Introduction
The concept of interpersonal relationship in health practice is something that continues to influence the quality of services and care available to different individuals. This idea forms a strong foundation for all interactions in clinical settings, thereby facilitating the establishment of meaningful patient-practitioner experiences. The relevant terms considered in the research paper below include professional values, ethics and the therapeutic relationship.
Professional values encompass all attributes that dictate the practice of caregivers. This term is informed by the major principles of health practice, including patient autonomy, justice and nonmaleficence. Ethics is a notion that focuses on evidence-based aspects and initiatives to protect other people’s rights and liberties while at the same time, promoting the ideas of morality and acceptable personal behaviours. The term âtherapeutic relationshipâ refers to positive interactions between caregivers and patients that promote caring, continuous support, empathy and healing. The existence of such relationships influences the quality of nursing care since practitioners are willing to offer evidence-based medical support.
The targeted patients will record positive experiences because clinicians address their health challenges using evidence-based practices. The final result is that positive care outcomes will be recorded. The paper below begins by linking field-specific aspects relating to the therapeutic relationship. The essay goes further to analyse the major issues that support the establishment of therapeutic relationships in nursing environments. The next section addresses the factors that support the maintenance of therapeutic relationships in health settings. The discussion also describes major barriers affecting the implementation of therapeutic relationships. The last section analyses the correlation between professional values and the maintenance of therapeutic nursing relationships.
Field-Specific Issues
In the nursing literature, numerous ideas have emerged to define the importance of therapeutic interpersonal relationships in care delivery. Scholars and researchers have been focusing on evidence-based aspects that have the potential to maximise patientsâ experiences and deliver positive health results. According to Pilgrim, Tomasini and Vassilev (2011), this idea is implemented in different settings, thereby acquiring various names or terms.
Some of them include purposeful relationships and nurse-client relationships. What stands out from such concepts is that the health professionals involved embracing appropriate aspects or practices that can improve the experiences of the targeted patients. Walker (2014) indicates that the therapeutic relationship idea is informed by the patient-centred care model. This is true because practitioners focusing on this framework establish desirable partnerships, identify emerging conflicts or challenges, involve other stakeholders and promote superior care delivery procedures.
Health professionals put the wishes and expectations of patients first. This initiative makes it easier for them to understand the emotional needs and expectations of the targeted individuals. Price (2017) asserts that a therapeutic relationship is a powerful model for implementing an individualised care delivery model. Nurses and clinicians who understand the power of this model find it easier to provide superior and timely medical services.
Therapeutic interpersonal relationships are capable of presenting positive results, including minimising anxiety, reducing healthcare costs, improving quality of care and promoting evidence-based treatment procedures. Numerous challenges will emerge and affect the medical outcomes of more patients when practitioners fail to establish positive interpersonal relationships whenever providing medical services. Some of them include psychological distress, burnout, dehumanisation and medication errors.
Nursing departments that promote therapeutic relationships will meet their patientsâ needs. Unfortunately, many healthcare professionals are yet to embrace the power of this model. This gap has been associated with some of the above negative outcomes. This is the reason why many researchers have been keen to present superior insights for enhancing therapeutic relationships (Grant et al. 2010). When professionals and nurse practitioners consider these issues seriously, it will be possible for many clinics and healthcare institutions to realise the benefits of interpersonal relationships and eventually meet the medical needs of many citizens.
Building Therapeutic Relationships
Relationships in nursing might take different shapes depending on the factors existing in targeted situations or departments. Positive interactions between caregivers and adult patients can address most of the diseases many people face in different parts of the world. Most of the concepts and strategies employed to support the establishment of therapeutic relationships are borrowed from Peplau’s interpersonal theory (Hawley 2007). According to this model, client-nurse relationships dictate the quality of medical services available to different people.
When the interaction is positive, the targeted patient will record better health outcomes and achieve his or her potential. From this analysis, it is evident that Peplauâs framework has become a useful resource for implementing or introducing therapeutic relationships in adult care (Price 2017). Some of the critical factors that practitioners and clinicians should take seriously include autonomy, listening and continuous empowerment.
