Therapeutic relationships in day surgery: A grounded theory study
http://usir.salford.ac.uk/id/eprint/8820/2/Acr3F.pdf
This study interprets the narrative from patients who experience care in a day surgery unit to identify significant therapeutic interventions as perceived by those patients.
‘I got great comfort from the staff. The entire experience (day surgery) is about entrusting your body and well‐being to people whom you have never met before. I think some of the ways in which this trust was engendered in me was, well, by a few things really … explanations of what to expect … general chit chat with the nurses … being in a ward with other people and seeing them go through the same process’.
(Mary, age 42 years)
Source: Mottram (2009)
Touch Point
Trust is critical in the nurse–patient relationship because often the individual is in a vulnerable position.
Rapport
Rapport is an essential component of the nurse–patient relationship and is established from the first encounter with the patient. This can be challenging, to say the least, and some healthcare professionals struggle to relax into an easy rapport on first meeting. All the aspects of the therapeutic relationship discussed in this chapter so far come into play when we develop a rapport with an individual. Clear attention to the individual and a genuine interest will help to establish a rapport. Body language and non‐verbal communication come into their own; smile, calmness, interpersonal warmth, a desire to make the person feel at ease, comfort, privacy and safety all play a role. (More detailed information about non‐verbal communication is available in Chapter 2 of this text.)
Initially, the nursing associate can establish a rapport with the patient through the questions they ask; this helps the nurse to understand the person’s frame of reference, how they are feeling and what they understand about their situation. Both verbal and non‐verbal prompts facilitate the process, alongside open‐ended questioning. Figure 3.2 shows the stages of motivational interviewing identified by Miller & Rollnick (2002). The so‐called OARS model highlights the key skills of motivational interviewing:
O – Open‐ended questioning invites the person to talk freely, for example, ‘how are you today?’
A – Affirmations provide a positive regard for what the person is saying, for example, ‘you have a real insight into why you are here today, and I can help you to understand more about your time in hospital’.
R – Reflective listening conveys through feedback that you are listening and taking note of what is said; often, the discussion will reflect the person’s own words, for example, ‘you say that you are anxious about having an anaesthetic?’
S – Summarising helps to establish that what was said is understood and agreed between you both, bringing together all the points made as a conclusion.
More formal and structured interviews, such as nursing assessment, are built on the initial rapport that you establish in a non‐emergency situation.
Tips for establishing a rapport with your patient:
Introduce yourself, say ‘hello’ and ask the person’s name. Use that name in conversation.
If appropriate, use touch to establish warmth and genuineness.
Employ effective non‐verbals such as maintaining a respectful distance, using eye contact, nod to show you understand, adopt an open stance and sit with the person if they are sitting
Be aware of the environment and privacy
Be aware of distractions such as pain or discomfort
Be culturally sensitive and aware
Actively listen and reflect feelings back to the individual
Speak calmly and slowly and avoid technical language
Maintain professional boundaries
Touch Point
Clear attention to the individual and a genuine interest will help to establish a rapport.
Figure 3.2 The OARS model of motivational interviewing.
Take Note
Maintaining Professional Boundaries
Maintaining professional boundaries is essential in the nurse–patient relationship. The lines of professional behaviour can be easily blurred. Crossing professional boundaries can be subtle and not easily recognised. Care is so varied, and the nursing associate will at some point perform intimate tasks or procedures on patients, spending time to develop trust and a therapeutic relationship. The nursing associate must always consider the boundaries of a professional and therapeutic relationship in terms of being underinvolved or overinvolved with their patient’s care. The nursing associate must recognise if they are building a personal relationship with a patient and should understand the implications of doing so. The nursing associate must always ensure their patient’s care, treatment and needs, which are paramount. Should the nursing associate find it difficult to maintain a therapeutic and professional relationship, they must request help and support and step away from the situation. The following are examples to assist the nursing associate in understanding if they are at risk of breaching a professional boundary:
Agreeing to contact or meet a patient out of the working environment
Discussing other colleagues or your working environment negatively
Engaging in discussions regarding your personal life in detail
Giving one patient more time than another unnecessarily
Agreeing to keep secrets with a patient
Accepting a friend request on social media
Receiving gifts (Nursing and Midwifery Council 2018b)
The
