The Therapeutic Nurse-Client Relationship
The purpose of this paper is to examine and discuss the therapeutic nurse client relationships that a nurse fulfills in accordance with the professional standards guidelines published by the College of Nurses of Ontario. The criteria used to do this will include therapeutic communication, client centered care, boundaries and appropriate use of power. “Maintaining clear, caring boundaries with patients and families, while remaining the consummate professional, is the role of the nurse operating from a standard of therapeutic relationship” (Allenbach & Steinmiller, 2004 p 24).
This is important because the therapeutic relationship is a professional relationship, and clearly differs from that as a social encounter. As nurses and nursing students this is a crucial relationship to manage. It requires constant assessment, evaluation and subjectivity on the nurse’s part to stay within the professional standards that the College of Nurses of Ontario (CNO) publishes. The document breaks the therapeutic relationship into five distinct components of trust, respect, professional intimacy, empathy, and power.
It does not matter the context or the length of this relationship or how involved in the individual’s care the nurse is these five components are always to be present and strictly adhered to (CNO, 2006). Nursing is a human endeavour it incorporates both interpersonal and social skills where communication occurs within the context of this relationship (Evans, 2007, p189). In every therapeutic relationship there are a minimum of 2 people involved that is the nurse and the client.
However the nurse will not only have to collaborate with other professional of the healthcare team, but may also have multiple family members involved. So when a nurse takes on a client they must also take on their family, their home life, their illness, and their lifestyle. The nurse needs to find the balance by maintaining a constant connection with the client so that she may obtain the necessary important feedback that is needed to help the client. For this reason it is important that nurses do not internalize the client’s problems.
This can be very challenging due to the fact that on a daily basis nurses deal with both physical and emotional situations to varying degrees and intensities. Therapeutic communication consists of the art of listening and articulation. This is extremely important to the nursing practice. Having a therapeutic relationship is not only about the caring and care giving it is about what is important to the client. What fears, anxieties and concerns they may have. This is particularly challenging for nursing student because of the inexperience in dealing with clients.
However nursing students can demonstrate this quite simply by introducing themselves upon entering the room, and asking the client how they would like to be addressed then listening to their response. This will begin to build a rapport and allow the client to become a little more comfortable with you. In our society individuals tend to articulate more than they listen. Nurses need to concentrate, and focus on what is being said by the client to successfully listen and understand what is being said, and as students this is a skill that needs to be practiced and developed.
It may be our innocence that allows cues to be missed and important information to be neglected. As a nurse you must pay attention to both the verbal and nonverbal cues and allow for silence if that is what is required by the client. It is about putting your agenda, insecurities, and prejudices in the proper perspective and focusing on your clients needs. In the therapeutic relationship another important component is that the care is to be client centered. Nursing care is determined by the way nurses use knowledge and skills to appreciate the uniqueness of the person in their care (Warelow, Edward, & Vinek, 2008, p. 46). It is important that the client have an open dialog and constant interaction so they are able to provide feedback in terms of their care, and the client must always understand and agree to that care. In client centered care the client is to be put first and foremost at every point in their care. Nurses need to remember that the client is an expert on their own wants, needs and circumstances. However there needs to be a balance of what the preferences of the client are and the medical interventions that need to occur that will ultimately benefit them.
It is the responsibility of the nurse to help that client make informed choices. This is important to the nursing practice because nurses lead the team for their clients. They are advocates for the client and play a critical role in sharing information with other members of the healthcare team to gain maximum benefits for that client. This partnership between the nurse and the client aims to strengthen the ability for the client to reach well informed decisions. Nursing student may demonstrate this client centered care by assessing what are the important goals for the client and trying to ncorporate them into the clients care plan. As simple as this may sound it could be very challenging again, because of the clinical inexperience that students have, and knowing what goals are realistic and which are not. The final criteria this paper will consider are that of the appropriate use of power and boundaries in the therapeutic relationship. It is important to realize that in this relationship a client entrusts their care to nurses. When the client does this they are putting themselves in a vulnerable position in the relationship.
Nurses need to recognize that this vulnerability can be seen as power over the client. For this reason nurses need to become good stewards of this privilege by respecting the dignity and worth of the client. “Nurses are responsible for effectively establishing and maintaining the limits or boundaries in the therapeutic nurse-client relationship” (CNO, 2006, p. 7). This ability to set boundaries and stay with them is very important to the practice of nursing, and it is up to the nurse to maintain such boundaries.
These boundaries are used to allow a safe connection between a nurse and a client that is always based on the clients health needs. Nurses need to always remain aware of the boundaries in the therapeutic relationship so that both the nurse and the client are protected by those boundaries. As students this can be demonstrated by being careful not to disclose any personal information or take any kinds of gifts. The challenge may be because we are meeting these clients for the first time the client may be very innocently just making small talk and meaning nothing harmful by it.
This paper has simply touched on a few key criteria in examining and discussing the nurse client therapeutic relationship. It can be seen that skills like therapeutic communication, client centered care, boundaries and appropriate use of power can go a long way to building a good therapeutic relationship. Nurses want to build therapeutic relationships that heal and not harm them or their clients. As nurses and nursing students it is important that we refer to the College of Nurses of Ontario if there is any standard that needs further clarification. References
Allenbach, A. , Steinmiller, E. , (2004). Waiting together: translating the principles of therapeutic relationships one step further. Journal for Specialists in Pediatric Nursing,9,(1), 24-31. Evans, A. M. , (2007). Transference in the nurse-patient relationship. Journal of Psychiatric and Mental Health Nursing, 14,189-195. Warelow, P. , Edward, K. , Vinek, J. , (2008). Care: what nurses say and what nurses do. International Journal of Human Caring,22 (3), 146-153. College of Nurses of Ontario. (2006). Therapeutic nurse-client relationship. Practice Standard, 3-17.
