Impact of Therapeutic Relationship on Patient Outcome

This document explores the impact of therapeutic relationship on patient care and outcomes. It emphasizes the importance of effective communication and discusses barriers to cooperation. The document includes annotated bibliographies and a summary of the literature search.

Running Head: THERAPUTIC RELATIONSHIP AND PATIENT OUTCOMES
Impact of Therapeutic Relationship on Patient Outcome
Student’s Name
Affiliate Institution

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
Table of Contents
Introduction................................................................................................................................4
Summary of the Literature Search.............................................................................................5
Search Strategy Table................................................................................................................5
Annotated Bibliographies...........................................................................................................9
Discussion................................................................................................................................12
Conclusion................................................................................................................................15

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
Introduction
According to Pullen and Mathias (2010), therapeutic nurse-patient relationship refers
to absolute mutual trust and honoring, the health of a patient by satisfying spiritual, emotional
and physical. Nurses should be prepared for the challenges that come with providing medical
services to patients. Though patients might be challenging to communicate with, health
provider should give them time to adjust and be willing to understand what they are going
through (Haverinen, 2017).
Subsequently, effective verbal and non-verbal communication is a crucial factor in
nurse-patient interactivity in providing care that enables the patient to have equal treatment
despite their shortcomings. Effective communication between health providers and patients is
critical in the delivery of quality services (Ross, 2018). However, nurses should be genuine
to the patient to promote a trustful relationship. Judgemental actions and discriminating
patients with disabilities may affect patients’ outcome. A nurse should be aware of how to
treat different conditions using different techniques. Pushing personal interests or spiritual
beliefs to patient may create a judgmental environment. Therefore, nurses should adopt the
method of listening and only talk when asking relevant questions and communicating the
treatment that will be used.
Subsequently, we will analyze why it is vital for patients to be transparent when
giving information to nurses. They should not omit any data since it might have a drastic
impact on the treatment. A therapeutic relationship should apply to all kinds of patients, be it
disable, mentally challenged or other health disorders.
Asking questions, allowing patients to express their feelings, and reassuring patients
support are effective communication skills that enhance satisfaction. Excellent healthcare
environment, active working practice promotes physical and psychological safety. This

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
annotated bibliography will explore three pieces of studies, and they include; interpersonal
relationship, interaction with mentally ill patients health and therapeutic relationship through
effective communication and possible barriers to cooperation.
Summary of the Literature Search
This research is completed through a descriptive method. The researcher gathers
current and past information from other scholars along with user experience and compares
the level of satisfaction concerning the relevance of therapeutic relationships in developing
quality health services. The research will capture data in two parts; the first part focuses on
secondary data obtained via the internet, journals, and books to ensure the information is
about therapeutic relationship. Secondary data is useful because it is reliable. Moreover, the
study was conducted by experts who had an interest in improving the experience of services.
Using primary data is also relevant in providing accurate information since one is able to
acquire current issues related to therapeutic relationship.
Secondly, the primary data will consist of an open questionnaire to conduct the
investigation. The research will explore, analyze and describe the relevance of therapeutic
relationship for nurses and health experts when providing care for physically, emotionally,
and mentally challenged patients. Moreover, the research will examine the nurse’s perception
of therapeutic relationship by comparing qualification, interpersonal skills, and experience.
Lastly, the study will propose the necessary recommendations to enhance the
development and sustainability of therapeutic relationship. It will analyze how pain,
emotional distress, lack of trust and unskilled nurse affect the overall quality of service given.
Search Strategy Table

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
Database
name
Search terms/
key words
database
headings
search
limits
results Decisions made
Dove medical
Press ltd
health, integrative
review, acute care,
and therapeutic
interpersonal
relationships,
N/A English
language 2016
10
studies
The research
emphasized on
therapeutic relationship
and how nurses and
health practitioner
should be equipped
with the skills.
The research provides a
vast amount of
literature, following a
change in search words
literatures were found.
Physical restraint,
therapeutic
relationship, quality
services, and mental
health nursing
N/A English
language
8 I went through the
research literature and
could not locate any
relevant information.
Due to of relevance I
couldn’t implement it
in the research which I
had to abandon.
SAGE Interpretive Not 2015-2016 15 The use of the search

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
Publications methods, interviews,
mental health
nursing, and
phenomenology
suggested English
language
Peer reviewed
sources
words and limits
facilitated more
beneficial literature for
the research topic.
From the data collected
from this study the
researchers suggest that
therapeutic relationship
is necessary in mental
ill patient. The study
provides a basis on
how emotional stability
is relevant in-patient
care. Establishing
common grounds and
friendliness is a
primary factor that has
been examined.
Interviews, mental
illness, and nurse-
patient relationship
Not
suggested
English
language
Peer reviewed
sources
25 After changing the key
terms and applying
the same limits as
the previous search.
The research provides
relevant literature. I
reviewed all of the

