Best Evidence Based Practice for Positive Therapeutic Relationship with Culturally Diverse Patients

Running head: NURSING
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Name of the Student:
Name of the University:
Author Note:

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Identification of the clinical issue:
The first quality standard of the NSQHS standard focuses on the establishment of a
positive therapeutic relationship with the client. Positive therapeutic relationship typically
refers to the creation of a positive rapport with the patients on the elements of mutual trust,
dignity and respect. Research studies mention in this regard that the establishment of positive
rapport with patients is directly dependent on acquiring positive patient outcome and
increased level of patient satisfaction (Betancourt et al., 2016).
Summary of the evidence base:
A large number of research studies suggest that the primary requisite for the creation
of a positive therapeutic relationship is based on the aspect of effective communication.
Effective communication refers to the use of both verbal and non-verbal gestures and
reinforcement of a comfortable therapeutic environment (Hermann et al., 2019). Poor quality
of communication has been studied to diminish access to care services and at the same time
contribute to poor care outcome for a significant percentage of the patient that includes
patients belonging to diverse cultures (Purnell et al., 2016). On the contrary fostering a
positive therapeutic environment can help to acquire positive healthcare outcome.
Justification for the choice of research topic:
The justification for the choice of the research topic can be explained as the
increased prevalence of poor access to health care facilities by the indigenous community
members and individuals of diverse community members. Despite a large number of
initiatives taken by the Australian government such as Close the gap policy, access to health
care services has remained poor for the indigenous community members that primarily
include Aboriginal and Torres Islander community members. Investigating best evidence best

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practice to overcome cultural barriers can help improve access to care facilities and improve
associated healthcare outcome (Vermeir et al., 2015).
Research Question:
The research question for the paper can be articulated as follows:
What is the best evidence based practice for the creation of positive therapeutic
relationship with patients who belong to diverse cultures?
PICO format:
P: Population What is the best evidence based
practice to establish positive therapeutic
relationship with culturally diverse
patients for nursing professionals?
I: Intervention Does appropriate use of verbal,
non-verbal gestures and cultural
competence improve care access and care
outcome for culturally diverse patients?
C: Comparison None
O: Outcome Does establishment of positive
therapeutic relationship improve overall
patient outcome and increase access to
care facilities?

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Search Strategy:
In order to locate research papers that were relevant to the research question, an
exhaustive search was conducted on the electronic databases of Google Scholar and Ovid. In
order to conduct the search relevant search terms were used that included terms such as:
Therapeutic relationship, rapport, nurses, communication barriers, patients and care outcome.
A set of inclusion criteria that included consideration of publications between the years of
2015 to 2019 was considered. In addition to this, papers that were published in English were
considered and papers that were accessible for full text were considered. The exclusion
criteria comprised of papers that were published in foreign language, were not accessible for
full text and papers that were published before 2015.
Hierarchy of evidence:
Research article (in text citations) Level of evidence (as per JBI)
(Foronda et al., 2016) 1a
(Norouzinia et al., 2016) 4b
(van Rosse et al., 016) 2a
(Moore et al., 2017) 2a
(Chaboyer et al., 2016) 3d
Part 2:
Synthesis of the articles
According to Norouzinia et al. (2016), communication is considered as the crucial
component of delivering high-quality of care and health assistance to the patient and achieve
enhanced health outcome. The researcher had conducted a descriptive and cross-sectional