Guidelines for Therapeutic Relationships in Nursing

In my professional development essay, I will be demonstrating an understanding of also discussing professionalism and therapeutic relationships in relation to the registered nurse role. This essay will refer to specific documents such as The Nursing Council of New Zealand (NCNZ) ‘Competencies for Registered Nurses’ (2016), The Health Practitioners Competence Assurance Act (2003), The Nursing Council of New Zealand ‘Code of Conduct’ (2012) and The Nursing Council of New Zealand ‘Guidelines: Social Media and Electronic Communications’ (2012). This will also be referred to the given scenario which will be based on a 6 part assessment task that Lucy Brown has to undertake.

In her Bachelor of Nursing program and apply it to her clinical nursing practice in relation to the given scenario.

According to (Smith, 2018) Professionalism is based on personal behaviors, appearance, and presentation. There are many qualities that all nurses must emulate in order to maintain professionalism. In order to maintain professionalism in nursing is by having a positive attitude, maintaining a positive environment and communication in all areas at all times (Smith, 2018).

Having a positive attitude requires to adapt a holistic and optimistic view on any situation and always aiming to help your patients. Patient Interaction is important as a nurse is capable of reaching out positively and productively with every patient. As they are under your care so you must treat them with dignity. Patient interactions should always convey with passion in the sense of respecting a patient’s feelings. Professional responsibility is a key element in healthcare where a patient’s well-being and lives are in your hands.

Teamwork is important in any healthcare as it is essential for nurses to maintain a collaborative and co-operative relationship. You must put your patient’s well-being first and work closely and effectively with your team which involves effective communication, taking time to help each other and showing moral support.

A therapeutic relationship is defined as maintaining a relationship based on trust, respect, and empathy. These 3 components are used to maintain and establish a therapeutic relationship between a nurse and a patient. (Pullen, 2010). A therapeutic relationship is established through mutual principles as well as skilled communication. For patient’s needs for care, guidance, and support (Pullen, 2010). Within a therapeutic relationship, the use of the appropriate aspects of maintenance is required for the patient. As the relationship itself is designed to focus on the patients’ health. And assisting with understanding of the patient’s physical, emotional, mental, and spiritual well-being (Pullen, 2010). The most significant part in a therapeutic relationship is trust between both the nurse and patient. Trust within a therapeutic relationship is built through communication skills between both peers.

The trust between both the nurse and patient should be seen as open-minded about their opinions by sharing their concerns without the need of getting judged. Respect is another key aspect that is also an important part of the therapeutic relationship. As it can be established towards the patient and their culture and ensuring that being open-minded is merged. Therefore being well mannered, prompt, having patience, and understanding shows respect toward the patient. Empathy is an important factor within a therapeutic relationship. A nurse has the ability to support and understand the feeling and distress of a patient. Empathy also lets the nurse comprehend amongst the families by approaching them and asking them about their concern. By working with families will create and understanding as the therapeutic relationship can build into a strong relationship with the patients family too. If a nurse shows empathy towards the patient it means they understand the patient’s feelings and grief (Pullen, 2010).

The Nursing Council of New Zealand ‘Competencies for Registered Nurses’ (2016). Registered nurses practice independently and in collaboration with other health professionals to perform nursing functions. They provide comprehensive assessments to develop, implement and evaluate plan of health care (Nursing Council of New Zealand, 2016). There are four domains of competencies for the registered nurse’s scope of practice. It is evidence of safety to practice as a registered nurse. Within the following domains, Domain one talks about professional responsibility. In this domain, the competencies relate to professional, cultural safety, legal and ethical responsibilities. Being able to be accountable for your own actions and decisions. While promoting a professional environment that maximizes health consumer safety. Domain two relates to managing health consumer care. Which means perform better care for the consumers while demonstrating nursing knowledge. Domain three talks about interpersonal relationships. This domain contains competencies that relate too interpersonal and therapeutic communication with health consumers. And how healthcare professionals can maintain and establish a therapeutic relationship with their client and other healthcare professionals. Lastly Domain four talks about interprofessional health care and quality improvement. This domain contains competencies that demonstrate how health care team members evaluate the effectiveness of care and promote a proper nursing perspective within the interprofessional health care team.

The Health Practitioners Competence Assurance Act (2003). The main purpose of this act is to protect the health and safety of the public. By ensuring that all health practitioners are competent and fit to practice for their professions. This document is providing assurance to the patients that their safety is important to us and that we are accountable, no nurse practice outside their scope of practice. The act talks about how certain activities are restricted and can only be performed by registered health practitioners as specified. The act is very much about handing to the authority’s responsibility for providing them with tools for ensuring that health practitioners are and remain competent and safe to practice (Nursing Council of New Zealand, 2003).

The Nursing Council of New Zealand ‘Code of Conduct (2012). Has a code of conduct that sets out standards of behavior that nurse are expected to uphold in their practice. The code of conduct advises both the nurses and the public what they can expect of a nurse in terms of the nurse’s professional role. The code is framed around four core values respect, trust, partnership and integrity and primary principles (The Nursing Council of New Zealand, 2012). The following principles are, Principle 1) is to respect and be aware of the patients. Principle 2) is to respect and be aware of the patient’s cultural needs and values. Principle 3) is to work in partnership with the patients to protect and promote their well-being. Principle 4) I to maintain the patient’s trust by providing safe and competent care. Principle 5) is to respect the patient’s privacy and confidentiality. Principle 6) is to work respectfully and in an orderly manner with colleagues to best meet the patients’ needs. Principle 7) is to act with integrity to justify the patient’s trust and lastly Principle 8) is to maintain public trust and confidence in the nursing profession.