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
literature, of which 10
were relevant.
Informa UK
Limited
Barriers, Effective
Therapeutic
communication,
nurses, and patients
Not
suggested
2017-2018
Akan and
English
language
112 The research identifies
some of the barriers to
effective therapeutic
relation. Pain, emotions
and mental illness my
hinder interactions. The
research emphasizes on
effective and skillful
communication.
Effective
communication,
nurse-patient
relationship
N/A None 100 The research provide a
manageable amount of
result but difficulties
arose when I was
review the literature. I
had to research on the
key terms provide in
the literature so that I
could understand the
purpose of the study.
Outcome After reviewing the data, three research papers were decided upon from the relevant
literature identified. The research papers were selected by going through abstracts and
identifying which papers appeared to facilitate my outcome of a critical assessment. The
selection maximizes on improving nurse-patient relationship and involved diverse

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
literature that analyzed therapeutic relationship. Some of the key elements that led to the
selection of the research; and they include common ground, frontline, therapeutic
relationship, effective communication and nurse patient relationship.
Annotated Bibliographies
Thibeault, Catherine. (2016). An Interpretation of Nurse–Patient Relationships in
Inpatient Psychiatry. Global Qualitative Nursing Research, [online] 3. Available
at: https://journals.sagepub.com/doi/full/10.1177/2333393616630465.
The principle intent of this study is to illuminate the relationship between inpatient
psychiatric mental wellness nurses and their patient. Mental health is an essential thing for
every human being. Individuals that have the illness should have access to the effective
nurse-patient relationship to allow them to express themselves easily. The author, Catherine,
uses semi-structured interview and non-participants observation which focuses on
phenomenological inquiry. Information and data gathered were transcribed from the audio
recorded during the interview.
Subsequently, the study shows that nurse-patient communication with mentally ill
patients has decreased, due to prolonged stay pressures. Interviews lasted for 1 hour for
participant and 40hours for nonparticipants. Moreover, nine inpatient mental health nurses
and six patients were involved in the study. Out of the 15 participants, only half took part in
the study, due to, patient discharge, scheduling problems and lack of interest.
The study emphasizes the theme of mindfulness and why it is essential when nurses
are communicating to patients since they experience psychological distress. Moreover, the
study uses secondary data from multiple sources that helped to explore on psychiatric

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
patients. However, the researched used common grounds and frontline as sub-themes to
emphasize reducing miscommunication and enhancing the nurse-patient relationship.
Kornhaber, R., Walsh, K., Duff, J. and Walker, K. (2016). Enhancing adult therapeutic
interpersonal relationships in the acute health care setting: an integrative review.
Journal of Multidisciplinary Healthcare, Volume 9, pp.537-546
Therapeutic interpersonal relationships are an essential element in health care that
facilitates excellent clinical-patient outcomes. The study uses integrative research technique
which involves; review, synthesis and critical analysis of literature. Integrative reviews
promote a broad understanding of the existing gaps and the knowledge available. The
research uses both qualitative and quantitative methods of research. Moreover, the study was
conducted in seven countries, and they include; USA, Canada, Australia, the United
Kingdom, Denmark, and the Netherlands. Participants of the involved in the research
included; patients, physicians, and nurses from the different hospitals. More so, the study was
conducted in mental health medical trauma, gerontology, oncology section, and the surgical
unit.
The study initially identified 900 papers after eliminating duplicates. Furthermore, the
authors independently identified 37 prospective documents based on inclusion and exclusion
standards. Disagreements that arose during the research were resolved by debating. During
the evaluation process, ten papers were qualified after using the inclusion criteria. However,
out of the ten studies, seven of them used the qualitative approach by the use of semi
structured interview and limited analysis of data that were frequently used. More so, two of
the studies used questionnaires, observations, and interviews. Lastly, the remaining research
used the qualitative method with pre and post-intervention questionnaire.

