THE NURSE-PATIENT

RELATIONSHIP

By: Katie Coon

THE ISSUE

THE ISSUE
a t h e r a p e u ti c re l a t i o ns h i p b et we e n a n u r s e a n d a c l i e n t b u i l t o n a s e ri e s o f
i n te r a cti ons a n d d eve l o p i ng ove r t i m e . Al l i n te r a cti ons d o n o t d eve l o p i n to
re l a t i o ns h i ps b u t m ay n o n eth e l e s s b e t h e r a p e u ti c. T h e re l a t i o ns h i p d i f fe r s fro m a
s o c i a l re l a t i o n sh i p i n t h a t i t i s d e s i gn e d to m e et t h e n e e d s o n l y o f t h e c l i e n t . I t s
s t ru c ture v a ri e s wi t h t h e c o n tex t, t h e c l i e n t' s n e e d s , a n d t h e go a l s o f t h e n u r s e a n d
t h e c l i e n t . I t s n a t ure v a ri e s wi t h t h e c o n tex t, i n c l udi ng t h e s et t i n g, t h e k i n d o f
n u r s i n g, a n d t h e n e e d s o f t h e c l i e n t . T h e re l a t i o n sh i p i s d y n a mic a n d u s e s c o gn i ti ve
a n d a f fe c t i ve l eve l s o f i n te r a cti on. I t i s t i m e - l i mite d a n d go a l - o ri e nte d a n d h a s t h re e
p h a se s. D u ri n g t he f i r s t p ha s e , t h e p h a s e o f e s t a b l i s h me n t, t he n u r se e s t a bl i she s t he
s t ru c ture , p u rp os e , t i m i ng, a n d c o n tex t o f t h e re l a t i o n s h ip a n d ex p re s s e s a n i n te re s t
i n d i s c us s i ng t h i s i n i t i a l s t ru c tu re wi t h t h e c l i e n t. D a t a c o l l e cti on fo r t h e n u r s i n g c a re
p l a n c o n ti nue s , a n d b a s i c go a l s fo r t h e re l a t i o ns h i p a re s t a te d . D u ri n g t h e m i d d l e ,
d eve l o p me nta l, p h a s e o f t h e re l a t i o n sh i p, t h e n u r s e a n d t h e c l i e n t get to k n ow e a c h
o t h e r b et te r a n d te s t t h e s t ru c ture o f t h e re l a t i o n s h i p to b e a b l e to t ru s t o n e a n o th e r.
T h e n u r se i s c a re fu l to a sse s s c o rre c t l y t h e d e gre e o f d e p e n d e ncy t ha t i s n e c e ssa r y
fo r t h e p a r t i cul ar c l i e n t . P l a n s m ay b e d ev i s e d fo r i m p rove d way s o f c o p i ng wi t h
p ro b l e m s a n d a c h i ev i n g go a l s . T h e n u r s e i s a l e r t to t h e d a n ge r o f l o s i n g o b j e c t i v ity
d u ri n g t h i s p h a s e . T h e l a s t p h a s e , te rm i n ati on, i d e a l l y o c c ur s wh e n t h e go a l s o f t h e
re l a t i o ns h i p h ave b e e n a c c ompl is h e d , wh e n b o t h t h e c l i e n t a n d t h e n u r s e fe e l a s e n s e
o f re s o l u t i on a n d s a t i s fa cti on.

OBJECTIVES
By the end of this seminar, students will be
able to:
Explain the importance of the nurse-patient relationship
Identify three barriers to the nurse-patient relationship
Identify three ways to improve the nurse-patient relationship
Discuss ANA standards and QSEN competencies in relation to
the nurse-patient relationship

BENEFITS
Builds trust
Quality
Safety
Patient compliance
Patient satisfaction
Nurse satisfaction

http://www.youtube.com/watch?v=iz06pmGlaHI

THEORY OF HUMAN CARING

Caring (and nursing) has
existed in every society. Every
society has had some people
who have cared for others. A
caring attitude is not
transmitted from generation to
generation by genes. It is
transmitted by the CULTURE
OF THE PROFESSION as a
unique way of coping with its
environment.

By Jean
Watson

THEORY OF HUMAN CARING

Actual Caring Occasion involves actions and
choices by the nurse and the individual. The moment
of coming together in a caring occasion presents the
two persons with the opportunity to decide how to be
in the relationship what to do with the moment.

Assumptions:
Caring can be effectively demonstrated and
practiced only interpersonally.
Caring consists of carative factors that result
in the satisfaction of certain human needs
The practice of caring is central to nursing.

By Jean
Watson

THEORY OF INTERPERSONAL
RELATIONS

Assumptions:
Both the patient and nurse mature as result of
the therapeutic relationship
Communication skills remain a fundamental
nursing tool.

