Therapeutic Relationships: Knowledge, Skills for Mental Health Nurses

This project report investigates the essential knowledge and skills necessary for mental health nurses to establish and maintain effective therapeutic relationships with mental health consumers and their carers. The report begins with an introduction outlining the importance of the nurse-client relationship in mental health settings, followed by a critical evaluation of research studies. These studies, including works by Clark et al. (2005), Dinga and Karvinen (2008), Moreno-Poyato et al. (2017), and Dziopa and Ahern (2013), highlight the significance of skills such as active listening, empathy, assertiveness, patient assessment, and effective communication. The report then presents critical observations from a clinical placement at Bankstown Hospital, where the author observed nurses demonstrating these skills in practice. The report concludes with recommendations for future practice, emphasizing the need for mental health nurses to continuously develop their knowledge of mental illness and refine their interpersonal and communication skills to foster therapeutic relationships. The provided references are comprehensive and support the findings.

Running Head: PROJECT REPORT 1
Project Report
Student Name:
Affiliated Institution:

PROJECT REPORT 2
Introduction/Background
The approved project question is as follows:
What knowledge and skills are required for developing the therapeutic
relationship/communication with mental health consumers and carers?
The rationale for selecting the aforementioned research question is that looking into it would
help to establish the essential knowledge, know-how and skill set that mental health nurses
need in order to establish and maintain good therapeutic relationship/communication with
mental health consumers and carers. Nurse-client therapeutic relationship is very important in
nursing practice. In mental health nursing for instance, the nurse-client therapeutic
relationship might be the main intervention for working through difficulties and/or promoting
growth and awareness (Clark, 2012). Effective nursing practice depends upon an effective
relationship between the patient and the mental health nurse.
Critical Evaluation
A number of scholars have attempted to explore the issue and reported their findings
in peer-reviewed journal articles. In their research study, Clark, Parker and Gould (2005)
examined the experience of rural generalist nursing personnel working with patients who had
mental health illness. A total of 13 registered nurses took part in the study and were working
full-time in an acute mental health facility. According to the researchers, the specific skills
and knowledge required for building the therapeutic relationship with the mental health
patients included nursing knowledge of mental illness, active listening, empathy,
assertiveness, observation, patient assessment, humour, problem solving ability, and
reflective practice. The strength of this article is that it reveals some of the essential skills that
mental health nurses posses or ought to posses when working with their patients. The

PROJECT REPORT 3
weakness is that the study used a small sample size of just 13 mental health nurses who were
obtained from a single mental health facility. This may affect the generalizabilty of the
findings. This source contributes to my discussion by shedding light on the essential skills
and knowledge that nurses in mental health facilities require to be able to have therapeutic
communication or relationship with their patients.
Other researchers Dinga and Karvinen (2008) carried out a systematic review to find
out what the client-nurse therapeutic relationship entails and the way in which healthcare
workers including nurses could develop these therapeutic relationships in primary care
settings. Trust, interpersonal skills and communication skills were found to be very important
for mental health nurses working with clients who have mental illnesses. These skills include
listening, paraphrasing, empathy, non-verbal communication, and authenticity (Dinga &
Karvinen, 2008). The strength of this article is that it describes what a client-nurse therapeutic
relationship involves and the skills needed by mental health nurses to develop these
relationships and maintain them. The weakness is that the authors included a relatively small
sample size of only 9 articles. This affects the generalizability of findings of the study. This
source contributes to my discussion by highlighting the skills needed by nurses to establish
and sustain therapeutic client-nurse relations.
In yet a different study, Moreno-Poyato et al. (2017) sought to create changes in the
way in which nursing personnel develop the therapeutic relationship within acute psychiatric
units as well as to assess the efficacy of implementing evidence via this method. The
researchers pointed out psychiatric nurses know that particular skills are needed for
developing and maintaining therapeutic relationships with clients. Skills like empathy,
teamwork, making a positive first impression, capacity to listen and creating a comfortable
and safe environment are essential in fostering and helping the development of a therapeutic
relationship (Moreno-Poyato et al., 2017). Reflecting skills are equally crucial. Using

PROJECT REPORT 4
reflective skills effectively communicates understanding and acceptance to the patient, builds
trust, and facilitates exploration, all of which help to develop therapeutic
relationship/communication with the client (Scanlon, 2006). The strength of this article is that
it is comprehensive, well-written, well-organized, and professionally presented. The
weakness is that the study was conducted in just a single psychiatric facility and therefore the
findings may not be generalizable to other settings. This source contributes to my discussion
by highlighting specific skills that psychiatric nurses need to posses in order to effectively
develop and maintain therapeutic relationships with their clients.
Dziopa and Ahern (2013) also investigated the subject matter. In their systematic
review, they aimed to conceptualize attributes or skills that contribute to the development of a
therapeutic relationship in advanced practice mental health/psychiatric nursing. They found
out that empathy, understanding, provision of individualized care, providing support, being
available/being there, being genuine, showing respect, demonstrating clear boundaries and
promoting equality are vital in developing a therapeutic relationship between a mental health
nurse and his/her patient. The strength of this article is the fact that it highlights crucial skills
that advanced practice clinicians should continuously review and refine to foster and sustain a
therapeutic relationship with their patient. This source contributes to my discussion by
identifying a number of skills that mental health nurses need to have for them to develop a
therapeutic relationship with their client.
Critical Observation
While on placement at Bankstown Hospital, I was able to critically observe the
practices within my clinical area in relation to the research question. What I observed is that
in developing the therapeutic relationship with mental health consumers and their carers at

