Julie Kennedy BSN RN

Nurse / Patient Therapeutic Relationships

Ice Breakers

There is a 3x5 card on your table

Write the names of the people in your life that you love

Lay the card in front of you so you can see the names

Let Us Take The Survey !

What Compels a Nurse to Practice ‘Always’ Care?

Therapeutic Relationship

Therapeutic relationship – one which is perceived by patients to be caring, supportive, non-judgmental and offers perception of safety from threatening events (McKlindon & Barnsteiner)

Therapeutic Relationship – is grounded in an interpersonal process that occurs between the nurse and the patient. It is purposeful, goal-directed relationship that is directed at advancing the best interest and outcome of the patient (Registered Nurses Association of Ontario 2002).

Elements of Therapeutic RelationshipEmpathy: Nurse should be able to perceive and experience the

feelings of the patient to be able to understand the patient

Genuineness: Nurse is sincere and honest in relationship with the patient. Consistency conveys sincerity that in turn foster the development of patient trust. Nurse must maintain an honest and open communication

Concreteness and specificity: Nurse’s ability to identify patients feelings and make the patient aware of them. Only when the nurse listens actively and is sensitive enough can she help the patient to gain awareness and insight regarding feelings, thoughts and behaviors

Respect: Nurse considers the patient with dignity, to be deserving of high regard. This is manifested when the nurse does not belittle or judge the patient’s feelings, verbalizations and behaviors.

Elements of a Therapeutic Relationship

Respect for personReceptivity which involves good listening skillsEmpathyAwareness of ones own skills and limitations

~Hobbs 1994

Therapeutic Relationship

It is not about being “nice”It is not about adhering to scripted communication It is not dependent on the clinicians personality

It is built on authentic words and actionsIt is knowledge-based and grounded in human caring science research and accumulated clinical wisdom

~Mary Koloroutis and Michael Trout

Therapeutic Relationship

Just as it would never be thought acceptable that a clinician fail to be technically proficient, it can never be thought acceptable that a clinician be permitted to lack relational proficiency

~Mary Koloroutis & Michael Trout

I Know It When I See It

Therapeutic Relationship

The phrase "I know it when I see it" was famously used by United States Supreme Court Justice Potter Stewart to describe his threshold test for pornography in Jacobellis v. Ohio (1964)

For Your Reading Pleasure…

Current articles that show the depth of the problem…

How Do We Unravel This Mess??

Operationalize Nurse/Patient Therapeutic Relationship

Standardization AcceleratorsMust Haves®

Performance Gap

Objective Evaluation

System

Nursing Development

STUDER GROUP®:

Agreed upon tactics and behaviors that demonstrate:EmpathyRespect

(for patients)Tactics and behaviors that demonstrate:Empathy Respect

(for nurses)

Critical conversations

Novice to expert for TR relational competency

Evaluations include therapeutic relationships

Processes that are consistent and enculturated for “always” patient care Magnet designation Nurse relational competencies

Aligned Goals Aligned Behavior Aligned Process

Ensure that nurse leaders have skills to teach/role model relational skills

Ensure that nursing development includes relational skills as well as clinical skill and they are equally weighted

Ensure that organizational goals focus on outcomes that support therapeutic relationships with patients and families

Rev 4.8.11

What are these tactics?

What are these tactics?

Caring for Patient is Caring for Nurses

Organizations with satisfied staff score well on patient experience

Investigation of hospitals where patients suffer very poor care have all found remote and inaccessible managers who refused to listen to staff and would not involve them in decision-making; bullying, low staff morale, fatalism among clinicians about management and a reluctance to raise concerns

Novice to Expert in Therapeutic Relationships (TR)

Novice Advanced Beginner

Competent Proficient Expert

No experience, and need rules to establish TR. Demonstration of TR is limiting and inflexible “Just tell me what to do and I will do it”

Demonstrates marginally acceptable performance, has enough experience to begin to formulate guiding principles of TR in practice

Develops a plan for establishing a TR that is conscious and deliberate, can cope with contingencies of different patient types but may have difficulty with prioritization

Understands TR in terms of long-term goals and prioritization, uses nuances as guides to development of TR. Understands modification of TR based on experiences

Intuitive grasp of maintenance of TR, without wasteful actions, is fluid and flexible and does not need rules or scripting to demonstrate extreme competency and consistency

~Patricia Benner 1984

Novice to Expert in Therapeutic Relationships (TR)

Novice

No experience, and need rules to establish TR. Demonstration of TR is limiting and inflexible “Just tell me what to do and I will do it”

What are some Novice behaviors?

~Patricia Benner 1984

Novice to Expert in Therapeutic Relationships (TR)

Advanced Beginner

Demonstrates marginally acceptable performance, has enough experience to begin to formulate guiding principles of TR in practice

What are Advanced Beginner behaviors??

~Patricia Benner 1984

Novice to Expert in Therapeutic Relationships (TR)

Competent

Develops a plan for establishing a TR that is conscious and deliberate, can cope with contingencies of different patient types but may have difficulty with prioritization

What are Competent behaviors??

~Patricia Benner 1984

Novice to Expert in Therapeutic Relationships (TR)

Proficient Expert

Understands TR in terms of long-term goals and prioritization, uses nuances as guides to development of TR. Understands modification of TR based on experiences

Intuitive grasp of maintenance of TR, without wasteful actions, is fluid and flexible and does not need rules or scripting to demonstrate extreme competency and consistency

What are Proficient behaviors?

How do they differ from Expert behaviors?

~Patricia Benner 1984

Where Is Your Team? From Novice to Expert?

What are patient outcomes when

we practice here?

What are patient outcomes when we practice here?

Care; What Nurses Say and What Nurses DoHolistic Nursing Practice, May/June 2008

Novice Expert

“We need to care differently rather than continue to declare that “we do not have time” as a

protective measure.”

®

…creates care like this….

The people on your cards matter….

Julie Kennedy BSN, R

N

Studer Coach

www.studergroup.co

m

julie.ke

nnedy@stu

dergroup.com

If you want to build a shipdon’t tell people to collect wood

and don’t assign them tasks and work but rather teach them to long

for the endless immensity of the sea-Antoine de Saint-Exupery