Developing effective and caring nurse-patient relationships
Appendix A: Differences Between a Therapeutic Nurse-Client Relationship and a Care Nurse Practitioners by providing more specific direction to RNs. great deal toward creating a solid nurse–patient relationship. What did she do forms the foundation of nursing care throughout the spectrum of health, illness, healing, and The timing of communication is also important when work- ing with. Reprinted January as Therapeutic Nurse-Client Relationship. Revised June inherent in the type of care and services that nurses provide. . importance.
It offers an opportunity to recognize how our attitudes, perceptions, past and present experiences, and relationships frame or distort interactions with others. An example of self-awareness would be acknowledging that showing anger is not a sign of weakness, because there were emotions outside of your control. Nurses need self-awareness in this relationship to be able to relate to the patient's experiences to develop empathy. Attributes such as being genuine, warm and respectful are a few to mention.
An aspect of respect is respecting an individual's culture and ensuring open-mindedness is being incorporated all throughout the relationship up until the termination phase. It is highly beneficial for the client to incorporate their family, as they may be the most effective support system. Revealing your whole self and being genuine with clients will accomplish the desired nurse client relationship. In addition, the nurse may also reduce distance to demonstrate their desire in being involved, restating and reflecting to validate the nurse's interpretation of the client's message, directing the conversation towards important topics by focusing in on them.
Furthermore, being polite and punctual displays respect for the client in addition to remembering to be patient, understanding, also to praise and encourage the client for their attempts to take better care of their health.
One of the non-verbal factors is listening. Listening behaviours are identified as S. R; S-sit squarely in relation to client, O-maintain an open position and do not cross arms or legs, L-lean slightly towards the client, E-maintain reasonable and comfortable eye contact, R-relax.
These behaviours are effective for communication skills, and are useful for thinking about how to listen to another person. Empathy Having the ability to enter the perceptual world of the other person and understanding how they experience the situation is empathy.
This is an important therapeutic nurse behaviour essential to convey support, understanding and share experiences. Patients are expecting a nurse who will show interest, sympathy, and an understanding of their difficulties.
When receiving care patients tend to be looking for more than the treatment of their disease or disability, they want to receive psychological consideration. During hard times, clients are looking for a therapeutic relationship that will make their treatment as less challenging as possible. Many patients are aware that a solution to their problems may not be available but expect to have support through them and that this is what defines a positive or negative experience.
Past experiences can help the clinician can better understand issues in order to provide better intervention and treatment. The goal of the nurse is to develop a body of knowledge that allows them to provide cultural specific care. This begins with an open mind and accepting attitude.
Cultural competence is a viewpoint that increases respect and awareness for patients from cultures different from the nurse's own. Cultural sensitivity is putting aside our own perspective to understand another person's perceptive. Caring and culture are described as being intricately linked.
It is important to assess language needs and request for a translation service if needed and provide written material in the patient's language.
As well as, trying to mimic the patient's style of communication e. Another obstacle is stereotyping, a patient's background is often multifaceted encompassing many ethic and cultural traditions. In order to individualize communication and provide culturally sensitive care it is important to understand the complexity of social, ethnic, cultural and economic. This involves overcoming certain attitudes and offering consistent, non-judgemental care to all patients.
Accepting the person for who they are regardless of diverse backgrounds and circumstances or differences in morals or beliefs. By exhibiting these attributes trust can grow between patient and nurse. It includes nurses working with the client to create goals directed at improving their health status. A partnership is formed between nurse and client. The nurse empowers patient and families to get involved in their health.
To make this process successful the nurse must value, respect and listen to clients as individuals. Focus should be on the feelings, priorities, challenges, and ideas of the patient, with progressive aim of enhancing optimum physical, spiritual, and mental health.
It is stated that it is the nurse's job to report abuse of their client to ensure that their client is safe from harm. Nurses must intervene and report any abusive situations observed that might be seen as violent, threatening, or intended to inflict harm.
