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Therapeutic Relationships Framework Assignment
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Introduction
A palliative care is an approach which reduces the stress and pain due to suffering from terminal disease. This is adopted mainly in life-threatening diseases where the cure is not possible. The palliative approach is utilised to improve the life of the patient from the pain and suffering related to the disease. This also helps and supports the life of the patient who is having a natural death. The life-threatening disease can be encountered at any stage of life. Different type of palliative care is required for different age groups .Hence an age-related palliative approach is required .The palliative approach is based on individual needs , it differs in different age and medical condition. The palliative approach helps to comfort the individual suffering from the disease.
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A therapeutic relationship is a relation between nurse and the patient. This relation is based on mutual respect and trust. It is a helping relationship in which the nurse should be sensitive to self and others . Providing physical, emotional, spiritual support to the patient and their family.
To be a successful nurse excellent communication skills are important. This helps in building an interpersonal relationship with patient and family. The nurse is able to take better care of the patient if she able to communicate properly with the patient. This also helps in building a relationship among the staff of the institute. More the communication by the nurse their is fewer chances of error. Also, he helps in creating a trust and positive environment.
Good communication skills help in building a therapeutic relationship. Communication is very important in nursing. All the aspects of nursing like prevention. Treatment , rehabilitation, health promotion closely depend on communication. The development of interpersonal relation with the patient is done by communication only. Communication involves an exchange of thoughts and information. The therapeutic practice involves communication between nurses with officials , patients and also their relatives. By effective communication, a comfort level with the patient is developed by which patient conveys his pain, fear , shares anxiety. All this helps in better recovery of the patient. The nurse can collect this information and in return can transfer other information for rehabilitation and health promotion of the patient. By effective communication, an understanding with the patient is developed. It requires great nursing skills to understand the patient’s concern . It is a reflection of knowledge and effective skills. Communication and interpersonal relationship should be studied by the nurses to progress further. There are few principles which should be taken care. Communication shows accurate and easy nursing work providing satisfaction to the patient as well as their relative. If communication skills are not proper then it becomes difficult to separate professional and personal life.In this problems transfer from one side to another. A two-way communication is always important to the patient . If the patient is able to relate to your words he will surely share his concerns with you. Communication cannot be kept unidirectional. Special attention is needed to be given by the care givers while using medical terminologies, Patient might hear something which is not appropriate for him. This will cause nervousness and anxiety in the patients. Patient might not be able to understand the meaning of the medical terminology which gives them great mental stress and communication become more and more difficult
Communication can be also non-verbal. It is done by facial expressions, gestures. Each patient has its own separate characteristic. Few patients might be comfortable with non-verbal communication but few may prefer verbal communication.
Listening is a very important mode of communication. It requires nursing skills and attention. By this nurses can access the situation and problems of the patient. By being a good listener nurses can provide care at all levels of recovery.
Along with listening , speaking with the patient also becomes important .Conversations should be held in appropriate condition. Each patient has its own way to discuss the problem.After the nurse has listened to all the problems she can talk to the patient.
The most important core of nursing practice is known as the therapeutic relationship. Its key role comes during palliative care. In this a person and its family members require support. This requires great sensitivity .IN palliative care a nurse should be able to carry out tough conversations with the patients family. These conversations include patient’s current health , the progression of a disease and anticipated death. The information provided should be honest and it should be provided in a way that the family members should be able to understand the situation. Palliative care nurses need to be knowledgeable and they should carry enough experience in nursing to deliver sensitive information in a proper manner. The role of the palliative nurse is extremely stressful . It is important for the nurse to focus on self-care along with the care of patient and family members. (Watanabe SM, Nekolaichuk C, Beaumont C-2011)
Physically palliative approach is followed to manage pain and physical discomfort in most of the situations. Pain being the most important complaint in the palliative approach to treatment. As the discomfort increases the need for palliative approach increases. It becomes very important where treatment is painful .
