Establishing Therapeutic Nurse-Client Relationship with Mentally ill Patients in a Community
Added on 2023-06-11
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Establishing Therapeutic Nurse-Client Relationship
with Mentally ill Patients in a Community
Cecilia Penda
Bachelor’sThesis
Degree Programme in Nursing
2017
with Mentally ill Patients in a Community
Cecilia Penda
Bachelor’sThesis
Degree Programme in Nursing
2017
DEGREE THESIS
Arcada University of Applied Sciences
Degree Programme: Nursing
Identification number: 18827
Author: Cecilia Penda
Title: Establishing Therapeutic nurse -client Relationship with
Mentally ill patients in a Community.
Supervisor (Arcada): Pamela Gray
Commissioned by:
Abstract:
Introduction: Mental well-being is necessary and important for a population health and well-
being. Many people may discover mental health problems in their daily life activities. Most often,
these mental health challenges go unnoticed by the patients as well as others.Therapeutic
relationship is very important in mental health .It is considered the fundamental of mental health
as it supports the changing insight and behaviour of mentally ill patient.It is a relationship built on
trust and respect between the nurse and the client.
The purpose of this study is to investigate articles of scientific journals related to topic and gain
deeper knowledge on means to build an effective nurse-client relationships and to understand
nurses role in the nurse-client relationship.
Method:Literature review was used as an electronic database search. The database search that
were used for the review are EBSCOHOST,SCIENCE DIRECT, SAGE JOURNAL and Google
Scholar utilizing the search terms ”therapeutic nurse-client relationship”, ”mental health”,
”Components of therapeutic relationship”, ”community care”.The search resulted to a number of
hits using the search criterions. Reading carefully through the articles, the total of fourteen
scientific articles were considered relevant for this study.An inductive content analysis was used
to analysed the data collected.The theoretical framework used for the study is Hildegard
Peplau’1988 interpersonal theory.
Findings:The literature review highlight trust, communication, empathy, genuineness,
empowerment, respect, continuity of care and patient confidentiality as the core components of
nurse-patient relationship.In addition to nurses role such as providing physical care, safety and
security and protection in the nurse-client relationship. The theoritical framework of Peplau’s
interpersonal theorycould be seen as it explained the phases of therapeutic nurse-client
relationship.
Conclusion: The study illustrate the role of nurses in a therapeutic relation to nursing practice as
a service provider through the provision of physical care to patient, conveying safety and security
to patient, protection as well as elements needed to establish an effective nurse-client relationship.
Keywords: Mental health, nurse-client relationship, Community
health, Therapeutic relationship
Numberof pages: 51
Language: English
Date of acceptance:
Arcada University of Applied Sciences
Degree Programme: Nursing
Identification number: 18827
Author: Cecilia Penda
Title: Establishing Therapeutic nurse -client Relationship with
Mentally ill patients in a Community.
Supervisor (Arcada): Pamela Gray
Commissioned by:
Abstract:
Introduction: Mental well-being is necessary and important for a population health and well-
being. Many people may discover mental health problems in their daily life activities. Most often,
these mental health challenges go unnoticed by the patients as well as others.Therapeutic
relationship is very important in mental health .It is considered the fundamental of mental health
as it supports the changing insight and behaviour of mentally ill patient.It is a relationship built on
trust and respect between the nurse and the client.
The purpose of this study is to investigate articles of scientific journals related to topic and gain
deeper knowledge on means to build an effective nurse-client relationships and to understand
nurses role in the nurse-client relationship.
Method:Literature review was used as an electronic database search. The database search that
were used for the review are EBSCOHOST,SCIENCE DIRECT, SAGE JOURNAL and Google
Scholar utilizing the search terms ”therapeutic nurse-client relationship”, ”mental health”,
”Components of therapeutic relationship”, ”community care”.The search resulted to a number of
hits using the search criterions. Reading carefully through the articles, the total of fourteen
scientific articles were considered relevant for this study.An inductive content analysis was used
to analysed the data collected.The theoretical framework used for the study is Hildegard
Peplau’1988 interpersonal theory.
Findings:The literature review highlight trust, communication, empathy, genuineness,
empowerment, respect, continuity of care and patient confidentiality as the core components of
nurse-patient relationship.In addition to nurses role such as providing physical care, safety and
security and protection in the nurse-client relationship. The theoritical framework of Peplau’s
interpersonal theorycould be seen as it explained the phases of therapeutic nurse-client
relationship.
Conclusion: The study illustrate the role of nurses in a therapeutic relation to nursing practice as
a service provider through the provision of physical care to patient, conveying safety and security
to patient, protection as well as elements needed to establish an effective nurse-client relationship.