Nurses must also report any health care provider's behaviors or remarks towards clients that are perceived as romantic, or sexually abusive. Interviews were done with participants from Southern Ontario, ten had been hospitalized for a psychiatric illness and four had experiences with nurses from community-based organizations, but were never hospitalized. The participants were asked about experiences at different stages of the relationship.
The research described two relationships that formed the "bright side" and the "dark side". The "bright" relationship involved nurses who validated clients and their feelings. For example, one client tested his trust of the nurse by becoming angry with her and revealing his negative thoughts related to the hospitalization. The client stated, "she's trying to be quite nice to me For example, one client stated, "The nurses' general feeling was when someone asks for help, they're being manipulative and attention seeking ".
One patient reported, "the nurses all stayed in their central station. They didn't mix with the patients The only interaction you have with them is medication time". One participant stated, "no one cares. It's just, they don't want to hear it. They don't want to know it; they don't want to listen". These findings bring awareness about the importance of the nurse—client relationship.
Developing effective and caring nurse-patient relationships
Building trust[ edit ] Building trust is beneficial to how the relationship progresses. Wiesman used interviews with 15 participants who spent at least three days in intensive care to investigate the factors that helped develop trust in the nurse—client relationship. Patients said nurses promoted trust through attentiveness, competence, comfort measures, personality traits, and provision of information.
Every participant stated the attentiveness of the nurse was important to develop trust. One said the nurses "are with you all the time. Whenever anything comes up, they're in there caring for you".
They took time to do little things and made sure they were done right and proper," stated one participant. One client stated, "they were there for the smallest need. I remember one time where they repositioned me maybe five or six times in a matter of an hour". One said, "they were all friendly, and they make you feel like they've known you for a long time" Receiving adequate information was important to four participants. One participant said, "they explained things.
The relationship was growing when nurses made home visits and gave support.
The experience was that home visits could give a deeper and more intimate relationship than in hospital-based nursing care. There were also barriers for a close relationship and it was obvious that each home visit and contact did not develop well.
Caring Relationships in Home-Based Nursing Care - Registered Nurses’ Experiences
When the nurse and the person had previous knowledge of each other and the relationship was established, remote communication could facilitate the maintenance of the relationship. The effort meant, among other things, to prioritize the building and maintenance of relationships by nurses. Usually it took time to reach a level where confiding occurred and patience was often necessary to develop the relationship.
To make an effort to show humility, empathy, respect and treat the person well seemed to be the prerequisites for a good working relationship in home-based nursing care. The secure presence was characterized by reciprocity between the nurse and the person and gave an opportunity to share time together and being seen and confirmed.
Being able to sit quietly together meant that the relationship had advanced. Showing interest and commitment meant among other things listening, asking questions and touching. The already developed relationship could be maintained through home visits or by keeping in touch with each other through distance-spanning technology, such as phone calls.
The relationship could work when there was a mutual giving and taking between the nurse and the person in need of care. The reciprocal relationship was stimulated by conversations where nurses avoided interviewing the person. The conversations were about other things than illness and problems and knowledge of people made it easier to find suitable topics of conversation.
This kind of conversation meant that the person and the nurse opened up and had a more personal conversation. This meant that the roles of nurse and care receiver were less pronounced and were characterized by the nurses as being a professional friend.
The experience was that reciprocity was hampered when too much focus was on the professional role and tasks. At the same time tasks could also open the door to the reciprocal relationship. There was an experience that there was a tendency that conversations via distance-spanning technology more often focused on the illness and was more task-oriented than face-to-face encounters and that affected the sense of reciprocity and community.
The nurses prioritized the person that she had most contact with and those she felt responsible to solve problems for, answered questions, and those she knew well. When the person showed confidence and told the nurse about their thoughts and problems and the nurse could meet their needs, so that a deeper and special relationship occurs.
The deeper relationship meant that nurses became more engaged, and reflected more extensive for the person and their situation, which also affected the relationship.
