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The importance of therapeutic relationships in the delivery of care.

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Introduction

The Importance of Therapeutic Relationships in the Delivery of Care A therapeutic relationship in the delivery of care could be viewed as the single most important factor when looking at the delivery of care and it's effectiveness. What is a therapeutic relationship and why is it important? It is a helpful and equal relationship between you and your client, Dougherty (2000) supports the theme that central to the therapeutic relationship is the patient, reliant on others to help them during a time of ill health. Hobbs (1994) describes the key characteristics of a therapeutic relationship as divided between patient and carer. The carer demonstrating respect, empathy, tolerance, self-awareness, good communication, always receptive and having confidence in her ability, maintaining a safe environment in which to work and care for her patient. The patient displaying trust and confidence in the carer, co-operation, an understanding of his treatment/illness, and the motivation to get well. In the majority of cases it is unlikely that a carer will care for one patient only, therefore each patient will have their own therapeutic relationship with the carer. As we are all unique individuals each relationship will be different, recognition of this by the carer, and adaptation to suit each patient's holistic requirements is essential, thus contributing to individualised care for each patient. Nursing is a caring profession, does this indicate that when caring for a person a therapeutic relationship exists automatically, or is it developed? Mallett (2000) suggests that health-care professionals have a special relationship with their patients, upon entering this relationship we assume certain special duties towards our patient, additional to those in an ordinary social relationship. It would for example be totally unacceptable to allow a stranger, or someone we know on a social basis to assist us with our toilet requirements, or see us in our nightclothes. It is the special features of this relationship, the therapeutic relationship, quite different from our normal everyday social relationships, which allow the intimacy and trust by which we permit a nurse to assist us. ...read more.

Middle

Do pillows need adjusting? Is the ventilation and lighting adequate? Two important elements of comfort are hygiene and sanitary requirements. We should encourage independence by patients looking after their own hygiene whenever possible, but when we carry out hygiene for them there are many things we should consider. We should ensure privacy, dignity, safety and self-esteem are always maintained, when we have finished leave the patient comfortable with all essential items, buzzer, spectacles, tissues etc. within easy reach. One of my first tasks on placement was to assist with a bed bath, I was horrified when the carer removed the nightdress and top sheet, leaving the elderly patient naked, cold and feeling vulnerable. We should place ourselves in a reverse situation and treat our patients with the respect and dignity we would expect. The same principles apply when dealing with sanitary requirements, from a patient perspective the most private bodily functions are being discussed and attended to by others, causing embarrassment and loss of dignity. A sensitive carer gives reassurance, is careful with body language, ensures the privacy, comfort and safety of the patient at all times. She makes sure the brakes are on when using the commode, the bed is properly screened, tissue and buzzer are within easy reach, and most importantly the patient is not left on the commode or bedpan longer than is necessary Within a therapeutic relationship we need to be self-aware and also reflective practitioners. Being self-aware means not forcing yourself or your values onto others, we need to be conscious of our own character including our beliefs, strengths and limitations. Bulman et al (2000) instills the thought that to be self-aware is to know yourself, and this is the foundation upon which reflective practice is built. When reflecting we look back at ourselves in a certain situation and think how the situation has affected us, and how we may have affected the situation. ...read more.

Conclusion

In adopting these we can assess, plan and implement the best course of action so that the most effective care can be given, holistic care. This is fundamentally at the heart of the therapeutic relationship and why it is so important in the delivery of care. Word count 3,276 Bond, D., Keogh, R., and Walker, D., (1985) Reflection : Turning Experience into Learning, London, Kogan Page. Bond, M., (1986) Stress and Self Awareness : A Guide for Nurses, London, Heinemann. Buckle, J., (1993) When is Holism not Complementary? British Journal of Nursing, Vol.2, No.15, pp744-745. Bulman, C., and Burns, S., (2000) Reflective Practice in Nursing, Oxford, Blackwell Science. Burton, M., and Watson, M., (1998) Counselling People with Cancer, Chichester, John Wiley. Cava, R., (1996) Dealing with Difficult People, London, Piatkus Publishers. Cavanaugh, C., Montgomery, J., Morrison, F.E., Schroeder, R.E. and West, M.P., (1999) Improving Communication among Health Professionals through Health Education : A Pilot Study, Journal of Health Administration Education, Vol. 17, No. 3, pp175-198. Cutcliffe, J., and McKenna, P., (1999) Evidence Based Practice : Demolishing some Myths, Nursing Standard, Vol. 14, No. 16, pp39-42. Fein, E., and Schneider, S., (1995) The Rules, London, Harper Collins. Garnham, P., (2001) Understanding and Dealing with Anger Aggression and Violence, Nursing Standard, Vol. 16, No. 6, pp 37-42, 44-45. Gilling, C., Kenworthy, N., and Snowley, G., (2000) Common Foundation Studies in Nursing, 3rd edition, Edinburgh, Churchill Livingstone. Hobbs, (1994) cited in Royal College of Nursing Clinical Effectiveness Initiative - A Strategic Framework, London, Royal College of Nursing. Logan, W., Roper, N., and Tierney, A.J., (2000) The Roper Logan Tierney Model of Nursing, 5th edition, London, Churchill Livingstone. Nicholls, K., (1993) Psychological Care in Physical Illness, 2nd Edition, London, Chapman Hall. Nightingale, F., (1859) Notes on Nursing : what it is and what it is not. Cited in Peet, R. van der, (1995) The Nightingale Model of Nursing, Edinburgh, Campion Press. Nursing & Midwifery Council, (2002) Code of Conduct, London, NMC. Pearson, A., and Vaughan, B., (1994) Nursing Models for Practice, Oxford Butterworth-Heinemann. Stockwell, F., (1972) The Unpopular Patient, London, Royal College of Nursing. 1 1 ...read more.

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