Therapeutic Nurse-Patient Relationship Essay 2022

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Introduction
A therapeutic nurse-patient relationship is a type of professional relationship that is based
on mutual trust and respect, being sensitive about needs of the patient, nurturing their faiths and
cultural values and assisting them in meeting their holistic care needs. It is an interpersonal
relationship that encompasses caring attitude and supporting nonjudgmental behaviour towards
an individual (Kornhaber et al. 2016). This essay will develop understanding regarding the way
to develop therapeutic relationship with patient by looking at the case study of Riley Smithson, a
16 year old boy who has been admitted for investigation regarding diabetes. The current issue for
Riley is that he is reluctant to discuss about his current health issue with anyone and his parents
are also confused regarding the doctor’s explanation for the admission. The essay will explore
how therapeutic communication skills can be used to develop therapeutic relationship with Riley
and discuss about initial care priorities while dealing with the patient. It will report about
stepwise methods to engage in therapeutic relationship with Riley too.
Keys issues and concerns for Riley
Riley was admitted to the hospital with symptoms of diabetes. Riley had been suffering
from symptoms of nausea, polyuria and faintness, due to which he was admitted to the hospital.
He had various other teenage related problems like social isolation, mild depression and acne. He
was taking medications for occasional asthma too. Currently, the main concern for him is his
diabetes. Diabetes is a chronic disease condition that affects the human body’s ability to process
blood glucose and results in abnormally high blood glucose level in the blood. Riley is in
adolescent stage and the trends related to diabetes prevalence in Australia suggesting that
children and adolescents are at risk of diabetes too. Ziegler and Neu (2018) reports that type 1

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diabetes mostly occur in children and adolescent. In addition, diabetes occur in adult, but also
seen occasionally among adolescents. The incidence is steadily rising in children and
adolescence. It is associated with poor glycemic control among adolescents and development of
vascular complications (Lyons, Libman and Sperling 2013).
Other psychological issue for Riley are mild depression, social isolation and preferring
games instead of meeting people. These symptoms are indicative of poor mental health which
could adversely affect his other health outcomes. For example, he is showing the symptoms of
social withdrawal and anxiety due to falling behind his peers. These social issues can not only
affect his adherence to treatment, but also lead to the deterioration of diabetic control because of
increase in risk of eating disorder and weight loss issues (Beckles et al. 2016). Riley was too
much engaged in online games and the evidence by González-Bueso et al. (2018) explains
internet gaming as a negative behavioural addiction as it increases the risk of social phobia,
anxiety and depression. The study by Lee (2014) acknowledged that cognitive deficits and
emotional problem is high in teenagers engaged in online games. Moreover, online gaming
increases risk of sedentary behaviour which in turn can increase risk of diabetes (Huang et al.
2020). Other concerns that could have increased risk of depression for Riley are his acne and
asthma. For the management of asthma, he is using puffers. He is taking isotretinon orally for the
treatment of his acne. Acne is an issue that predispose many adolescents to social anxiety and
poor self-esteem. This might be the reason Riley’s social withdrawal and anxiety symptoms too
(Mahapatra 2016). Moreover, the need to carry puffer at all time during school might be
distressing for him and it might be affecting his self-esteem needs (Withers and Green 2019).
These factors are the predictors of his mild depression symptoms.

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Riley is a teenager and his parent’s understand of the medical information might have
minimized barriers to treatment and facilitating therapeutic relationship with patient. However,
in case of Riley, it was found that his parents were confused regarding the reason for admission
too. This may be due to low health literacy or limited sharing of information. Hence, engaging in
therapeutic relationship with Riley’s parents is important to foster their support in management
of diabetes for their son. According to Young et al. (2014), parents must be engaged in diabetes
care of their children as they can lead to better diabetes related outcomes. Parents are the best
person to promote self-efficacy, adherence and glycemic control in their children. Hence,
interaction can help to identify whether Riley’s parent have the ability to support his children in
diabetes management or they are intrusive parents whose involvement is not liked by Riley. The
therapeutic alliance will help to identify Riley’s parent relationship with children, their ability to
control their child’s behaviour and the motivation or knowledge to engage in diabetes care.
Care priorities for Riley:
Thus, ensuring mental well-being of Riley is one of the care priorities to effectively
manage his diabetes and ensure that he adapts positive behaviour for holistic well-being. The
second care priority for care of Riley is to educate him about diabetes, its symptoms and
management so that he can understand why he has been admitted and why his involvement is
important for his recovery. The third priority will be to collaborate with Riley in such a way that
his sedentary behaviour is reduced and he is encouraged to engage in activities that increases his
physical activity levels. This will depend on involving Riley’s parent in the session too.
Strategies to develop therapeutic relationship with patient:

