Establishing Therapeutic Relationships Acknowledgement The Registered Nurses in them nor accept any liability. in any form. including in electronic form. . Authors such as Forchuk and colleagues have looked more specifically at the phases C. (). & Brown. Charles B. ). Journal of Advanced Nursing. in research and practice and to facilitate comparison with other nursing theories. Keywords Peplau, Nursing Theory, Inter-personal, Nurse-Client Relationship. Abstract Nurse-client relationships have been considered the foundation of from the Relationship Form (Forchuk & Brown, ) were compared over time to .
She reported that those patients who remained in the orientation phase longer also had longer hospitalizations.
Forchuk has also studied interpersonal relations in persons with persistent mental illness using nurse-patient dyads. She determined that preconceptions held by the nurse and the patient influenced relationship development. More recently, she examined factors that influence the movement of the nurse-patient relationship from the orientation phase to the working phase Forchuk et al.
She conducted a descriptive, exploratory study of seven women who were once hospitalized for depression. Following an average duration of 11 weeks, there was an improvement in depressive symptoms that was correlated with their self-efficacy and self-esteem.
Women who had depressive symptoms were randomized to either an eight week nurse-delivered group intervention for the education and treatment of dysphoric moods depression, anxiety, and anger or usual care. Throughout each of these phases, it should be clear that the elements of successful recruitment and retention include: According to Peplauthe nurse should identify herself and her professional status, as well as the purpose of the interaction, in this case the research project.
The orientation phase for the study included phone recruitment, a baseline enrollment visit, and the first few weeks of the SWEEP program. In the study reported here, phone recruitment was the first step to building trust. When participants called about the study, the nurses asked how they found out about the study. Participants were asked to describe why they called to participate. Through this interaction, the nurses were able to understand their needs.
Sometimes as reported by Kennedy and Burnettpotential participants were seeking medical care, but were informed that the study was not a replacement for their medical care. If they were in need of healthcare mental or physicalthey were directed to their healthcare provider. And, if they did not have a healthcare provider, a contact list was provided. Next, the SWEEP program was described and participants were informed that they would be randomly assigned to either the group that gets the nursing intervention or the group that does not.
It is during this time that participants must understand that they may not get the nursing intervention. On one occasion, a potential participant stated that she would only participate if she was given the treatment. In this situation the person was advised to decline participation. If patients were interested in the study, they were informed that a health screening would be conducted to determine their eligibility for participation. It was important to let the persons know that because of exclusionary criteria, they might not be eligible for participation.
Upon conclusion of the phone screening, all participants were told how valuable their contribution had been, and were thanked for their interest and their time. If they were eligible, they were informed that a letter would be mailed providing detailed information regarding their first study visit. As identified by Goldberg and Kiernanbranding is important for recruitment so that participants remember the study.
Upon their visit, the nurses reiterated the purpose of the study and explained the informed consent document. They were given adequate time to review, process, and ask questions regarding the consent and their participation in the study.
A caring environment was provided by skilled nurses who did the laboratory and physical measurements. Subsequently, participants were directed to a private room where breakfast was provided and they completed the self-administered questionnaires.
The booklets were checked for missing data to determine if it was accidental or intentional prefers not to answer ; the desire not to answer questions was always respected. Upon completion of the data collection, every participant treatment and control was given a stipend.
We provided a personal thank you card that included monetary compensation for their time as well as a parking token. Women were paid for their data collection points using a stepped compensation method each return visit payment was higher than the previous one to demonstrate that we valued their time and continued participation. During the visits, trust was building between nurses and participants. Once randomization was complete, all participants were called and their assignment was discussed.
At this time, some persons who did not receive the treatment expressed disappointment. It was important for them to voice their concerns; however, the nurses reiterated the random assignment process and reminded them that they were extremely valuable to the study. All participants were sent a personal letter regarding their study group assignment and a depression resource list. Keeping contact was important to trust-building. For participants who began treatment in the SWEEP program, further trust-building occurred, particularly in the first week of class.
In order to ensure familiarity among the group participants, name tags were used and self-introductions were performed. They were also asked if any additions or changes were needed for these rules. This was done to provide a respectful, caring, and secure environment so that persons could be successful in the program.
During the first class, an overview of the program was provided. All participants were given a blue bag with SWEEP program materials dates of the meetings, the phone numbers for the group leaders, and space for the weekly class handouts and homework. At the completion of the first class, a rose ceremony was performed.
This included giving each participant a live rose decorated with ribbons to thank them for attending. 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. 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.
Nurse–client relationship - Wikipedia
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. They followed it through, step by step". Emotional support[ edit ] Emotional Support is giving and receiving reassurance and encouragement done through understanding. Yamashita, Forchuk, and Mound conducted a study to examine the process of nurse case management involving clients with mental illness.
Nurses in inpatient, transitional, and community settings in four cities in Ontario Canada were interviewed. The interviews show the importance of providing emotional support to the patients. One nurse stated that if the client knows "Somebody really cares enough to see how they are doing once a week To them it means the world".
A nurse stated that "We're with the families. We can be with them as oppositional and overly involved and somewhere else in between, and we're in contact with them as much as they want". The study reaffirmed the importance of emotional support in the relationship. Humour[ edit ] Humour is important in developing a lasting relationship. Astedt-Kurki, Isola, Tammentie, and Kervinen asked readers to write about experiences with humour while in the hospital through a patient organization newsletter.
Letters were chosen from 13 chronically ill clients from Finland. The clients were also interviewed in addition to their letters. The interviews reported that humour played an important role in health. A paralyzed woman said, "Well you have to have a sense of humour if you want to live and survive. You have to keep it up no matter how much it hurts". One participant stated, " A participant said, "For male patients humour is also a way of concealing their feelings.
It's extremely hard for them to admit they're afraid".
Interpersonal Relations in Nursing. Interpersonal Theory in Nursing Practice: