteristics of the relationship, while the essay would also explore how the skills related to therapeutic care is implemented

Within the context of healthcare one of the most important factors is the establishment of an effective therapeutic relationship between the nurse and patient. It has been observed in several previous literatures that the therapeutic care is beneficial for the patients to gain support in the health care context and provide the motivation to deal with the illness with positive strength. Nurses need to show some skills and competencies to develop a strong and trustworthy relationship with the patient. Grove et al. (2012) argued that understanding the basic components of this therapeutic relationship and the way to achieve these components in nursing practice is a vital aspect of nursing training and continuous professional development.

To appreciate the importance of therapeutic relationship in the health care context, defining the nurse patient therapeutic relationship in practice context is very important. Blais (2015) described therapeutic relationship as “the way through which nurses communicate and interact with patients to establish a clear clinical outcome”. In 1950s, famous psychotherapist Carl Rodgers defined therapeutic relationship as the fundamental element to the care of a patient. According to the psychotherapist, “it is a relationship in which one of the participants intends that there should come about, in one or both parties, more appreciation of, more expression of, more functional use of the latent inner resources of the individual”. The therapeutic environment, which involves therapeutic relationship, promotes the integration of therapeutic nursing care. In this context communication is the key element of therapeutic nursing care. The relationship is dependent upon the professional and behavioural attributes of the nurse, the communication style, compliance of the nurse towards the ethical standards of nursing as well as the adherence of the patient with the therapeutic relationship standards.

Key Characteristics Required by a Nurse for Establishing a Positive Therapeutic Relationship

In this context, the nursing staffs should consist some key characteristics to ensure the efficacy of the care process. The nurse needs to have these characteristic skills for recognizing the boundaries of the therapeutic relationship, while keeping the focus on the patient instead of exploring own feelings and experiences. Following characteristics are crucial for the nurse to comply with the standards of therapeutic nursing relationship establishment with the patient in a positive and efficient manner. These key characteristics include:

Good communication skills: Communication skill is the most crucial skill required by a therapeutic nurse, for building a positive relationship with the patient. There a several communication styles, but the nurse need to select appropriate one, which is suitable for establishing the positive relationship with the patients in her professional field. The communication skills involve both verbal and non-verbal communication skills. The nurse should ensure that all the therapeutic information and awareness are thoroughly provided to the patient. It would maintain the transparency within the communication. Listening skills also important for the nurses to consider all the patient’s concerns, this can be incorporated in his care plan. On the other hand, non-verbal communication is also important in the health care context. Non-verbal communication like body posture, eye contact, facial expression, space and the voice tone can indicate actual feelings and expression of the patient (Kourkouta and Papathanasiou 2014). Touch is a key non-verbal communication in the therapeutic context, which shows support and care for the patient. These skills help to improve efficiency of therapeutic care and build trust within the relationship.

Empathy: The next required characteristic within the therapeutic care is showing empathy towards the patient. It is basis of effective communication within the patient and health care professional. Muran and Barber ( 2011) defined empathy as the capability of   the care giver to identify or share the emotional state of the patient and prioritize the patient’s feelings and expression; therefore empathy is related to the care giver’s emotional intelligence. However, in several cases, people confuse empathy with sympathy. However, sympathy makes patient to feel more helpless, but empathy is different, which promote the self-esteem of the patient, to overcome the illness quickly. It also strengthens the therapeutic relationship, thereby improving the health outcomes of the patient. Kelley et al. (2014) claimed that this is an intrinsic quality, possessed by some of the care givers and represented through appropriate communication and emotional skills in clinical therapeutic practices.

Communication Skills

Respect and dignity: The health care environment is different than the home environment of the patient. Thus, patient may not feel comfortable in the therapeutic environment and may also feel insecure. It is responsibility of the nurse to feel the patient secure in the health care environment through a positive relationship building. It can only be developed when the patient starts to trust the care giver and the therapeutic practices. In this context, they need to show respect and dignity towards the patient.

