A psychosocial relationship is building a therapeutic nurse patient relationship which is considered as the central element in the nursing process. The social and psychological aspects are considered as elements in building relationship. The therapeutic nurse patient relationship is a synergistic process which includes the nurse employing the general attributes of conveying sympathy, accepting individuality, providing support, showing respect and maintaining professional boundaries. The therapeutic nurse patient relationship can be described as involving the mutual satisfaction of the nurse and the patient that helps to achieve better health outcomes(Lemone & Burke, 2008).The therapeutic nurse patient relationship will develop as the nurse by using his/her specific skills responds to the needs of her patient.
Building communication to develop therapeutic relationship:
The development of the therapeutic nurse patient relationship needs time, it is not established quickly. In nursing theory there are four main phases involved in the development of the therapeutic nurse patient relationship. These are orientation, identification, exploitation, and resolution phase. Each phase has its own significance in the development of therapeutic nurse-patient relationship. These phases correspond to different types of communication (active listening, silence, empathy, touch and clarifying).These are now explored in more detail below:
1) Orientation phase- during the orientation phase there is a discussion between the nurse and the patient about the patient health status and their needs. They both set the goals for introductory and forthcoming meetings, which assist the nurse in making treatment plans that meet patient's needs under changing circumstances.
2) Identification phase- during this phase the nurse provide the relevant information to the patient about the particular disease and the treatment options. The final aim of this phase is to provide a chance for the patient to achieve a level of eagerness to accept for his/her care (Cherry & Jacob, 2009, pp.41-47).
3) Exploitation phase - in this phase the patient develops the capacity for self-care and independence. The bond between the nurse and the patient has been established. Primary goals have been met, providing an opportunity for further development.
4) Resolution phase- this is the final phase. The patient will feel a sense of security because he/she has achieved his/her goal of wellness that is the main aim of the therapeutic nurse patient relationship.
Factors affecting the development of therapeutic nurse patient relationship: touch, clarifying, silence active listening and empathy are the five important factors which plays an important role in the development of therapeutic nurse patient relationship.
Using Touch- Touch is best way of responding to the patient queries and also gives moral support to the patient. It is most trusted, which is a fundamental element in the development of a therapeutic nurse patient relationship. The patients' trust in nurses is necessary in developing a therapeutic nurse patient relationship, as trust has a major influence on patients' acceptance of care and treatment. However, gaining trust in a relationship can only occur when any differences in power, culture and attitude are respected (Jackson, Firtko & Edenborough, 2007, pp.1-9). In order to gain accurate information from the patient, trust needs to be established. Moreover, a trusting relationship allows the patient to focus on achieving optimal health instead of doubting reliability of care and information.
Active listening: It is important to know the physical state of the patient and also to know the behaviour of the patient because the patient will be in unusual state. The patient's family is to be made clear about the facilities provided by the health care. The patient who is generally admitted may feel nervous, adjusting to the conditions of the health care facility, need for guidance by health care providers. The status of the patient is to be monitored carefully by direct contact with the patient or relatives who could give information about the previous history of medical reports and also to know the present status. The client is to be made clear about the treatment given and also about the side effects of the medicines that will be used. This would strengthen the relationship between the client and healthcare provider by providing support. The mental status will be known which is important in later stages of providing care that could not lead to confusion .The patient's condition who is suffering from the disease should be recorded for research studies in the future.
The medical reports of the client will give out information that could be useful to carry out the treatment. The environmental conditions could be new to the client and should be made clear and should need to explain to the client about the facilities that are provided to the client. The assessment is carried out to establish a report based on patient behavior which gives a better chance to the health care providers to resume the treatment process that will help the patient to recover from the problem. The patient's belief is to be considered while giving the treatment which would allow overcoming the ethical issues that may arise during the treatment.
In the nursing profession is defined as interaction between the nurse and the patient. It involves the nurse's ability to understand patient's thinking, body language and feelings this will enables the nurse to establish a clear rapport with the patient and assess the patient's condition and health issues more precisely. Effective communication between the nurse and the patient plays an important role in developing the therapeutic nurse patient relationship as it brings forward patient quality care and accurate information transferred among health care professional for the benefits of the patient. According to (Robinson, 2010, p.B4) communication problems have negative effects on the establishment of a therapeutic relationship. However, communication is significantly improved when there is a deep respect for the patient, where respect is shown by a willingness to listen. Research studies states that communicating with patient involves respecting their values and beliefs during communication exchange.
Clarifying-It is an essential component in providing health care; however, the communication lines must be established for education to be successful. During the education process, nurses need to avoid medical terms and necessary to prevent frightening and intimidating patients. When patients are feeling alienated with complex medical terms, they are unlikely to feel comfortable with the nurse, therefore the relationship is compromised. According to (Schofield et al., 2008, p.604) the nurse and patient must feel comfortable with each other for a level of trust to begin. The nurse should begin by carefully explaining the medical terms necessary to understand the content being taught.
Empathy -empathy is crucial when attempting to develop a therapeutic relationship between the nurse and the patient. According to (Schofield et al., 2008, p.604) spending time in listening and sharing information is a key factor in assisting cross-cultural communication. Empathizing with people from a different cultural background involves listening, understanding and appreciating what they are saying without judgment. Without empathy, a patient may feel unheard, unsafe and thus unable to open up and communicate with the nurse. According to (Younger, 2009, pp.45-51), feelings of empathy and compassion will motivate the nurse to come to know the patient as an individual with respect for their beliefs.
Silence: Silence is another different type of communication and the nursing practices to build the therapeutic nurse patient relationship which helps a transitioning graduate nurse to develop their knowledge and skills as a registered nurse,Graduate registered nurse faces difficulties in developing a trusting nurse patient relationship because he/she has beginner's knowledge and skills but have little experience in performing their duties individually that is why they do not feel much confident/competent in establishing therapeutic nurse patient relationship. Therefore, Graduate registered nurses needs more time to develop their knowledge and skills in order to build a trusting nurse patient relationship. Self reflection will also help him/her to become competent / confident so that he/she can apply their learned knowledge in practice. Graduate registered nurse feel more competent/confident in developing a therapeutic nurse patient relationship when he/she got clinical supervision and support from his/her clinical preceptor and co-workers. Evidence-based practice helps graduate registered nurses to develop the skills of critical- thinking, decision- making and problem -solving which result in better patient health outcome that is the main goal of the therapeutic nurse patient relationship. Anxiety is a possible barrier in the development of the therapeutic nurse patient relationship. The graduate registered nurse may be anxious because it is his /her first experience to develop a therapeutic nurse patient relationship (Younger, 2009, pp.45-51). In fact , many factors act as barriers for graduate registered nurse when he/she tries to develop a therapeutic nurse patient relationship ,such as high expectations, self -awareness, stressful environment, lack of support, lack of cultural competence, language differences and difficulties in maintaining professional boundaries. Graduate registered nurse is still trying to adapt themselves to the new environment so sometimes it is challenging for his /her to maintain professional boundaries. Maintaining professional boundaries is essential so that the nurse and the patient can interact in a safe environment.The Graduate registered nurses can be successful in maintaining boundaries when he/she works in accordance with a care plan; always learns from self-reflection; is susceptible to situations; and able to initiate, maintain and terminate the nurse-patient relationship appropriately. Working with professional boundaries will help the transitioning graduate nurse to practice safely within their scope of practice to provide better quality care.
The psychosocial nurse patient relationship enables the patient to share their positive and negative feelings with the nurse without any fear and with proper understanding. Achieving that level of truthfulness proves to be valuable and sometimes can be a turning point in the life of the patient.