Therapeutic Relationship Essay: Nursing Practice and Reflection

This essay delves into the crucial concept of therapeutic relationships within the nursing profession, emphasizing the nurse's self-awareness and its impact on patient care. It explores the therapeutic use of self as an essential tool in assessment and intervention, highlighting the importance of a safe, open, and non-judgmental environment for patients. The essay examines the influence of bias and stigma, both implicit and explicit, on therapeutic interactions, and how these factors can affect patient trust and engagement with healthcare. It further discusses the role of personal and professional values in fostering effective relationships, including respect, empathy, and effective communication. The strategies employed to maintain integrity in therapeutic relationships are outlined, such as honesty, consistency, and ethical communication. The essay draws on the author's experience with diabetic patients, emphasizing the application of these principles in clinical practice to build trust and improve patient outcomes. Effective communication and teamwork are also highlighted as crucial elements in delivering quality patient care. The essay concludes by reinforcing the importance of therapeutic relationships and the nurse's commitment to patient well-being.

Running Head: THERAPEUTIC RELATIONSHIP
0
Therapeutic Relationship
Essay
student
4/30/2019

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Therapeutic Relationship
The therapeutic use of self is the essential focus of nursing and needs that the nurse is
conscious of his or her own opinions, feelings and activities. It is actually the use of oneself in
such a manner that one turn into an effective tool in the assessment and intervention process
(Browne, Cashin, & Graham, 2012). The purpose of a therapeutic association is to help the
individual in treatment to alter his or her life for the better. Such a relationship is vital; as it
is oftentimes the first setting in which the person is getting treatment shares close thoughts,
opinions, and emotions concerning the issue(s) in question. As such, it is very significant
that therapist delivers a safe, open, and non-judgmental atmosphere where the pretentious
individual can be at ease (Kameg, Mitchell, Clochesy, Howard, & Suresky, 2009). In this
particular essay the impact of bias, and stigma on the therapeutic use of self, personal and
professional values, strategies used to manage the integrity, will be discussed.
Throughout my nursing career, I have been working as a registered nurse dealing
with diabetic patients. I have been addressing patient from different cultures and belief.
Most of the patient felt anxious and distressed during their hospitalizations period as they
are concerned about the treatment process and their diseases. Diabetes is the long-lasting
disorder that may develop different psychological issues like depression, anxiety and stress
among the patients (Lee, et al., 2013). In this case, nurses can play a key role, as they spent
more time with the patient compared to the other health care providers. Being as a nurse I
was my responsibility to develop the patient’s trust in the health care setting and the
treatment process. This has been done by developing a therapeutic relationship with the
diseased people. The therapeutic relationship is the process or method that can be used by

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the nurses to make a healthy relationship with the client. There are different components of
therapeutic alliances that must be used by the nurses including, respect, and empathy. All
the health care worker specifically nurses are supposed to address the client with respect and
must be dealt empathetically. Establishing therapeutic alliances is a vital step in the patient
recovery process. Once a therapeutic relationship is built with the patient; the individual
involved in the therapy might be more inclined to discuss their actual condition more easily.
Therapeutic relationship allows the nurses in the effortless assessment of the patient
(Hammer, Fox, & Hampton, 2014). Therapeutic use of self becomes a core component of the
health care systems. It involves determining what is medically proper for the diseased
person. It also used for a purpose, as it helps in understanding. I have been providing my
services to the patient who is experiencing stigmas and distress, some of the lost their faith
in the health care system as they think that the mediation process is not working for them. It
is hard for the patient to discuss their actual condition clearly due the trust issues; therefore
I have used my communications skills to deal with these kinds of patients. Communications
skills such as active listening, making eye contact, showing interest by using specific words,
must be used while dealing with the patients (Szpak, & Kameg, 2013).
Stigma and bias have different impacts on the therapeutic use of self. Different
researchers have found that stigma is the negative process or labelling people who retain or
demonstrate the personal or behavioural qualities that are dissimilar with the social norms.
It involves the explicit devaluation of the social identity and outcomes in the stigmatized
people being stunned and avoided by others and sensing shame or embarrassment (Corrigan,
Larson, & Ruesch, 2009). It can also impact an individual’s engagement and relationship
with the nurses and physician. It can develop discomfort and distrust with the nurses and

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might discourage the patient from seeking care because of fear or abuse, discrimination or
being made to sense unwelcome it has been recognised that the client experiencing stigma
are less likely to access the health care resources when required. Biases may also impact the
therapeutic use of self. There are two bias; implicit and explicit bias. Implicit biases are the
unconscious association, belief or the attitude of nurses and patients towards each other
(Vogel, Bitman, Hammer, & Wade, 2013). Due to the implicit biases, individuals might
commonly attribute some characteristics to all other people, this called stereotyping, which
directly affect the therapeutic use of self. Most of the health care providers develop
discriminations or bias towards people from different culture and groups, this hinders the
delivery of quality care for the patient, and they address to deal with the client negatively
(Lannin, Guyll, Vogel, & Madon, 2013). I have been avoiding these issues throughout my
career which helped me to develop a healthy relationship with the patient and developed a
positive image of healthcare setting in the patient's mind.
Following personal and professional values of the therapeutic relationship can be
beneficial for the patient. There are some standards and values have been set to allow nurses
to deliver their best services for the patient (Diener, & Monroe, 2011). I have been dealing
with a client for all age groups and followed the values throughout my career. In order to
provide a high quality of care, the nurse must master some key components such as trust,
respect, empathy, good communications skills, incusing the patient in the decision-making
process. Showing empathy allows the patient to feel like somebody care for them and they
care to share their feeling to them without hesitations. The nurses must provide height
quality services to every patient equally without biases and discriminations (Vilardaga, &
Hayes, 2010). A nurse must make eye contact with the patient as it allows the patient that

