A Call for the Return of Therapeutic Relationships

As I approach becoming an ‘older adult’, I’m increasingly worried. Although I am healthy and do not foresee needing acute care, home care, or long term care services in the near future, I do realize that needing these services will likely come sooner than I would like. This frightens me because of what my home care research is revealing – the lack of safe, quality supportive care for older adults, especially for those residing in rural areas. There is inconsistency in home care providers which makes it difficult for both the clients and their family caregivers as introductions and instructions are needed to be repeated at each visit.  There is also an emphasis on providing a service/task within a certain number of minutes (Forbes et al., 2012, 2008). These conditions do not contribute to the building of trusting therapeutic relationships which promote the sharing of knowledge based on research evidence, clinical experiences, client and family experiences, and preferences between the home care provider, the client, and family caregiver.

When my mother, who had severe dementia, was hospitalized with a fractured spine, she was left to tell the nursing staff when she needed “a pill for her pain”. Needless to say, she never received her pain mediation until I realized that the PRN order needed to be given routinely. When has nursing care become so task focused that getting to know the person in the bed and their capabilities are not a priority? There is something terribly wrong with a system and a management that places such pressure on nurses to focus exclusively on tasks that they do not have the time or desire to develop therapeutic relationships with those for whom they care. As a result, nurses are not fulfilling their full scope of practice (Fry, 2013).

The focus of a therapeutic relationship should be ‘person-centred care’ which is different than patient-centred care. Patient-centred care focuses on the disease, illness or injury.  Person-centred care focuses on getting to know the person behind the presentation of symptoms. This will require consistency of care providers, exploring with the person his/her perceptions of their illness, showing compassion and sharing evidence about the condition so that together new ways of managing or relieving their symptoms and healthy living can be explored.  “Nurses should be the leaders in the care of older adults. It is an opportunity to demonstrate what we are capable of. High-quality care requires so much of what is fundamental to nursing” (Pringle, 2009, p. 4).  When nurses cannot or choose not to function to the full extent of their scopes of practice, which includes developing therapeutic relationships, they will be replaced by less qualified personnel (Fry, 2013). Developing therapeutic relationships with our patients, clients, and their families ensures that the ‘care’ is present in our nursing care.

References

Forbes, D., Finkelstein, S., Blake, C., Gibson, M., Morgan, D.G., Markle-Reid, M., Culum, I., & Thiessen, E.J. (2012). Knowledge exchange throughout the dementia care journey by rural community-based health care practitioners, persons with dementia, and their care partners: A qualitative interpretive descriptive study. Journal of Rural and Remote Health, 12, 2201.   http://www.rrh.org.au

Forbes, D., Markle-Reid, M., Hawranik, P., Peacock, S., Kingston, D., Morgan, D., Henderson, S. Leipert, B., & Jansen, L. (2008). Availability and acceptability of Canadian home and community-based services: Perspectives of family caregivers of persons with dementia. Home Health Care Services Quarterly, 27(2), 75-99.

 Fry, B. (2013). Straight talk: Why we need to do better. Canadian Nurse, 109(1), 32-32.

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