Old age people become prone to life-threatening disease or their suffering increases due to the natural ageing process. In many countries, palliative services are provided at home only. Mostly people by the end stage of their life prefer to spend their time at home. The palliative approach helps patient’s family to cope with the terminal illness of the patient. Palliative care leads to hospice care which includes focusing on comfort and quality of life. A personalised action plan is required for every patient for comfort and care. In this, it has been found that the survival expectancy is increased by 6 months. In this, the main focus is on pain control which troubles the patient most. Pain control is done by analgesics and comfort measures which can be achieved at home. The GNP (gerontological nurse practitioner ) can be utilised for palliative care. When a patient is in hospital or home , a GNP can educate and train the family members and staff regarding palliative care. GNP is very much required to provide psychological support to patient’s family. A GNP can guide the family to use hospice care services. GNP can explain the family the progression of the disease and what are the challenges they have to face in coming days. So that the family can be psychologically prepared for the upcoming challenges. GNP also clarifies the goals of end life care of the patient with the family member. NP’s help in medical treatment to achieve their goals.GNP can help the family in a spiritual , psychosocial and emotional way.( American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons-2009)
It is important to develop an integrated care pathway for the dying patient. This is for the patients whose diagnosis is known and loss of life is inevitable. In this symptoms are closely monitored and palliative approach is followed accordingly. In few cases, older people denied access to palliative care. In these cases, their admission in hospital and nursing home becomes very important. Specialised palliative care is required in many patients.
Proper symptom control is impossible in older adults without proper communication. An accurate assessment of patient’s health requires effective communication. Communication is the centre of all treatment. At times it requires great planning before you start a topic. Communication will deliver a great amount of palliative care to the older adults. In the society conversation about death is often very awkward and difficult. Among the health care professionals, their is a requirement of improvement of techniques to overcome these obstacles. In last two decades, their is awareness of the importance of communication skills.( R Twycross and A Wilcock-2008) Good communication in end life patient involves the ability to both give and receive information. It is important for the nurse to make the patient understand his/her condition. Also to prepare the family for the near future events which will occur. However, In the case of old adults, it is sudden death. Thos may come as a shock to the family. It is the duty of the nurse to explain the correct situation of patient’s health to the family so that they can deal with any sudden emergency. Communication helps in various aspects. Not only patient shares its fear and concern with the nurse but the family members also share their grief, fear and concern. The nurse should be an experience and expert in communication and palliative approach of treatment so that she can deal with the situation. The nurse and patient need to understand the goals of care. At times in older adults, the decision-making ability is hampered. In this case, the nurse has to keep a clear communication. She needs to keep patient’s relative about patient’s condition. For the patient’s family circumstances change on a day to day basis depending on the patient’s health. Like in the case of older adult the family may need to discuss something which is very difficult and emotive. Open and sensitive communication works in the best way. It also depends on an appropriate situation. This applies to nurse, patient and family members. Communication in nursing practice comes naturally. It's not simple, it is always difficult to communicate with some terminally ill. It required education and experience. The need of great communication skills is required by nurses worldwide especially in a situation of serious illness or end life care. Nurses are the one who spends most of their time with the patient and around them . Hence communication with them plays a significant role. Nurses help patient and their family to interpret the bad news , they also play a crucial role in listening to them post such information. In these case, nurses need to reflect positive care towards the patient and their family .Patients and their families have concerns regarding the dying process and death. In this stage, the patient is in great pain and many unrelieved symptoms. Nurses should actively participate in providing information and explaining the medical terminologies. They also need to listen patient and family to find out most suitable palliative option for the patient. In this stage giving accurate information and understanding patient’s mental condition is very important. Nurses need to be in constant communication with the patient as end life days their condition deteriorate rapidly. There may be in pain which they are not able to communicate but their gestures will help you understand their symptoms. It may happen that a person who is about to die communication is everything. As the medicines have already played their role. It is a stage where a patient wants to say want he actually feels and at the time someone who has knowledge and presence of mind is required. The communication area has been surprisingly ignored but since two decades there has been significant focus on it.