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To meet the above care priorities, the first important thing is to engage in therapeutic
relationship with patient. This will depend on employing therapeutic communication skills of
rapport building, active listening, empathy, paraphrasing and effective questioning skills. Such
therapeutic communication skills will be crucial to develop therapeutic alliance with Riley.
According to Maame Kissiwaa Amoah et al. (2018), face-to-face interaction is the best way to
engage in therapeutic communication with client as by verbal and non-verbal gestures of patient,
both physical and emotional needs of patient can be identified. As Riley is a reluctant patient,
rapport building and empathy is even more important to communicate as per client’s comfort
zone. Rapport building can start in the very first meeting with Riley and this will involve
showing mutual respect, empathy and trust. Ross (2013) defines confidence, empathy,
compassion, respect and thoroughness as important factors for the success of rapport building.
Empathy is the ability to respond to patient’s feelings and concerns and open communication
style is the way to explore state of mind of Riley. This can be done by placing oneself in another
person’s position and trying to interpret their concerns based on their situation (Finset and Ørnes
2017). For instance, during interaction with Riley, the nurse should explore Riley’s attitude
towards his diabetes. If their concern is not recorded, it would have an impact on treatment
outcomes (Price 2017). Thus, to achieve positive patient outcome, understanding patient concern
is also an important part of therapeutic nurse-patient relationship.
In addition to the use of rapport building and therapeutic building skills with Riley, it is
also necessary to invest time in develop therapeutic alliance with Riley’s parents. This is very
crucial for promoting health of Riley because parents can provide all cues needed to understand
Riley’s strength and weakness and use them in planning behavioural change and reviewing
treatment plan accordingly. Fostering good therapeutic relationship with them involves taking

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adequate time to discuss about Riley’s health concern, educating them about the impact of his
social and psychological issues on his ability to manage diabetes and clearly describing the
rationale for current admissions. This form of open communication and sharing information
would help to understand about their interest in changing the behaviour of Riley too. His parents
can be encouraged to use resources like websites and information brochure on diabetes so that
they have trust regarding the information given and have clear perception regarding Riley’s
current treatment and admission (Nordfeldt et al. 2013).
Step to meet initial care priorities for Riley:
The first care priority is to maintain mental health of Riley. This is important because
currently he is affected by depression and anxiety which is affecting his school attendance,
academic performance and social function. Hence, prioritizing mental health is crucial to so his
anxiety during social gathering is reduced and he is better able to respond to treatment during
hospital stay. This can be done by using communication skills like active listening, effective
questioning and using open-ended questions to find out the factors that have resulted in his
depression and social withdrawal. Based on the information gathered, the nurse can engage in
consultation with psychologist or social worker to find out appropriate intervention needed to
promote his mental health. Richardson et al. (2014) affirms that collaborative care interventions
like psychotherapy along with use of social interventions like can help to enhance depression
treatment and reduce social withdrawal symptoms for Riley.
The second care priority is to provide education on diabetes so that Riley is motivated to
learn about self-management skills to manage his diabetes. To facilitate implementing
educational session with Riley, it will be essential to create a comfortable space for interaction

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first. It will also be necessary to pre-inform Riley about the purpose of the session. Luan et al.
(2017) argues regarding benefits of diabetes education in improving self-management skills,
quality of life and medical costs. During therapeutic communication, the nurse can foster using
strengths of Riley to increase his motivation towards changing his health behavior. Improved
personal resources like resilience would lead to stronger will power and ability to control disease
in patients with diabetes (Chew, Shariff-Ghazali and Fernandez 2014). Thus, diabetes education
would help to promote Riley’s engagement in self-management. His knowledge related to
challenges associated with current behaviour will be discussed and the benefits for him in
engaging in physical activity and taking proper diet will be given. He will be introduced to seven
diabetic self-care practices such as healthy diet, proper medication, physical activity, glucose
monitoring, risk reduction, behaviour, problem solving abilities and adapting skills. However, as
he is a teenager, he may not have self-efficacy in all areas (Eva et al. 2018). Thus, Riley parents
will be involved in self-care and therapeutic communication process too.
In addition, to meet the thirde care priority of increasing the physical activity level of the
client, Riley’s parents will be educated regarding ways to enhance his son’s interest in physical
activity and avoiding being overprotective parents. Research revealed that adolescents often tend
to ignore self-care related to diabetes because of overprotective parents. Many adolescents feel
depressed because of nagging or controlling parents. However, studies have also reported poor
quality of life in adolescents who perceive their mothers to be uninvolved (Young et al. 2014).
Thus, fostering collaboration between Riley and his parents is important to promote better
adherence and metabolic control in patients.
Conclusion:

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From the analysis of strategies needed to develop therapeutic relationship with Riley, it
can be concluded that therapeutic communication or alliance is a cornerstone of nurse-patient
relationship. It not only helps in better understanding about patient’s concern and needs, but it
also helps to alleviate patient dissatisfaction issues. The experience of analyzing health needs of
an adolescent’s patient gave the lesson regarding the importance of considering developmental
stage of client during communication process. The paper developed knowledge regarding the
best practice in developing therapeutic relationship. It involves initiating communication with
mutual trust and respect and non-judgmental attitude and proceeding with interaction by use of
rapport building, empathy and active listening skills.
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