Concept Analysis: Therapeutic
India Boyd Nursing 182
Therapeutic nursing is a very vital component of nursing. . Neal (2003, p100) states a therapeutic relationship can be described as being between nurse and patient and is based on patients’ needs for care assistance and guidance. It is a relationship that is established solely to meet the patient’s needs and therefore, is therapeutic in nature. Chambers et al (2005, p303) suggest interpersonal and therapeutic relationships are at the center of nursing work, the relationship that exists between nurse and patient can often provide the energy and be the catalyst, the motivation and the source of strength to continue with treatment or face difficult sometimes life threatening situations.
I feel there is a need to establish a therapeutic relationship with your patient in order to build a relationship with them that will allow you to be able to fully meet their needs. So often health care workers are unable to meet a person needs simply because they are unaware of what those needs are. Cutcliff (2005, p57) states that you can gain comfort from drawing on your interpersonal skills (therapeutic) and having seven skills within yourself. These are: 1.Strength 2.Endurance 3.Feeling self- confident and brave
6.At peace with self
7.Sense of value
Freshwater et al (2005, p101) suggests the nurse patient relationship can be viewed as a major therapeutic tool of effective patient care. McHugh Schuster (200, p7) sates that communication plays an important role in the therapeutic relationship. Clark & Bridge (1998, p2) suggest that forms of communication such as asking questions, allowing patients to express their feelings, or reassuring patients by means of touch will also result in important patient care, and increase patient satisfaction and well- being. Nichols (cited in McQueen 2000, p723-731) also suggests that the nurse is the central figure in the patient care and is best placed to provide much of the psychological care and this demands good interpersonal skills to form a therapeutic relationship with patients and to communicate more effectively with relatives and other health professionals. Communication covers a wide range of things including touch, play, and enthusiasm. Touch is important as it showed that I was listening to the patient’s, touch can mean different things, and it is a silent language of non- verbal behavior. Touch is an affectionate way of transmitting warmth. Not all people are comfortable with using touch so it’s important to know the boundaries with each individual patient, which you learn through communication. Another non- verbal communication skill could be silence giving both the patient and the health care worker time to reflect upon prior or future events in the patient’s care. Although it is important that the patient’s needs are still met and that the focus is still on them. Therefore it is important that the nurse involves the patient through other means of communication which again could be through touch or play. The NMC (2004) states that the nurse must recognize and respect the role of the patient/client as partners in their care and the contribution they can make to it. This would be the phase of identification in Peplau’s (1988) model of the nurse patient relationship. Peplau (cited in Hinchliff et al 2003, p130) views the nurse patient relationship as passing through four phases. They are as follows: 1.Orientation 2.Identification 3.Exploitation
Riley (cited in Cutcliffe et al 2005, p304) suggests that therapeutic relationships are about patient’s disclosure of personal and occasionally painful feelings with the nurse at a calculated emotional distance near enough to be involved but objective enough to be of help. Neal (cited in Hinchliffe et al 2003, p102) states that confidentiality and trust are two sides to the same coin and trust is another important attribute to the therapeutic relationship as the patient will place their trust in the nurse.
Therapeutic care does not only exist in nursing care but should also be seen in every day interactions with people that you come in contact with on a daily basis. In order to fully understand therapeutic care as a concept, I have reviewed the original definition of this word. The dictionary definition states “providing good effects of your mind or body”, “of or relating to the treatment of illness”. Based on the definitions listed above there are some attributes that should be noted with effective therapeutic care. These include but are not limited to: 1. Therapeutic care is healthy 2. Therapeutic care is wholesome 3. Therapeutic care is alleviative
4. Therapeutic care is corrective
5. Therapeutic care is tonic
6. Therapeutic care does note judge based on race, creed, sex or financial basis Model Case An elderly homeless man admitted to the nursing home. He has no insurance nor does he have any support from his family to assist with the financial cost of the facility. The nurse admitting and assessing the patient knows the issues that the patient is dealing with financially. The nurse takes the time to talk to the patient, reassuring him that all things will work out for the best. She informs him of the support services offered through the facility, educates him on the facility therapy benefits, meal times, call- light and rest room locations. She also assisted him to warm shower, reassurance through touch with a nice back wash and light massage with the application of lotion and lastly clean clothes.