Keywords: Mental health, nurse-client relationship, Community
health, Therapeutic relationship
Numberof pages: 51
Language: English
Date of acceptance:
4
Contents
1 INTRODUCTION ................................................................................................... 8
2. BACKGROUND ..................................................................................................... 11
2.1 The history of mental health treatment and therapeutic relationships ......................................... 12
2.2 The key concept. ............................................................................................................... 14
3. Theoretical framework .......................................................................................... 17
3.1 Peplau`s theory as a framework. ............................................................................................ 17
3.1.1. The orientation Phase ................................................................................................... 18
3.1.2. The identification Phase ................................................................................................ 18
3.1.3 The exploitation phase .................................................................................................... 19
3.1.4The Resolution Phase ...................................................................................................... 19
3.2 Relevance of the theory ......................................................................................................... 19
4. AIMS AND RESEARCH QUESTION ...................................................................... 20
5.METHODOLOGY ................................................................................................... 21
5.1 Data collection ..................................................................................................................... 21
5.3 Presentation of reviewed articles ............................................................................................ 23
5.4 Ethical consideration. ............................................................................................................ 24
6. FINDINGS .............................................................................................................. 27
6.1 Elements of therapeutic nurse- client relationship ............................................................ 27
6.1.1 Trust ................................................................................................................................. 27
6.1.4 Genuineness .................................................................................................................. 31
6.1.6 Continuity of care .......................................................................................................... 32
6.1.7 Respect (unconditional positive regards).......................................................................... 33
6.8 Confidentiality and privacy ............................................................................................... 33
6.2. The role of nurse in Therapeutic relationship ................................................................... 34
7. DISCUSSION .......................................................................................................... 37
7.1. Strength, Limitation and Recommendation ...................................................................... 41
8.CONCLUSIONS ...................................................................................................... 42
9. REFERENCES ....................................................................................................... 43
Appendices ............................................................................................................... 48
Contents
1 INTRODUCTION ................................................................................................... 8
2. BACKGROUND ..................................................................................................... 11
2.1 The history of mental health treatment and therapeutic relationships ......................................... 12
2.2 The key concept. ............................................................................................................... 14
3. Theoretical framework .......................................................................................... 17
3.1 Peplau`s theory as a framework. ............................................................................................ 17
3.1.1. The orientation Phase ................................................................................................... 18
3.1.2. The identification Phase ................................................................................................ 18
3.1.3 The exploitation phase .................................................................................................... 19
3.1.4The Resolution Phase ...................................................................................................... 19
3.2 Relevance of the theory ......................................................................................................... 19
4. AIMS AND RESEARCH QUESTION ...................................................................... 20
5.METHODOLOGY ................................................................................................... 21
5.1 Data collection ..................................................................................................................... 21
5.3 Presentation of reviewed articles ............................................................................................ 23
5.4 Ethical consideration. ............................................................................................................ 24
6. FINDINGS .............................................................................................................. 27
6.1 Elements of therapeutic nurse- client relationship ............................................................ 27
6.1.1 Trust ................................................................................................................................. 27
6.1.4 Genuineness .................................................................................................................. 31
6.1.6 Continuity of care .......................................................................................................... 32
6.1.7 Respect (unconditional positive regards).......................................................................... 33
6.8 Confidentiality and privacy ............................................................................................... 33
6.2. The role of nurse in Therapeutic relationship ................................................................... 34
7. DISCUSSION .......................................................................................................... 37
7.1. Strength, Limitation and Recommendation ...................................................................... 41
8.CONCLUSIONS ...................................................................................................... 42
9. REFERENCES ....................................................................................................... 43
Appendices ............................................................................................................... 48
5
ABBREVIATION
W.H.O World Health Organization.
Chapt. Chapter
Vol. Volume
List of figures
Figure 1: The search process
Figure 2: Illustration of the data analysis process
Figure 3: Communication that supports safety in Psychiatric nursing.
ABBREVIATION
W.H.O World Health Organization.
Chapt. Chapter
Vol. Volume
List of figures
Figure 1: The search process
Figure 2: Illustration of the data analysis process
Figure 3: Communication that supports safety in Psychiatric nursing.
6
Dedication
Dedicated to my beloved sons Pekka – Kelton & Clive
Dedication
Dedicated to my beloved sons Pekka – Kelton & Clive
7
Acknowledgement
I am grateful to God almighty for the guidance and support provided to me throughout
the writing of this study.
I wish to express my sincere gratitude to my supervisor Pamela Gray for her encour-
agements, supports and reviews that brought this work to fulfillment. Not leaving out all
the academic staffs in the Arcada Nursing Department who in one way or the other con-
tributed to make my studies and the writing of this paper a success, thank you so much.