The Nursing Council of New Zealand ‘Guidelines: Social Media and Electronic Communications’ (2012). Is a document to help nurses think about their social media and electronic communication. In relation to standards of professional conduct and in relation to protecting and respecting health consumer’s privacy and confidentiality (The Nursing Council of New Zealand, 2012). Maintaining public trust and confidence in nursing profession in the nursing profession. Nurses are reminded to be aware that patient emails, answering phones, and text messages may be accessed by others.

Lucy is undertaking her clinical practice in a simulated environment where she has too meet The Nursing council of New Zealand ‘Competencies for Registered Nurses (2016). The three domains I will be discussing is where Lucy has to incorporate a synthesis of her practice of bed bathing Mr. S. Domain one – Professional Responsibility, Competency 1.1 Accepts responsibility for ensuring that his/her nursing practice and conduct meet the standards of the professional, ethical, and relevant legislated requirement. In relation to the scenario by applying this competency I would always ensure to do 5 moments of hand hygiene before and after bed bathing Mr. S. To always ensure to close the door and curtains before I start the bed bath for Mr. S to respect his privacy and confidentiality, as per the code of rights. In the scenario, it states that Mr. S has limited movement on the right side of his body due to his stroke. I would ensure that there is always a 2x assist when turning him to wash his back during a bed bath. As this meets the standards and legislation requirements for health and safety when 2X assist is required. Competency 1.4 promotes an environment that enables consumer safety, independence, quality of life, and health. In relation to the scenario by applying this competency I would ask Mr. S if he is able to wash places that he can reach with his left hand. By doing this he is promoting independence for himself.

Also by making sure that I uncover only the areas of the body that I will be washing as this will keep Mr. S from getting cold and will also provide him with privacy. When turning him always reassure with him that he’s being turned and by turning him carefully it provides him with patient safety. Domain two – Management of Nursing, Competency 2.1 Provides planned nursing care to achieve identified outcomes. In relation to the scenario by applying this competency it states that Mr. S has limited movement on the right side of his body. With encouragement and practice, he could try moving side to side in his bed and when it’s time for his next bed bath I could see his progress. Domain 3 – Therapeutic Interpersonal Relationship, Competency 3.1 Establishes, maintains, and concludes a therapeutic relationship with the client. In relation to the given scenario by applying this competency always make sure to use AIDET with Mr. S. so he knows who I am and what procedure I am going to do on him In this case giving him a bed bath. By maintaining the relationship between Mr. S is by making sure while giving him bed bath I always keep the communication going so he knows what I am doing and to always ask if he comfortable and okay.

In the given scenario it states that Lucy’s patient had requested to video Lucy doing her practice so the patient could send it to his mother on Facebook. According to (Nursing Council of New Zealand, 2012). You should always maintain privacy and confidentiality therefore Lucy should tell the health consumer that with all due respect she does not want to be videoed. As it violating her privacy and confidentiality in this situation it might leave her feeling uncomfortable and anxious. Therefore Lucy might not know how the video would be used if it was getting shared around social media.

The difference between a professional relationship and a social relationship is that professional relationships is related to a client’s needs for nursing care. And is time-limited therefore it could be short or long term. Whereas in social relationships personal choices is not defined by care needs and it may not last a lifetime. Professional relationships are located to where nursing care is required or provided. Therefore social relationships can occur anywhere professional relationships is where nurses can maintain an objective, respect the client’s choice. And make sure that their personal values don’t conflict with professional practice. Whereas in social relationships respect may or may not be present it may change depending on the type of relationship.

The three phases of developing an interpersonal therapeutic relationship is by using the first phase which is establishing. By establishing a therapeutic relationship with Mr. S you should always greet him and introduce yourself using AIDET. Preferably ask Mr. S what he prefers to be called. The second phase is maintaining the relationship with Mr. S is by actively listening and making sure you understand his concerns. Maintaining eye contact and smiling at the interval and speaking calmly and slowly so that Mr. S understands. By making sure that Mr. S has privacy when providing him with his care and his bed bath so his privacy is maintained. The last phase is terminating the relationship which is by making sure that Mr. S is comfortable in bed after his cares are done. That his call bell is on the left side of his bed so he is able to reach it. By asking him if he needs anything or if there is anything else you could do for him and that if he needs anything just ring the call bell.

This essay demonstrated an understanding of professionalism and a therapeutic relationship, and it also discussed the four main documents. The Nursing Council of New Zealand (NCNZ) ‘Competencies for Registered Nurses’ (2016), The Health Practitioners Competence Assurance Act (2003), The Nursing Council of New Zealand ‘Code of Conduct’ (2012) and The Nursing Council of New Zealand ‘Guidelines: Social Media and Electronic Communications’ (2012). Lucy has to undertake and demonstrate in her clinical practice from the given scenario.

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