Running head: NURSING RELATIONSHIPS
1
Nursing Relationships with Patients
Every day, hundreds of thousands of patients are admitted and discharged from the
hospital. Through their stay, those patients interact with many healthcare workers. Those
interactions shape their perception of the health care system as a whole, whether in a positive or
a negative way. The majority of the interactions patients have is with the nursing staff. Ensuring
nursing staff have positive relationships with their patients is crucial to maintaining the integrity
of the hospital, the nursing profession, and the health care system as a whole.
The PICOT question being asked in this paper is this: In nurse-patient relationships, how
does the nurse’s communication techniques, emotions, and nursing abilities compared with the
nurse’s ability to establish a therapeutic relationship with the patient affect the nurse’s ability to
provide adequate nursing care for the patient throughout the patient’s course of care? This is
important to study and research because having a good relationship with the nursing staff can
have all sorts of positive effects on not only the patient’s perception of the nursing profession,
but can also lead to better outcomes, decreased hospital stay time, and increased compliance with
follow-up care (Tevis, Kennedy, & Kent, 2015). Therapeutic relationship can be defined as the
nurse’s ability to consciously using the nurse’s personality to get close to the patient to be able to
perform nursing interventions effectively (Mirhaghi, Sharafi, Bazzi, and Hasanzadeh, 2017).
Nurses need to realize their importance to the patient and systematically as nurses’ routine
interactions affect many more things than are consciously thought of.
Therapeutic Relationships in Home Health Care
A case study was conducted on a 74-year-old male with multiple comorbid conditions
under the care of a home health nurse. The problem being studied was the complexity of home
health care needs and the ways therapeutic relationships between the home health patient and the
NURSING RELATIONSHIPS
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nurse affects compliance with directed self-cares and attitudes toward the nurse and nursing care.
The study was conducted in the patient’s home. Notes were taken by the home health nurse on
two separate visits to the patient. The first visit was the patient’s initial assessment and the
second visit studied was the patient’s follow-up appointment (Doherty & Thompson, 2014).
Findings
The home health patient studied in this case study became increasingly compliant with
self-cares and began to let the nurse provide more and more cares. The patient was used to doing
things independently and now had to rely on the nurse for these cares, making him defensive
from the beginning. As the nurse used more and more therapeutic techniques, the patient let
down his emotional wall he built up toward the nurse and the nurse began to establish a
therapeutic relationship with the patient. The nurse listened to his concerns and let him
participate in his own cares as much as possible which let the patient feel less dependent on the
nurse.
During the second visit to the patient’s home, the nurse was able to get the patient to
discuss his emotional concerns with beginning home health treatments, which led to an increased
understanding in his situation, which helped the nurse know what kinds of therapeutic techniques
will help with this patient the best. The key takeaway from this case study is how important it is
to learn your patient. Nurses should use therapeutic communication techniques, both verbal and
non-verbal, to establish therapeutic relationships with their home health patients the same way
they would in an acute care setting (Doherty & Thompson, 2014).
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Bereaving Families’ Views on Oncology Nurses’ Relationships with Patients
Not only was the opinion and viewpoint of patient and nurse identified, but outsiders’
viewpoint was also assessed for this paper as well. In an oncology unit in Hong Kong, fifteen
experienced oncology nurses and twenty-one family members of patients were interviewed about
how they felt about the end-of-life care of the oncology patient. The nurses were also asked
about how prepared they felt to give bereavement care, defined in this article as the end-of-life
care of the patient and the patient’s loved ones and emotional support for the deceased’s friends
and family. The problem being studied was the gaps in bereavement care given by the oncology
nurses and how it affected the relationship between the nurses with the patient and patients’
families (Chan, Lee, & Chan, 2012).
