The Nurse-Client Relationship

“I've learned that people will forget what you said, people will forget what you did,

but people will never forget how you made them feel.”
                                                                                                                         ~ Maya Angelou

A therapeutic relationship, also known as a helping relationship, refers to the relationship between a healthcare professional and a patient.  Specifically, the professional and therapeutic relationship between a nurse and a client is referred to as the nurse-client relationship. 

The nurse-client relationship is the foundation of nursing practice across all populations and cultures and in all practice settings. It is therapeutic and focuses on the needs of the client. It is based on trust, respect and professional intimacy, and power. It ensures that the needs of the client are met, not the needs of the nurse.    The nurse-client relationship is conducted within boundaries that separate professional and therapeutic behaviour from non-professional and non-therapeutic behaviour. It is the professional responsibiltiy of the nurse to establsh and maintain boundaries with clients, regardless of how the patient behaves, to ensure the client’s maintains their dignity, autonomy and privacy relationship.

The expectations of the LPN within the nurse-client relationship are outlined in the CLPNBC Practice Standard:

The Nurse Client Relationship.

 
In Chapter 2 of your textbook Communication in Nursing, Balzer Riley (2012) identifies several successful characteristics of a nurse-client relationship. In addition, she summarizes several Do's and Don'ts to help guide you in your nurse-client relationships.  Refer to these on page 22-23 in your textbook.  Consider how these tips will impact your communication with your patients.

Components of the Nurse-Client Relationship

As a nurse, you must become knowledgable about how the essential components of the nurse-client relationship: trust, respect, professional intimacy, and power will impact your therapeutic relationships. Regardless of the context, length of interaction and whether a nurse is the primary or secondary care provider, these components are always present.

Trust. Trust is critical in the nurse-client relationship because the client is in a vulnerable position. Initially, trust in a relationship is fragile, so it’s especially important that a nurse keep promises to a client. If trust is breached, it becomes difficult to re-establish.

Respect. Respect is the recognition of the inherent dignity, worth and uniqueness of every individual, regardless of socio-economic status, personal attributes and the nature of the health problem.

Professional intimacy. Professional intimacy is inherent in the type of care and services that nurses provide. It may relate to the physical activities, such as bathing, that nurses perform for, and with, the client that creates closeness. Professional intimacy can also involve psychological, spiritual and social elements that are identified in the plan of care. Access to the client’s personal information also contributes to professional intimacy.

Power. The nurse-client relationship is one of unequal power. Although the nurse may not
immediately perceive it, the nurse has more power than the client. The nurse has more authority and
influence in the health care system, specialized knowledge, access to privileged information, and the
ability to advocate for the client and the client’s significant others. The appropriate use of power, in a
caring manner, enables the nurse to partner with the client to meet the client’s needs. A misuse of
power is considered abuse.

The College of Nurses of Ontario presents the Therapeutic Nurse-Client Relationship, Revised 2006, practice standard: Therapeutic Communication and Client-Centred Care in the following learning module:    

Review the following learning module developed by the College of Nurses of Ontario (CNO):

Therapeutic Communication & Client-Centered Care Learning Module

Nurses use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse-client relationship.  Some of the indicators for therapeutic communication are:

• Nurses achieve therapeutic communication by introducing themselves to clients by name and category; giving clients an opportunity to express themselves without diminishing the clients’ feelings or immediately giving advice; and telling clients about the role of the health care team and that information will be shared with other members of the team.

• Nurses also achieve therapeutic communication by being aware of their verbal and non-verbal communication style and how clients may perceive it.  For example, if you stand with your arms crossed while listening to a client, the client may feel you are not interested.  It’s also essential to use communication resources as necessary. For example, when language or literacy is hampering communication, you may use a translator or provide an easy-to-read pamphlet.

• In addition, nurses achieve therapeutic communication by recognizing that all behaviour has meaning.  They try to understand the cause of a client’s unusual comment, attitude or behaviour.  For example, the meaning behind a client refusing to eat may be that the client is fasting as part of a religious practice.  By exploring the client’s refusal to eat, you’re respecting the client’s beliefs and values, and can integrate these into the plan of care.  Throughout the relationship, engage the client in discussions on how the client will meet care needs after the nurse-client relationship ends.  For example, you’ll need to discuss discharge planning and arrange follow-up appointments or a referral to a community agency.

• Nurses achieve client-centred care by actively including the client and significant others as partners in the care; identifying the client’s goals, wishes and preferences and making these the basis of the plan of care; recognizing that the client’s well-being is affected by the nurse’s ability to establish and maintain a therapeutic relationship; acknowledging that biases and feelings can affect the nurse-client relationship; and requesting to transfer care when the relationship is not evolving therapeutically.

Now that you have explored the differences between a professional helping relationship such as the nurse-client relationship and a social relationship, take some time to consider how your own values, beliefs about helping relatinships affect your nursing practice.  The reflective exercise below is a graded assignment that will count for 10% of your final mark in this course.

    Consider the questions in Exercise 3 on page 30 in your textbook and submit to the dropbox:

Exercise 5.1 - Dropbox

References:

Balzer Riley, J.  (2012).  Communication in Nursing, 7th edition. St.Louis, MO: Elsevier Mosby

College of Nurses of Ontario (2006). Therapeutic Nurse-Client Relationship practice standard: Therapeutic Communication and Client-Centred Care.  http://www.cno.org

College of Nurses of Ontario. (2006). Therapeutic nurse-client relationship. Toronto: Author.

College of Licensed Practical Nurses of British Columbia (2013).  Boundaries in the Nurse Client Relationship.