On these pages you will find various essays about nursing topics.
I worked on a three year Bachelor of Nursing degree at a famous NZ university. This learning has shaped me and honed my clinical skills and knowledge. I hope you enjoy reading these essays and find them stimulating.
I’ll start the ball rolling with a look into the Therapeutic relationship – the absolute foundation of patient and practitioner rapport, and this applies to any healing profession. Hearing the patient’s voice is an art more than a science. Without it, medicine fails to a certain degree. Nurses are taught this practical valuable skill that biomedicine has been criticised for lacking.
Other topics are: (click on them to go to that page)
Recovery model in Mental Health
Post Natal Depression
Pain and Trauma (NOF fracture)
Establishing a Therapeutic Nurse – Client Relationship
By Andrew Gowan © All rights reserved
At the core of all the helping/healing professions is the concept of caring for the sick, weak, disadvantaged or disabled. Caring in the healing professions occurs at many levels and in different ways depending on the context. In Nursing, it can be argued that care is the “foundational element” (Daly, Speedy & Jackson, 2010, p.81), and this type of care is uniquely focussed on the patient rather than on the illness or condition they have. This means it is a relationship where courtesy, understanding and empathy are shown to the client. Making them comfortable and making sure all their needs are being met (as much as is possible) ensures quality care to the patient, and that they matter (Field & Smith, 2011). Establishing a therapeutic relationship between Nurse and client embodies the concept of setting up a caring, helpful, empowering and healing relationship. The quality of this relationship has an impact on the health and wellbeing of the client (Edwards, Peterson & Davies, 2006; Oudshoorn, Ward-Griffin & McWilliam, 2007).
The therapeutic nurse–client relationship is a partnership between nurse and client with the goal of improving health outcomes for the client. Like a social relationship, there are elements of care, mutual trust, compassion, and empathy; however there are distinct differences to social and other relationships. The therapeutic relationship is unequal, built exclusively on the client’s needs and the nurse’s skill and knowledge to address those needs. The nurse is the professional providing the assistance and accountable for the outcomes of the relationship, whereas the client receives the assistance (Taylor, Lillis, LeMone & Lynn, 2011). The therapeutic relationship is dynamic; both parties are active participants. It has a specific purpose and a specific time frame. It takes place within the context of a healing or helping role and in an environment or location purposely set up for the relationship. Both parties have responsibilities: the client is responsible to provide accurate information where possible about his or her health status, and the nurse is responsible to provide a positive health outcome for the client (Taylor, et al., 2011). The nurse also has ethical responsibilities, for example: confidentiality, beneficence, justice, non-maleficence, faithfulness and truthfulness. These values are inherent in the nurse –client relationship (Code of Ethics, 2010, p.15).
There are three phases to the therapeutic nurse–client relationship: orientation, working and termination. The orientation phase involves introductions, explanation of the relationship and nursing process with respect to the client, and assessment. The working phase is the longest phase of the relationship; the ‘nuts and bolts’ care for the client’s physical and psychological needs. It is an interactive partnership between nurse and client, with the aim of increasing the client’s independence as much as possible. The termination phase is the natural end of the relationship when the nurse and client evaluate goals and outcomes together (Taylor, et al., 2011).
Communication is the core skill required by the nurse to effectively establish and maintain the therapeutic relationship (Edwards, Peterson & Davies, 2006). Any factor which limits communication will impact on the quality of the therapeutic relationship. It is important that the nurse recognises when a person is experiencing any difficulties, and show understanding, and take measures to improve communication.
There are specific qualities which, if engendered in the nurse, will promote a successful therapeutic relationship. Empathy or identifying with another how they are feeling goes hand in hand with care (Taylor, et al., 2011). Mindfulness or the ability to be totally alive and present is a valuable skill for the nurse to acquire (Scheick, 2011). It means to be self-less, self-aware and self-controlled so that the nurse- client relationship can be as positive as possible, and so the nurse can focus objectively and solely on the client. In nursing a key concept is that one’s own self become the healing vehicle. Scheick (2011, p.115) emphasises this point: “Nursing mandates that students… use self as the therapeutic instrument in life and death situations”. In a recent study, nurses themselves identified six themes critical for a therapeutic relationship: advocacy, empathy, care, intentionality, respect and responsibility (Burhans & Alligood, 2010). For patients (clients) the most important demonstration of nursing care is that their requests are responded to in an appropriate and timely manner (Van Eps, Pearson, et al., 2007). Integrity is important in maintaining a therapeutic relationship; it involves honesty, trust, competency, confidence, and showing respect. Still other important aspects in the successful therapeutic relationship are: intuition, being non-judgemental, and treating the client with dignity.
If these important elements of nursing care are missing or impaired in some way, the therapeutic relationship will suffer, and the health outcomes may be less than ideal. Many factors may hinder the development and maintenance of a therapeutic relationship. Communication difficulties have already been mentioned. Difficulties arise when the nurse is not self –aware and mindful, and shifts empathy into sympathy. This is known as counter –transference, where the nurse “shares personal concerns and feelings and projects these onto the patient” (Taylor, et al., 2011, p.450). Anytime that the nurse is more concerned with personal matters instead of the care of the client, when there is any deficit of integrity in the relationship, the care will suffer and the client will feel less important. Nursing often involves a level of power over the client. This may be intentional or even necessary, but is often detrimental to the relationship as it can make the client feel powerless and uncomfortable (Oudshoorn, Ward-Griffin & McWilliam, 2007). Workplace stress and high demands on staff will impact the care delivered. Edwards, Peterson & Davies (2006) note that nurses generally do possess good communication skills “but organizational culture and workplace policies create barriers to effective communication” (p.4).
Burhans L.M. & Alligood M.R. (2010). Quality nursing care in the words of nurses. Journal of Advanced Nursing, 66(8), 1689–1697.
Code of Ethics (2010) New Zealand Nurses Organisation Code of Ethics. Wellington, New Zealand.
Daly, J., Speedy, S. and Jackson, D. (2010) Contexts of nursing. (3rd ed.). Sydney, N.S.W: Churchill Livingstone, Elsevier.
Edwards, N., Peterson, W.E., & Davies, B.L. (2006). Evaluation of a multiple component intervention to support the implementation of a ‘Therapeutic Relationships’ best practice guideline on nurses’ communication skills. Patient Education and Counselling, 63(1-2), 3-11.
Field, L. & Smith, B. (2011). Nursing care: An essential guide for nurses and healthcare workers in primary and secondary care. (2nd ed.). Essex, England: Pearson Education.
Henderson, A., Van Eps, M. A., Pearson, K., James, C., Henderson, P. & Osborne, Y. (2007). ‘Caring for’ behaviours that indicate to patients that nurses ‘care about’ them. Journal of Advanced Nursing, 60(2), 146-153.
Oudshoorn, A. Ward-Griffin, C. & McWilliam, C. (2007). Client-nurse relationships in home-based palliative care: A critical analysis of power relations Journal of Clinical Nursing, 16(8),1435-1443.
Scheick, D. M. (2011). Developing self-aware mindfulness to manage countertransference in the nurse-client relationship: An evaluation and developmental study. Journal of Professional Nursing, 27(2), 114-123.
Taylor, C., Lillis, C., LeMone, P. & Lynn, P. (2011). Fundamentals of nursing. (7th ed.). Sydney, NSW: Lippincott, Williams and Wilkins.