Developing Patient-Centered Therapeutic Relationships

Definitions therapeutic relationship

one that allows nurses to apply their professional knowledge, skills, abilities, and
experiences towards meeting the health needs form the power point
A patient-centered relationship is when a patient and healthcare provider work together to
help the patient reach their health goals. The healthcare provider uses their knowledge and
skills to meet the patient's health needs. Patient-centered care involves understanding the
patient's experience of illness, helping them manage chronic health problems, promoting
healthy behaviors, and making sure the patient is satisfied with their care. The patient is an
active participant in their healthcare, and their preferences and values are an important part of
their care. Trust, coordination, and continuity of care are important for a good patient-provider
relationship. Patient-centered care can happen in different healthcare settings, from critical
care to long-term care.
Patient-centered care (PCC) relationships can be time-limited and subject to treatment and
regulatory concerns. They can occur over an 8-hour shift, episodically, or at regularly scheduled
times. Longer-term relationships can last for days, weeks, or months. Each PCC relationship
should be meaningful, and it typically ends when clinical objectives are achieved, or the patient
is transferred to a different care setting.

Patient-Centered Care Relationships

Based on the premise that each person’s experience of an illness, injury, or disease is a total
human experience Is consisting of 4 components holistic, respectful, individualized, and
empowering from power point
Addressing situational, cultural, religious, and family circumstances allows for a more inclusive
holistic targeted understanding of the patient’s preferences and life goals. Listening to what a
patient identifies as primary concerns provides stronger information about the patient’s values
and preferences.
Respectful care starts with careful listening and emphasizes the patient’s strengths, abilities,
wishes, and goals. Nurses demonstrate respectful care when they support patient autonomy
and realistic care goals.
PCC is individualized care. Listening to what the patient identifies as his or her main concern
provides contextual data about patient values and preferences within the family and
community.
Dr. Edward Wagner and colleagues (2001). This model proposes “a patient-professional
partnership, involving collaborative care, and self-management education”
Collaborative Patient-Centered Relationships
Collaborative interprofessional care approaches embedded in designated health care teams,
rather than single practitioners assuming responsibility for the patient-centered health care of
patients have become the new norm in health care delivery

Elements of Patient-Centered Relationships

A patient-centered relationship considers each individual patient as a person first and
foremost; with distinctive personally held values, beliefs, and life goals.
Second, this person is a “patient with a medical or psychiatric diagnosis,” requiring treatment
and tangible professional support to resolve a chronic illness, or to improve preventive care.

Patient-Centered Versus Social Relationships

The differences relate to purpose, the type of involvement, and the privacy protections. Social
relationships are established and maintained to meet mutual need, and/or friendship purposes.
Therapeutic relationships are established for professional health-related purposes within a
specific time setting.

Theoretical Frameworks

Hildegard Peplau's interpersonal nursing theory identifies four phases of a nurse-patient

relationship: pre-interaction, orientation, working phase, and termination. The theory also
outlines six professional roles that a nurse can assume during the relationship.
Carl Rogers' model suggests that when someone is sick, they can feel better if they are treated
with respect and kindness in a caring and honest relationship. Rogers thinks that there are
three important things that the person helping the sick person should do: be honest and real,
show that they trust and respect the sick person, and try to understand how they feel.
Abraham Maslow's needs theory provides a framework for nurses to prioritize patient needs in
planning their care. Maslow's model is shown as a pyramid with basic survival needs at the
bottom and self-actualization needs at the top, with needs occurring in an ascending fashion.

Elements of Patient-Centered Care

Patient-centered care (PCC) is an approach to healthcare that involves forming good
relationships between patients, healthcare providers, and others who are important to the
patient's life. The Institute of Medicine thinks that PCC is very important and should be part of
making healthcare better in the US. PCC means that healthcare providers should always think
about what the patient wants and needs, and make decisions based on that. It's important to
always put the patient first in healthcare.
Structure of Patient-Centered Relationships
Boundaries
Professional boundaries spell out the parameters of the health care relationship. They define
how nurses should relate to patients as a helping person: not as a friend, not as a judge, but as
a skilled professional partner committed to helping the patient achieve mutually defined health
care goals
Examples of professional relationship boundaries include the setting, time, purpose, focus of
conversation, and length of contact.

Level of Involvement
The level of involvement on the professional behavior continuum can fluctuate, depending on
patient needs. becomes emotionally over-involved in a patient’s care. Over-involvement can be
associated with countertransference. Over-involvement results in the nurse’s loss of the
essential objectivity needed to support the patient in meeting health goals.
The opposite of over-involvement is disengagement, which occurs when a nurse emotionally or
physically withdraws. the outcome of disengagement is that a patient feels isolated and
sometimes abandoned when care is mechanically delivered with limited human connection

Maintaining a Helpful Level of Involvement

Maintaining a helpful level of involvement is always the responsibility of the professional nurse.

 Focus on the process of care while acknowledging that the outcome may or may not be
nicating With Familie
within your control.
 • Focus on the things that you can change while acknowledging that there are things
over which you have no control.
 • Be aware and accepting of your professional limits and boundaries.
 • Monitor your reactions and seek assistance when you feel uncomfortable about any
aspect of the relationship.
 • Balance giving care to a patient with taking care of yourself, without feeling guilty.

Gathering Assessment Data

• Nurse should ask about the family’s:
• Cultural identity
• Rituals
• Values
• Level of involvement
• Decision making
• Spiritual beliefs
• Traditional behaviors
• Past medical experiences
• Concurrent family stressors
• Expectations for treatment
Problem Identification
• Nursing diagnoses may include:
• Compromised family coping
• Ineffective family therapeutic regimen
management
• Readiness for enhanced family processes
• Readiness for enhanced relationship