Findings
It was found that the nurses felt they did not have adequate education about bereavement
care sufficient enough to care for the end of life needs of the dying oncology patients as well as
the needs of the patients’ family members. The nurses felt confident in their ability to establish
therapeutic relationships with their patients to ease them into the process of dying but felt
unprepared to help the family members of patients through that process. The family members of
patients had almost the exact same things to say. The family members felt their loved one was
given great care by the nurses in their final days of life but once their loved one had passed, the
support ceased as the family members had to figure out how to continue to go on their lives
without the family member who had just passed. The conclusion of this study was that the gaps
in bereavement care did not exist in the end-of-life care given to the patient, but the gaps existed
between the nurses and the family members. The important takeaway of this study to use in
practice is that nurses should not only focus on developing therapeutic relationships with their
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patients, but also with their loved ones who are with them in the hospital/care facility. Family
members are a crucial part of care and should be treated as such (Chan, Lee, & Chan, 2012).
Emotional Labor and Therapeutic Relationships in Oncology Nurses
In Istanbul, Turkey, twenty-five oncology nurses were interviewed about their
relationships they had developed with the patients and their families in comparison to job
satisfaction and performance. The problem being studied was the declining emotional status, job
satisfaction, and job performance over time. These nurses are expected to provide emotional
labor and develop good therapeutic relationships with their patients they care for. The oncology
nurses in Istanbul were asked open-ended questions about how they feel about their job, the ways
they establish relationships with their patients, and how they feel when one of their patients
passes away. Because oncology can be a high-mortality field to become involved in, checking in
on the wellbeing of nurses working in these environments is key to ensuring success in nursing
care provided to your patients (Tuna & Baykal, 2017).
Findings
The expectation of the oncology nurses to establish in-depth therapeutic relationships
with their patients led to decreased job satisfaction, loss of enjoyment of life outside work,
becoming depersonalized about death, and increased burnout in the nurses. Establishing good
therapeutic relationships is essential to be a good nurse, but it can come at an emotional and even
physical cost to the nurses providing care. Nurses go into the field of nursing because they
deeply care about the wellbeing of others and are selfless people to begin with. Organizations
need to make sure they have resources established for their nurses and that their nurses are
utilizing these resources to prevent burnout, depression, and other effects of their constant
NURSING RELATIONSHIPS
5
emotional support for others as they establish good therapeutic relationships with every patient
they care for (Tuna & Baykal, 2017).
Public Health Nursing and Therapeutic Relationships in Minorities
In public health settings, nurses see all kinds of populations. The problem being studied is
the barriers between public health nurses and their ability to establish therapeutic relationships
with vulnerable and potentially stigmatized clients. In this study, single mothers living in lowincome situations were looked at. Twenty-one low-income, single mothers and fifteen public
health nurses were studied in rural Canada. The mothers and the nurses were asked open-ended
questions to identify themes in responses. The researchers looked at how establishing therapeutic
relationships with these low-income single mothers influenced the mothers’ ability and
confidence in finding adequate health care for both themselves and their children (Porr,
Drummond, & Olson, 2011).
Findings
The researchers found that low-income single mothers had a harder time becoming
emotionally vulnerable to the public health nurses than what the public health nurses had found
in their non-minority public health patients. Once the nurses were able to visit these mothers a
few times and get to know the mothers and their children, the nurses were more comfortable with
receiving care and allowing the nurse to give care to their child(ren). One trend in the mothers’
answers was that they were more likely to seek health care in settings other than in public health
visits to care for both themselves and their children. The nurses interviewed in this study said
they had to be creative in how they approached the low-income, single mothers. There were
many techniques they had to use to establish therapeutic relationships with this population, but
once they had established a therapeutic relationship, the outcome was successful. This study
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shows that “textbook” therapeutic relationships establishing techniques is not a one-size-fits-all.
Nurses need to have lots of different techniques to develop therapeutic relationships with their
patients to help improve outcomes and make their patients more comfortable (Porr, Drummond,
& Olson, 2011).
The Impact of Therapeutic Relationships on Surgical Outcomes
Because most views on nursing therapeutic relationships are subjective, a group of
researchers wanted some objective, statistical data on how therapeutic relationships affect
hospitals systematically. The problem being studied is how low patient satisfaction scores
correlate with higher mortality and complication rates in hospitals throughout the United States.
300 surveys are collected annually from each hospital throughout the United States who want to
be eligible for Medicare and Medicaid reimbursement. Patient satisfaction surveys were given to
surgical patients and were asked to rate things about their hospital stay on a scale of 1-10, with
things ranging from the temperature of their food they ordered from the cafeteria to their opinion
on their own surgical outcome. In the middle, the patients were also asked about their views on
the nursing staff’s friendliness, timeliness, productiveness, and how personable they were (Tevis,
Kennedy, & Kent, 2015).
Findings
High patient satisfaction survey numbers were associated with low mortality rates in high
surgical and hospital volume. This means the more satisfied the patients were with the nursing
staff, the better their hospital outcome was. The better a surgical outcome is, the more money the
hospital makes through reimbursement. This study should give nurses more motivation, seeing
that the “routine” therapeutic relationships they make with their patients every day impacts the
entire hospital. The little things like taking a quick fifteen seconds to fill a patient’s water jug or
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making sure pain medications are always given when due can save the hospital thousands of
dollars. Without even realizing it, nurses can help the rising health care costs with the therapeutic
techniques they are using every shift (Tevis, Kennedy, & Kent, 2015).
Guideline
The Registered Nurses Association of Ontario (RNAO) created a guideline on therapeutic
relationships and was the only guideline available on the subject. The RNAO created the first
guideline in 2001 and called for an update to the guideline every three years, the most recent
update being in 2006. The guideline creation team involved ten nurses with high-level degrees
and multiple years of experience in nursing (Registered Nurses Association of Ontario, 2006).
Guideline Assessment with GIN Matrix
The guideline does not meet most of the criteria needed for a quality guideline according
to the GIN matrix. There were only nurses involved in creating the guideline, leaving gaps in
outside opinions from doctors, patients, or other health care workers. The quality of the research
was poor as the guidelines were mostly based on opinions and experiences of the nurses creating
the guideline. The guideline has not been updated since 2006, even though it calls to be updated
every three years (Registered Nurses Association of Ontario, 2006).
Key Points
Though this guideline’s background information, research, and evidence is shaky, the
guideline does make some good recommendations to take into consideration. The guideline
agrees with the research presented in the articles assessed in this paper in that establishing a
therapeutic relationship with patients is the baseline for being able to provide quality care. There
was not much disagreement about this key point between the guideline and the findings of the
articles (Registered Nurses Association of Ontario, 2006).
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Barriers to Having Therapeutic Relationships with Patients & Overcoming These Barriers
There are many things that can cause a nurse to not establish a therapeutic relationship
with their patient. Lack of personality in nurses is a main contributor to a nurse being unable to
establish therapeutic relationships with their patients. Learning to become more approachable is
something less personable nurses may have to work on while it may come more naturally to
other nurses. Ways to overcome this barrier include using communication skills such as active
listening and silence as techniques to show patients you care about what they have to say.
A second main barrier to nurses establishing therapeutic relationships with their patients
is gaps in education. Some nurses are unable to find ways to establish necessary therapeutic
relationships with their patients because of the lack in education provided. One consistent finding
in the research is how nurses said they felt they were not given adequate education about how to
establish healthy therapeutic relationships with their patients, rendering them unable to have
therapeutic relationships with their patients. Gaps in education can be fixed by adding required
continuing education classes in hospitals having to do with establishing therapeutic relationships
with their patients (Tuna & Baykal, 2017).
Conclusion
The importance of nurses establishing therapeutic relationships with their patients is one
of the most important unspoken tasks of a nurse. Nurses are the front of health care and spend
the most time with patients, so nurses will be what patients remember about their hospital stays.
Nurses need to know their value in the health care system and the value in the relationships they
develop with their patients. Knowing that you as a nurse can make a difference both individually
to our patients and systematically to our organizations can affect a nurse’s attitude about their job
and profession. Nurses can be the change in health care the United States needs, and it starts with
a single nurse deciding they will be that change.
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References
Chan, H.Y.L., Lee, L.H., Chan, & C.W.H. (2013). The perceptions and experiences of nurses
and bereaved families toward bereavement care in an oncology unit. Support Care
Center. 21, 1551-1556. doi: 10.1007/s00520-012-1692-4
Doherty, M., & Thompson, H. (2014). Enhancing person-centred care through the development
of a therapeutic relationship. British Journal of Community Nursing. 19(10), 502-507.
doi: http://dx.doi.org.resources.kirkwood.edu/10.12968/bjcn.2014.19.10.502
Mirhaghi, A., Sharafi, S., Bazzi, A., & Hasanzadeh, F. (2017) Therapeutic relationship: Is it still
the heart of nursing? Nursing Reports. 7:6129, 4-9. Doi: 10.4081/nursrep.2017.6129.
Nyatanga, B. (2014). Does humour have a place in palliative care? British Journal of Community
Nursing. 19(4), 202-202. doi: 10.12968/bjcn.2014.19.4.202
Porr, C., Drummond, J., & Olson, K. (2011). Establishing therapeutic relationships with
vulnerable and potentially stigmatized clients. Qual Health Res. 22(3), 384-396. doi:
10.1177/1049732311421182.
Registered Nurses Association of Ontario. (2006). Establishing therapeutic relationships.
Retrieved from https://rnao.ca/sites/rnao-ca/files/Establishing_Therapeutic_
Relationships.pdf
Tevis, S.E., Kennedy, G., & Kent, K.C. (2015). Is there a relationship between patient
satisfaction and favorable surgical outcomes? Adv Surg. 49(1), 221-233. doi:
10.1016/j.yasu.2015.03.006.
Tuna, R., & Baykal, U. (2017). A qualitative study on emotional labor behavior of oncology
nurses and its effects. International Journal of Caring Sciences. 10(2), 929-936.
Retrieved from https://search-ebscohost.com.resources.kirkwood.edu/login.asp
?direct=true&db=c8h&AN=124801513&site=ehost-live&scope=site
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Article Evaluation Grid
Name of Article: Enhancing person-centered Fill in the information asked for from
care through the development of a
your article in the grid below.
therapeutic relationship
1. What is the problem being studied?
Problem being studied:
The complexity of home health care needs
and ways therapeutic relationships between
the home health patient and the nurse affects
compliance with directed self-cares and
attitudes toward the nurse and nursing care
2. What is the PICOT question that the
article tries to answer?
PICOT question:
In home health patients, how do therapeutic
techniques of the home health nurse
compared with the attitude of the home
health patient affect the patient’s compliance
with directives throughout their care?
3. Where does the study take place
(setting)?
Setting:
In a home health patient’s home
4. What (people, thing)is being studies
(sampled) in an attempt to answer the
question? How many people/things
were studied? (What is the sample
size?)
What was studied?
A 74-year-old male who was under the care
of a home health nurse. The male had
multiple comorbid conditions
How many were studied?
One, this was a case study
5. What method is being used in the
study? Is it primarily objective
(numbers/hard quantifiable data
focused) OR subjective (perception,
belief focused)?
Method used to study the problem/answer
the question:
This was a case study, so notes were taken
by the home health nurse on two different
visits to the patient. The first visit studied
was the patient’s initial assessment and the
second visit studied was the patient’s
follow-up appointment.
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6. What was the answer(s) to the
question?
7. How can this study’s findings be used
in practice?
Objective vs. Subjective:
Data was objective, perceptions about the
observations were subjective.
Answer:
The home health patient studied in this case
study became increasingly compliant with
self-cares and letting the nurse provide care
as the nurse used more therapeutic
techniques and established a therapeutic
relationship with the patient. The patient’s
attitude was very negative at the beginning
of the nurse-patient relationship but became
more compliant as his attitude toward the
nurse improved. His attitude improved
because of the home health nurse’s
therapeutic techniques.
Use of Findings in Practice:
Nurses should use therapeutic
communication techniques, both verbal and
non-verbal, to establish therapeutic
relationships with their home health patients
just as they would in acute care settings. One
special consideration when establishing your
relationships in home health care would
include being aware that you are in the
patient’s home and to be respectful of your
surroundings. Respecting the person’s home
is imperative to helping establish trust for
the course of care. Most home health
patients are used to being independent and
now are dependent on you for their cares, so
being aware of this and being sure you
involve the patient in their plan of care is
important for establishing mutual respect.
