Exploring Therapeutic Relationships in Bachelor Nursing: A Case Study

This essay delves into the critical role of therapeutic relationships within nursing practice, emphasizing the importance of effective communication, both verbal and nonverbal, in establishing trust and providing patient-centered care. The essay uses a case study of Amy Walters, a 68-year-old woman with acute pyelonephritis, to illustrate the practical application of therapeutic relationships. It examines how registered nurses can utilize communication techniques to address patients' emotional and physical needs, alleviate anxieties, and foster a supportive environment. The essay highlights the significance of patient-centered care, referencing Picker's eight principles, and explores how nurses can integrate these principles to provide holistic care. It also discusses the importance of assessing vital signs, diagnostic results, and patient comfort to ensure comprehensive care. The essay concludes by underscoring how nurses can employ nonverbal cues, such as touch, eye contact, and facial expressions, to strengthen therapeutic relationships and support patients through their health challenges.

Running Head: BACHELOR NURSING ASSIGNMENT
BACHELOR NURSING ASSIGNMENT
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Introduction
Therapeutic relationship is the fundamental in the nursing practice, especially to the
registered nurse. Therapeutic relationship helps in providing the patient centered care plan.
Establishing, upholding and settling the therapeutic relationship for the registered nurse is
important while discussing the past health history of the patient through interview (Brownie,
Scott and Rossiter 2016). Based on the information obtained from the interview with the help
of therapeutic relationship, patient centered plan is evaluated. To establish a therapeutic
relationship with the patient, effective communication both verbal and nonverbal type is
required. Verbal communication such as doing interpersonal and intrapersonal
communication and nonverbal communication such as maintain eye contact, voice tone, calm
body language should be done by the registered nurse (Lindquist, Tracy and Snyder 2018).
According to standard 2 of the Enrolled Nurses Standards for Practice, therapeutic
relationship is maintained with the patient and other professional boundaries (NMBA 2019).
The essay focuses on the case study of Amy Walters, who is 68-year-old woman who
is suffering from acute pyelonephritis. She is physically fit and independent women. She has
also undergone plastic surgery and bilateral breast expansion, which has a small wound that
continuously oozes. She is on fluid diet which is provide by the hospital. Her heart rate, pulse
rate, respiratory rate all came down to normal only except her back pain for which oxycodone
was suggested by the doctors. Back pain settle after that but there is moderate pain in her left
flank for again oxycodone was prescribed by the doctors. After considering the effect of
oxycodone, she was nervous and worried as by taking oxycodone, condition can get worse. In
addition, she is also worried for her family.

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Importance of the therapeutic relationship in relation to the role of registered nurse
The therapeutic relationship of the registered nurse is fundamental to the nursing
practice. It is defined as the relationship of the nurse with their patients based on respect and
mutual trust, being subtle to others and self and nurturing of faith and hope.by maintaining
the therapeutic relationship, a registered nurse through their knowledge and skills
acknowledge patients emotional, physical and spiritual needs. Maintaining therapeutic
relationship is necessary for registered nurse as it helps in focusing on the personal issue of
the patient (Phillips et al. 2018).
Therapeutic relationship helps in designing person centered nursing care plan based
on the physical and emotional needs of the patient. It is different from social relationship and
mainly based on the communications skill of the patient (Brownie, Scott and Rossiter 2016).
It is mainly focused on the issue and complication of the patient explained during the
interview and based on that needs of the patients are identified. Alternate approach for
problem solving is assessed and along with that new skills of coping are developed. After that
behavioral change is assessed and encouraged by providing patient center care (McCormack
and McCance 2016).
Patient centered care is provided to the patient by the help of maintaining therapeutic
relationship. Patient centered care refers to the designing of the care plan based on the need,
preferences and values of the patient. It varies from individual to individual but receives great
appreciation because of their effectiveness (Rasheed 2015).
Here in this case Amy Walters, who is a 68 year old is physically active women and
typically fit. She is suffering from urinary tract infection. After the blood and urine test it is
confirmed that she has pyelonephritis. With the help of therapeutic relationship a person
cantered care plan is designed in case of Amy Walters. To provide the patient centered care a

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framework was introduced by picker, developed by Harvard medical school. Picker’s patient
centered plan contains eight principle.
According to these principle, consumers are involved in decision making which is
done by giving preference to their needs and values. They must be treated with dignity and
respect and along with that autonomy and privacy of the patient is maintained (Lacny et al.
2016) Here Amy walkers who can make her own decision making should be involved in
designing the patient care plan.
Integration and coordination of care is maintained, that is coordination with family
and physician is required while evaluating the care plan with the help of therapeutic
relationship (Lacny et al. 2016). Amy is extremely close to their family Amy Walkers helps
her brother in law Thomas in taking care of her sister. Hence in the case of Amy,
coordination with her family is required.
Physical comfort of patient is considered before designing a patient centered care plan
which provides effective pain management by listening to patient experience. It helps in
providing daily needs of the patient (Ortiz 2018). As in case of Amy, her diet is regularly
monitored. She has been given ward food but in the limited quantity as much she can tolerate.
She can feed on her own and hence does not need any special care regarding that. She is
physically fit and hence can move on her own. As she has no mobility issue, she can
maintain her own hygiene and can also take care of her skin integrity. As she is suffering
from urinal tract infection, extra care is required regarding her sanitation. Along with that,
urine samples will be monitored on regular basis. Her comfort is considered in the case of
invasive devices as she is under IV access. Therapeutic relationship helps in promoting
recognizable health service amenities and environment.