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they are being heard carefully and the listener is really interested in a patient's problem.
Nurses who are assigned to a specific patient must introduce themselves by name and
professional designation and their role in the patient's care. The nurse should also address
the client by their actual name and title. Nurses should also be asked for filled consent form
before providing any intervention. Nurses must adhere to the privacy regulations, and
different standards set by the government organisations (Theodoridou, Schlatter, Ajdacic,
Rössler, & Jäger, 2012).
While providing the quality care to the patient's nurse must also maintain their
integrity of self and personal pliancy by intra and interactions with the individuals in the
healthcare practice. There are different strategies that I have been using to maintain the
integrity including, respecting another member of the team, protecting personal information,
communicating with honesty, be consistent, establishing the language of ethics, ask the
appropriate question. I have used these strategies while dealing with the client and other
health care team member. The nurses must speak when identify or feel more unethical
behaviours within the health care setting. The nurse must have the courage to reset some
ethical boundaries in order to develop an effective professional career (McElligott, 2010).
The health care providers should agree to admit that persons will have dissimilar standards
inside this framework. The nurse must remember that persons are usually not as moral as they
expect they are. They should define ethical beliefs early in novel relationships with the client or
other team members. He or she must be ready to redefine ethical prospects in established
associations. Supporting the team’s efforts to sustain high values for ethical conduct,
interconnect about ethics, and resolve ethical problems. Dependability and flexibility actually go
hand-in-hand as an important area of professional strength essential for nursing careers. Patients

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require specialized care daily, and your managers will count on you to highlight on time every
day that you are arranged to work (Arnold, & Boggs, 2019). Effective structural communications
are essential to build and uphold effective functioning relationships between staff, administration
and other shareholders (McElligott, 2010). Efficacious communications are likewise linked with
better teamwork and health care delivery for patient. Effective communication approaches are
particularly significant when nurses are working in a diversity of flexible work engagements.
Communications and cooperation training must be obtainable to all nurses and management. A
popular teamwork model is Team STEPPS that was developed by the United States AHRQ and
US department of defence to emphasise the importance of mutual support and effective
communications. Developing interpersonal skills is found to be effective in developing a healthy
relationship with a fellow worker in a health care setting (Riley, 2015).
Therapeutic use if self is recognised as the important emphasis of the nursing profession
and requires that the nurses must be conscious of his opinion, feeling, and actions. During my
career as diabetic patient care nurses, I have been applying this in clinical practice. Professional
values like providing the client with respect, empathy, including them in the decision-making
process, and effective communications are identified as essentials of health care delivery. Some
of the strategies that are effective in maintaining the integrity of self and personal pliancy
include; respecting other members, protecting personal information, asking the question,
establishing the language of ethics, and communicating with honesty, and implementing
effective communication skills in practice.

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References
Arnold, E. C., & Boggs, K. U. (2019). Interpersonal Relationships E-Book: Professional
Communication Skills for Nurses. Saunders.
Browne, G., Cashin, A., & Graham, I. (2012). The therapeutic relationship and Mental Health
Nursing: it is time to articulate what we do!. Journal of Psychiatric & Mental Health
Nursing, 19(9), 839-843.
Corrigan, P. W., Larson, J. E., & Ruesch, N. (2009). Self‐stigma and the “why try” effect: impact
on life goals and evidence‐based practices. World Psychiatry, 8(2), 75-81.
Diener, M. J., & Monroe, J. M. (2011). The relationship between adult attachment style and
therapeutic alliance in individual psychotherapy: A meta-analytic
review. Psychotherapy, 48(3), 237.
Hammer, M., Fox, S., & Hampton, M. D. (2014). Use of a therapeutic communication simulation
model in pre-licensure psychiatric mental health nursing: Enhancing strengths and
transforming challenges. Nursing and Health, 2(1), 1-8.
Kameg, K., Mitchell, A. M., Clochesy, J., Howard, V. M., & Suresky, J. (2009). Communication
and human patient simulation in psychiatric nursing. Issues in Mental Health
Nursing, 30(8), 503-508.
Lannin, D. G., Guyll, M., Vogel, D. L., & Madon, S. (2013). Reducing the stigma associated
with seeking psychotherapy through self-affirmation. Journal of Counseling
Psychology, 60(4), 508.

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Lee, C. M. Y., Colagiuri, R., Magliano, D. J., Cameron, A. J., Shaw, J., Zimmet, P., & Colagiuri,
S. (2013). The cost of diabetes in adults in Australia. Diabetes research and clinical
practice, 99(3), 385-390.
McElligott, D. (2010). Healing: the journey from concept to nursing practice. Journal of Holistic
Nursing, 28(4), 251-259.
Riley, J. B. (2015). Communication in nursing. Elsevier Health Sciences.
Szpak, J. L., & Kameg, K. M. (2013). Simulation decreases nursing student anxiety prior to
communication with mentally ill patients. Clinical Simulation in Nursing, 9(1), e13-e19.
Theodoridou, A., Schlatter, F., Ajdacic, V., Rössler, W., & Jäger, M. (2012). Therapeutic
relationship in the context of perceived coercion in a psychiatric population. Psychiatry
research, 200(2-3), 939-944.
Vilardaga, R., & Hayes, S. C. (2010). Acceptance and commitment therapy and the therapeutic
relationship stance. European psychotherapy, 9, 117-139.
Vogel, D. L., Bitman, R. L., Hammer, J. H., & Wade, N. G. (2013). Is stigma internalized? The
longitudinal impact of public stigma on self-stigma. Journal of counseling
psychology, 60(2), 311.