Caregivers should embrace these concepts in order to identify existing obstacles and create the best environment for promoting the positive patient-practitioner therapeutic relationship. The targeted patients will offer appropriate insights and be part of the care delivery process.
The second issue to consider whenever building therapeutic relationships is that of communication. Banks and Gallagher (2009) indicate that practitioners should consider this aspect from different perspectives. The existence of effective communication will promote numerous evidence-based practices, including listening and conversation. Beauchamp and Childress (2012) go further to assert that therapeutic listening is a powerful approach that fosters positive patient-caregiver relationship.
Practitioners who listen to their patientsâ needs will diagnose conditions accurately, receive timely feedback and offer appropriate guidance to support the healing process. Pryjmachuk (2011) supports this argument by indicating that attentive listening is a powerful instrument for maintaining meaningful clinician-patient relationships.
Another issue that nurses should take into consideration is the ability to respond to patientsâ emotions. In an attempt to record positive results, attributes such as empathy and sympathy should become guiding principles for practitioners planning to establish positive therapeutic relationships. Nurses can liaise with their patients, focus on the health issues their patients face and develop evidence-based models to meet their needs (Beauchamp & Childress 2012). Skilled nurses can go further to study and understand patientsâ emotions. This practice will make it easier for them to establish desirable interpersonal relationships.
Therapeutic engagement is a powerful aspect that makes it easier for practitioners to establish interpersonal relationships with their patients. A study completed by Pryjmachuk (2011) revealed that nurses focusing on individuals suffering from suicidal thoughts recorded positive results after applying these ideas. BryczyĆska and Simons (2011) also indicate that a therapeutic engagement is a powerful strategy for reducing feelings of hopelessness, isolation and stress. Practitioners who embrace these two aspects will promote superior attributes, including empathy, listening, genuineness and trust.
Whenever focusing on critically-ill adults, clinicians can embrace the power of humour to establish positive therapeutic relationships. This practice results in emotional satisfaction and promotes therapeutic engagement. The use of laughter throughout the care delivery process can foster interpersonal communication (Callaghan & Gamble, 2015). These initiatives are known to act as icebreakers and encourage patients and caregivers to interact efficiently. Every person finds it easier to ask questions or gives answers depending on the existing situation.
Maintaining Therapeutic Relationships
The promotion and existence of therapeutic relationships in nursing departments result in positive health outcomes. When clinicians focus on this concept, it becomes easier to solve emerging problems and meet the changing needs of different people. The framework also guides nurses to engage in positive interactions and assist individuals facing physical and emotional challenges (Slade 2009). Healthcare professionals should focus on evidence-based initiatives and strategies in an attempt to maintain therapeutic interpersonal relationships once they have been established. This means that there are various approaches that should be considered in different health settings.
The first critical factor for maintaining these relationships is that of leadership or supervision. Different theories of management focus on the best approaches for guiding, empowering and mentoring others. After therapeutic relationships have emerged, nurse leaders (NLs) and supervisors in various departments should empower clinicians to continue embracing evidence-based practices (Callaghan & Gamble 2015).
They should interact with patients in a positive manner, address emerging issues and focus on their ever-changing needs. The emotional concerns of different individuals should inform the course of the existing relationship. Those who are led should also become accountable. This concept will ensure that nurses are willing to meet their objectives while at the same time empowering their patients.
The second approach for maintaining such relationships in healthcare settings is that of change. Edwards (2009) argues that departmental leaders can introduce new ideas and make them part of a given unit. Practitioners providing primary medical services can benefit from this form of change. This means that desirable therapeutic relationships between clinicians and patients will become evident. Powerful incentives such as cultural consideration and provision of resources will support the introduced change.
The working environment should be able to support the existence of therapeutic interpersonal relationships. Christiansen et al. (2015) indicate that unit leaders should empower their followers, promote trust, build confidence and encourage them to engage in lifelong learning. Emerging problems will be articulated and addressed using evidence-based approaches. When the environment is desirable, a positive working relationship will emerge, thereby minimising negative outcomes such as anxiety and dysfunctional behaviours.
