Nursing Care Assessment: Therapeutic Communication and Boundary Errors

This report analyzes a nursing scenario where a student RN interacts with a patient, identifying four key errors in therapeutic communication and professional boundaries. The errors include rude and dismissive behavior, failure to listen to the patient, using a cell phone during patient care, and discussing personal matters. The report discusses the significance of each error, emphasizing the importance of empathy, active listening, and maintaining professional boundaries to build trust and provide quality patient care. It also provides recommendations for the correct actions the student RN should have taken, such as demonstrating empathy, active listening, maintaining hygiene, and adhering to professional boundaries. The analysis highlights the impact of these errors on patient well-being and treatment outcomes, reinforcing the need for nurses to prioritize effective communication and ethical conduct. This report is a student contribution on Desklib, a platform offering study resources.

Running Head: NURSING-CARE
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Therapeutic communication
Essay
student
5/18/2019

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Therapeutic communication
Therapeutic communication is the part of the therapeutic relationship which is defined as the
direct interaction process that emphasis on advancing the bodily and emotional health of a
patient (Knapp, 2014). Therapeutic communication is commonly used by the nurses to provide
their support and info to the patient. To develop therapeutic communication nurses needs to
develop some essential skills such as active listening, making eye contact, and respecting the
patient (Fan, and Taylor, 2016). In this particular essay, four different errors of therapeutic
communication and professional boundaries observed, its significance, and correct action in the
case scenario will be discussed.
It has been mentioned in the case study that the patient is 33 years old women suffering from PV
bleeding, and has a history of childhood asthma, eczema, hypotension, and endometriosis. She
has been previously admitted to the hospital for pain management.
In the case scenario, 2 different errors of therapeutic communication are; Rude and dismissive
behaviours towards patients concern, and another one is not listening to the patient. Two errors
of professional boundaries are; using a cell phone and discussion her personal matter with the
patient on cell phone, and discussing personal life who the patient. In the beginning, it has been
observed that the nurse was unable to recognise the patient’s name and she tied her hairs in the
patient's room. The patient asks her that she should maintain her hand hygiene after touching the
hair. But the nurse was not very concerned about it and she replied the patient rudely rather than
addressing the patient’s concern. According to the government policies on nursing care, a nurse
must not be rude with the patient and deal with them empathetically and respectfully, as being
rude may develop anxiety issues in the patient (Buhari, 2013) Being rude can also reduce the

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chances of developing therapeutic communications with the patient as they might think that the
nurses is not concerned about their health issues (Riley, 2015). It has also been observed that the
nurse was not very concerned about the patient as she left her in the room while she was crying.
The nurse was just in a hurry to perform her duty and go away. Another communication error
was that the nurse did not hear the patient carefully and interrupted her before she finishes her
sentence; here the most important skills of therapeutic communications active listening were not
used (Chard, and Makary, 2015). Not hearing the patient carefully, may develop a lack of trust
issues in the patient related to the care being provided to her. To provide psychological support
to the patient and getting a complete assessment of the patient, not being rude with the patient,
and listening to them carefully are the most significant activities (Hewitt, Tower, and Latimer,
2015).
Two professional boundaries that have been breached in the given case scenarios was using a
cell phone and discussing her personal life with the patient. It has been identified after watching
that clip that the nurse used her cell phone while checking patient’s record sheet. She discussed
her personal life with the patient and did not check her health records accurately. She must have
understood that decussating personal life with the patient is considered unprofessional
(Johnstone, & Facn, 2019). The significance of the professional boundary of sharing the
personal life or aspects of a nurse with their clients, may lead them undertake their care on
their own. This may further help or assist the nurse or professional to explain patients, about
taking care of their health and attain wellbeing. Thus, nurses must ensure maintaining balance
between the professional boundaries of sharing their personal information related to their life,
problems and other aspects to the client. As mentioned in the case study the patient has been
experiencing some health issues like bleeding PV, endometriosis, hypotension, eczema, and

