Communication Strategies for Therapeutic Relationships

This reflective essay aims to refresh critique and develop existing knowledge and understanding of communication techniques and how these transferable skills and approaches can build therapeutic relationships with a patient that lies within the scope of professional boundaries. This essay identifies in a role play video clip the different approaches to building therapeutic relationships and traces the barriers that prevent the nurses from engaging in such a relationship. In addition to the above, it offers an analysis of both vignettes critically reflecting on their therapeutic skills and approaches. It will draw in on my own personal experience from clinical practice and the skills developed with the assistance of Borton’s reflective model.

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It is indispensable that nurse’s caring for children, adolescents, adults and their families develop and maintain effective communication techniques as it makes it central to the provision of compassionate, trusting and collaborative therapeutic relationships. Reflecting and critiquing can be viewed as an in-depth examination reviewing an experience so each stage can be described, explored, assessed and be accordingly used to inform and change future practice. Evaluating the main communication skills and approaches to building therapeutic relationships identified in the video, it is clear to distinguish between who is a good nurse and who is not. The nurse’s in the video should serve as client advocates and as part of an interdisciplinary team whose members may have different ideas about priorities of care. The techniques used by the first nurse were poor and her approach created a stressful relationship between nurse and patient. In the beginning, the nurse doesn’t offer any form of recognition which is easy to criticize as acknowledging the patient and indicating awareness of change would have shown that the nurse saw Mrs. Miller as an individual. Giving information such as “Hello, My name is…” can build trust which is key in later on forming a therapeutic relationship and building a better rapport.

Mrs. Miller was “really uncomfortable” as she was left unattended too all night. The nurse exhibited non- accepting gestures such as rolling her eyes and not maintaining eye contact. Non-accepting gestures can create barriers between nurse and patient as it can imply to them that the nurse does not have a genuine interest in their requests and make them feel like the nurse is rejecting not only their communication but also themselves. If she had expressed an accepting gesture towards Mrs. Miller it would have conveyed that the nurse recognised and empathised with her whilst simultaneously following the train of thought. Examples of this include head nodding, eye contact, and non-judgemental facial expressions. A critical component in therapeutic nursing is active listening. The nurse does not fulfill this useful technique as she and the patient seem to continuously talk over each other. When actively listening, a nurse can hear and understand what the patient is saying, which more importantly allows for the proper interpretation and translation of what the patients expressing. Silence can enable this as it allows for the patient to focus on the issues that are of most importance and it encourages the person to put thoughts and feeling into words only if the nurse is listening passively and attentively.

A client and nurse relationship can be characterised as a partnership where both work together to improve the patient health status and fulfil purposeful objectives where they agree about the nature of the problem, develop and implement a plan designed to reach the objectives which in this case is a comfort and pain relief. Reflecting on the dos and don’ts in the video, the nurse shouldn’t have procrastinated the patient’s reasonable request. As a nurse, she didn’t offer herself to help or seem interested in what the person thought. A positive outcome in developing their relationship could have occurred if she had offered her full attention, interest, and desire to understand, without demanding anything from Mrs. Miller, leaving the offer unconditional. When Mrs. Miller expressed “I didn’t sleep all night and I kept buzzing the buzzer and the nurse would not come in”, the nurse didn’t refrain from showing a negative response as she immediately crossed her arms and said, “Well you’re not the only patient I have today”. This is a very defensive and judgemental gesture. Research shows that being defensive prevents the patient from expressing their true concerns and it is a failure in considering the patient’s feelings whilst also making them feel as if they need to defend a position, all while the nurse is just protecting herself from weakness. A therapeutic connection between the nurse and Mrs. Miller in the first vignette did not form as the development of their relationship for the nurse proved a challenge and it seemed she does not have the skills to cope with difficult reactions from her patients.

