In order to define the term 'therapeutic relationship' one must break it down to it's simplest form. That is 'therapy' and relationship'. A simple definition of a relationship is the association between 2 or more individuals who are connected in some way or another. 'Therapy' is a term that represents the aid one gives to another individual helping them enhance their physical, emotional, physical, mental state and so on. Therefore a Therapeutic relationship is the alliance that exists between an individual assisting a patient medically as a health care professional with the aim of helping the patient advance in his/her life. In order for this to be a functional relationship it must be appropriately mutual at all times between the medical professionals and the patient and their loved ones therefore the medical staff must always respect the patient as a valuable individual and try to meet their needs from supporting them emotionally and providing them with physical comfort as stated by the principles of patient-centered care. A therapeutic relationship involves four phases, the reorientation phase is the first phase in which involves initial thoughts a medical professional can have on their first clinical experience it may involve elements of anxiety and fear. The orientation phase refares to the series of reactions and feelings exhibited on the encounter with the patient in which the one playing the role as the carer must analyse. In this phase a level of trust must be gained. The next phase is then the working phase in which the relationship with the carer and the patient must be applied in practice, here is the time when the carer works with resolving the patients issues and the bond must be maintained. The last phase is then the termination phase which involves ending the carer to client relationship when accomplishing both the carers and client's goals. Medical professionals must be especially aware that the patient is an individual human being in need of their care and support due to the fact that daily and prolonged exposure to patients may cause health care professionals to become emotionally detached and indifferent to a patients emotional needs. Not having a healthy therapeutic relationship with your patient may result in many consequences such as lack of motivation to help a patient recover, no account of knowing where you stand with the patient therapeutically or the patient may even be overconfident and impose on your personal life.
Describe 5 skills which are required in this kind of relationship.
communication:
One of the most useful skills in maintaining a therapeutic relationship is the ability to effectively communicate with the patient. Communication may not only involve speaking, it also involves communicating through body language. The aim is to use communication to make work easier for the nurse and have the ability to separate their work from their personal lives to make the interaction between nurse and patient strictly professional. The patient must understand that in order for the nurse to help they must first be able to clearly state what the problem is, the nurse must also be clear upon explaining, such as when explaining different routines ( for example when taking blood pressure). Here the use of medical jargon should be avoided as the patient may not necessarily be able to understand and consequently make the patients confused and add on to mental stress. The first encounter is what will determine the relationship between good or bad, therefore upon first encounter both the nurse and the patient must be kind to each other in order to create an environment that comfortable and peaceful and not have any distractions that might harm the relationship between nurse and patient.
Empathy:
Empathy is also a useful skill as it helps a carer understand and acknowledge the patient's pain. With this skill the nurse is able to identify and try to share the patients feeling and thoughts in order to able to better understand the patient. Researchers have stated that being able to better understand the patients have eventually helped them with their diagnosis and how to help them. A nurse should always be sincere in what he/she does and the main goal must always be to help the patient, therefore a good way to form a sense of empathy is to ask the patients how they feel, this replaces the patients and make them more open to communication and helps them develop a mutual understanding to one another therefore maintaining a healthy therapeutic relationship.
Self-reflection and the ability to listen:
The ability to reflect on words and feelings exhibited by the patient is also a very useful skill to have when maintaining a healthy therapeutic relationship. It is important and it shows the patient that the nurse is making a conscious effort to understand and try to empathize with their feelings. When one reflects it shows that not only are you listening but also trying to understand the world the same way the person speaking does, and this encourages the person speaking to continue opening up. In order to be able to reflect you must first be able to listen, listening can encourage the patient to continue speaking and allow them to feel comfortable expressing their emotions. Listening to a patient not only involved listening to what they are saying but one must also be able to read between the lines.
Trust:
In order to establish a patient to nurse relationship there must be an element of trust involved. In order to communicate with the patient the patient must first trust you enough to open up about their concerns on their well being. The patient may only do this if they know that there is a certain level of discretion held within the medical staff. For a patient to trust the healthcare professionals the patient must clearly know the intentions of the staff members to avoid unneeded suspicion. Nurses can do this by communicating with the patients about their health so that the patients can feel involved in the medical process. Like the patients should trust the nurses with making decisions that are well informed , nurses should also trust and respect that the choices patients make are what they think is best for themselves. In a therapeutic relationship there is no higher or lower power, therefore trust is always needed to be there equally between patient and nurse. ]
Respect:
In nursing, respecting the individual as a whole is always important, whether that be respecting the patient's opinions, feelings, views, ethnicity and so on despite whether you agree with them or not. A nurse must never judge as everyone copes with different situations according to what they're used to in their daily life. To be respected is a basic human right therefore if the nurse doesn't respect the patient, the patient will consequently not respect the nurse and a healthy therapeutic relationship will not be established. A nurse must always respect a patients decisions whether they agree with them or not and provide unconditional positive regard.
references :
http://www.goodtherapy.org/blog/psychpedia/definition-of-therapeutic-relationship
http://www.lesley.edu/counseling-and-psychology/six-critical-skills-every-counselor-should-cultivate/
http://www.nursetogether.com/importance-empathy-nursing
http://www.ohsu.edu/xd/outreach/occyshn/training-education/upload/developingtheraputicrelationships_ch10.pdf
http://www.skillsyouneed.com/ips/reflecting.html
http://www.natal.org.il/english/?CategoryID=229&ArticleID=197
http://www.goodtherapy.org/blog/therapeutic-relationship-trust-trauma-1022125
https://www.crnm.mb.ca/uploads/document/document_file_99.pdf?t=1438267436#
https://www.ukessays.com/essays/nursing/therapeutic-relationship-patient.php
2. Why is communicaion essential to nursing?
The simple definition of communication is the exchange information which can take any form from body language to writing. Communication is one of the most important means to form a therapeutic relationship with a patient. Without communication it would be impossible to create any relationship with the nurse and patient at all. Having good communication skills can ease the minds of both patient and nurse, whereas bad communication skills can cause a lot of stress, confusion and misunderstandings. Communication skills in nursing are extremely essential as they may also mean life or death for a patient. If a patient does not feel comfortable enough telling the nurse of a particular symptom, which can greatly help with the patient's diagnosis, then a lot of damage would be done solely based on poor communication skills. Communication is also essential to make patients more comfortable and their stay in the hospital. Certain patients may have responsibilities at home to deal with such as children or even financial issues which can in-turn make them more impatient and frustrated. Therefore communication is essential to relieve some of the mental stress the patient may be feeling which could even benefit them physically. It is also within the responsibilities of a nurse to make patients feel involved in their own health care, this is also done through communication and involves telling a patient how they would like to deal with their situation and regularly giving them updates on their physical state. Communication with the patient's loved ones is also very important especially when dealing with a patient who may not find it as easy to understand such as children and elderly. Communication is not only important between the patient and their loved ones, but communication between staff members is also very essential. With the hectic life of working in a hospital, changes of shifts and with people's lives at steak it is important that the medical staff are constantly communicating with each other whether that be to actively speaking or through documentation. Failure of communication between staff members can cause severe cases such as confusion of cases, failure to administrate the correct and so on, some cases may even involve the death of a patient.