By Hildigard
Peplau

UNCERTAINTY
REDUCTION THEORY

INTERDISCIPLINARY PERSPECTIVE:
communication is a cornerstone of nursing care

By Charles
Berger

INTERDISCIPLINARY
PERSPECTIVE

continued

Policies
Nurse-patient boundaries
Research is implementing
more

Resources
Instilled characteristics
Humor
Relationship hindrances

ASSESSMENT
OF THE
HEALTH CARE
ENVIRONMENT

Quality and Safety

Knowing the patient
Four attributes of feeling safe
RCA

Underlying Assumptions
There is always a relationship
Environments are too busy
http://www.youtube.com/watch?v=TFHP7WbICro

ASSESSMENT
OF THE
HEALTH CARE
ENVIRONMENT

Cindy is a 44-year-old woman admitted post

automobile accident. The nurse caring for Cindy
today has developed a therapeutic relationship
with her by introducing herself and asking about
her family. Cindy has called for the nurse on two
occasions and the nurse has come promptly.
Cindys nurse inquires about her pain when she
checks on her, pro- vides pain medication when the
pain is increasing and fol- lows up to assure she is
comfortable. The nurse educated Cindy about the
importance of pain control and to let the nurse
know when her pain is increasing. Cindys husband
spends three hours a day at her bedside supporting
her. Cindy expressed to her husband she feels
cared for and safe as the nurses are always right
outside her door. Cindy also tells her husband the
nurses are so knowledgeable and always watching
over her. She trusts them to take care of her even
when she is unable.

ROOT CAUSE
ANALYSIS
SCENARIO

Presence
By husband

Introducing self
?s family

By nurse always
watching over

Frequent checks
and follow ups

Trust

ROOT CAUSE
ANALYSIS

Therapeutic
Relationship
Established

RN pain
education
Knowing the pt

RN knowledge

Pt. feels safe

Quality and Safety

Knowing the patient
Four attributes of feeling safe
RCA

Underlying Assumptions
There is always a relationship
Environments are too busy
http://www.youtube.com/watch?v=TFHP7WbICro

ASSESSMENT
OF THE
HEALTH CARE
ENVIRONMENT

 Patient
Trust safety & comfortsatisfaction
compliance

Healthcare Organization
Faster healing LOS costs

Nurse
More comfort Less stress focused
Individualized care emotions

INFERENCES
AND
IMPLICATIONS

 Policies and Procedures

Sacred Moment
Relationship based care models

Educate
Leadership and Support
To successfully
implement a transition
from a culture of
tasks, silos, and
production pressures
to a culture with the
nurse-patient
relationship as the
cornerstone, nurses
need leadership
suppor t and attention
on an ongoing basis.
-Hedges et al.

SUGGESTIONS
FOR QUALIT Y
AND SAFET Y
IMPROVEMENT

QSEN
COMPETENCIES
Patient Centered Care
Recognize the patient or designee as the source of control and
full partner in providing compassionate and coordinated care
based on respect for patients preferences, values, and needs .

ANA
STANDARDS
Communication
Quality of Practice
Collaboration

OBJECTIVES
You should now be able to:
Explain the importance of the nurse-patient relationship
Identify three barriers to the nurse-patient relationship
Identify three ways to improve the nurse-patient relationship
Discuss ANA standards and QSEN competencies in relation to
the nurse-patient relationship

QUESTIONS?

REFERENCES
Abra, A. (2014, March 5). Hildegard Peplau. Retrieved from http://www.youtube.com/watch?v=eybeyvpSOBA
Allen, D. (2014). Laughter really can be the best medicine. Nursing Standard, 28(32), 24-25.
American Nurses Association. (2010). Nursing: Scope and standards of practice. Silver Spring MD: American Nurses
Association.
Butcher, L. (2014). Making time for a Sacred Moment. H&HN: Hospitals & HealthNetworks, 88(7), 2224. Retrieved
from http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2012639578&site=ehost-live.
Codier, E. (2014). End-of-life care in the emergency department: Nurses who invest in the nurse patient relationship are
better able to manage the emotional aspects of caring for dying people and their relatives. Evidence Based
Nursing, 17(3), 94.
Griffin, M. [A First Look at Communication Theory]. (2014, Jan. 29). Charles Berger on uncertainty reduction theory.
Retrieved from http://www.youtube.com/watch?v=j5HasECwSyc.
Gonzalo, A. (2011). Theoretical Foundations of Nursing. Retrieved from http://nursingtheories.weebly.com/hildegard-epeplau.html.
Hedges, C., Nichols, A., and Filoteo, L. (2012). Relationship-based nursing practice: Transitioning to a new care delivery
model in maternity units. Journal of Perinatal and Neonatal Nursing, 26(1), 27-36.

REFERENCES
Johnson & Johnson. (2008, Dec. 11). Patient perspectives 3- Nurses. Retrieved from
http://www.youtube.com/watch?v=iz06pmGlaHI.
Kitson, A., Athlin, A., and Conroy, T. (2014). Anything but basic: Nursings challenge in meeting patients
fundamental care needs. Journal of Nursing Scholarship, 46(5), 331 339.
Mollon, D. (2014). Feeling safe during an inpatient hospitalization: A concept analysis. Journal of Advanced Nursing,

70(8), 17271737. doi: 10.1111/ jan.12348

Mosby'. (2009). Mosbys Medical Dictionary (8th ed.). Elsevier.
QSEN Institute. (2014). Pre-licensure KSAs. Retrieved from http://qsen.org/competencies/pre- licensure-ksas/.
Tremayne, P. (2014). Using humor to enhance the nurse-patient relationship. Nursing Standard, 28(30), 37-40.
Zolnierek, C. (2014). An integrative review of knowing the patient. Journal of Nursing Scholarship, 46(1), 3-10.
Youngson, R. (2014, April 18). Every ICU nurse and doctor should watch this film. Retrieved from http://
www.youtube.com/watch?v=TFHP7WbICro.