A large amount of literature exists in nurse and client therapeutic relationship. This relation is also called helping relationship . In this, the patient depends on the nurse for all the help and care required. Hence therapeutic has been considered as the fundamental of nursing. A patient who gives better outcome when the relationship is based on therapeutics.( Cahill, J., Paley, G., Hardy, G- 2013).Patient and people around them need to feel and understand the need of therapeutic relationship. The therapeutic relation has been challenged as there is a shift in evidence-based practice and focus on measurable outcomes. The therapeutic relation is rarely discussed. The therapeutic relation has many qualities such as respect, empathy . The literature has focussed on the key elements of the therapeutic relationship. Like the quality of the relationship , the sequencing process , the impending process and lastly the outcome. The qualities of this relationship consist of active listening . In this, the nurse has to listen patiently what the patient is saying. It is important that the patient trusts the nurse , only then effective communication will happen. The nurse has to respond to the patient in the same manner addressing the concerns. The patient and nurse should have genuineness and empathy towards each other. Some relationship goes through a series of phases . At times the therapeutic relationship might act as a very efficient tool and patient response to it very well. However, in many cases, the patient might take a good amount of time to understand the approach of the therapeutic relationship and respond to it. To appreciate the effects of therapeutic relationship we must look for its outcome. Researchers have shown that therapeutic relation improves the quality of the life of the patient . Moreover, they are able to communicate in a better way and therefore sharing their concerns which are very important. The therapeutic relationship also helps in reducing cost. As the patient responds well to the therapeutic relationship he/she recovers and responds well to treatment. (Clark, L -2012)Hence helps in early discharge from hospital and reducing the cost of the treatment. By using literature in many hospitals the retention rate of nurses , their health , satisfaction and their reaction to towards the patient has improved. The institutes that support the well-being of nurses must make efforts to reduce their work-related stress. Organisation must help and assist nurses in gathering knowledge over the therapeutic relationship. Institutes should support their nurses and their findings so that they can participate in the therapeutic relationship. however, Institutes should not only promote communication between nurse and the patient but communication between nurses and the nurses and all levels of management is also required. Nurse information is accessible by everyone. It creates a supportive environment and hence helping everyone by therapeutic relationship. () Dziopa, F., Ahern, K -2009).It is the duty of the senior management to an environment that supports creativity , risk taking, new ideas so that nurses can implement their skill in a better way.
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Consequently with all your skills and knowledge you can help the patient to achieve harmony and peace in his/her body, mind and spirit. The therapeutic relationship is all based on effective communication and interpersonal skills. It is the care which the patient requires and deserves while going through the most difficult of the phases. Therefore it is a complete win-win situation in which nurse develop their therapeutic relationship skills and patient recover fast.
References
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1) (2016). Retrieved 16 September 2016, from http://Watanabe SM, Nekolaichuk C, Beaumont C, et al. A multicenter study comparing two numerical versions of the Edmonton Symptom Assessment System in palliative care patients. J Pain Symptom Manage 2011; 41:456.
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2) (2016). Retrieved 16 September 2016, from http://American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 2009; 57:1331.
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3)(2016). Retrieved 16 September 2016, from http://) Gapapentin. In: Hospice and Palliative Care Formulary, 2nd Edition, R Twycross and A Wilcock. (Ed), Palliativedrugs.com, Nottingham 2008. p.209.
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4) (2016). Retrieved 18 September 2016, from http://Cahill, J., Paley, G., Hardy, G. What do patients find helpful in psychotherapy? Implications for the therapeutic relationship in mental health nursing. Journal of Psychiatric and Mental Health Nursing.2013;20:782–791
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5) (2016). Retrieved 18 September 2016, from http://Clark, L. The therapeutic relationship and Mental Health Nursing: it is time to articulate what we do!. Journal of Psychiatric and Mental Health Nursing. 2012;19:839–843
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6)(2016). Retrieved 18 September 2016, from ) Dziopa, F., Ahern, K. What Makes a Quality Therapeutic Relationship in Psychiatric / Mental Health Nursing: A Review of the Research Literature. Internet Journal of Advanced Nursing Practice.2009;10:7–7.15236064 (Available at: https://ispub.com/IJANP/10/1/7218, accessed 28 December 2014).
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