The therapeutic nurse – patient relationship

Role of the communication in the nurse-client relationship in psychiatry

• To be effective, a nurse must excel in both the art and the science of communication.

• 1.Therapeutic relationships-one of the main principles of psychiatry

• 2.Definition of communication• 3. Communication Strategies• 4. When communication breaks

down• 5. Building relationships

• At the core of nursing is the therapeutic nurse-client relationship. Communicating receptivity, empathy, trust and respect is how nurses establish and maintain therapeutic relationships.

• Communication is defined as the act of transmitting information by speaking, writing or using non-verbal means. But communication in the nursing profession is more than that. Nurses first learn the science, the technique, of communicating as students.

• The art of communicating, the ability and confidence to finesse both verbal and non-verbal messages so interactions can be purposeful and effective, is acquired gradually and improves with reflective practice and experienc

• Nurses regularly apply the art and science of communication in establishing and maintaining relationships with clients and other members of the health care team, in resolving ethical dilemmas or situations of conflict, in their advocacy efforts on behalf of clients and in promoting quality practice environments that help them meet the standards of practice.

• “Good communication skills are essential to a regulated profession such as nursing,” says Elizabeth Bildfell, RN, a Practice Consultant at the College.

• In nursing, staff focus on every aspect of verbal and non-verbal communication so interactions are therapeutic.” Nurses are accountable to the public and, through self-regulation, are responsible for ensuring that nursing practice and conduct – including communication in all of its forms – meet the standards of the profession

• . A major component of this accountability involves conducting oneself in ways that promote respect for the profession.

• dividual nurses form the group which the public recognizes as the nursing profession,” says Phyllis Lewis, RN, an adjunct assistant professor at Queen’s University School of Nursing in Kingston. “To maintain the public’s trust and respect, and our fine reputation, nurses have the responsibility to achieve and maintain proficient communication skills.”

Communication Strategies that Strengthen Nurse-Client Relationships• Here are 12 tips to help establish

and maintain a relationship of trust and respect with a client.

• Imagine how you would like a nurse to treat a close relative, and then model your behaviour accordingly.

• Introduce yourself by name and title.• Use the client’s preferred name.• Make eye contact, when culturally

appropriate, and be aware of your body language.

• Ask your client open-ended questions to encourage more than a “yes” or “no” response.

• Listen actively to and show an interest in your clients.

• Inquire into unusual comments or behaviours.

• Identify your client’s care needs and goals.

• Provide sufficient information for clients to make choices and have realistic expectations.

• Collaborate with your client to find the best possible solutions.

• Follow through on your client commitments and notify clients of any changes in routine.

• Reflect on how your clients perceive you.

• The RN and RPN entry-to-practice competencies contain an expected standard of communication competency. After entering practice, nurses are expected to develop their communication skills throughout their careers. The College offers a number of documents and learning resources to help members facilitate this ongoing process.

• “Since communication is integral in nursing, it’s a theme found in most CNO practice standards and practice guidelines,” says Bildfell. “Another relevant document is the Self-Assessment Tool, which includes six statements on the assessment of nurses’ communication competencies. The College also provides Regional Education Network sessions that focus on issues of communication.”

When communication breaks down• Expert communicators are inquisitive,

systematic, analytical, open-minded, self-confident, empathetic and receptive. Communication starts to erode in situations in which there is a lack of empathy, respect and trust. It can also be undermined by not actively listening to clients, family members and colleagues.

• A vital component of skilled communication is critical thinking; the ability to analyse gestures and words and determine what is and is not working.

• “A nurse must sift through an enormous amount of information gathered from a multitude of sources to accurately assess clients’ status and monitor risk,” says Craig. “Without critical-thinking skills, the nurse becomes merely a conduit passing on information.

• Nurses skilled in critical thinking are able to analyse client information, synthesize it with their expert knowledge and experience, prioritize the care required and communicate effectively with physicians and other team members.

• At the root of many complaints to the College is communication breakdown. According to Karen Puckrin, RN, an Investigations Case Coordinator at the College, there are two common types of complaints made to the College. “The first is nurses communicating inappropriately with clients and family members,” she says, “and the second is nurses communicating inappropriately with colleagues.”

Case Study

• Susan, a client, was bruised after being pushed by another client at a long-term care facility. Louis, an RN, completes an incident report but doesn’t contact Susan’s family to tell them about the injury. Should Louis have contacted the family?

Answer

• Yes. Part of the nurse-client relationship is maintaining trust and respect with the client’s family members through communication. While the injury wasn’t serious, Louis has to be receptive to the fact that the family is concerned about Susan’s well-being and wants to be kept aware and involved with her care. They would be upset to see the bruise on their next visit and not know how it happened.

Building relationships

• To build a therapeutic nurse-client relationship, a nurse must first seek to understand the client’s needs and situation, and this takes strong skills in active listening.

• “Nurses develop nurse-client relationships by building trust between themselves and their clients,” adds Puckrin.

• “Most clients understand that there are heavy demands on nurses as they work in challenging practice environments in the health care system

• Clients are part of the system because they have certain needs,” says Puckrin. “As long as clients believe that the nurse is making every effort to understand and meet their needs, and they trust that the nurse really cares about their situation, the clients, and by extension the clients’ families, will accept that nursing resources might be limited.”

• nherent in the nurse-client relationship are power and goal differentials that the nurse must be able to recognize and address. The nurse has more power than the client because of her/his nursing knowledge and influence in the health care system. Furthermore, the goal of the nurse-client relationship is to promote the health and well-being of the client and not to meet the needs of the nurse.

• Nurses must acknowledge their role when first establishing the nurse-client relationship and remain empathetic and receptive to what the client is going through. For Angela McNabb, RN, an advanced practice nurse in the Law and Mental Health Program at the Centre for Addiction and Mental Health in Toronto, that means remembering that her clients’ freedom is limited, in varying degrees, by their legal status.