The Therapeutic Nurse Client Relationship Nursing Essay


Mencap (2004) cited in Blair (2011) state that people with intellectual disabilities (ID) are admitted to hospital generally twice as much as the general population, estimating the annual admission rates as high as 26% compared to 14% of the general population. Recent reports by Mencap (2007) details (Diagnostic Overshadowing, (Dinsmore 2011) the poor inadequate diagnosis and care received by clients within primary healthcare, as a result of poor undiagnosed care and maltreatment, patents are dying needlessly (Blair 2011). People with learning disabilities are extremely vulnerable within the primary health care system and are often overlooked for prolonged periods of time. In recent years, the fundamental right for people with intellectual disabilities to achieve health has been recognized nationally and internationally within a policy pursuing equity and inclusion. In many international countries including America, Canada, Australia and Scandinavian countries, addressing a commitment to provide health and social care in mainstream services that embrace the principles of rights, independence, choice and social inclusion rather than exclusion [Scottish Executive 1999, Horwitz et al. 2000, DOH]. (Miller et al 2008) supported by (Philips (2012) suggests that people with intellectual disabilities are living longer now therefore need better primary healthcare and more frequently, general nurses who are at the forefront primary care will therefore need to provide adequate care form them. This essay will look at the importance of nurses working with people with intellectual disability their families and carers through the nurse-client therapeutic relationship. This essay will look at the core of nursing care a therapeutic relationship, it will then look between communication, empathy, trust and respect and how these elements are important factors in delivering care to clients and their families.

Therapeutic relationship

At the core of nursing is the therapeutic nurse-client relationship. A therapeutic relationship is defined as a relationship which develops between nurse and patient and is centred solely on patients’ needs for care, guidance and support (Arnold and Boggs 2007). Therapeutic relationship is based on empathy, respect, trust and professional communication, and requires appropriate use of aspects in the care provider’s role (Arnold and Boggs 2007). Arnold and Boggs (2007) state the nurse-client relationship is professional and therapeutic and it ensures the client’s needs are first and foremost. It exists to meet the needs of the client, not the needs of the nurse. The Nurse-patient relationship is often described as ‘therapeutic’; because it is built on a mutual respect between a nurse and the patient. It is a relationship which is normally developed over time and requires a number of important interactions, ‘trust’ being one of the most important and influential factors (Arnold and Boggs 2003). Batch and Grant (2011) say that trust is paramount in order for any relationship to develop. The relationship between a nurse and their patient demands the nurse to possess excellent communication and interpersonal skills (Batch and Grant 2011). This relationship differs from other relationships as it is designed to focus around the health and wellbeing of the patient only but in the case of Intellectual disability the patient’s family or career must also be included (Purtilo and Haddad 2002). There are several types of nurse-patient relationships all of which will depend on the length of patient contact with the nurse, the patient’s illness, requirements and dependency (CRNBC 2006). Regardless of the type of relationship, the patient must feel respected, important and confident to communicate any concerns and be able to trust the nurse (Sheldon et al 2006). Effective communication underpins good healthcare (Webb 2010).


When communicating with a patient the nurse must address many issues both with patient and family. The environment the nurse is in must be allow patient and family privacy, be free from distraction, noise and allow the patient enough space to free and be able to move about. At times physical factors/objects which can block affective communication, patient maybe hungry, tired or in pain (Purtilo and Haddad 2002). Nurese must also bear in mind emotional factors may also have to be considered as some ID patients may find it hard to listen, concentrate and communicate if they are emotionally, scared, anxious or maybe just don’t understand the way things are being explained. (Purtilo and Haddad 2002). If all these possible issues which may hinder the ability to communicate with the patient to maximum effect the when communicating the nurse must always think about the patients physical closeness, no-one likes to feel or overwhelmed because the nurse is to close to them. Nurses need to be careful how they say things because it cannot just be the things are said but in the way in which there said that can make the difference to how the words are understood by the client and their family (Harmer 1999). Body posture, the way one’s body posture is also important nurses need to sit facing the patient with an open posture and give suitable eye contact, always look interested, attentive, empathise with the patient, this makes patients feel that the nurse is more open, the nurse should take time to listen and observe because very often what a person tells you may not give the same message to their actual physical health appearance, facial expressions and overall wellbeing (Barrett 2012).


Empathy is the expression of understanding, validating and resonating with the meaning that the health care experience holds for the client. In nursing, empathy includes appropriate emotional distance from the client to ensure objectivity and an appropriate professional response (CRNBC2006). McQueen (2000) cited in (O’ Connell 2008) Say feelings of empathy and compassion can also motivate the nurse to develop practical strategies in order to come to know the patient as an individual with his/her own set of beliefs and values. Through setting appropriate boundaries (Briant and Freshwater, 1998) cited in(O’ Connell 2008) , the nurse and patient enter into a mutual and reciprocal relationship that enables the provision of nursing care that is individually tailored to meet the patient’s needs (Freshwater, 2002) sited in (O’ Connell 2008) as well maintain the professional satisfaction of the nurse (O’ Connell 2008). Empathy allows the nurse to understand the patients and families feeling and concerns, working with them through times of illness will enable the nurse to build a good rapport, through rapport nurses can evolve the therapeutic relationship into a strong trusting relationship between client and family (O’ Connell 2008).


Trust is critical in the nurse-client relationship because the client is in a vulnerable position. Initially, trust in a relationship is fragile, so it’s especially important that a nurse keep promises to a client with intellectual disability (CRNBC2006). If trust is breached, it becomes difficult to re-establish. Trust is one of the most important standards, without trust relationships are hard to develop. Patients and their family need know that they can rely on the nurse and have confidence in the work they do (Keating et al 2002). A nurse must remember they hold a very powerful position and most patients without question place their trust in a nurse merely because that’s what a ‘nurse’ is associated with. A sick patient depends on the nurse to nurse them back to health. The nurse knowing patient’s information and being in unfamiliar surrounding afraid of the unknown can at times leave a patients and their careers feeling vulnerable, this is why ‘trust’ is extremely important, the nurse who gains the client and families trust will also gain their respect (AMA 2006).


Respect is the recognition of inherent dignity, worth and uniqueness of every individual, regardless of socio-economic status, personal attributes and the nature of the health problem (CRNBC2006) nurses need to value and respect that. The nurse has a duty to treat each person as whole they are individual and unique, and remember never to stereotype or be judgemental of the person no matter what situation, illness or disability maybe (Silverman et al 2005). Every patient will have unique requirements, from the foods they like to how many pillows they normally sleep on; this must be observed and implemented in order to make the patients care or hospital stay as comfortable as possible (Silverman et al 2005). Religious, cultural beliefs and requirements must be met. If a patient has intellectual, physical or mental disabilities always be respectful of that. Respect patient’s wishes; treat them with dignity (Purtilo and Haddad 2002).


If every factor preventing developing good nurse-patient relationship has been addressed then the relationship will have a positive overall effect on a patients care experience, because in a good relationship the patient and their relatives are happy with every element of the care received???? Can you do my conclusion please ta xxxx