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
Some of the themes that emerged as a result of the study include emotions and
continuing needs, responding to patients, and prioritizing patients, and engagement through
the establishment of a therapeutically relationship. The three themes interlink and lead to the
establishment of therapeutic interpersonal relationships.
Maame Kissiwaa Amoah, V., Anokye, R., Boakye, D. and Gyamfi, N. (2018). Perceived
barriers to effective therapeutic communication among nurses and patients at
Kumasi South Hospital. Cogent Medicine, 5(1).
The search explores the relevance of skillful and effective communication skills in
quality service. The purpose of the research is to investigate the possible barriers to enhanced
therapeutic interaction. More so, the study uses a descriptive research design using the
quantitative method to gather data. The study participants consisted of registered nurses and
clients specifically in the emergency, medical, recovery section and surgical unit of the
Hospital. A sample of 72 nurses and 40 patients was used for the research. Data collected was
by the use of close-ended questionnaires.
The key findings from the information collected revealed that anxiety, pain, and
discomfort from patients and overloading nurses are the key major issue that affects
therapeutic relationship. Participants had to identify their level of disagreement or agreement
by the use of a health system that had questions concerning nurse and patient barriers to
effective therapeutic communication. The scale used was; 5= strongly agree, 4= Agree, 3=
Disagree, = disagree, 1= Strongly disagree.
The ethical standards of the research are excellent. The researchers sent a letter to the
institution to request for investigating the hospital. Moreover, participants, we willing to
engage in the study and the research caused no harm.

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
Discussion
Nursing is a broad, demanding, interactive, and rewarding career. Health providers
are educated to be efficient in providing services to all persons regardless of skin complexion,
age, language, and gender. Similarly, the purpose of nurses is to provide culturally relevant
services. Eliminating obstacles of interaction is crucial for hospitals. Culture and language
difference and health awareness are some of the elements that may hinder the delivery of
service and may be obstacles to how doctors give treatment to consumers of health services.
According to Brabers, Rademakers, Groenewegen, van Dijk & de Jong (2017), health
awareness refers to the act of acquiring, interacting and understanding simple health data and
services that will promote appropriate health decision making.
Over the years, the therapists have confirmed that therapeutic relationship is an
essential element in achieving successful patient experience. Despite the difficulties
experienced by inpatient PMH nurses, they continue to find opportunities to engage in
therapeutic work. Catherine’s study is crucial since it emphasizes on mental health and why
nurses should set aside their interests when communicating with patients. When patients are
in pain, emotionally unstable and psychological unwell they tend to be resentful. Nurses
should understand the condition of the patient and try offering solutions such as painkillers
which will help the patients express themselves.
Moreover, the study explores the need for nurses to set up a common ground which
will allow patients to engage and willing to share their health issues. Subsequently, the data
collected from the research was accurate. Patients and nurses involved in the study were
willing to provide information that would help diminish the shortcomings of the health
facility. However, the study’s major limitation is the fact that it used a few participants which

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
might lead to inaccurate information. Moreover, the study was only conducted in a single
facility which might also mean that some of the issues may not apply in other facilities.
Secondly, Communication refers to the act of conveying and receiving information
from one person to the other. Lack of practical communication skills by nurses or health
practitioners can be an obstacle in providing health care services. Unclear communication
may lead to misdiagnosis, health complications, misinterpretation, misunderstanding, and
dissatisfaction. The nurse-patient relationship can only be attained in effective therapeutic
communication. Besides, the therapeutic connection is the process of interacting face-to-face
between nurse and patient to achieve physical and emotional health of a patient.
The shortcoming of the third annotation may be the use of convenience sampling
method such that; only the participants available at the time were used. Moreover, some of
the nurses were not sure about the intention of the study which might have triggered the
disclosure of some information (Haverinen, 2017). Additionally, one of the researchers works
at the hospital which might have altered the responses. However, the findings of the research
were not affected by the constraints. The research made use of convenience sampling
methods and therefore only the participants who were involved and at the convenience of the
researchers were used. A group of nurses were doubtful on the purpose of the study and
therefore were not ready to and give out information.
Therapeutic interpersonal relationships are the primary element in healthcare and can
transform and improve the patient experience. Consequently, the study found that listening,
reacting to the client’s emotions and continuing needs, and patient prioritization is the
primary element in improving therapeutic relationships.
To successfully attain therapeutic relationships nurses should acquire the right skills
such as consider their interpersonal communication skills. Verbal and non-verbal interaction

