NURSE-PATIENT RELATIONSHIP

BASIC CONCEPT OF NURSE-PATIENT RELATIONSHIP


The structural aspects of developing a nurse-patient relationship have guidelines to strengthen the process of shared humanness through caring communication. Unlike a social relationship, a therapeutic relationship has definite boundaries, marked by purpose, client-centered communication, stages of development, health-related concepts and requires a considerable amount of time, thought, sensitivity and energy.

The therapeutic nurse-patient relationship is considered a basic building block underlying all biophysical, psychosocial and cognitive treatments (Travelbee, 1971). There are certain guiding principles – purpose, mutuality, authenticity, empathy, active listening, confidentiality and respect for the dignity of the patient- strengthen the entire process and flow through identifiable phases of a nurse-patient interaction. Healing involves more than medicine and treatment protocols. Since illness affects the whole person, it is important to discover the particular personal meanings woven into the illness as it is address the physical and psychological origins of the disorder and how the patient affects by it.

The nurse integrates three fundamental forms of nursing knowledge: theoretical, technical and creative – in the nurse-patient relationship (University of Maryland School of Nursing). The theoretical component consists of all the scientific principles that form the basis for establishing and maintaining professional relationship in nursing practice. The second component is the technical aspect, seen in the application of specific communication skills and strategies used to facilitate the purposes of the relationship. The creative element consists of the special and unique application of self for the express purpose of helping a fellow human being realize his or her fullest potential in a clinical setting.

Basic Concepts includes:

• Focuses of the Relationship – Therapeutic relationships differ from social relationships in that the connections and bonding are purposeful and directed by the nurse. The helping professional takes primary responsibility for maintaining the boundaries and guiding relationship.

According to Heinrich, the nurse must be consistently walking a fine line between having compassion for a client and developing relationship that is too close, which may cause complication and conflicts. Boundaries meant to safeguard the purposes of the relationship.

• Purpose – All behavior in the relationship is purposefully planned, carried out, and evaluated in terms of helping patient needs identified treatment goals. The goals of all therapeutic relationships are three-fold: (1) to enhance patient’s well being, (2) to promote recovery and (3 to support the self-care functioning of the patient. A relationship between the nurses and the patient is therapeutic when there is a goal-directed, helping focus related to an identifiable health care needed.

“In this type of relationship, two separately existing individuals come together for the sole purpose of helping one of them, the patient; achieve maximum levels of self-care and functioning.” –Rogers, 1973

• Context – the context of Nurse-patient interaction is extremely important in accurately identifying the over-all success of activity.

• Empathy – is the ability of the nurse to perceived the meanings and feelings of the client and to communicate that understanding to the client. Being able to put himself or herself in the client’s shoes is essential to develop to help understand the client. But it does not mean that the nurse has had the same exact experience as the client. Nevertheless, by listening and sensing the importance of the situation to the client, the nurse can imagine the client’s feeling about the experience. Both of the client and the nurse give a gift of self when emphaty occurs – the client feeling safe enough to share feelings and the nurse by listening closely enough to understand.

• Authenticity – or genuine interest. When the nurse is comfortable, aware of his or her strengths and limitations, and clearly focused, the client will perceived a genuine person showing genuine interest. Clients with mental illness can detect when someone the client may choose to reveal more information to the nurse. is exhibiting dishonest or artificaial behavior such as asking questions without waiting for an answer, talking over the client or assuring the client everything will be alright. The nurse should be open and honest and display congruent behavior. Doing so, helps to develop trust and allows the client to see the nurse as a real person with perhaps similar problems.

• Confidentiality – it is important to respect the client’s right to keep private any information about his or her mental and physical health and related care. Confidentiality means allowing only those dealing with the client’s care to have access to the information that the client divulges. Only under precisely defined conditions can third parties have access to this information; for example, many states require that staff report suspected child and elder abuse.

• Self –Disclosure – It is revealing personal information such as biographical information and personal ideas, thoughts and feelings about oneself to client (Deering, 1999). The nurse can use self-disclosure to convey, support, educate clients, demonstrate that a client’s anxiety is normal and even facilitate emotional healing.

Hildegard Peplau was the first nurse theorist to describe the nurse-patient relationship as the foundation of nursing practice (Forchuk, 1991). She identified ways in which the nurse makes specialized use of a professional relationship to identify and intervene therapeutically in psychosocial nursing problems.