of the therapeutic relationship.
Once deemed to be a dangerous bond, therapeutic relationships between patients and nurses are now encouraged in order to provide the best support and care within the practice setting. Over the years, several nurse theorists have supported the idea of a nurse–patient relationship. As early as, Hildegard Peplau (1952) asserted that the nurse–patient relationship is the foundation of nursing practice. The experience of caring and being cared for creates a human dynamic where both parties encounter personal growth through that experience. She highlighted what she termed ‘character roles’ of the nurse, including the nurse as a resource, interpreting information and answering questions; the nurse as a technical expert, providing expert physical care through clinical skills and the nurse as a teacher, nurturing, understanding and providing instruction. Travellbee (1966) used the phrase ‘therapeutic use of self’ where the purpose of nursing is to establish human‐to‐human relationships. Watson (1979) asserted that therapeutic relationships are two‐way reciprocal relationships, where each grows and learns from the other.
Nursing associate proficiencies and platforms of NMC (2018a) state:
The ability to communicate effectively, with sensitivity and compassion, and to manage relationships with people is central to the provision of high‐quality person‐centred care. These competencies must be demonstrated in practice settings and adapted to meet the needs of people across their lifespan.
Annex A is an overarching proficiency necessary to be achieved in all six platforms of the proficiencies.
Blue Flag Relationships
A woman visits the local centre of excellence for cancer treatment. In the outpatient department, she sees the same nursing team when she visits for regular chemotherapy treatment.
‘All of the staff are warm and welcoming; they want to make you feel the best you can in a difficult situation. One staff member “goes the extra mile” if you know what I mean. I really like her; she makes me feel happy to see her, she listens intently and recognises when I am extra anxious. Once she took time out to introduce me to a volunteer makeup and style therapist, I had told her that I was anxious about an upcoming family wedding. She is knowledgeable and highly skilled in her work but is honest enough to say if she is unsure of anything that I ask’.
At this point, you might want to take a step sideways and reflect on what aspects you would want to see in a healthcare worker who is supporting you through a vulnerable health episode. Perhaps, many of the aspects highlighted in Figure 3.1 would have come into your mind: a sense of caring, a genuine interest in you, someone who is respectful and communicates well, someone who makes you feel like an individual and someone who feels that the time with you is as important as anything else that might be going on. Similar skills occur in several human relationships, for example, mentor–mentee, teacher–learner, doctor–patient and so on.
Green Flag Standards of proficiency for nursing associates, NMC
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 |
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