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
skills are categories of interpersonal communication requirements. Non-verbal
communication skills are a very effective way to transfer a message; nurses should, therefore,
show sympathy and actively listen to patients. Significant forms of non-verbal interaction
include; body movement, gestures, facial expressions, sign language, and behavior. On the
other hand, verbal communication techniques include active listening through paraphrasing
and asking questions. The nurse should be aware of then to ask open and closed questions to
avoid pressuring the patient.
Listening to patients helps to build a strong, relevant, trustful relationship (Haverinen,
2017). Moreover, attention may make a difference since the patient feels to empower and will
comfortably open up to the nurse. Subsequently respecting patients’ beliefs, culture, sexual
orientations, skin complexion, age, and religion is essential in attaining patient satisfaction.
Quality services from healthcare facilities are as a result of well-trained health
providers. Providing mentoring programs to enhance personal growth will also help improve
the effectiveness of the hospital. Top management of organizations should ensure that
patients receive quality medical services at all time. Training of health practitioner on the
importance of a therapeutic relationship is an essential element. Honoring patients need
makes them be at ease and fully supported. Therefore, it is critical for nurses to demonstrate
professionalism so that patients will be will to communicate with them without omitting
relevant information.
Reliable practice in health facilities is an essential part of promoting health and social
honoring. Subsequently, Effective communication between health providers and patients is
crucial in the delivery of quality services (Ross, 2018). Clinical training, governance, and
leadership are vital elements that ensure nurses and health experts are equipped with the right
skills to establish a productive therapeutic relationship. Subsequently, the regulations and

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
policies that emphasize on nurse-patient interaction help to improve satisfaction and quality
of care given in the future.
Additionally, hospitals should provide non-verbal specialist that will help in service
delivery between the nurse and client. Nurses also have the responsibility of being culturally
competent and being able to deal with the diverse patients that visit the hospital. Lastly,
matters regarding the cultural and communication limitations in healthcare, nurses should be
ready to facilitate interconnection between the culture of the patient, and health awareness, to
achieve therapeutic competence.
Conclusion
The process of establishing a therapeutic relationship starts from the time a health
expert comes into contact with a patient. Nurses require effective communication skills,
respect, non-judgmental character, and empathy when handling patients. More so, being non-
judgmental is crucial since it helps in understanding, providing the required attention and
compassion. Similarly, patients tend to omit information if they spot any judgment from
nurses.

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
Reference
Brabers, A., Rademakers, J., Groenewegen, P., van Dijk, L., & de Jong, J. (2017). What role
does health literacy play in patients' involvement in medical decision-making?. PLOS
ONE, 12(3), e0173316. doi: 10.1371/journal.pone.0173316
Haverinen, E. (2017). Paediatric Intensive Care Nurses' Intercultural Communication
Competences. Retrieved from https://www.theseus.fi/handle/10024/121894
Kornhaber, R., Walsh, K., Duff, J. and Walker, K. (2016). Enhancing adult therapeutic
interpersonal relationships in the acute health care setting: an integrative review.
Journal of Multidisciplinary Healthcare, Volume 9, pp.537-546.
Maame Kissiwaa Amoah, V., Anokye, R., Boakye, D. and Gyamfi, N. (2018). Perceived
barriers to effective therapeutic communication among nurses and patients at Kumasi
South Hospital. Cogent Medicine, 5(1).
Moreno-Poyato, A., Delgado-Hito, P., Suárez-Pérez, R., Leyva-Moral, J., Aceña-Domínguez,
R., Carreras-Salvador, R., Roldán-Merino, J., Lluch-Canut, T. and Montesó-Curto, P.
(2017). Implementation of evidence on the nurse-patient relationship in psychiatric
wards through a mixed method design: study protocol. BMC Nursing, 16(1).
Pullen, R. and Mathias, T. (2010). Fostering therapeutic nurse-patient relationships. Nursing
Made Incredibly Easy!, 8(3), p.4.
Ross, J. (2018). Effective Communication Improves Patient Safety. Journal Of
Perianesthesia Nursing, 33(2), 223-225. doi: 10.1016/j.jopan.2018.01.003
Thibeault, C. (2016). An Interpretation of Nurse–Patient Relationships in Inpatient
Psychiatry. Global Qualitative Nursing Research, [online] 3. Available at:
https://journals.sagepub.com/doi/full/10.1177/2333393616630465.

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
Appendix 1: Critical appraisal grid
Author/
date/ title
Research
question/
Aim
Research
approach
/ design
Ethica
l issue
Samp
le
Data
collectio
n
Data
analysis
Finding
s
Gene
ralisa
bility/
Tran
sfer
abilit
y
Implication for
practice & usefulness.
Thibeault,
Catherine.
(2016). An
Interpretation
of Nurse–
Patient
Relationships
in Inpatient
Psychiatry.
Global
Qualitative
Nursing
Research
The study
illuminates
the
relationship
between
inpatient
psychiatric
mental
wellness
nurses and
their
patient
Uses
semi-
structured
interview
and non-
participant
s
observatio
n which
focuses on
phenomen
ological
inquiry
the
researc
hed
used
comm
on
ground
s and
frontli
ne as
sub-
themes
to
empha
size
reduci
ng
misco
mmuni
cation
and
9
inpati
ent
menta
l
health
nurse
s, 6
patien
ts and
non-
partic
ipants
were
invol
ved in
the
study
Informati
on and
data
gathered
were
transcrib
ed from
the audio
recorded
during
the
interview
.
The
research
uses a
few
particip
ants
which
might
lead to
inaccura
te
informa
tion.
Moreov
er, the
study
was
only
conduct
ed in a
single
The
study
explores
the need
for
nurses
to set up
a
commo
n
ground
which
will
allow
patients
to
engage
and
willing
to share
their
All
the
nurse
s that
partic
ipated
in the
resear
ch
acquir
ed
new
skills
and
were
able
to set
a
comm
on
groun
When patients are in pain, emotional
unstable and psychological unwell th
tend to be resentful. Nurses should
understand the condition of the patie