The situation was very different when the nurses worked as a stand-in nurse and or a secondary nurse. In those situations the relationship could also work well but it was often at a different more shallow level compared with the relationship when they were the primary nurse. I absolutely think without a relationship it will not work…you have to build a relationship with the person you should take care of in order to be able to provide the best care, because otherwise it becomes very superficial…you go in and take care of the wound and then out, by by DN2: Limited time could lead to a limitation of relationships and broken relationships.
It was obvious that the relationship with the person to whom the nurse was a primary nurse was given a higher priority. Good communication was important for the relationship and when the language barrier occurred it was another limitation of the relationship. The experience was that the relationships in home-based nursing care also needed some frames and boundaries. The relationship was also restricted by nurses when the person came too close and the relationship tended to be too personal and private and they could sense the risk to lose their professionalism.
The caring relationship in this study could be understood as a trusting relationship, which is needed in order to provide good nursing care at home. The finding shows that a personal caring relationship could make trust possible and also that several encounters could create trust on which a relationship can be built.
A concept analysis of nurse-patient trust [ 22 ] defines trust as the optimistic acceptance of a vulnerable situation, following careful assessment, in which the truster believes that the trustee has his best interest as paramount importance.
In addition, Hagerty and Patusky [ 23 ] showed that the person in need of healthcare might trust the nurse in one area but not in another. A trusting relationship is one where the nurse cares for and about the person [ 24 ]. According to Hupcey, Penrod, Morse and Mitcham [ 25 ] the outcome of trust is an evaluation of the congruence between expectations of the trusted person, i. The caring relationship is inherently asymmetrical and means that the person with health problems is a suffering human and the nurse is caring and responsible.
Buber [ 26 ] highlights that a fully reciprocal therapeutic relationship would be at the expense of its healing characteristics. The choice to embrace the approach I-Thou and entering the relationship and abandon the approach I-It [ 26 ] could be understood as an ethical choice [ 27 ] in home-based nursing care. On the other hand the asymmetry that exists in the caring relationship could potentially be unethical if it is not balanced with reciprocity [ 28 ].
According to the findings in present study it seems that the context of home-based nursing care encourages the reciprocal aspect of the relationship and reduces the asymmetry within the caring relationship. The encouragement of reciprocity in the caring relationship seems to relate to the fact that the nurse enters the home as a guest and has to balance between being personal, and in that encourage reciprocity, and being professional.
This does not mean an equal relationship, and should not be confused with the ethical demand within the relationship [ 8 ].
Interdependence can be understood as what the nurse does for the person the nurse also does to herself. Despite the interdependence the nurse in home-based nursing care cannot, as a professional, demand to receive from the relationship as it is always an ethical relationship where what the nurse gets could be seen as a gift. Buber [ 29 ] asserts that the desire for confirmation and the ability to confirm others is fundamental to human life with others and being personal. The findings of present study also indicate that nurses work in different levels of the relationship and closeness was not always the primary goal.
Using the description by Buber [ 29 ] it can be described that the nurses had two movements, one to enter the relationship with the person in need of care and another to preserve a distance. The choice of the primary nurses in present study was to consciously chose to enter the relationship and work towards a deeper level of the relationship. This meant that the nurse had more contacts, was engaged with the person, knew the person well, and developed a common story. The importance of a common story could be an argument for a higher continuity with the primary nurse in healthcare at home, in order to protect the caring relationship.
In situations of being the secondary nurse and the stand-in nurse, the movement of preserving distance [ 29 ] often was the choice of the nurses in present study, where they consciously chose to work in a more shallow level of the relationship. We can assume that it could be experienced as unethical for a secondary nurse and a stand-in nurse to ask the person to share deeper feelings and then leave the person without any follow-up. The choice of level in a relationship in home-based nursing care is also dependent on the will of the person in need of care.
Staff at municipal psychiatric group dwellings described some of their relationships with long-term psychiatric clients as characterized by distance. Reasons for professional distance in a caring relationship could, according to Bergum and Dossetor [ 31 ], be fear of getting too involved or fear of not having the time to get involved at all.