The concept of continuous learning can guide nurses to acquire superior concepts and use them to support existing therapeutic relationships. This concept makes it easier for health professionals to improve their care delivery models. This practice will make it easier for them to become good communicators, solve emerging challenges and deliver positive results (Edwards 2009). The notion of cultural competence can also become common when practitioners engage in lifelong learning. This concept ensures that nurses are able to form therapeutic relationships that are informed by their patientsâ cultural, religious and social backgrounds.
The four principles of nursing ethics offer powerful incentives for maintaining meaningful therapeutic relationships between patients and caregivers. These include autonomy, beneficence, justice and nonmaleficence. Practitioners who consider these values will focus on their patientsâ rights and liberties, respect their decisions and consider the importance of personalised care delivery models (NHS Education for Scotland 2012). They will also involve their relatives and ensure emerging challenges are addressed. When patients realise that their caregivers act ethically and professionally, the chances are high that the established therapeutic relationships will be supported.
Barriers to Therapeutic Relationships
Many institutions encounter numerous challenges or obstacles that make it impossible for them to develop desirable therapeutic relationships. One of these gaps is that of ineffective communication. The above discussion has outlined attentive listening as a powerful attribute for promoting interpersonal relationships. When nurses fail to communicate positively with their patients, the chances are high that problems such as lack of trust will emerge. The individuals involved will not share ideas or exchange views that can improve the quality of medical services (Edwards 2009). Poor communication will affect patientsâ responsiveness throughout the care delivery process.
The absence of leadership is another factor that hinders the maintenance of therapeutic relationships. When clinicians lack appropriate support and guidance, the levels of burnout and dissatisfaction will increase significantly. Some obstacles that might emerge include lack of mentorship and the ability to focus on patientsâ ever-changing needs (Grant et al. 2010). The situation will also worsen since most of the practitioners will lack role models.
Institutions that lack adequate incentives will be unable to promote the establishment and maintenance of therapeutic relationships. For instance, institutions that do not encourage their physicians and nurses to embrace powerful concepts such as lifelong learning, cultural competence and teamwork will be unable to establish positive interpersonal relationships with their patients (Ferrell, Coyle & Paice 2015). This is true because many patients are usually from different backgrounds. They will also find it hard to involve their relatives and friends.
A negative culture in a given institution will make it impossible for targeted caregivers and nurses to form positive therapeutic relationships with their patients. This happens to be the case because they are not empowered, mentored, or equipped with adequate resources (McCormack & McCance 2010). Emerging conflicts and problems that can strain relationships go unnoticed.
Nurses who possess negative feelings about their patients will hinder the development of therapeutic relationships. Underpowered practitioners might harbour negative feelings and avoid their colleagues or patients (Hendrick, 2010). This means that they will establish frustrated relationships with them, thereby affecting the intended health outcomes negatively. They will also be unable to understand the unique issues facing the targeted individuals.
Professional Values and the Development and Maintenance of a Therapeutic Nursing Relationship
Professional values in nursing practice empower clinicians to focus on the changing needs of their patients. When employed properly, practitioners can find it easier to develop and maintain therapeutic relationships with their respective patients. The core professional nursing values include dignity, justice, altruism, integrity (Hope, Savulescu & Hendrick 2008). Caregivers who embrace the power of dignity and justice will always consider the demands of the targeted individuals.
Many scholars have referenced the concept of integrity as a powerful value for improving care delivery. This approach makes it possible for clinicians to formulate evidence-based philosophies and focus on their patientsâ needs. They also embrace attributes such as ethics, morality and professionalism (McCarthy & Rose 2010). This practice will empower them to establish meaningful relationships with their respective patients. They will address emerging problems, form teams and identify superior initiatives for maximising patientsâ health outcomes.
The value of altruism encourages practitioners to remain selfless and focus on other peopleâs wellbeing. This attribute can become a model for promoting therapeutic relationships between individuals and their caregivers. Professionals embracing this value will create personalised care delivery models (Lawrence, Perrin & Kiernan 2015). They will be optimistic, create the best environment, identify appropriate resources and solve emerging problems. The established relationship between nurses and patients will deliver positive results.
