The therapeutic nurse – patient
relationship
Role of the communication in the
nurse-client relationship in
psychiatry
• To be effective, a
nurse must excel in
both the art and the
science of
communication.
• 1.Therapeutic relationships-one of the
main principles of psychiatry
• 2.Definition of communication
• 3. Communication Strategies
• 4. When communication breaks down
• 5. Building relationships
• At the core of nursing is the therapeutic
nurse-client relationship. Communicating
receptivity, empathy, trust and respect is
how nurses establish and maintain
therapeutic relationships.
• Communication is defined as the act of
transmitting information by speaking,
writing or using non-verbal means. But
communication in the nursing profession
is more than that. Nurses first learn the
science, the technique, of communicating
as students.
• The art of communicating, the ability and
confidence to finesse both verbal and nonverbal messages so interactions can be
purposeful and effective, is acquired
gradually and improves with reflective
practice and experienc
• Nurses regularly apply the art and science
of communication in establishing and
maintaining relationships with clients and
other members of the health care team, in
resolving ethical dilemmas or situations of
conflict, in their advocacy efforts on behalf
of clients and in promoting quality practice
environments that help them meet the
standards of practice.
• “Good communication skills are essential
to a regulated profession such as nursing,”
says Elizabeth Bildfell, RN, a Practice
Consultant at the College.
• In nursing, staff focus on every aspect of
verbal and non-verbal communication so
interactions are therapeutic.” Nurses are
accountable to the public and, through selfregulation, are responsible for ensuring
that nursing practice and conduct –
including communication in all of its forms
– meet the standards of the profession
• . A major component of this accountability
involves conducting oneself in ways that
promote respect for the profession.
• dividual nurses form the group which the
public recognizes as the nursing
profession,” says Phyllis Lewis, RN, an
adjunct assistant professor at Queen’s
University School of Nursing in Kingston.
“To maintain the public’s trust and respect,
and our fine reputation, nurses have the
responsibility to achieve and maintain
proficient communication skills.”
Communication Strategies that
Strengthen Nurse-Client
Relationships
• Here are 12 tips to help establish and
maintain a relationship of trust and respect
with a client.
• Imagine how you would like a nurse to treat
a close relative, and then model your
behaviour accordingly.
• Introduce yourself by name and title.
• Use the client’s preferred name.
• Make eye contact, when culturally
appropriate, and be aware of your body
language.
• Ask your client open-ended questions to
encourage more than a “yes” or “no”
response.
• Listen actively to and show an interest in
your clients.
• Inquire into unusual comments or
behaviours.
• Identify your client’s care needs and goals.
• Provide sufficient information for clients to
make choices and have realistic
expectations.
• Collaborate with your client to find the best
possible solutions.
• Follow through on your client commitments
and notify clients of any changes in routine.
• Reflect on how your clients perceive you.
• The RN and RPN entry-to-practice
competencies contain an expected
standard of communication competency.
After entering practice, nurses are
expected to develop their communication
skills throughout their careers. The College
offers a number of documents and learning
resources to help members facilitate this
ongoing process.
• “Since communication is integral in
nursing, it’s a theme found in most CNO
practice standards and practice
guidelines,” says Bildfell. “Another relevant
document is the Self-Assessment Tool,
which includes six statements on the
assessment of nurses’ communication
competencies. The College also provides
Regional Education Network sessions that
focus on issues of communication.”
When communication breaks
down
• Expert communicators are inquisitive,
systematic, analytical, open-minded, selfconfident, empathetic and receptive.
Communication starts to erode in
situations in which there is a lack of
empathy, respect and trust. It can also be
undermined by not actively listening to
clients, family members and colleagues.
• A vital component of skilled
communication is critical thinking; the
ability to analyse gestures and words and
determine what is and is not working.
• “A nurse must sift through an enormous
amount of information gathered from a
multitude of sources to accurately assess
clients’ status and monitor risk,” says
Craig. “Without critical-thinking skills, the
nurse becomes merely a conduit passing
on information.
• Nurses skilled in critical thinking are able
to analyse client information, synthesize it
with their expert knowledge and
experience, prioritize the care required and
communicate effectively with physicians
and other team members.
• At the root of many complaints to the
College is communication breakdown.
According to Karen Puckrin, RN, an
Investigations Case Coordinator at the
College, there are two common types of
complaints made to the College. “The first
is nurses communicating inappropriately
with clients and family members,” she says,
“and the second is nurses communicating
inappropriately with colleagues.”
Case Study
• Susan, a client, was bruised after being
pushed by another client at a long-term
care facility. Louis, an RN, completes an
incident report but doesn’t contact Susan’s
family to tell them about the injury. Should
Louis have contacted the family?
Answer
• Yes. Part of the nurse-client relationship is
maintaining trust and respect with the
client’s family members through
communication. While the injury wasn’t
serious, Louis has to be receptive to the
fact that the family is concerned about
Susan’s well-being and wants to be kept
aware and involved with her care. They
would be upset to see the bruise on their
next visit and not know how it happened.
Building relationships
• To build a therapeutic nurse-client
relationship, a nurse must first seek to
understand the client’s needs and
situation, and this takes strong skills in
active listening.
• “Nurses develop nurse-client relationships
by building trust between themselves and
their clients,” adds Puckrin.
• “Most clients understand that there are
heavy demands on nurses as they work in
challenging practice environments in the
health care system
• Clients are part of the system because they
have certain needs,” says Puckrin. “As long
as clients believe that the nurse is making
every effort to understand and meet their
needs, and they trust that the nurse really
cares about their situation, the clients, and
by extension the clients’ families, will
accept that nursing resources might be
limited.”
• nherent in the nurse-client relationship are
power and goal differentials that the nurse
must be able to recognize and address. The
nurse has more power than the client
because of her/his nursing knowledge and
influence in the health care system.
Furthermore, the goal of the nurse-client
relationship is to promote the health and
well-being of the client and not to meet the
needs of the nurse.
• Nurses must acknowledge their role when
first establishing the nurse-client
relationship and remain empathetic and
receptive to what the client is going
through. For Angela McNabb, RN, an
advanced practice nurse in the Law and
Mental Health Program at the Centre for
Addiction and Mental Health in Toronto, that
means remembering that her clients’
freedom is limited, in varying degrees, by