Nurse-Patient Relationship

Therapeutic nurse-patient relationship is an experience of mutual learning for the nurse and the patient as well as a corrective emotional experience for the patient. The relationship is developed on the basis of the underlying humanity of nurse and patient, with both respecting and accepting each other's ethno-cultural differences.

The concept of nurse-patient relationship was introduced by American nurse Hidlegard Peplau in her work Internersonal Relations in Nursing published in 1952. Peplau's theory emphasizes the interpersonal processes and therapeutic relationships that develop between the nurse and patient. As part of the theory's interpersonal focus the nurse is required to attend to the interpersonal processes occurring with the patient. The interpersonal processes include the nurse-client relationship, communication, pattern integration as well as the nurse's roles.

Peplau identifies four phases in the nurse-patient relationship. In the first phase, orientation, nurse and patient are strangers, they meet because of the patient's "felt need," and work together to recognize, clarify and define facts connected to the need. During the second phase, identification, the patient participates in the setting of goals and has a feeling of belonging, selectively responding to those who can meet his or her needs. The third phase, exploitation, sees the patient actively seeking and drawing knowledge and expertise of those who can help him or her. The final phase, resolution, which occurs after the successful completion of the other phases, leads to the termination of the nurse-patient relationship.

In the nursing process the orientation phase overlaps with the assessment phase. Working together the nurse and patient clarify and gather information. The nurse formulates diagnoses and sets outcomes and goals on the basis of this assessment. The nurse plans and carries out interventions and evaluates the process on the basis of their behaviors, which are mutually established and expected.

According to Intervention in Psychiatric Nursing by Joyce Travelbee, the nurse-patient relationship has a number of goals. The nurse helps the patient cope with his or her problems and also helps him or her to understand them. The nurse helps the patient understand his or her active participation in the experience, while also helping in the realistic identification of emerging problems. The nurse helps the patient find a new alternative for the problem and try out new patterns of behavior. The nurse also helps the patient with communication and in finding meaning in his or her illness.

On the basis of these goals, the therapeutic relationship can be divided into several types. In the immediate relationship, the nurse and patient do not know each other and the nurse has to interact or intervene to help the patient with an immediate severe difficulty. In the short-term relationship the nurse may know the patient but is not responsible for him or her. In the long-term relationship the nurse interacts with the patient and tries to provide a corrective emotional experience, while supporting him or her and giving care.

The components of the nurse-client relationship are rapport, power, trust, respect, genuineness and intimacy and they are present whenever nursing services are provided by the nurse. The primary tasks in the development of a relationship are for the nurse and patient to get acquainted and establish rapport, which implies special feelings on the part of both sides on the basis of acceptance, friendliness, warmth, a sense of trust, common interest and non-judgmental attitude. Power in the therapeutic nurse-client relationship is unequal, because, even if nurses do not perceive it like that, their power is greater than that of the patient. The authority of a nurse's position in the health care system, specialized knowledge, access to privileged information and other factors determine the nurse's power.

Confidence in the nurse's experience, integrity, reliability, veracity and sincere desire to provide assistance when the patient requests it is what he or she needs to trust the nurse and this is the basis of the therapeutic relationship. The nurse's respect for the dignity and worth of the patient is fundamental to their relationship. Genuineness represents the nurse's ability to be honest, open and real when interacting with the client. Intimacy refers to activities performed by the nurse for and with the patient, which make them feel close on many levels.

A nurse needs to be competent and to have the professional attributes that are required to manage a therapeutic relationship. The nurse establishes and maintains the nurse-client relationship using professional knowledge and skill, caring attitude and behavior.

Selected full-text books and articles on this topic

Communication in Nursing
Julia Balzer Riley.
Mosby, 2000 (4th edition)
Librarian’s tip: Chap. 2 "The Client-Nurse Relationship: A Helping Relationship"
Strengthening the Nurse-Patient Relationship: "What Is the Most Important Thing I Can Do for You Today?"
Cappabianca, Agnes; Julliard, Kell; Raso, Rosanne; Ruggiero, Jillian.
Creative Nursing, Vol. 15, No. 3, July 1, 2009
The 'Difficult' Nurse-Patient Relationship: Development and Evaluation of an E-Learning Package
Brunero, Scott; Lamont, Scott.
Contemporary Nurse : a Journal for the Australian Nursing Profession, Vol. 35, No. 2, June 2010
Exploring Boundaries in the Nurse-Client Relationship: Professional Roles and Responsibilities
Peternelj-Taylor, Cindy A.; Yonge, Olive.
Perspectives in Psychiatric Care, Vol. 39, No. 2, April-June 2003
Counselling Skills for Nurses, Midwives, and Health Visitors
Dawn Freshwater.
Open University Press, 2003
Librarian’s tip: Chap. 3 "Beginning a Relationship," Chap. 4 "Sustaining the Relationship," and Chap. 7 "Caring for the Career"
Graduate Nurses' Experiences of Developing Trust in the Nurse-Patient Relationship
Belcher, Melanie; Jones, Linda K.
Contemporary Nurse : a Journal for the Australian Nursing Profession, Vol. 31, No. 2, February 2009
Using an Eclectic Model to Educate Students about Cultural Influences on the Nurse-Patient Relationship
Kleiman, Susan; Frederickson, Keville; Lundy, Theresa.
Nursing Education Perspectives, Vol. 25, No. 5, September-October 2004
Nurture: The Fundamental Significance of Relationship as a Paradigm for Mental Health Nursing
Raingruber, Bonnie.
Perspectives in Psychiatric Care, Vol. 39, No. 3, July-September 2003
Symbolic Interactionism and Nurse-Mother Communication in the Neonatal Intensive Care Unit
Cleveland, Lisa Marie.
Research and Theory for Nursing Practice, Vol. 23, No. 3, October 1, 2009
The One-to-One Nurse-Patient Relationship
Lego, Suzanne.
Perspectives in Psychiatric Care, Vol. 35, No. 4, October-December 1999
The Perspective of Mystery: Threading the Connection between Patient and Nurse
McCabe, Susan.
Perspectives in Psychiatric Care, Vol. 40, No. 1, January-March 2004
The Nurse, the Patient, and the Illness: An Object Relations Approach to Nursing
Teising, Martin.
Perspectives in Psychiatric Care, Vol. 33, No. 4, October-December 1997
Settling into and Moving in a Climate of Care: Styles and Patterns of Interaction between Nurse Psychotherapists and Clients
Raingruber, Bonnie Jean.
Perspectives in Psychiatric Care, Vol. 37, No. 1, January-March 2001
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