Establishment of Therapeutic Relationship – Care Example

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"Establishment of Therapeutic Relationship" is an engrossing example of a paper on care. The encounter demonstrates the three phases of a therapeutic relationship namely orientation, working phase or middle phase, and resolution phase or ending phase.   According to Knapp, at the beginning of a therapeutic relationship, the nurse and client are strangers to each other and this seems like the first encounter. The relationship starts with the nurse introducing herself to the client making her feel comfortable. The components of the relationship are established in the first encounter. The meeting place appears to have been established.

It is important to uphold respect, trust, and effective communication during the first encounter and throughout therapy. All these have been done effectively (2007). In the working phase, the nurse inquires about the issues that have made the client seek help. The nurse is validating the client’ s feelings and thoughts. The client is afraid that the surgical procedure she had just had would be scary. The nurse allows the client to express herself by just leading the session. Here the nurse acts as a facilitator, controlling the direction of the session, and together with the client, they determine the client’ s needs.

These are then addressed with the client's perspective considered in the plan for care (Knap, 2007). According to Chue (January 01, 2006), the ending stage is reached when the client’ s problems have been addressed. In this case, the end comes when the nurse reassures the client that her fears may or may not be valid. The client is somewhat convinced and shows gratitude for the time allocated. Components of the Relationship According to Taylor (2011), there are five components of any therapeutic relationship.

These are trust, empathy, professional intimacy, respect, and power. Taylor explains that it is very important that the client trusts the nurse. Trust must be cultivated especially at the beginning of the relationship. The client is in a fragile state and the nurse tries to assure her that she can trust her. Taylor (2011) states that empathy is the ability of a nurse to experience and express an understanding of the client’ s situation and how healthcare is perceived. The nurse needs to differentiate between empathy and sympathy in patient care.

Empathy is objective and involves nurse understanding but keeping a distance. In the video, the nurse seems indifferent to the client’ s plight but goes ahead and reassures her though not so convincingly (Taylor, 2011). According to Williams, respect refers to treating others with dignity regardless of their ethnicity, socio-economic status, condition, or behavior. The video shows the nurse and client to have mutual respect for each other. Professional intimacy is evident in this relationship. The client is reassured that what they discuss will be confidential (Williams, 2008).

The nurse has more power in the therapeutic relationship. She controls when the session begins and when it ends. She has more authority in matters of health care and determines the way forward (Williams, 2008). Capacity to Establish Therapeutic Relationship According to Johns (2013), self-awareness is expressed when the nurse listens to the client’ s concerns and expresses her thoughts regarding the client's concerns. This is clear when she reassures the client that she may not be permanently scarred. The nurse’ s understanding distinguishes her experiences from that of the client in this case demonstrate self-knowledge.

She is aware of diversity among individuals and is able to tell the difference between her experiences and those of the client. She manages to reassure her client without imposing her beliefs on the client. She provides a solution and explains it professionally (Johns, 2013). According to the Registered Nurses' Association of Ontario, empathy is best described by the nurse’ s ability to relate to the client's views of the world and what the client perceives in relationships. Here, the nurse seemed detached from the client's concerns about scarring and what this would mean for her.

The nurse tries to explain away her concerns (2011). Behavior Registered Nurses' Association of Ontario’ s “ Establishing therapeutic relationships. ” explains that in a therapeutic relationship, the nurse needs to take care and not to propagate or encourage unacceptable behaviors. These behaviors include special treatment accorded clients in terms of the length of time spent on particular clients compared to others. When the nurse goes the extra mile to please a client and feels they are alone to sort out certain clients’ issues, then this can be considered to be crossing the boundary.

Another inappropriate behavior occurs when a nurse ignores the protocols stipulated in the nurse-client relationship guidelines. These protocols stipulate the appropriate time to be spent with each client, inability to be impartial when it comes to a particular patient, and failing to document sessions (William, 2011). In this case, the nurse-client relationship was appropriate and the nurse followed stipulated protocols. Components of Therapeutic Relationship Knapp (2007) explains that a nurse needs to know the client under her care in terms of their world, their life story, and the reason why they seek professional help.

The nurse needs to allocate time to understand her patient. This can be achieved in-session or out-session. The latter refers to the nurse checking clients’ files and learning about them. According to Williams (2008), a nurse needs to be aware of the client’ s issue in terms of health or physical problem that they present. He further explains that this is to facilitate appropriate therapeutic care and relationship. He/she needs to understand the illness etiology, determinants, symptoms that the client presents with, the standard interventions, and best practices (Williams, 2008). The nurse is required to be aware of the policies in place regarding patient care.

This could be hospital-based policies or those policies that govern the whole healthcare system. He/she also needs to be conversant will the procedures involved in healthcare. That is admission, assessment, diagnosis, therapy, discharge, and follows up. It is imperative that the nurse knows the health care system and how it operates to be able to explain this to the client. This is in order to assist the client to access much-needed care (Knapp, 2007). In therapeutic care, the nurse needs to start by deciding on the plan of care.

This needs to be comprehensive in order to meet the client’ s needs. This is done together with other healthcare workers involved in the client’ s therapeutic journey. Knapp explains that it is the nurse’ s mandate to ensure that client-nurse confidentiality is upheld. He/she should not disclose anything discussed between them and the client to anyone, not even the family members or spouse. This confidentiality continues even after the relationship has been terminated. It is the nurse’ s duty to explain this to the client right from the start of care.

Patients’ records need to be securely stored to ensure confidentiality is maintained (2007). According to the College of Nurses of Ontario & College of Nurses of Ontario’ s “ Therapeutic nurse-client relationship. ” culture plays an important role in a therapeutic relationship. The nurse needs to be sensitive to the client’ s culture and ensure that he/she does not cross boundaries according to the client’ s perception. It is important that the nurse treats the client with respect, she should be able to recognize that the client has dignity and worth regardless of the situations economically, ethnically, and medically (2006).


College of Nurses of Ontario., & College of Nurses of Ontario. (2006). Therapeutic nurse-client relationship. Toronto: College of Nurses of Ontario = Ordre des infirmières et infirmiers de l'Ontario.

Chue, P. (January 01, 2006). The relationship between patient satisfaction and treatment outcomes in schizophrenia. Journal of Psychopharmacology, 20, 38-56.

Johns, C. (2013). Becoming a Reflective Practitioner. Chicester: Wiley.

Knapp, H. (2007). Therapeutic communication: Developing professional skills. Los Angeles: Sage Publications.

Registered Nurses' Association of Ontario. (2011). Establishing therapeutic relationships. Toronto, Ont: Registered Nurses' Association of Ontario.

Taylor, C. (2011). Fundamentals of nursing: The art and science of nursing care. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Williams, C. L. (2008). Therapeutic interaction in nursing. Sudbury, Mass: Jones And Bartlett Publishers.

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