1. Therapeutic Relationships
Zrinko Vranjes
Lisa Nurmilaukas
Chris Kokkola

2. Zrinko Vranjes

3. Nurse-patient communication is a crucial issue in
nursing elderly people because it serves
as a pointer to the quality of nurse-patient
relationships (Wells, 1980; Bond and Bond,
1990). While the concept of a meaningful nurse-patient
relationship is important in every
nursing speciality, it takes on added relevance in
elderly care for several reasons. Firstly,
for many elderly patients nurses form the most
regular, if not the sole, human contact.
Therefore if patients’ need for love and
reassurance are not met by nursing staff, they may
remain unmet (Fielding, 1979).

4. Secondly, without the development of therapeutic nurse-patient
relationships through the
medium of communication, effective nursing care is impossible, as
“effective and meaningful
nursing care of the elderly rests on effective and meaningful nurse-patient
relationships”
(Wells, 1980 p. 123). Wells illustrates this through the example of
patient incontinence. She
argues that solving this problem can only be achieved within a
nurse-patient relationship
which facilitates gaining the patient’s views on the subjective
meaning of the problem and
what will be helpful in treatment. Castledine (1987) similarly views
meaningful nursepatient
communication to be an essential component of the nurse-patient
relationship, but
believes that only qualified staff are capable of forming this
relationship.

5. Thirdly, effective communication with elderly patients is
an essential precursor to the
provision of care tailored to individual needs.
Communication skills are necessary to enable
nurses to gather relevant information about patients, for
example in taking a nursing
history, to plan and administer appropriate care and to
evaluate the effectiveness of care
with patients. Wells puts this succinctly:
“nurse-patient communication is important because it is
a measure of the effectiveness of nursing
care, i.e., the patient’s need is defined, appropriate
help provided, and the effectiveness of care
evaluated.” (1980 p. 123)

6. Again, while the need to gain detailed patient
knowledge in order to plan, give and evaluate
care is not confined to nursing elderly patients,
they frequently have multiple nursing and
A COMPARISON OF THE VERBAL
INTERACTIONS OF QUALIFIED NURSES 233
medical problems as well as an increased need for
social and domestic support and,
frequently, health education (Syred, 198 1).
Finally, elderly patients often have special
communication needs as a result of, for
example, memory (Armstrong-Esther and Browne,
1986) or speech and sensory problems
(Walton and MacLeod-Clark, 1986).

9. LOIS H. THOMAS, Ph.D., B.A.(Hons.), R.G.N.
Research Associate, Centre for Health
Seruices Research, University of Newcastle
upon Tyne, 21 Claremont Place

10. Lisa’s part of the primary nursing group
work

11. Support= maintainance, bearing, sustaining
Primary= the highest in rank
Nursing= well everyone should know this which
is a profession specialized in taking care of the
sick or infirm

12. Own
Patient
System
• Enables
individualized
care
Therapeutic
relationship
• Promotes a
patient’s feeling of
safety and a
nurse’s knowledge
about the patient
Multiprofes
sional
teamwork
• Facilitates
practitioners’
decision making
for the good of the
client

13. Feeling of support created:
Understanding the client
Providing care according to the patient’s needs
By using a nursing care planing more efficiently
By making nursing more visible
-> higher quality of nursing care

14. Factors indicating the feeling of being
supportive:
www.nursinggrip.com
Genuiness
Empathy
Respect
Self-exploration
Immediacy

15. Sharing experiences and knowledge about the
client among nurses and other professionals
Nurse to nurse
Nurse to doctor
Nurse to Practical Nurse
Supervision
http://www.ncbi.nlm.nih.gov/pubmed/11
882129

16. Chris Kokkola

17. Knight and Field (1981) present a study
showing how a task-orientated and routinized
form of nursing organization led to routinized
verbal communication with cancer patients. A
further consequence was the division of labour
whereby qualified staff occupied them-selves
with administrative and ward management tasks
while unqualified and junior nursing staff
performed the majority of direct patient care
(cf. Seers, 1986), and thus found them-selves
on the receiving end of patient anxiety about
their condition. (Thomas)

18. While maintaining friendly relationships with
these patients, ward organization facilitated
evasion tactics by junior nurses in order to
avoid patients’ questions. It was possible
for nurses to work elsewhere, thus avoiding
contact with a particular patient, and/or the
nurse could indicate by her actions that she
had no time to talk. Wells (1980) and
Armstrong-Esther and Browne (1986)
similarly cite task allocation as militating
against nurse-patient interaction. (Thomas)

19. Anger is an inevitable part of primary care nursing.
The demand that patient’s and their family demand
of care takers escalate during times of crisis.
Patients and family are fond of their nurse and
have little tolerance when the nurse takes a day
off, cares for another patient of takes a meal break.
This is because the patients sees the nurse as the
only one that understands.
This pressure adds up and is added to the nurse.
(Jellinek)

20. Common feeling during demanding periods of
nursing
May place primary nurse in a dilema
Anger may be inevitable
(Jellinek)

21. Reduces stress and guilt
Signals a problematic patient or rising unit
tension.
(Jellinek)

22. Psychiatrist and/or Psychiatric Nurse may be of
assistance.
Careful interview assessment
Understanding long-term therapeutic care
relationships
Appreciating the stresses of caring for ill patients
May help their encounter.
(Jellinek)

23. LOIS H. THOMAS, Ph.D., B.A.(Hons.), R.G.N.
Research Associate, Centre for Health
Seruices Research, University of Newcastle
upon Tyne, 21 Claremont Place
Primary nursing: Psychological implications
Jellinek, Michael S;Herzog, David B;Stoddard,
Frederick J Nursing Management; May 1994;
25, 5; ABI/INFORM Complete pg. 40