A standpoint of distance in a caring relationship means the risk of not being able to establish and build a trusting relationship with the person in need of nursing care at home and thereby no fruitful caring relationship. A study [ 32 ] shows that time and geographical distance are important factors when building relationships between nurses and persons in home-based nursing care.
Another study [ 33 ] shows that time and the continuity between the nurse and the person are preconditions for establishing a trusting relationship. It is especially the first visit that requires time to build the base for a trusting relationship.
It is also important that the person can reach the nurse by a telephone call. Present study shows that the trusting relationship could be maintained through contacts by distance-spanning technology which also meant that the continuity could be supported. This means that nurses are responsible in home-based nursing care to protect the trusting relationship when different technology applications for distance communications are used in contemporary home-based care.
A previous study [ 35 ] shows that when the person trusts the DNs they also felt confident with the use of technology in healthcare at home.
- Nurse–client relationship
The development of different distance-spanning technologies can open up new solutions to perform care and maintain relationships at home [ 3637 ]. As a reaction to this development of increased use of distance-spanning technology, Meleis [ 1 ] argues that many theorists in nursing are going back to basics in human relationships, where the sharing of information during situations of health and illness and the interaction is a tool for building relationships.
Nurse–client relationship - Wikipedia
This emphasis on the importance of basic human interaction highlights the importance when implementing distance-spanning technology in home-based healthcare to work consciously to build and protect the trusting relationship in order to provide good healthcare.
Methodological Consideration The data about relationships in present study was elicited from interview text where nurses were narrating about their experiences about encounters in home-based nursing care.
During the narrations the nurses made detailed descriptions of the relationship and its importance for good nursing care at home. However, it is obvious that the narrations contained limited experiences of harmful or negative relationships in home-based nursing care. This can be seen as a limitation and might have emerged if the nurses had received specific questions about these kinds of relationships.
The authors are well-versed in the nursing literature and have extensive experience in the methodology. The authors have consciously used their theoretical orientation in nursing and their understanding of the text and discussed the different steps of the analysis thoroughly [ 15 ].
In addition, the rigor of the process was supported by using NVivo 9 computer program [ 18 ], which altogether strengthen the trustworthiness of the analysis [ 15 ]. The topic of the study relates to common human phenomenon and is therefore possible to transfer to other similar context in home-based care.
The finding could be transferred in the manner of naturalistic generalization [ 38 ] where the reader interprets and determines which findings can be generalized to another context and also adds to previous knowledge. The transferability is also supported by the fact that it is supported in other nursing literature. In order for nurses to build a trusting relationship in home-based nursing care they have to accept that they enter the home as a guest and communicate something about themself as the person in need of healthcare needs to know who is entering and visiting the home, or who is communicating through distance-spanning technology.
The relationship in home-based nursing care requires conscious efforts from the nurse and a choice of a suitable level of the relationship when maintaining the relationship through home visits as well as through distance-spanning technology. The working context of home-based care is anticipated to change, with the introduction of new technology and revised templates of care. In this process nurses have to safeguard the possibilities of building trusting relationships with the persons in need of home-based care.
Elstad I, Torjuul K. The issue of life: Aristotle in nursing perspective. Nurse-patient interaction and communication: Department of Caring Science. Caring relationship in an out-patient clinic: Int J Hum Caring.
Patients' and relatives' experiences and perspectives of 'good' and 'not so good' quality care. The nurse-patient relationship as a caring relationship. Walshe C, Luker KA. Int J Nurs Stud. Clients' perceptions of client-nurse relationships in local authority psychiatric services: Int J Ment Health Nurs.
Swedish nurses' experiences of caring for dying people: Mok E, Chiu PC. Nurse—patient relationships in palliative care. Qualitative research methods for the social sciences.
Kvale S, Brinkmann S. InterViews - learning the craft of qualitative research interviewing.