Each experience linking nurse and patient whether short or extended is an opportunity for healing. Evaluating the second episode for different therapeutic techniques and communication barriers, it was straightforward to highlight the experiences and interactions that enhanced the development of this nurse and Mrs. Miller’s relationship. In the beginning of the vignette, the nurse acknowledged the patient by giving recognition i.e. “Mrs. Miller, you were resting. I didn’t want to disturb you”. You can see that respect for this nurse is crucial to the care and quality of a patient’s experience, where each component of the person is recognised and valued. Almost immediately the nurse sits down offering herself and giving her presence, interest, and desire to understand. The nurse actively listens to Mrs. Miller and indicates an accepting response without inserting her own values or judgements. Listening is a difficult skill as it requires you to eliminate any external noise and focus your attention on all the verbal and non-verbal messages. Mrs. Miller states how she has a biopsy procedure to get done and the nurse effectively plays the role of a functioning resource person by making the information available to her which increased her knowledge of the biopsy procedure and prepared her for what to expect, i.e. “They will put you to sleep with anaesthesia”. This seemed to enhance the wholeness and wellbeing of Mrs. Miller and facilitate in building trust between nurse and patient. Feeling as if she has someone to confide in, Mrs. Miller described an experience she had with a nurse on the night shift as “rude and awful” and when she would come in, “she would just stick her head in” and leave. The nurse passively listens, a skill which involves being present non-verbally, maintaining eye contact whilst head nodding and then she actively listens by reflecting and directing questions back to Mrs. Miller by restating what she had said “so you felt like you weren’t cared for?. This approach conveys to Mrs. Miller that the nurse has listened and understood what the client’s basic message was whilst also allowing for her to get a clearer idea of what she has said. After Mrs. Miller revealed her ordeal in the hospital during the night, the nurse showed compassion towards her by placing her hand on hers and expressed her sincerest apologies, “I am so sorry that happened to you”. A critical component of therapeutic nursing and communication is the act of touch. The laying on of hands and touch can demonstrate care and empathy but it is also central to the idea of healing.

The nurses use of various therapeutic and communication approaches to help Mrs. Miller express her idea’s and feelings in a way that demonstrates respect and acceptance enabled the development of a therapeutic relationship between nurse and patient, which was solely influenced in a positive way by their interactions. It is easy to say that from the video even brief encounters like this one can be therapeutic. Patients can act out when stressed about upcoming procedures or if they are in pain but it requires a mature and patient nurse to transfer their skills and knowledge with the therapeutic use of one’s self to respond in healing ways in less than ideal situations.

My clinical nursing practice experience in Parklands care home provided me with the opportunity to work with real patients, experience a nursing home environment which I may now pursue once I have earned my degree and it offered me the chance to learn how to work with fellow nurses and other members of the healthcare team, but most importantly it presented me with numerous moments to deliver individualised and holistic care by the use of therapeutic touch. Below there will be subheadings based on Borton’s 1970’s Reflective framework, where I have critically reviewed on how I developed the use of therapeutic touch in my placement.

What? : What I have learned is that there is a required need for other alternatives to pharmacological therapy among older adults with dementia due to their harmful side effects. The therapeutic use of touch offers a non-pharmacological treatment which can decrease behavioural symptoms such as restlessness. What surprised me was how the use of touch can provide a healing effect and make the residents feel my “caring nature” and what I hoped for at Parklands was for the residents to believe that I took into consideration all of their needs.

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So what? : So, the important message I have gained an understanding in during my experience is that touch is a nursing intervention and so, what I have learned is that residents were more responsive to a good listener, touch and a reassuring word as it communicated to them that I cared, especially as the therapeutic use of touch affectionately transmits warmth.

So, what I need to know more about is that with touch there has to be acceptability and that may vary from person to person as I have to take into consideration their culture and background. Experience in completing more clinical practices will develop my self-awareness.

Before I used to believe touch was an invasion of privacy and could be interpreted wrongly as ‘sexual’ to the resident. So, the ideas of what I had previously thought about touch have changed as it can facilitate comfort and healing.

Now what? : Now what I can do with my new perception is connect with my patients by offering myself with a simple application of touch which portrays a genuine interest. Experience will be beneficial as I will be enhancing my self-awareness and knowledge base around the use of therapeutic touch and this will give me confidence when interacting with members of a multidisciplinary team and patients themselves.

Reviewing both vignettes showed how each experience we have with our patients can be healing and helpful but also harmful and unfeeling. Mastering the skills required for developing a therapeutic relationship is a lifelong process assisted by reflection which can be viewed as an impersonal scrutiny and valued judgement of your work or another’s using an objective approach which is to highlight you or your colleague’s strengths and weaknesses. When engaging a therapeutic relationship and effectively using the different approaches and techniques such as touch, active listening, and recognition you can help your patient achieve harmony, peace of mind, body, and spirit.