Bridges to the Relationship – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
Bridges to the Relationship (Components):
1. Caring
2. Trust
3. Empathy
4. Mutuality
5. Confidentiality
Definition of Caring:
Caring is an attitude that enhance communication as well as a goal of therapeutic communication. Caring is the basis of a nurse client relationship and makes the client feel important. The client can easily identify a caring attitude.
Or,
Caring is an intentional human action characterized by commitment and sufficient level of knowledge and skill to allow the nurse to support the basic integrity of the person being cared for. The nurse offers caring to the client by means of the therapeutic relationship. The nurse’s ability to care develops from a natural response to help those in need: from the knowledge that caring is a part of nursing ethics, and from respect for self and others. The caring nurse involves clients in their struggle for health and wellbeing
rather than simply doing for clients those actions they cannot perform for themselves.
Trust
Trust represent an individual’s emotional reliance on the consistence and continuity of experience which are provided by an organized combinations of familiar and predictable persons and things. In a trusting relationship, the client perceives the nurse as trust worthy, a save persons with whom to share difficult feelings about health related needs and trust provides a non-threatening interpersonal climate in which the client feels comfortable revealing his or her needs to the nurse.
Trust develops best on past experiences. In the nurse client relationship, maintaining and open exchange of information contribute to trust. Trust appears as attitude such as respect, honesty, consistency, faith, caring and hope.
Empathy in the nurse-client relationship
Empathy, the capacity to understand another parson’s feelings or perceptions of situation, is an objectives awareness of, or a sensitivity to another person’s feelings and thoughts. Although the nurse is not involved in the thoughts and feelings of the clients, through empathy the nurse is able to understand and accept the feelings and thoughts of the client. Sympathy is different from empathy. In sympathy, the nurse shares in the feelings and thoughts of the client. These feelings and thoughts are generally related to a loss.
Mutuality:
Mutuality creates a balance between the patient and the caregiver. It is an element that functions well under stress and at the same time promotes most effective nurse client relationships. Nursing practice is a caring practice. Caring takes place within a nurse patient relationship. Establishing nurse patient relationship can help to decrease anxiety provoking situations.
This concept can be applied to nursing practice by keeping the client well informed about treatments and diagnosis, responding to concerns and complaints in a timely manner Including the client in decisions about the plan of care can enhance sense of situational control resulting in positive outcomes.
Confidentiality
Confidentiality is one of the core duties of medical practice. It requires health care providers to keep a patient’s personal health information private unless consent to release the information is provided by the patient.
Confidentiality and honesty form the basis of a trusting relationship between the nurse or midwife and the patient. Patients have a right to expect that their personal information remains private.
Steps of Caring Process:
Keller Baker (2000) identify four steps to help communicate a caring attitude to a clients: (CARE)
1. C=Connect with the client:
- Make eye contact
- Be at eye level when speaking to client
- Address client formally by the last name.
2.
- Listen carefully
- Focus on what client is saying
- Acknowledge clients point of view
- Express concerned.
3. R=Respond to client needs;
- Clarify what is being asked
- Respond in ordinary language
- Late client know what to expect.
4. E-Empower the client;
- Find out what client knows about condition and acknowledge opinion
- Work as partner to develop plan of care
- Allow choices as appropriate encourage questions.
Phages of Therapeutic Relationship:
Hildegard E. Peplau was an American nurse and the first published nursing theorist since Florence Nightingale. She identified four phages of therapeutic/ nurse-client relationships. The following phages are-
1. Orientation Phase
2. Identification Phase
3. Exploitation Phase / Working Phase
4. Resolution Phase/Termination Phase
A. Orientation Phase
a) The parameters of the relationship are established (e.g., place of meeting, length, frequency, role or service offered, confidentiality, duration of relationship).
b) Trust, respect, honesty and effective communication are key principles in establishing a relationship.
c) The nurse gathers information and ensures that priority issues are appropriately addressed.
d) Consistency and listening are considered by clients to be critical at the beginning of the relationship.
e) The nurse assists in promoting client comfort that may include reducing anxiety or tension.
B. Identification Phase
a) The client begins to identify problems to be worked on within relationship.iame
b) The goal of the nurse is to help the patient to recognize his/her own interdependent/participation role and promote responsibility for self
C. Exploitation Phase/Working Phase
a) The working phase of the relationship is where nursing interventions frequently take place.
b) The nurse assists the client to explore thoughts (e.g. views of self, others, environment, and problem solving), feelings (e.g. grief, anger, mistrust, sadness), and behaviors (e.g. promiscuity, aggression, withdrawal, hyperactivity).
c) The nurse advocates for the client to ensure that the client’s perspectives and priorities are reflected in the plan of care
D. Resolution Phase/Termination Phase
a) The resolution or ending phase is the final stage of the nurse-client relationship.
b) After the client’s problems or issues are addressed, the relationship needs to be completed before it can be terminated.
c) The ending of the nurse-client relationship is based on mutual understanding and a celebration of goals that have been met
d) Termination may be met with ambivalence.
e) Both should share feelings related to the ending of the therapeutic relationship.
f) Validating plans for the future may be a useful strategy
g) Increased autonomy of both the client and the nurse is observed in this phase
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