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Essay: Therapeutic Relationships: A Cornerstone of Nursing and Patient Well-Being

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  • Published: 1 April 2019*
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“Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations.” (Nursing: Scope and Standards of Practice, 2015). Nurses thrive in their practice when they have the opportunity to establish and develop meaningful human connections with their patients. As a result, this healthcare profession takes a holistic approach in regards to the prevention of illness, the promotion of healthy habits, and the maintenance of optimal health.

“Nursing as a human science focuses on life and health as humanly experienced. Intentionality is a philosophical idea of particular significance to nursing as a human science.” (The Concept of Intentionality in Human Science Nursing Theories, 2010). Because nursing is a human science, it enables the nurse to be conscious of his or her emotions and conscious of the bonds with other people around him or her. Each person can grow in their own unique ways. As a result, nurses derive their knowledge from their experiences with the patients. This knowledge is developed through the individual therapeutic relationships that they cultivate with them. Thus, nursing cannot thrive without the existence of therapeutic relationships.

The philosophy of Lehman College’s Nursing Department is that when we graduate, we will have the theoretical and practical knowledge needed to adequately promote wellness for human beings in both their internal and external relationships. There is a cyclical relationship between human beings and their environment. In order to be caring, nurses must be able to apply their knowledge and skills to improve the health of their patients. Thus, caring is an essential characteristic of a great nurse.

Interpersonal relationship is defined as “a close association or interaction between

individuals who share common interests and goals.” Interpersonal relationships are reciprocal and involves social and emotional interactions between two or more individuals in an environment. Interpersonal relationships are important because it improves the quality of care for our patients and, as a result, creates a safe environment. It is very important to foster this quality, especially when our patients are at low points in their lives. When interpersonal relationships are at their peak, there is a significant improvement in “patient satisfaction, adherence to treatments, quality care, the level of depression and anxiety, and healthcare costs.” (Enhancing Adult Therapeutic Interpersonal Relationships In The Acute Health Care Setting: An Integrative Review, 2016).

Interpersonal relationships include social relationships, intimate relationships, and professional relationships. Since we are social beings, we have to engage in social

relationships in order to thrive and survive. It is in our nature to seek out and form and maintain these kind of relationships. In order to fulfill this need, we tend to look for it in social circles such as school, the workplace, religious organizations, and other parts of the community. Forming these relationships are significant because we belong to something greater than ourselves and we do not feel as alone. If such relationships are not formed, people tend to become withdrawn and depressed. Thus, cultivating a social relationship with our patients is positive overall because it creates a sense of unity and care.

An example of a professional relationship is the nurse-patient relationship. In a nurse-

patient relationship, the nurse commits to an oath of optimal care for the patient. This oath  symbolizes an agreement between the two to work together for the well being of the patient. The nurse functions within professional, legal, ethical, and personal boundaries to develop a relationship that meet the needs of the patient. However, interpersonal relationships tend to suffer when one or both participants involved have needs that are not satisfied. For example, the nurse tends to end the relationship with the patient during the termination phase. But the patient may feel neglected with this particular act because sometimes people have a difficult time coping with change, especially when a relationship has been developing for a while.

Hildegard Peplau identified five phases of the nurse-patient relationship: the orientation

phase, the identification phase, the exploitation phase, the resolution phase, and the termination phase. These phases are therapeutic and focus on interpersonal interactions. In the orientation

phase, the patient seeks help and the nurse identifies the problem so they can then solve it if possible. In the identification phase, also known as the working phase, the patient begins to understand their reactions to illness and connects to the nurse in either an independent, dependent, or interdependent way. The nurse assures the patient that he or she understands his situation and cares about resolving it. In the exploitation phase, the patient uses the nurse’s services and other resources based on his or her needs. In the resolution phase, the patient’s needs are resolved and next steps of care are discussed. In the termination phase, the nurse is preparing the patient for discharge and the nurse reviews and evaluates the progress and ultimately end it. (Peplau’s Theory of Interpersonal Relations: An Alternate Factor Structure for Patient Experience Data, 2005)

Nursing is more than just medicine—it is about understanding human behavior and treating everyone with the quality care we would like to be treated with. The concept of interpersonal relationship gives nurses the chance to display genuineness and empathy towards our patients and to support patients towards the goal of optimal health. Effective interpersonal relationship results in effective communication and the breaking down of barriers that often exist between healthcare providers and patients. The ultimate goal is to strengthen relationship with our patients regardless of race, gender, socioeconomic status, religious backgrounds, etc. Nurses should embrace everyone and make each patient as comfortable as they can be because we are the ones who are most engaged in their care.

The movie Wit highlights the importance of interpersonal relationships between nurse and patient. In the movie, the terminally ill patient narrates her experiences and reflections in the health care facility. When a nurse has a positive interpersonal relationship with his or her patient, he or she is able to assure patients that they are receiving care from great healthcare providers. A  negative interpersonal relationship dehumanizes the patient and the person may lose trust in not only the nurse, but the entire healthcare system in general. Another example is the interpersonal relationship between the physician and the patient. The patient felt devalued by the physician because the physician failed to recognize her as a person, he just saw her as a disease. The patient had the desire to be treated as human but because of the lack of empathy, this interpersonal relationship suffered.

A positive interpersonal relationship is the foundation of great nursing care

and to establish this relationship solely depends on the nurse because they have the expertise and have to honor the oath of a healthcare provider. As a result, the nurse must always value the wishes of the patient regardless of what he or she might personally think is best for the patient. Thus, nursing care is efficient when the relationship is patient-centered and goal oriented.

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