The model case shows how health care staff can provide full therapeutic care while simply treating people the way anyone should be treated. The nurse took the time to hear the man situation and offer reassurance and referral services to assist in making his transformation easier. Contrary Case An elderly homeless man was admitted to the nursing home. He has no insurance nor does he have any support from his family to assist with the financial cost of the facility. The nurse admitting and assessing the patient knows the issues that the patient is dealing with financially. The nurse advises the man that he will need some means of payment and very soon because the facility can’t provide free service long. She asks “what did you do to your family to make them not deal with you”. The nurse speaks very fast and short with the man, and shows no care or concern for his well-being. She directs him to the shower room yet does not offer any assistance. Lastly she tells him to enjoy his short visit here unless he acquires some financial assistance.
There were no gestures of therapeutic care seen in Contrary case because the nurse never took the time to see the gentleman as being worthy of her care. She allowed her nursing duty and human duty of giving simple therapeutic common concern to be clouded with his lack of finances and his current living situation. Borderline Case An elderly homeless man was admitted to the nursing home. He has no insurance nor does he have any support from his family to assist with the financial cost of the facility. The nurse admitting and assessing the patient knows the issues that the patient is dealing with financially. The nurse takes the time to talk to the patient, reassuring him that all things will work out for the best. She neglects to inform him of the support services offered through the facility, nor does she educate him on the facility therapy benefits, meal times, call- light and rest room locations. She does assist him to warm shower, yet barely touching him. Lastly she does give him clean clothes. The nurse in the borderline case did some of the things she should have done however she didn’t do a lot of things she should have. She was clouded by his current situation yet somewhere in her heart part of her still wanted to try and assist the gentleman. Her bad attributes truly outweighed her good because she should always offer full therapeutic care to the mind and body if given the opportunity. Invented case An elderly tiger allowed to join a community of young tigers. He has some obvious physical disabilities and does not show any positive signs of making a full recovery without assistance. A middle aged female tiger takes notice to him and decides to care for him the way she cared for her ill father before he passed. She nursed his wounds, provided him with food and showed him where to find fresh water. She spent time with him, sometimes in silence and other times with soft sounds and back rubs. They exercised together and shared personal inside jokes. He soon made a full recovery and was able to fully care for himself again. Illegitimate uses of the term therapeutic would be when someone uses therapeutic gestures to gain something for themselves like trying to obtain information that has no bearing on the person’s well-being. Some people may pretend to care about someone’s well-being for financially or materialistic gain. They may offer some therapeutic care like a massage or assistance with a shower just to gain information when they know they have no true desire to help in order to benefit the person in return. Antecedent and Consequence Antecedents for Therapeutic care 1. Having someone whom you can assist
2. Wanting to help someone
3. Assurance that overall therapeutic assistance will not cause harm Consequences for Therapeutic care 1. Increases someone’s overall well-being
2. Feel needed by health care provider
3. Adds quality to someone’s day
4. Shows growth as a person overall
The measurement of therapeutic care would surely require more non-direct research in order to give a more accurate conclusion. These would include but not limited to: 1. Observation of people interacting with total strangers 2. Interviewing people that were assessed by health care professionals 3. Speaking to people that offered a kind word, touch or gesture and inquire into how it made them feel
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Nichols, K.A. (1993) Psychological care in physical illness. 2nd ed. London: Chapman & Hall. Cited in McQueen, A. (2000) Nurse patient relationship and partnership in hospital care: The journal of clinical nursing. Vol 9 (5), 723-731. Peplau, H. (1998) interpersonal relationships in nursing. New York: Putman. Cited in Hincliff, S., Norman, S. and Shober, J. (eds.) (2003) Nursing practice and health care. 4th ed. London: Aronold. Riley, J. B., Kelter, B.R, Schwecker, L.H. (2003) Communication: cited in Cutcliffe, J.R. and McKenna H.P. (2005) The essential concepts of nursing. London: Churchill Livingstone. Therapeutic. (2012)