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childhood asthma. Therefore it is essential to check her vital signs regularly to examine any
changes in the health status (Freeling, & Parker, 2015). But the nurse totally ignored that fact and
used her cell phone. Another professional boundary errors observed in the video was that the
nurse did not perform Blood Pressure checking carefully. The sphygmomanometer was not
attached to the patient’s arm accurately. She was also not very confident while applying a
particular device for Sandra. In this case, the patient might develop a sense that the nurse is not
very experienced and taking her health issues very casually. This might develop stress and
anxiety issues. Not assessing the vital signs carefully might lead to missing interpretations of her
health conditions and ultimately results in failure of the treatment process (Watkins, Whisman,
and Booker, 2016).
To encounter the issues related to dismissive and rude behaviour, the nurses must understand that
the patient is already in pain and she must be dealt with empathy (Riley, 2015). The patient has
many health-issues; therefore, she was worried about hygiene issues. This might be understood
by the nurse and she should tie her hair before entering the room. The nurse must also understand
that the patient in fear for her health and for her children, therefore, she must be dealt with
respect and empathy. The nurse must listen to her carefully in order to build a therapeutic
relationship with her. The nurse must provide her psychological support by listening to her
problems and using the touch method like holding her hand, and hug her for a moment (Brownie,
Scott, and Rossiter, 2016). As the patient is suffering from PV bleeding related issues, hygiene
should be the priority in her case. The nurse must not use the cells phone while providing care to
the patient, must check her vital-signs cautiously, and conforming it to the patient. Another
professional boundary error was discussing about private life with the patient. As blood pressure
is the main indicator of a patient's health status, the sphygmomanometer should be attached to

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the patient’s arm correctly to achieve accurate results (Munroe et al., 2016). She should also
record the BP observations in the patient record sheet.
Therapeutic communication is the part of the therapeutic relationship which allows the nurses
and patient to share health-related information. There are four different issues have been
identified in the case scenario; two communication errors were being rude and dismissive
behaviour towards patient’s concern and not listening to the patient. Two professional
boundaries errors were using cells phones and showing her personal matter to the patient on cell
phone, and discussing her private life with the patient. These issues can develop an anxiety issue
among the patient and inaccurate observations of vital signs. These issues should be solved by
using skills like active listening, showing empathy, and using medical devices accurately. The
nurse should have no discussed her private life with the patient and must develop therapeutic
relationship with the client rather than being rude and ignoring patient’s feeling.

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References
Brownie, S., Scott, R. and Rossiter, R., 2016. Therapeutic communication and relationships in
chronic and complex care. Nursing Standard, 31(6), p.54.
Chard, R. and Makary, M.A., 2015. Transfer‐of‐care communication: nursing best
practices. AORN Journal, 102(4), pp.329-342.
Fan, C.W. and Taylor, R., 2016. Quality of a Theory-Based Assessment to Measure Therapeutic
Communication Styles During Rehabilitation. American Journal of Occupational
Therapy, 70(4_Supplement_1), pp.7011500070p1-7011500070p1.
Freeling, M., & Parker, S. (2015). Exploring experienced nurses' attitudes, views and
expectations of new graduate nurses: A critical review. Nurse education today, 35(2), e42-e49.
Hewitt, J., Tower, M. and Latimer, S., 2015. An education intervention to improve nursing
students' understanding of medication safety. Nurse education in practice, 15(1), pp.17-21.
Johnstone, M. J., & Facn, P. B. R. (2019). Bioethics: a nursing perspective. Elsevier.
Knapp, H., 2014. Therapeutic communication: Developing professional skills. Sage Publications.
Munroe, B., Curtis, K., Murphy, M., Strachan, L., Considine, J., Hardy, J., Wilson, M., Ruperto,
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assessment and nontechnical skills of early career emergency nurses: a pre-post study using full
immersion simulation. Journal of clinical nursing, 25(15-16), pp.2262-2274.
Riley, J.B., 2015. Communication in nursing. Elsevier Health Sciences.

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Watkins, T., Whisman, L. and Booker, P., 2016. Nursing assessment of continuous vital sign
surveillance to improve patient safety on the medical/surgical unit. Journal of clinical
nursing, 25(1-2), pp.278-281.