Julie Kennedy BSN RN Nurse / Patient Therapeutic Relationships

Ice Breakers There is a 3x5 card on your table Write the names of the people in your life that you love Lay the card in front of you so you can see the names

Let Us Take The Survey !

What Compels a Nurse to Practice ‘Always’ Care?

Therapeutic Relationship Therapeutic relationship – one which is perceived by patients to be caring, supportive, non-judgmental and offers perception of safety from threatening events (McKlindon & Barnsteiner) Therapeutic Relationship – is grounded in an interpersonal process that occurs between the nurse and the patient. It is purposeful, goal-directed relationship that is directed at advancing the best interest and outcome of the patient (Registered Nurses Association of Ontario 2002).

Elements of Therapeutic Relationship Empathy: Nurse should be able to perceive and experience the feelings of the patient to be able to understand the patient Genuineness: Nurse is sincere and honest in relationship with the patient. Consistency conveys sincerity that in turn foster the development of patient trust. Nurse must maintain an honest and open communication Concreteness and specificity: Nurse’s ability to identify patients feelings and make the patient aware of them. Only when the nurse listens actively and is sensitive enough can she help the patient to gain awareness and insight regarding feelings, thoughts and behaviors Respect: Nurse considers the patient with dignity, to be deserving of high regard. This is manifested when the nurse does not belittle or judge the patient’s feelings, verbalizations and behaviors.

Elements of a Therapeutic Relationship Respect for person Receptivity which involves good listening skills Empathy Awareness of ones own skills and limitations ~Hobbs 1994

Therapeutic Relationship It is not about being “nice” It is not about adhering to scripted communication It is not dependent on the clinicians personality It is built on authentic words and actions It is knowledge-based and grounded in human caring science research and accumulated clinical wisdom ~Mary Koloroutis and Michael Trout

Therapeutic Relationship Just as it would never be thought acceptable that a clinician fail to be technically proficient, it can never be thought acceptable that a clinician be permitted to lack relational proficiency ~ Mary Koloroutis & Michael Trout

I Know It When I See It Therapeutic Relationship The phrase "I know it when I see it" was famously used by United States Supreme Court Justice Potter Stewart to describe his threshold test for pornography in Jacobellis v. Ohio (1964)

For Your Reading Pleasure… Current articles that show the depth of the problem…

How Do We Unravel This Mess??

Operationalize Nurse/Patient Therapeutic Relationship Standardization Accelerators Must Haves ® Performance Gap Objective Evaluation System Nursing Development STUDER GROUP ® : Agreed upon tactics and behaviors that demonstrate: Empathy Respect (for patients) Tactics and behaviors that demonstrate: Empathy Respect (for nurs es) Critical conversations Novice to expert for TR relational competency Evaluations include therapeutic relationships Processes that are consistent and enculturated for “always” patient care Magnet designation Nurse relational competencies Aligned GoalsAligned BehaviorAligned Process Ensure that nurse leaders have skills to teach/role model relational skills Ensure that nursing development includes relational skills as well as clinical skill and they are equally weighted Ensure that organizational goals focus on outcomes that support therapeutic relationships with patients and families Rev What are these tactics?

Caring for Patient is Caring for Nurses Organizations with satisfied staff score well on patient experience Investigation of hospitals where patients suffer very poor care have all found remote and inaccessible managers who refused to listen to staff and would not involve them in decision-making; bullying, low staff morale, fatalism among clinicians about management and a reluctance to raise concerns

Novice to Expert in Therapeutic Relationships (TR) NoviceAdvanced Beginner CompetentProficientExpert No experience, and need rules to establish TR. Demonstration of TR is limiting and inflexible “Just tell me what to do and I will do it” Demonstrates marginally acceptable performance, has enough experience to begin to formulate guiding principles of TR in practice Develops a plan for establishing a TR that is conscious and deliberate, can cope with contingencies of different patient types but may have difficulty with prioritization Understands TR in terms of long-term goals and prioritization, uses nuances as guides to development of TR. Understands modification of TR based on experiences Intuitive grasp of maintenance of TR, without wasteful actions, is fluid and flexible and does not need rules or scripting to demonstrate extreme competency and consistency ~Patricia Benner 1984

Novice to Expert in Therapeutic Relationships (TR) Novice No experience, and need rules to establish TR. Demonstration of TR is limiting and inflexible “Just tell me what to do and I will do it” What are some Novice behaviors? ~Patricia Benner 1984

Novice to Expert in Therapeutic Relationships (TR) Advanced Beginner Demonstrates marginally acceptable performance, has enough experience to begin to formulate guiding principles of TR in practice What are Advanced Beginner behaviors?? ~Patricia Benner 1984

Novice to Expert in Therapeutic Relationships (TR) Competent Develops a plan for establishing a TR that is conscious and deliberate, can cope with contingencies of different patient types but may have difficulty with prioritization What are Competent behaviors?? ~Patricia Benner 1984

Novice to Expert in Therapeutic Relationships (TR) ProficientExpert Understands TR in terms of long- term goals and prioritization, uses nuances as guides to development of TR. Understands modification of TR based on experiences Intuitive grasp of maintenance of TR, without wasteful actions, is fluid and flexible and does not need rules or scripting to demonstrate extreme competency and consistency What are Proficient behaviors? How do they differ from Expert behaviors? ~Patricia Benner 1984

Where Is Your Team? From Novice to Expert? What are patient outcomes when we practice here? Care; What Nurses Say and What Nurses Do Holistic Nursing Practice, May/June 2008 Novice Expert “We need to care differently rather than continue to declare that “we do not have time” as a protective measure.”

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…creates care like this…. The people on your cards matter….

Julie Kennedy BSN, RN Studer Coach If you want to build a ship don’t tell people to collect wood and don’t assign them tasks and work but rather teach them to long for the endless immensity of the sea -Antoine de Saint-Exupery