Article Evaluation Grid
Name of Article: The perceptions and
experiences of nurses and bereaved families
toward bereavement care in an oncology
unit
1. What is the problem being studied?
Fill in the information asked for from
your article in the grid below.
Problem being studied:
The problem being studied was the gaps in
bereavement care given by the nurses in an
oncology unit and how it affected the
NURSING RELATIONSHIPS
2. What is the PICOT question that the
article tries to answer?
12
relationship between the nurse and the
patient and patient’s family.
PICOT question:
In experienced oncology nurses, how do the
nurses’ relationships with their patients
compared with the patients’ families
influence bereavement care given by the
nurse over the course of the patient’s
disease?
3. Where does the study take place
(setting)?
Setting:
The study takes place in an oncology unit in
Hong Kong.
4. What (people, thing)is being studies
(sampled) in an attempt to answer the
question? How many people/things
were studied? (What is the sample
size?)
What was studied?
Experienced nurses’ beliefs about
bereavement care they had given to the
nurses’ patient and the patients’ families in
comparison to the patients’ families beliefs
about bereavement care they received from
the nurses.
5. What method is being used in the
study? Is it primarily objective
(numbers/hard quantifiable data
focused) OR subjective (perception,
belief focused)?
How many were studied?
15 oncology nurses with at least one year of
oncology nursing experience and 10 family
members of patients
Method used to study the problem/answer
the question:
Individual, semi-structured interviews with
open-ended questions were formulated to
collect data.
Objective vs. Subjective:
The study was subjective.
6. What was the answer(s) to the
question?
Answer:
Nurses felt they did not give bereavement
care to the families like they would have
been able to because of lack of education on
bereavement care, lack of privacy in the
patients’ rooms, and having a need to deal
with their own emotions over the death of
their patient before they were able to provide
bereavement care to the family. Family
members of patients felt they were not
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13
7. How can this study’s findings be used
in practice?
communicated with enough throughout the
course of their family member’s treatment,
which affected their ability to cope with the
loss of their family member. The family
members of patients also expressed the need
for more private areas in the hospital to
grieve.
Use of Findings in Practice:
From this study, it seems there is a lot that
can be done organizationally. Hospitals
should ensure proper bereavement care
training is given to their nurses to ensure
they have the skills necessary to give proper
bereavement care. Hospitals should also
look at providing more private rooms for
patients whose conditions are deteriorating
rapidly to give families room and time to
grieve and say goodbye to their loved one.
Healthcare providers individually should be
sure they are communicating with family
members about their loved one’s treatment
plans, condition status, and be sure they are
educated properly on everything happening.
Article Evaluation Grid
Name of Article: A qualitative study on
emotional labor behavior of oncology nurses
and its effects
1. What is the problem being studied?
2. What is the PICOT question that the
article tries to answer?
3. Where does the study take place
(setting)?
Fill in the information asked for from
your article in the grid below.
Problem being studied:
The problem being studied is the declining
emotional status of oncology nurses over
time, as they are expected to provide
emotional labor and establish good
therapeutic relationships with their patients
they care for.
PICOT question:
How do oncology nurses with at least one
year of experience, how does the nurses’ job
satisfaction compared with job performance
influence their ability to establish
therapeutic relationships and provide
emotional labor throughout their career?
Setting:
The study was conducted at an oncology
center in Instanbul.
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4. What (people, thing)is being studies
(sampled) in an attempt to answer the
question? How many people/things
were studied? (What is the sample
size?)
What was studied?
Oncology nurses with at least one year of
oncology experience
5. What method is being used in the
study? Is it primarily objective
(numbers/hard quantifiable data
focused) OR subjective (perception,
belief focused)?
Method used to study the problem/answer
the question:
11 open-ended questions were asked to
collect responses and identify themes
between the interviewees.
How many were studied?
25
Objective vs. Subjective:
The data was subjective.
6. What was the answer(s) to the
question?
Answer:
The expectation of the oncology nurses to
establish in-depth therapeutic relationships
with their patients led to decreased job
satisfaction, loss of enjoyment of life outside
work, became depersonalized about death,
and increased burnout in the nurses.
7. How can this study’s findings be used
in practice?
Use of Findings in Practice:
Nurses in extremely emotionally vulnerable
specialties, such as oncology, where death
frequently occurs need to make self-care a
priority. Because nurses are selfless people
to begin with, organizations need to make
sure they have resources established for their
nurses to prevent burnout, depression, and
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15
other effects of establishing their therapeutic
relationships with every patient they care
for.
Article Evaluation Grid
Name of Article: Establishing therapeutic
Fill in the information asked for from
relationships with vulnerable and potentially your article in the grid below.
stigmatized clients
1. What is the problem being studied?
Problem being studied:
The problem being studied is the barriers
between public health nurses and their
ability to establish therapeutic relationships
with vulnerable and potentially stigmatized
clients, specifically looking at single
mothers living in low-income situations.
2. What is the PICOT question that the PICOT question:
In public health nurses caring for lowarticle tries to answer?
income single mothers, how do typical
therapeutic relationship development
techniques compared to non-typical
therapeutic relationship development
techniques affect the low-income single
mothers willingness to seek care for them
and their children during their vulnerable
state?
3. Where does the study take place
Setting:
The study takes place in rural Canada.
(setting)?
4. What (people, thing)is being studies
(sampled) in an attempt to answer the
question? How many people/things
were studied? (What is the sample
size?)
What was studied?
Public health nurses with an average of 18
years of experience and low-income single
mothers with an average of 2.3 children.
How many were studied?
21 mothers and 15 nurses were studied.
NURSING RELATIONSHIPS
5. What method is being used in the
study? Is it primarily objective
(numbers/hard quantifiable data
focused) OR subjective (perception,
belief focused)?
16
Method used to study the problem/answer
the question:
Interviews that were audiotaped and
analyzed later were used to collect data.
Open-ended questions were asked to the
nurses and the mothers to allow a safe
environment to talk in.
Objective vs. Subjective:
The data collected was subjective.
6. What was the answer(s) to the
question?
7. How can this study’s findings be used
in practice?
Answer:
The researchers found that low-income
single mothers had a harder time letting their
emotional wall down to the public health
nurses than what the public health nurses are
used to with their other patients. The
researchers identified six stages of building
the therapeutic relationship between public
health nurses and low-income single
mothers. The mothers identified as financial
hardship and psychological distress as main
barriers of seeking care for themselves and
their child(ren).
Use of Findings in Practice:
This study shows that “textbook” therapeutic
relationship techniques is not a one-size-fitsall kind of deal. There are many factors that
play a part of how a nurse goes about
developing a therapeutic relationship with
their patient to ensure the patient has the
best holistic outcome. Though this study was
aimed at a specific population, it is a good
lesson for nurses to be sure their approach to
developing a therapeutic relationship with
their patients is not the same for every room
you step into. Being aware of the patient’s
holistic situation as well as having an arsenal
of techniques to use with your patients is
imperative to being able to serve a wide
variety of patients.
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Article Evaluation Grid
Name of Article: Is there a relationship
between patient satisfaction and favorable
surgical outcomes?
1. What is the problem being studied?
Fill in the information asked for from
your article in the grid below.
Problem being studied:
The problem being studied is low patient
satisfaction scores correlating with higher
mortality and complication rates in hospitals.
2. What is the PICOT question that the
article tries to answer?
PICOT question:
How do patient satisfaction scores compare
with favorable surgical outcomes in
Medicare and Medicaid facilities over the
course of one fiscal year?
3. Where does the study take place
(setting)?
Setting:
The study took place throughout multiple
acute care settings across the United States.
4. What (people, thing)is being studies
(sampled) in an attempt to answer
the question? How many
people/things were studied? (What is
the sample size?)
What was studied?
Patient satisfaction scores were compared
with things such as infection rates,
readmission rates, and nosocomial infections.
How many were studied?
300 surveys were collected from every
hospital in the United States wishing to
receive reimbursement from
Medicare/Medicaid.