Genuineness and concreteness: Genuineness is another trait needed to be present within the patient, which promotes the openness, honesty, sincerity and authentication of the relationship. It shows the self-awareness of the care giver, showing clear and concrete in interacting with the patient. It promotes the spontaneous therapeutic communication in appropriate manner, thereby promoting the establishment of therapeutic relationship (Hennessey 2011).

Positive regards: This characteristic is related to the showing respect towards the patient and the therapeutic relationship. Showing positive attitude towards the patient, irrespective of patient’s non-compliance, nonprofessional or annoying behaviour is important. It is also related to listening skills and non verbal skills of the care giver.

The characteristics of therapeutic care and the skills required by a care giver to ensure adequate care to the patient through therapeutic relationship establishment can be implemented for enhancing the therapeutic value of nursing care. For instance, in nursing care, the therapeutic relationship building would help the nurse to enhance the quality of care and support provided to the patient. Moreover, communication is a key tool for achieving success in any profession. The therapeutic value of nursing care can be increased through a positive relationship building with the establishment of patient’s trust towards the clinical practice and the improved overall health outcomes of the patient (Fonagy and Allison 2014). In this context, the nurse should have all the skills and characteristic traits discussed above for establishing the therapeutic alliance with the patient.

Appropriate verbal and non verbal communication skills are required by the nurse for promoting health related communication with the patient, to promote awareness of the patient regarding his health status and provide emotional support to the patient, which would in turn helps the patient to improve his self esteem. Next, genuineness and positive regards are also required for improving patient’s perception through the care procedure and towards the care givers including the nurse. The nurse needs to have a transparent and open communication with the patient and patient’s family to promote genuineness in the practice. Showing respect and dignity is key skills of registered nurse, which are also present in the nursing competency standards and ethical codes. Therefore, these skills would help to align the practice with the ethical standards of nursing care. Non verbal communication skills are very important to be present in the nursing staffs (Hennessey 2011). It is because, being unfamiliar to the therapeutic environment, the patients sometimes do not attempt to communicate with the nurses, or sometimes patients are not able to communicate with the nurse due to health condition. At this situation, the nursing staffs needs to utilize her non verbal skills to identify and analyze patient’s body posture, facial expression, voice tones and other nonverbal signs to promote the communication (Kourkouta and Papathanasiou 2014). For instance, while dealing with a patient with severe pain, it is important to understand the severity of pain by observing the patient’s facial expression and posture carefully. Therefore, these skills are promoting the quality of nurse-patient relationship and the overall care services provided to the patient, thereby improving nursing therapeutic values.

The essay revealed that therapeutic relationship within nurse and patient is crucial in the therapeutic environment to promote patient’s positive heath outcomes, by enhancing trust and adherence of the patient towards the therapeutic practises. Here, the characteristic of the therapeutic care and the skills required by the care giver to provide adequate therapeutic care has been demonstrated. Finally, the implications of these skills on the nursing care sector have also been demonstrated. 

Reference List

Arnold, E.C. and Boggs, K.U., 2015. Interpersonal relationships: Professional communication skills for nurses. Elsevier Health Sciences.

Blais, K., 2015. Professional nursing practice: Concepts and perspectives. Pearson.

Fonagy, P. and Allison, E., 2014. The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy, 51(3), p.372.

Grove, S.K., Burns, N. and Gray, J., 2012. The practice of nursing research: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences.

Hennessey, R., 2011. Relationship skills in social work. Sage Publications.

Kelley, J.M., Kraft-Todd, G., Schapira, L., Kossowsky, J. and Riess, H., 2014. The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PloS one, 9(4), p.e94207.

Kourkouta, L. and Papathanasiou, I.V., 2014. Communication in nursing practice. Materia socio-medica, 26(1), p.65.

Muran, J.C. and Barber, J.P. eds., 2011. The therapeutic alliance: An evidence-based guide to practice. Guilford Press. 

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