I would like to take this chance to express my deep sense of gratitude to my beloved
mothers, brothers and sisters for their support and understanding and to my late father
Mr. Ngoh Emmanuel Penda, who made me to be who I am today. I know you are happy
where you are now for this great achievement, thank you so much.
This study couldn’t have been accomplished without the support of this wonderful,
lovely family of Heli Norja and Matti Norja. Thank you for your enormous support
morally, financially and physically. Your encouragement when the times got tough, it
was a great comfort and reliefs to know that you were and are still willing provide any-
thing you can to see that I succeed. God bless you.
To my classmates and friends, Bola, Gordon& Celine, Susanna and to those whose
names are not mentioned here. They are worthy and trusted people who gave me their
support and ask for nothing in return. A big thank you.
I would like to thank my sons for his unique kindness and understanding he showed to
me throughout the writing of this study.
Acknowledgement
I am grateful to God almighty for the guidance and support provided to me throughout
the writing of this study.
I wish to express my sincere gratitude to my supervisor Pamela Gray for her encour-
agements, supports and reviews that brought this work to fulfillment. Not leaving out all
the academic staffs in the Arcada Nursing Department who in one way or the other con-
tributed to make my studies and the writing of this paper a success, thank you so much.
I would like to take this chance to express my deep sense of gratitude to my beloved
mothers, brothers and sisters for their support and understanding and to my late father
Mr. Ngoh Emmanuel Penda, who made me to be who I am today. I know you are happy
where you are now for this great achievement, thank you so much.
This study couldn’t have been accomplished without the support of this wonderful,
lovely family of Heli Norja and Matti Norja. Thank you for your enormous support
morally, financially and physically. Your encouragement when the times got tough, it
was a great comfort and reliefs to know that you were and are still willing provide any-
thing you can to see that I succeed. God bless you.
To my classmates and friends, Bola, Gordon& Celine, Susanna and to those whose
names are not mentioned here. They are worthy and trusted people who gave me their
support and ask for nothing in return. A big thank you.
I would like to thank my sons for his unique kindness and understanding he showed to
me throughout the writing of this study.
8
1 INTRODUCTION
The world Health Organisation (WHO) estimated that, one in four in the world will be
affected by mental or neurological disorder at some point in their life. They reported
that, number of people around the world suffering from mental health problems was 450
million placing mental disorder amongst the leading cause of ill health around the world
(WHO, 2001). In European union countries,27% (approximately 83 million) of adult
between the age of 18 – 65 have experience one of the series of mental disorder, sub-
stance use, psychoses, anxiety, depression (WHO, 2017)
Mental health problems and substance abuse are among the most serious threats for
public health in Finland. About one quarter of Finnish people suffer from psychological
symptoms with adverse effects at some time in their lives. It is estimated that that 7% of
all Finnish adult suffer from depressive, anxiety and alcohol- related disorders (Mental
health briefing sheets, consensus paper, 2008).
Mental health care services in Finland are provided by municipal authorities, district
hospitals, private service providers and third sector stakeholder that is different type of
organisation, but their implementation differs from one town to another. The structure
of the service in larger towns is more robust and versatile with more service provider as
compared to smaller towns. Patient can seek assistance from health care centres, private
clinics, occupational health care, specialised psychiatric care, private psychotherapist,
church and various organisations involved in the different kinds of mental health ser-
vices. (Meili. The Finnish Association for Mental Health).
In Finland, mental disorders are treated with a combination of medication, conversation
and different kinds of group activities. For long term and more severe cases, patients are
treated in an inpatient care where the patient is admitted in a psychiatric care unit or
outpatient care where patients visit the hospital few times a week or months to receive
treatment (Meili, The Finnish Association for Mental Health). In this case the responsi-
bilities to assess and manage the mental illness and or mental well-being do not only
depend on the health care personnel but also on the patient.
1 INTRODUCTION
The world Health Organisation (WHO) estimated that, one in four in the world will be
affected by mental or neurological disorder at some point in their life. They reported
that, number of people around the world suffering from mental health problems was 450
million placing mental disorder amongst the leading cause of ill health around the world
(WHO, 2001). In European union countries,27% (approximately 83 million) of adult
between the age of 18 – 65 have experience one of the series of mental disorder, sub-
stance use, psychoses, anxiety, depression (WHO, 2017)
Mental health problems and substance abuse are among the most serious threats for
public health in Finland. About one quarter of Finnish people suffer from psychological
symptoms with adverse effects at some time in their lives. It is estimated that that 7% of
all Finnish adult suffer from depressive, anxiety and alcohol- related disorders (Mental
health briefing sheets, consensus paper, 2008).