5. What method is being used in the
study? Is it primarily objective
(numbers/hard quantifiable data
focused) OR subjective (perception,
belief focused)?
Method used to study the problem/answer
the question:
Patient satisfaction surveys were given to
patients at hospitals all over the United States
and compared with different quantifiable
data about outcomes in the hospital.
Objective vs. Subjective:
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18
This study was objective.
6. What was the answer(s) to the
question?
Answer:
High patient satisfaction survey numbers
were associated with low mortality rates in
high surgical and hospital volume. The most
important patient satisfaction factor that
patients reported was the way their nurse
treated them. Some nurses caused a patient to
significantly decrease their patient
satisfaction scores, while other nurses caused
patients to increase their scores. The
importance of nurses developing therapeutic
relationships with their patients were
emphasized in this article because of the
systematic differences it can make
throughout the hospital.
Use of Findings in Practice:
Nurses should use this article as motivation,
seeing that they can make or break a patient’s
satisfaction with the hospital as a whole.
More so, supervisors and administrators
should also seek to improve the education
they give their nurses and nursing staff on the
importance of developing therapeutic
relationships with their patients. Since high
patient satisfaction scores are correlated with
lower mortality and nosocomial
complications, it can systematically save
money for hospitals in the end.
7. How can this study’s findings be
used in practice?
Guideline International Network Guideline Quality Assessment Grid (G.I.N Matrix): RNAO
Establishing Therapeutic Relationships
Qaseem, A., Forland, F. Macbeth, Ollenschläger, G., Phillips, S. van der Wees, P., for the Board
of Trustees of the Guidelines International Network. (2012). Guidelines international
network: Toward international standards for clinical practice guidelines. Annals of Internal
Medicine, 156(7), 525-531.
Component
1. Composition of
guideline
Description
A guideline development
panel should include diverse
and relevant stakeholders,
Met


Not Met
Not met because
the guideline
development panel
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19
development
group
such as health
professionals,
methodologists, experts on
a topic, and patients.
members are all
nurses with no
doctors, social
workers, patients,
or other types of
input given for
guideline.
2. Decision-making
process
A guideline should describe
the process used to reach
consensus among the panel
members and, if applicable,
approval by the sponsoring
organization. This process
should be established
before the start of guideline
development.

 No, the guideline did not
specify a process used to
reach consensus among
panel members.
3. Conflicts of
interest
A guideline should include
disclosure of the financial
and non-financial conflicts
of interest for members of
the guideline development
group. The guideline should
also describe how any
identified conflicts were
recorded and resolved.

 No, the guideline did not
include any financial or
non-financial conflicts of
interest.
4. Scope of a
guideline
A guideline should specify
its objective(s) and scope.
 Yes, objectives
were specified
along with the
scope.

5. Methods
A guideline should clearly
describe the methods used
for the guideline
development in detail.


Yes,
methodology
was specified in
this guideline.
However,
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20
methodology
was only based
on the
experience of the
nurses creating
the guideline.
6. Guideline
recommendations
A guideline
recommendation should be
clearly stated and based on
scientific evidence of
benefits; harms; and, if
possible, costs.


No, the guideline was
based on opinions and
experiences of the
nurses involved in the
guideline-making
process.
7. Rating of evidence
and
recommendations
A guideline should use a
rating system to
communicate the quality
and reliability of both the
evidence and the strength
of its recommendations.


No, there was no rating
system specified in this
guideline.
8. Peer review and
stakeholder
consultations
Review by external
stakeholders should be
conducted before guideline
publication.

9. Guideline
expiration and
updating
A guideline should include

an expiration date and/or
describe the process that
the guideline groups will use
to update
recommendations.
Yes, external
stakeholders
reviewed the
guideline before
it was published.

Yes, the guideline
did make
recommendation
s for a panel of
experts and
specialists to
update the

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21
guideline every
three years.
10. Financial support
and sponsoring
organization
Total
A guideline should disclose
financial support for the
development of both the
evidence review as well as
the guideline
recommendations.

Yes, funding was
provided by the
Ontario Ministry
of Health and
Long-Term Care.
