At the point of registration, the nursing associate will be able to:
Identify the need for and use appropriate approaches to develop therapeutic relationships with people
A therapeutic nurse–patient relationship can be defined as a helping, nurturing and sensitive interaction, considering the individual’s physical, emotional, mental, social, sexual and societal needs.
Take Note
The key components of a therapeutic relationship are unique, never time dependant (a brief meeting, or a relationship that extends through time) and are centred around the patient to support and enhance healing and functioning, what Peplau in 1991 described as ‘professional closeness’. These components include the following:
Respect
The Dignity Challenge Framework (Health and Social Care Information Centre 2010) identifies respect as ‘the need to support people with the same respect you would want for yourself or a member of your family’. Respect implies a recognition of the individual as they are, engaging in an open and non‐judgemental attitude to those in your care.
The Essence of Care document (Department of Health 2010) benchmarks for respect and dignity provide best practice guidance to ensure people (clients, patients and carers) experience care that is focused upon respect and encompasses their values, beliefs and personal relationships. The 2015 National Health Service (NHS) Constitution for England states:
We value every person – whether patient, their families or carers, or staff – as an individual, respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits. We take what others have to say seriously. We are honest and open about our point of view and what we can and cannot do. (National Health Service 2015)
Green Flag Benchmarks for respect and dignity.
| FACTOR | BEST PRACTICE |
| Attitudes and behaviours | Individuals feel that they matter all the time |
| Personal world and personal identity | Patients experience care in an environment that actively encompasses individual values, beliefs and personal relationships |
| Personal boundaries and space | Staff protect people’s personal space |
| Communication | Individuals experience communication with staff that respects their individuality |
| Privacy – confidentiality | Individuals experience care that maintains their confidentiality |
| Privacy, dignity and modesty | Individuals receive care which protects their privacy, dignity and modesty |
| Privacy – private area | Individuals can have access to areas that safely maintain privacy |
Source: Based on Department of Health (2015).
Rogers (1961) described respect in terms of unconditional positive regard. This approach to respecting another relies on the ability to accept an individual’s personal beliefs despite one’s own feelings. Rogers’ approach recognises the abundance of experiences and exposures individuals have experienced in their lifetime, making their beliefs and behaviours unique. Acceptance does not imply approval or agreement, rather a non‐judging approach to the person as an individual.
Touch Point
Respect implies a recognition of the individual as they are, engaging in an open and non‐judgemental attitude to those in your care.
Genuineness
Being oneself within the context of a professional healthcare role is referred to as genuineness. Rogers (1961) describes this approach as congruence, where the carer does not hide behind a professional veneer but rather promotes an open and genuine contact. In a nurse–patient relationship, the nursing associates’ perceptions are underpinned by their values and beliefs and their own culture; these inevitably play a role in how they facilitate genuineness (Van den Heever et al. 2015).
It can be difficult to adapt our behaviours to be genuine within the context of the care setting; we are taught to be polite, pleasing, socially and professionally appropriate which can detract from a true demonstration of genuineness. Consider the approach of the nurse in the two scenarios in the Blue flag example, in the sexual health clinic below:
Blue Flag Brief patient encounter. Sexual Health Clinic
Patient: ‘this is really embarrassing, last night I had unprotected sex and I don’t really know what to do, what if I am pregnant’
Nursing associate: ‘OK, (smiles) I need to first take some details, then I’ll get the clinic doctor to come and sort you out. Please wait there’
Scenario 2
Patient: ‘this is really embarrassing, last night I had unprotected sex and I don’t really know what to do, what if I am pregnant’
Nursing associate: ‘I am glad that you have come today, please, don’t feel embarrassed. I can tell that you are anxious, and that’s perfectly understandable. Let’s just take some time to find out a little more about your experiences yesterday. Are you comfortable to share this with me?’
(Patient nods and shares her experience.)
Nursing associate: ‘Thank you for sharing what happened with me, I understand how difficult this can be. OK, there are several options that we can explore together, and you need to know that at some point, the clinic doctor will be here to see you. I hope that you will feel comfortable enough to ask me anything along the way that you are unsure of…’
Red Flag