Mental health care services in Finland are provided by municipal authorities, district
hospitals, private service providers and third sector stakeholder that is different type of
organisation, but their implementation differs from one town to another. The structure
of the service in larger towns is more robust and versatile with more service provider as
compared to smaller towns. Patient can seek assistance from health care centres, private
clinics, occupational health care, specialised psychiatric care, private psychotherapist,
church and various organisations involved in the different kinds of mental health ser-
vices. (Meili. The Finnish Association for Mental Health).
In Finland, mental disorders are treated with a combination of medication, conversation
and different kinds of group activities. For long term and more severe cases, patients are
treated in an inpatient care where the patient is admitted in a psychiatric care unit or
outpatient care where patients visit the hospital few times a week or months to receive
treatment (Meili, The Finnish Association for Mental Health). In this case the responsi-
bilities to assess and manage the mental illness and or mental well-being do not only
depend on the health care personnel but also on the patient.
9
Before the 1990s, specialised mental services were administered separately from other
health services. For this reason, Finland was divided into mental health districts, com-
posed by federation of municipalities.
In the beginning of 1990, Finnish mental health service undergone transformation with
the integration of mental services and other specialised health services with decentrali-
sation of financing and de-institutionalisation of the services. The deinstitutionalization
of psychiatric services has been possible by developing outpatient care and community
based mental health services (Salokangas R.k.R. and Saarinen S., 1998). The former
mental health districts were dissolved, and psychiatric and specialised health care were
merged into new administrative units called health care districts (Ville L. and Vappu T.,
2001). As compared to mental health services in Africa for example Cameroon, the
Cameroon government spends 0.1% of the total health budget for mental health, (WHO
Mental health atlas, 2011) Sources of mental health financing are from taxes, by patient
themselves or their family and private insurance services. Apart from the government,
some non-governmental organisations are involved with mental health, but their role is
limited to advocacy, promotion, prevention and rehabilitation. Budget that is allocated
for mental health program particularly for the development of community -based mental
health are never implemented. Even if budget programmes are present, the plans in
mental health are very slow to activate because of low priority. Since 1989, mental
health has been included as a public health priority, but greater priority has been given
to family planning and hospital medicine (WHO, 2013).
There is no mental health reporting system because the collection of data is poor and
information gathering is not developed due to lack of infrastructure, trained and moti-
vated staff (WHO, 2013). There are no community care facilities for patient with mental
disorder. The country has no data collection system or epidemiological study on mental
health. A research carried out by WHO (2011) in Cameroon shows that nurses and other
healthcare professionals working in hospitals, are not train and equipped to work with
people with possible mental health problems and do not have the interpersonal interac-
tion skills and the methods available to provide the best possible care for these clients.
Community care can be described to be various services available to help individuals
manage their physical and mental problems in the community with dignity and inde-
pendence in other to avoid social isolation (Sidmore, 1997). Community care can be a
means of providing the right level of interventions and supports to enable people to at-
Before the 1990s, specialised mental services were administered separately from other
health services. For this reason, Finland was divided into mental health districts, com-
posed by federation of municipalities.
In the beginning of 1990, Finnish mental health service undergone transformation with
the integration of mental services and other specialised health services with decentrali-
sation of financing and de-institutionalisation of the services. The deinstitutionalization
of psychiatric services has been possible by developing outpatient care and community
based mental health services (Salokangas R.k.R. and Saarinen S., 1998). The former
mental health districts were dissolved, and psychiatric and specialised health care were
merged into new administrative units called health care districts (Ville L. and Vappu T.,
2001). As compared to mental health services in Africa for example Cameroon, the
Cameroon government spends 0.1% of the total health budget for mental health, (WHO
Mental health atlas, 2011) Sources of mental health financing are from taxes, by patient
themselves or their family and private insurance services. Apart from the government,
some non-governmental organisations are involved with mental health, but their role is
limited to advocacy, promotion, prevention and rehabilitation. Budget that is allocated
for mental health program particularly for the development of community -based mental
health are never implemented. Even if budget programmes are present, the plans in
mental health are very slow to activate because of low priority. Since 1989, mental
health has been included as a public health priority, but greater priority has been given
to family planning and hospital medicine (WHO, 2013).
There is no mental health reporting system because the collection of data is poor and
information gathering is not developed due to lack of infrastructure, trained and moti-
vated staff (WHO, 2013). There are no community care facilities for patient with mental
disorder. The country has no data collection system or epidemiological study on mental
health. A research carried out by WHO (2011) in Cameroon shows that nurses and other
healthcare professionals working in hospitals, are not train and equipped to work with
people with possible mental health problems and do not have the interpersonal interac-
tion skills and the methods available to provide the best possible care for these clients.
Community care can be described to be various services available to help individuals
manage their physical and mental problems in the community with dignity and inde-
pendence in other to avoid social isolation (Sidmore, 1997). Community care can be a
means of providing the right level of interventions and supports to enable people to at-
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