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Another importance of therapeutic relationship in case of registered nurse is that, it
provides mental and physical support and alleviate anxiety and fear. It helps in attending and
supporting the patient’s and nurse’s emotional experience. It provides benefit by facilitating
the response of patient to the anxiety and fear over their health status. It also facilitates the
treatment and assessment experience and along with that impact of the illness on the patient,
family is also minimized (Richardson and Hughes 2015). In the case of Amy walkers, doctors
suggested oxycodone to her, but she is worried as she thinks it will make things worse.
However, with the help of therapeutic relationship, registered nurse can help her in
alleviating her fear (Lacny et al. 2016. She is also afraid that after her hospitalization, her
family will not be able to cope up with the situation. This can be also eliminated by the
registered nurse with the help of maintaining therapeutic relationship with Amy Walkers.
Registered nurse will generate a patient centered care plan by assisting therapeutic
relationship by taking support from family and close friend. It also helps in providing better
assessment to the treatment (Richardson and Hughes 2015). In case of Amy walkers, her vital
signs such as temperature, respiratory rate, blood pressure, SpO2, and pulse rate are assessed.
Her diagnostic such as, urine and blood culture are also evaluated. Her urinalysis is
performed on daily basis and intravenous pyelogram is also assessed.
By maintaining therapeutic relationship by the registered nurse, attention on the health
service location, transport facility and support services are also assessed (Richardson and
Hughes 2015).
Verbal and Non-Verbal communication techniques related to therapeutic relationship
Communication is referred to as the method which is used extensively by registered
nurse in the field of healthcare. Ascertaining, maintaining and accomplishing an effective
therapeutic relationship needs effective communication. Both verbal and nonverbal

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communication is required in establishing the therapeutic relationship to the patient by the
registered nurses (Martin and Chanda 2016). With the help of effective communication,
patient will be more comfortable and will be able to discuss her pain and worry with the
registered nurse. Through effective communication nurse will be able to understand the crisis
of the patient and will be able to maintain therapeutic relationship with the patient which
leads to formation of better patient centered care plan.
Verbal communication is referred to as the type of communication that is used for
exchanging information with others with the help of words both in written and spoken
format. Verbal communication used by the registered nurse in maintaining the therapeutic
relationship is both in written and spoken form (Kiani, Balouchi and Shahsavani 2016). In the
case of Amy walkers, interpersonal communication is conducted by the registered where she
will be able to discuss her past detail such as information about her plastic surgery and breast
augmentation. With the help of conducting an interpersonal communication session,
information about the past medical history of the patient is assessed (Arnold and Boggs
2015). She is on the dose of oral medication was assessed, which was later ceased by Dr
Avery and gentamicin IV was prescribed. Verbal communication also helps in relaxing her
anxiety during the administration of Oxycodone. Along with that her worry about her brother
in law and her sister is also minimized by establishing a therapeutic relationship by verbal
communication.
Nonverbal communication is another effective ways of transmission a message,
feeling, or care through body gestures, position, and also facial expressions. Nonverbal
communication plays a major role in building a strong therapeutic relationship between a
patient and a care giver. It has the ability to improve a patient’s physical as well as mental
health in situations where the medication may not help. A better understanding of the

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nonverbal communication may help the nurse to develop a better and stronger relations with
the patients (Eaves and Leathers 2017).
As Amy is suffering from various health issues, she is on medication and several
treatment process. She is going through a lot of tough conditions due to her health, at the
same time she is also worried about her family. At such situation, she need some support and
therapy in order to come out to the trauma and worries. The nurse needs to build a strong
therapeutic relationship with her so that the nurse can help her in getting better. For this, a
nonverbal communication between Amy and the nurse will be needed.
Touch is a nurse’s one of the most influential forms of practicing effective nonverbal
communication. Nurses have a privilege of experiencing supplementary intimate practice of
personal interaction than other healthcare specialized. Touch has a capability of conveying
several messages, such as love, emotional care, inspiration, sensitivity, and also personal
attention (Riley 2015). A comforting touch that can be holding hand, is particularly important
for patients like Amy, who are facing severe issues which include physical and emotional
loss. A comforting touch can help Amy understand that the nurse is there to help her and she
can comfortably share her problem. This way the nurse can understand her in a much better
way and use strategies which can help her recover.
Eye contact provides a nurse or a patient with the knowledge about whether the
information that is transferred is understood by the other person or not. A constant eye
contact during a conversation reflects that the person is willing to listen and is respecting to
whatever is being said.it also shows a person’s interest in the conversation. In contrast,
absence of eye contact might direct nervousness, defensiveness, uneasiness, or induce lack of
confidence in communication process (Williams, Kemper and Hummert 2016). In order to
help Amy, the nurse needs to maintain eye contact with her, so that she understands that the

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nurse respects her point. And it will also build a relationship with Amy, and she may listen to
the nurse, trusting her and come out of her problems.
Facial expressions are stated to be reflecting feelings and emotions like fear, surprise,
anger, sadness and happiness. Smiling is a confident facial communication and is also
considered as a symbol of warmth, and imminence. Communicating with a smile shows
warmth and interest in the conversation. It builds trust and affection between people
(Defenbaugh and Chikotas 2016). The nurse to build a strong therapeutic relationship needs
to gain trust and confidence of Amy, so that she can make her understand that she is getting
better and the medications will do her better, though they have side effects, she should not
worry about taking them again. The nurse will make her understand that her family is doing
better, she should not worry so much as it may affect her health condition.
Conclusion
From the above essay it is concluded that, maintaining therapeutic relationship by the
registered nurse is required in order to create an effective patient centred plan. In case of
Amy also, therapeutic relationship is established to generate a care plan with respect to her
diet, hygiene, sanitation, treatment and diagnosis. To establish a therapeutic relation, effective
communication skill is required. Both communication and non-communication skill was
required by the registered nurse in order to evaluates the therapeutic relation to give effective
result.

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