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
enhanc
ing the
nurse-
patient
relatio
nship
facility
which
might
also
mean
that
some of
the
issues
may not
apply in
other
facilitie
s.
health
issues
d
which
helps
them
to
easily
relate
with
client
s.
Kornhaber,
R., Walsh,
K., Duff, J.
and Walker,
K. (2016).
Enhancing
adult
therapeutic
interpersonal
relationships
in the acute
health care
setting: an
integrative
review.
Journal of
The
relevance
of
promoting
therapeutic
al
relationship
The study
uses
integrative
research
technique
which
involves;
review,
synthesis
and
critical
analysis of
literature
Every
hospita
l and
individ
ual
involvi
ng in
the
researc
h was
aware.
The
study
initial
ly
identi
fied
900
paper
s after
elimi
nating
duplic
ates.
Furth
ermor
e, the
The
research
used the
qualitativ
e method
with pre
and post-
interventi
on
question
naire.
Some of
the
themes
that
emerge
d as a
result of
the
study
include
emotion
s and
continui
ng
needs,
respond
Lack of
practica
l
commu
nication
skills by
nurses
or
health
practitio
ners can
be an
obstacle
in
providin
g health
The
study
found
that
listeni
ng,
reacti
ng to
the
client
’s
emoti
ons
and
contin
uing
To successfully attain therapeutic
relationships nurses should acquire t
right skills such as consider their
interpersonal communication skills.

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
Multidisciplin
ary
Healthcare
autho
rs
indep
enden
tly
identi
fied
37
prosp
ective
docu
ments
based
on
inclus
ion
and
exclu
sion
stand
ards.
ing to
patients,
and
prioritiz
ing
patients,
and
engage
ment
through
the
establis
hment
of a
therape
utically
relation
ship.
care
services
needs
, and
patien
t
priorit
izatio
n is
the
prima
ry
eleme
nt in
impro
ving
therap
eutic
relati
onshi
ps.
Maame
Kissiwaa
Amoah, V.,
Anokye, R.,
Boakye, D.
and Gyamfi,
N. (2018).
Perceived
barriers to
The
purpose of
the
research is
to
investigate
the possible
barriers to
enhanced
therapeutic
interaction.
The study
uses a
descriptiv
e research
design
using the
quantitativ
e method
to gather
The
researc
hers
sent a
letter
to the
institut
ion to
request
The
study
partic
ipants
consis
ted of
regist
ered
nurse
Participa
nts had
to
identify
their
level of
disagree
ment or
agreeme
Some of
the
nurses
were
not sure
about
the
intentio
n of the
The key
findings
from the
informa
tion
collecte
d
revealed
that
Nurse
s that
partic
ipated
in the
resear
ch
were
to
Verbal and non-verbal efficiency by
health providers is essential.

IMPACT OF THERAPEUTIC RELATIONSHIP ON PATIENT CARE
effective
therapeutic
communicati
on among
nurses and
patients at
Kumasi
South
Hospital.
Cogent
Medicine,
5(1).
data. for
investi
gating
the
hospita
l.
s and
client
s. A
sampl
e of
72
nurse
s and
40
patien
ts was
used
for
the
resear
ch.
Data
collec
ted
was
by the
use of
close-
ended
questi
onnai
res.
nt by the
use of a
health
system
that had
questions
concerni
ng nurse
and
patient
barriers
to
effective
therapeut
ic
communi
cation.
study
which
might
have
triggere
d the
disclosu
re of
some
informa
tion.
One of
the
research
ers
works at
the
hospital
which
might
have
altered
the
respons
es
anxiety,
pain,
and
discomf
ort from
patients
and
overloa
ding
nurses
are the
key
major
issue
that
affects
therape
utic
relation
ship
acquir
e new
comm
unicat
ion
skills
that
will
enhan
ce
health
care.