PROJECT REPORT 5
the healthcare organization, the mental health nurses exhibited knowledge in mental illness.
This is in line with literature findings. According to Dinga and Karvinen (2008), nurses
should possess a very sound knowledge of mental illness in order to properly read what is
going on. In addition, having knowledge of mental illness allows the nurses to be able to
communicate well with the client and work with the client, not against him or her.
The nurses at Bankstown Hospital also exhibited skills such as active listening, for example
when they sat quietly with the patients and listened to them. This greatly helped to develop
therapeutic relationship and effective communication between the mental health nurses and
the client/patient. In addition, they exhibited empathy. The nurses knew that these patients
came in an acute state and were practically left in the care of the nurses and it was sometimes
rather frightening for those patients. By displaying empathy, the nurses are able imagine
walking in the shoes of their patients in order to truly comprehend what they may be feeling,
and this really helps to developed a relationship between the nurses and the patients (Cahill,
Paley & Hardy, 2013).
Another vital skill that was observed is patient assessment when the nurses observed
and assessed their patients to ensure ongoing patient of the client. Schroeder (2013) pointed
out that critical, continuous assessment is of great importance in ensuring the ongoing safety
of patients. Having outstanding patient assessment skills makes it easier for the mental health
nurse to work with his/her patient and to predict a way forward in the patient’s care. This in
turn helps to foster good therapeutic relationship with the mental health patient and his/her
carer (Hem & Heggen, 2010). The other skill that was observed in the mental health nurses
is assertiveness. Assertion, as Clark (2012) stated, is the ability of the mental health nurse to
challenge a client in a therapeutic context and attain positive outcome. Also, the skill of
problem solving, empower and educate the patients was displayed by the nurses.

PROJECT REPORT 6
Furthermore, they demonstrated the ability to communicate well with the clients.
Mental health nurses must communicate effectively with their clients as this is critical in
developing therapeutic relationships with the clients (Hewitt & Coffey, 2005). Lastly, they
demonstrated humour which made the patients smile, and in so doing develop great
therapeutic relationship with the patients. Cahill, Paley and Hardy (2013) mentioned that if
possible, mental health nurses should maintain a sense of humour and give the patient a smile
as this helps to establish a good therapeutic relationship. For future practice, it is
recommended that mental health nurses should seek to gain relevant knowledge in mental
illness. They should also strive to develop a number of crucial skills including effective
communication skills, good sense of humour, active listening, understanding, respect,
empathy, and assertiveness. These skills and knowledge are of great importance in
developing and maintaining the therapeutic relationship/communication with mental health
consumers and their carers.
Conclusion
To sum up, there is a need for improvement in effective people skills from some
healthcare professionals with mental health patients. Nurses and psychiatrists in mental health
facilities need to gain the essential knowledge to effectively establish therapeutic
relationships. They should strive to refine their knowledge in mental illness. They should also
acquire various skills such as interpersonal skills, effective communication skills, reflecting
skills, problem-solving ability, humour, listening, understanding, empathy, being genuine and
show respect. Having these critical skills would help the mental health nurse develop and
maintain therapeutic relationship/communication with the mental health client and their carer.

PROJECT REPORT 7
References
Cahill, J., Paley, G., & Hardy, G. (2013). What do patients find helpful in psychotherapy?
Implications for the therapeutic relationship in mental health nursing. J Psychiatr
Ment Health Nurs, 20(9):782–791.
Clark L. (2012). The therapeutic relationship and Mental Health Nursing: it is time to
articulate what we do! J Psychiatr Ment Health Nurs, 19(9):839–843.
Clark, C., Parker, E., & Gould, T. (2005). Ruralist generalist nurses’ perceptions of the
effectiveness of their therapeutic inter-ventions for patients with mental illness”,
Australian Journal Rural Health, 8(13): 205-213.
Dinga, B., & Karvinen, O. (2008). Building therapeutic relationships with mental health
clients in primary care settings. Journal of Clinical Nursing, vol. 8, p. 643-652.
Dziopa F, & Ahern K. (2013). What Makes a Quality Therapeutic Relationship in
Psychiatric/Mental Health Nursing : A Review of the Research Literature. Internet J
Adv Nurs Pract, 10(1): 12-26.
Hem, M. H., & Heggen, K. (2010). Being professional and being human: one nurse’s
relationship with a psychiatric patient. J Adv Nurs, 43(1):101–108.
Hewitt, J., & Coffey, M. (2005). Therapeutic working relationships with people with
schizophrenia: literature review. J Adv Nurs, 52(5):561–570.
Moreno-Poyato, A. R., Degad-Hito, P., Suarez-Perez., & Leyva-Moral, J. (2017).
Implementation of evidence on the nurse-patient relationship in psychiatric wards
through a mixed method design: Study protocol. BMC Nurs, 16(1): 34-39.
Schroeder, R. (2013). The seriously mentally ill older adult: perceptions of the patient-
provider relationship. Perspect Psychiatr Care, 49(1):30–40.
Scanlon, A. (2006). Psychiatric nurses’ perceptions of the constituents of the therapeutic
relationship: a grounded theory study. J Psychiatr Ment Health Nurs,13(3):319–329.

PROJECT REPORT 8