Nurse-Patient Relationship
What is the Nurse-Patient Relationship?
Many individuals will be hospitalized at one point during their lifetime. And recent studies indicate that the percentage of people hospitalized has increased in recent years. From 2000 to 2018, almost 6% of Americans between the ages of 18 and 44 were hospitalized at least once. In 2018, that percentage rose to 6.7%. In 2020, during the beginning of the COVID-19 pandemic, over 10% of Americans were hospitalized.
In order to limit the strain on the American medical system, it is important to minimize the length of each patient's hospital stay. One way to do this is by fostering a positive relationship between nurse and patient. A therapeutic nurse-patient relationship is a caring, professional relationship that supports the patient's well-being. The following lesson details the various components, stages, and benefits of a therapeutic nurse-patient relationship.
Why Do Nurses Build Therapeutic Relationships?
A therapeutic relationship is an interactive relationship between a care provider, their patient, and their patient's family. The relationship is characterized as boundaried and professional as well as caring and empathetic. Data suggests that there are many positives to establishing these bonds. Nurses seek to foster a relationship with their patients in order to benefit both the patient and the nurse.
Benefits of a successful nurse-patient relationship:
- Decreases the length of hospital stays
- Decreases the overall cost of a hospital visit
- Conserves valuable hospital resources
- Conserves nurse's time, allowing them to care for more individuals throughout the week
- Increases quality of care for patients
- Increases quality of life and overall job satisfaction for nurses
Components of a Therapeutic Relationship in Nursing
Although each nurse-patient relationship is unique, there are some key components that are essential. Nurses must show a genuine interest in their patients. Genuineness is the ability to be one's authentic self in a professional role. When time allows, a nurse may get to know their patient by asking questions about their family, work, hobbies, or interests. Although a nurse may see dozens of patients throughout the day, expressing an equal and genuine interest in each one's background, condition, and well-being is paramount.
Nurses must also provide empathy. Empathy is educated compassion for another's feelings. A successful nurse has the desire to understand their patient's experience. Empathy in a therapeutic nurse-patient relationship allows the nurse to assess the patient's condition and needs, set goals with the patient, and intervene when necessary.
Trust is the foundation of all successful intrapersonal relationships, including nurse-patient relationships. When hospitalized, an individual is in a vulnerable state. It is essential for the patient to believe that their nurse is honest, genuine, knowledgeable, and respectful. Trust is ultimately given by the patient. However, nurses may facilitate the establishment of trust in a number of ways.
Facilitating trust:
- Treating patients with dignity and respect
- Active and careful listening, makes the patient feel seen and heard
- Being accepting of the patient's background, culture, or lifestyle, allowing the patient to feel comfortable sharing information
- Being honest and consistent, showing the patient that they are trustworthy and their care is dependable
A successful nurse-patient relationship also requires mutual respect. Respect is the unconditional positive regard for another's beliefs, in spite of one's own feelings. Each patient brings with them a lifetime of experiences. Some patients may have unhealthy habits such as smoking or excessive drinking. Some patients may have poor hygiene. Good nurses are nonjudgmental and accepting of their patients. Nurses may ensure they are treating their patients in the following ways.
Showing respect:
- Introducing themselves and asking their patient for their preferred title (Mr., Mrs., Ms.)
- Prioritizing patients' comfort, privacy, and modesty
- Communicating with the patient before all procedures
- Expressing a genuine willingness to learn and understand the patient's emotions, condition, and background
Effective Nurse-Patient Relationship: Phases
There are four defined phases in an effective nurse-patient relationship. The phases were first described by Hildegard Peplau, an American nurse and nurse theorist born in the early 1900s. The phases are listed below.
1. Pre-interactive: The nurse gathers all the relevant information about the patient to prepare for their first interaction.
2. Orientation: The nurse helps the patient become oriented through an introduction.
3. Working: The nurse help explore solutions, providing care and problem-solving.
4. Termination: The nurse evaluates the patient's response to treatment and terminates the relationship.
Pre-interactive Phase
The pre-interactive phase occurs before the nurse and patient meet. It is a time during which the nurse can build self-awareness of the patient, the patient's history, and the patient's condition. During this phase, the nurse must evaluate potential concerns. For example, their approach to a new mother whose baby is in the ICU would be different than their approach to a new mother whose baby is healthy and staying with the mother.
Orientation Phase
The orientation phase follows the pre-interactive. During the orientation phase, the nurse introduces themselves to the patient. They provide their name and professional status. Spoken words may be reinforced with physical gestures such as eye contact or a handshake. It is important to undergo the orientation phase even if a patient is confused, unresponsive, or nonverbal. For example, a nurse might say, ''Hello, my name is Jane Doe, I am an LPN. I will be taking care of you today until 9:00 pm. I will be in and out of your room until then, but I am available at any time; simply ring the call bell and I will come to check in.''
Working Phase
The working phase begins after orientation is complete. During the working phase, solutions are explored, tried, and evaluated. It is essential for nurses to understand that this phase is often uncomfortable or scary for the patient. There may be some resistance, and the nurse must be patient throughout this phase. A nurse may guide the patient through the working phase by using active listening to understand their concerns and helping them to develop healthy coping skills. This phase also focuses on self-direction and self-management by the patient. For example, a nurse may educate a diabetic patient on how healthy eating affects their blood-glucose levels. This encourages the patient to make healthy choices in the future, which will benefit their long-term health even after they are discharged.
Termination Phase
The final stage of a therapeutic nurse-patient relationship is the termination phase. The goal of this phase is to foster the patient's independence in order to support their transition out of the hospital. The nurse evaluates the patient's response to treatment and whether their goals were met. This is discussed with the patient and the patient's family. It is also important to discuss the patient's plan for the future in order to limit their likelihood of rehospitalization. The termination stage ends the relationship between nurse and patient. Implying that the relationship can continue is unprofessional and unethical. For example, a nurse may not suggest that they will find the patient on social media to check up on them after discharge.
Lesson Summary
A therapeutic nurse-patient relationship is a caring, professional, boundaried relationship that supports the well-being of the patient. An effective nurse-patient relationship has many benefits, including decreased length of hospital stays; decreased use of hospital resources; decreased cost of hospital visits; increased ability to provide care to many patients; increased quality of care for the patient; and increased job satisfaction for the nurse. Essential components of a nurse-patient relationship include genuine interest, empathy, trust, and respect.
There are four distinct phases of a therapeutic nurse-patient relationship as defined by Hildegard Peplau, an American nurse and nurse theorist. During the pre-interactive phase, the nurse builds self-awareness of the patient, the patient's history, and the patient's condition to prepare for interaction. This is followed by the orientation phase, during which the nurse introduces themselves to the patient. This phase is essential even if the patient is nonverbal, confused, or unresponsive. After introductions, the working phase begins. During the working phase, solutions are explored, tried, and evaluated. A nurse-patient relationship ends with the termination phase. During this final phase, the nurse fosters the patient's independence in order to support their transition back to normal life. They evaluate the success of treatment, whether the goals were met, and provide a plan of action for the future. It is unethical and unprofessional for the nurse and patient to continue a relationship or remain in contact after the patient's discharge from the hospital.
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What are 3 important characteristics of the nurse-patient relationship?
An effective therapeutic nurse-patient relationship can decrease the overall length of a patient's hospital stay. Three important characteristics of this relationship are:
1. Genuine interest
2. Empathy
3. Trust
What is the importance of the nurse-patient relationship?
A therapeutic nurse-patient relationship is incredibly important. It can decrease the length of a hospital stay, conserve valuable resources and time, increase the quality of care for the patient, and increase overall job satisfaction for the nurse.
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