Conclusion
The field of nursing theory has presented numerous concepts to guide and improve healthcare delivery. Practitioners and clinicians should embrace emerging ideas to improve their philosophies and address the major medical challenges affecting many patients. Therapeutic interpersonal relationships can transform patientsâ experiences and make it easier for them to achieve their health goals. In the recent past, many scholars and nursing theorists have offered numerous concepts to promote the patient-centred practice.
This approach has become a powerful model for encouraging clinicians and nurses to establish therapeutic relationships with targeted people. This evidence-based practice can make it possible for many patients to receive high-quality medical services. The above discussions have examined the major issues revolving around the implementation of therapeutic relationships in the field of nursing. In order to build therapeutic relationships, practitioners and clinicians should focus on aspects such as autonomy, listening and continuous empowerment. The idea of communication should also be taken seriously.
Other issues to consider include responding to patientsâ demands and emotions, humour and engaging in therapeutic engagement. The above discussion has also highlighted critical aspects that can sustain meaningful therapeutic relationships. These include proper leadership or supervision, implementation of organisational change, better working environment, continuous learning and principles of nursing ethics.
Poor incentives, ineffective leadership, negative culture and personal behaviours or feelings can inhibit the introduction and maintenance of therapeutic relationships. Finally, the professional values of altruism, justice, autonomy, integrity and dignity will empower many practitioners and clinicians to establish therapeutic relationships with their respective patients and eventually deliver positive health results.
Reference List
Banks, S & Gallagher, A 2009, Ethics in professional life: virtues for health and social care, Palgrave MacMillan, Basingstoke.
Beauchamp, TL & Childress, JF 2012, Principles of biomedical ethics, 7th edn, Oxford University Press, Oxford.
BryczyĆska, GM & Simons, J 2011, Ethical and philosophical aspects of nursing children and young people, Wiley-Blackwell, Chichester.
Callaghan, P & Gamble, C (eds) 2015, Oxford handbook of mental health nursing, 2nd edn, Oxford University Press, Oxford.
Christiansen, A, OâBrien, M, Kirton, J, Zubaru, K & Bray, L 2015, âDelivering compassionate care: the enablers and the barriersâ, British Journal of Nursing, vol. 24, no. 16, pp. 833-837.
Edwards, SD 2009, Nursing ethics: a principle-based approach, 2nd edn, Palgrave Macmillan, Basingstoke.
Ferrell, BR, Coyle, N & Paice, JA (eds), 2015, Oxford textbook of palliative nursing, 4th edn, Oxford University Press, Oxford.
Grant, G, Ramcharan, P, Flynn, M & Richardson, M 2010, Learning disability: a life cycle approach, OU Press, Milton Keynes.
Hawley, G (ed) 2007, Ethics in clinical practice â an interprofessional approach, Pearsons Education Limited, London.
Hendrick, J 2010, Law & ethics in childrenâs nursing, Wiley-Blackwell, Chichester.
Hope, T, Savulescu, J & Hendrick, J 2008, Medical ethics and law: the core curriculum, 2nd edn, Churchill Livingstone, Edinburgh.
Lawrence, J, Perrin, C & Kiernan E (eds), 2015, Building professional nursing communication skills, Cambridge University Press, Cambridge.
McCarthy, J & Rose, P (eds) 2010, Values-based health & social care: beyond evidence-based practice, Sage Publications Limited, London.
McCormack, B & McCance, T 2010, Person-centred nursing: theory and practice, Wiley-Blackwell, Chichester.
NHS Education for Scotland 2012, The ten essential shared capabilities: supporting person-centred approaches: a learning resource for health care staff, NHS, Glasgow.
Pilgrim, D, Tomasini, F & Vassilev, I 2011, Examining trust in healthcare: a multidisciplinary approach, Palgrave MacMillan, Basingstoke.
Price, B 2017, âDeveloping patient rapport, trust and therapeutic relationshipsâ, Nursing Standard, vol. 31, no. 50, pp. 52-61.
Pryjmachuk, S 2011, Mental health nursing: an evidence-based introduction, Sage, London.
Slade, M 2009, Personal recovery and mental illness: a guide for mental health professionals, Cambridge University Press, London.
Walker, S 2014, Engagement and therapeutic communication in mental health nursing, Sage, London.