This chapter contains sections titled: Models of the Nurse–Patient Relationship. Care Versus Principles? Care Plus Principles. References. PDF download for An Interpretation of NursePatient Relationships in The PMH nurse–patient relationship in acute inpatient psychiatry continues to. Participants will consist of nurses and patients from two psychiatric units in Barcelona. Nurses The TR is also called the helping relationship, the nurse- patient relationship, the trusting relationship, and the .. Tashakkori A, Teddlie C, editors. Article; |; PubReader; |; ePub (beta); |; PDF (K); |; Citation.
Multiple terms are used to describe the same concept. The TR is also called the helping relationship, the nurse-patient relationship, the trusting relationship, and the therapeutic alliance.
Nevertheless, the central focus of all these concepts is the helping working relationship [ 4 ]. Likewise, the concept of the TR has been enriched by diverse perspectives and paradigms, including the psychodynamic perspective originating with Freud, the pantheoretical model, and the humanist or person-centred approach. Consequently, some authors have stated that personal qualities rather than theoretical orientation take centre stage in the TR [ 4 ]. Psychiatric nurses are aware of the concept of the TR and its importance [ 24 — 10 ].
However, they are also aware that specific skills are required to develop and maintain a TR with patients [ 7 ], which involves a huge effort and, moreover, implies difficulty in its achievement.
Factors such as consistency, empathy, the ability to listen, making a positive first impression, a safe and comfortable environment, and teamwork are basic pillars, encouraging and aiding the development of a TR [ 10 ]. For their part, patients perceive attitudes, values and a trusting relationship as being more important than technical skills in the therapeutic relationship [ 4 ]. Service users expect to receive individual attention as part of their treatment plan [ 11 ].
Having a feeling of control and of self-determination is highly important, and this sense of meaning and control is provided by interpersonal relationships [ 12 ]. So much so, that what patients want most are empathetic nurses, ie, those able to identify what the patient expects or needs from the nurse at any given moment [ 4 ]. Patients value nurses who are patient and imaginative and have a sense of humour [ 9 ], who listen and are empathetic [ 4 ].
The greater the chronicity, the more patients lose interest in their physical needs and the more they value relational aspects of care [ 13 ].
Despite evidence of the greater effectiveness of the TR and psychodynamic training in clinical practice [ 14 ], mental health nursing has been strongly influenced by the biomedical model and has become increasingly depersonalized [ 15 ]. There is no recognition of the need for the care of emotions, or of the importance of the emotional work required to develop and maintain a quality TR [ 13 ].
In this regard, routine tasks and administrative duties, as well as the time they consume, hamper the provision of individual attention and consequently the effectiveness of the TR [ 11 ]. Nevertheless, some evidence suggests that staff spend increasingly less time with patients, despite an increase in the staff-to-patient ratio in some units [ 16 ].
For some patients, inaccessibility and lack of communication-and therefore a lack of information provided by some staff-are factors that limit the TR [ 17 ]. Likewise, lack of availability, inequality, and differences in values and experience are factors that distance nurses from patients and hamper the development and maintenance of the therapeutic alliance. Often, patients feel they are given little opportunity to collaborate in their care [ 17 ], perceive that they spend most of their time alone and that they have little relationship with the care team [ 16 ].
Some patients feel like prisoners and report that staff who are themselves insecure adopt intimidating and condescending attitudes [ 18 ].
In this regard, and although nurses are aware of the importance of the TR and how to foster such an alliance, the scientific evidence shows that theoretical knowledge of communicative and interpersonal skills alone is insufficient to develop these skills effectively, and hence to establish an effective therapeutic relationship and provide high-quality nursing care [ 3915 — 1720 — 23 ].
Therefore, if knowledge of these skills does not necessarily lead to their use in daily clinical practice, it seems necessary to devise strategies to promote these competencies. Effecting change for action and through action is characterised by participation and reflection, which encourages both learning through action and about the action taking place.
Theoretical framework Participatory Action Research PAR is a method that encourages participatory and reflective change at the same time as it increases an understanding and transformation of practices [ 24 ].
This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships.
The concept is also interrelated with that of patient-centered care. Patient-centered care also known as person-centered or patient- and family-centered care describes a standard of care that ensures the patient and their family are at the center of care delivery. Therefore, the aim of this review is to identify strategies to enhance therapeutic interpersonal relationships between patients and health care professionals in the acute care setting.
Methods Integrative review process An integrative review is a research strategy involving the review, synthesis, and critique of extant literature.Nurse Patient Relationship/Communication
In addition, the reference lists of potential papers retrieved were examined to identify any further material that met the inclusion criteria. Both versions of British and American spellings were used to construct the search strategy as to reflect a systematic and comprehensive approach. The concept of therapeutic interpersonal relationships is not confined to any specific time period or type of peer-reviewed publication, and so no limitations were placed on these parameters to ensure a broad and diverse scope of knowledge.
Papers that focused on pediatrics and adolescence were also excluded as this review focused on adult patient—staff interaction. In addition, papers involving student cohorts were also excluded as were papers that reported solely on satisfaction surveys. Data evaluation The search strategy initially identified papers after removal of duplicates Figure 1.