Although nurses go to school to acquire all the knowledge and clinical practice they need to be good nurses, simply understanding a textbook cover-to-cover does not cut it. It is considered by many that the nurse-patient relationship is the core of nursing.
Beginning with the introduction phase and development of trust, the working phase comprises consistent and continual nurse care, and the termination phase with a transfer or goodbye, nurses and patients have a unique bond that can develop through nurtured care over time. The relationship between a nurse and their patient can foster trust, empathy, and genuineness – being a therapeutic relationship in times of vulnerability in and of itself.
The nurse-patient relationship is crucial to the delivery of care and is transformative when done well. A successful nurse-patient relationship requires a foundation of trust. But how can trust be built between a nurse and a patient?
Let’s take a look at what nurse-patient relationships can look like, both healthy and unhealthy, so nurses can grow in the ways they serve their patients with care.
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What is trust in the context of nursing?
In nursing, initial trust is established in the introductory stage of a nurse-patient relationship. This is crucial, as trust creates an environment where patients can identify the problems they hope to work with nurses to solve. Trust lays the foundation for a context in which patients are able to share valid and reliable information about their condition and needs, cooperate with healthcare advice, and ultimately accomplish their healthcare goals.
Trust can also be tricky, meaning you can trust someone to do one thing but not another – just as a patient can trust a nurse to perform basic care with competency, but may not trust them with vulnerable information about their family history or story. Nurse-patient relationships that lack trust can still be functioning working relationships, but everything changes when trust is in the picture.
How is trust built through role expectations?
There are also role expectations that may contribute to an established baseline of trust. For example, a patient may have a basic level of trust that a nurse is equipped and qualified to do their job if they are working as a nurse. This means that they have a degree in nursing and meet the requirements of the job title at hand, or else they would not be employed. But trust is not only built in one direction.
Nurses also walk into a nurse-patient relationship with expectations of their patients. Nurses expect that their patients want a healthy nurse-patient relationship, that they will be compliant, and that they will receive help from the nursing staff with the common goal of the patient feeling better.
Beyond the basic trust built due to the job titles and positions of a nurse and patient in the context of medical care, the extra layer of trust that allows nurses and patients to connect and enter into the therapeutic relationship is patient vulnerability.
Why do nurses need to build therapeutic relationships that foster vulnerability with their patients?
Nurses are the “givers” in their relationship with patients: they provide basic medical care, keep up with charts, and relay information between physicians and patients. With nurses labeled as the “givers,” it is also by association implied that patients are to be compliant, do as they are told, and have no pushback to the medical practices that are prescribed to them.
Unhealthy situations can crop up when nurses’ and patients’ expectations of each other are not met. This could look like a nurse feeling disgruntled with a stubborn patient that wants to talk to a physician himself instead of through the nurse or a patient feeling stifled and invalidated when they raise concerns that are dismissed by the nursing staff.
A therapeutic relationship in nursing is an active relationship between the nurse, the patient, and the patient’s family. This type of relationship is dynamic: having boundaries and being professional as well as compassionate and empathetic.
In a study conducted by Heifner (1993), where it was identified that nurses were able to develop a greater sense of connectedness with their patients when patients reciprocated by responding to treatment and who communicated to nurses that they were valued.
People are relational beings. Experiencing human relatedness eases anxiety and enables people to engage in relationships that not only aid survival (at its core) but also satisfy the natural longing that people have for companionship. Having healthy relationships that include this kind of interpersonal relatedness influences the development of our brain through hormonal and neurotransmitter regulation (Siegel, 2001).
Fostering therapeutic relationships in the medical field benefits both the nurse and the patient in many ways:
- Decreases the length of hospital stays.
- Less time in the hospital also decreases the cost of hospital visits.
- Conserves the nurse’s time, allowing them to care for more patients throughout their rotation.
- Increases the patient’s quality of care.
- Increases the nurse’s job satisfaction.
The basics of building trust in nurse-patient relationships
Building trust across the nurse-patient plane can take many routes. Here are some basic things that nurses can do in order to set a foundation of mutual respect upon which trust can be built:
- When introducing yourself to a patient, share your name and remember theirs. Use their name as you are speaking to them. This will help you remember it and help them feel seen and noticed.
- Beyond helping ease your patients’ discomfort or pain, protect their privacy while you are providing them care. Close the door behind you, pull a curtain around the bed, or cover their body to ease the feeling of being exposed.
- Actively listen to your patients. Fully understand their concerns, ask clarifying questions, and verbalize/repeat what you have heard them saying so that they know their words were correctly heard.
- As with all human connections, eye contact is a game changer. Smiling, nodding your head, and sharing eye contact are ways of demonstrating you care and are on your patient’s team.
- Maintain professional/personal boundaries. Follow the lead of your patients and what they are comfortable with, always respecting their personal or cultural boundaries.
- Showing honesty and consistency demonstrates to patients that their nurse/caretaker is dependable and trustworthy.
How can nurses foster an environment to encourage patient vulnerability?
Relationships evolve over time. That is a fact. One mindset that nurses can remind themselves of is that each interaction with a patient is an opportunity for connection and achieving the nurse/patient common goal: well-being. This mindset is especially relevant in nursing, where not all relationships with patients are long-term but may be short-term or one-time patient interactions.
Nurses can also grow their nurse-patient relationship by showing genuine interest. Asking the patient questions about their family, hobbies, interests, or work allows connections and conversations to happen that may break down barriers or bring mutual respect.
Empathy is another practical way that nurses can build connections with their patients. Empathy is the educated compassion for the experiences of another person. Nurses who can express empathy and understand their patients’ experiences are better able to assess their patient’s conditions and needs and offer appropriate care.
Another way that patients and nurses can grow a trusting, goal-oriented relationship is through reciprocity. How are nurses and patients able to express themselves as equals?
Reciprocity: Acts of service in nursing
It is no secret that most nurses in the field are servant-hearted, or else they would not be working in the profession that they are. Nurses enter the profession with the goal of serving others in very tangible ways: bringing comfort, healing, and companionship to those that are vulnerable due to ailment.
Of course, the primary concern for nurses is to achieve an optimal post-clinical outcome. The patient experience, however, is just as important as their healing and discharge from a medical facility.
Many clinics, hospitals, and medical facilities have created service standards that encourage nurses to serve their patients with excellence. Let’s look at some practical ways that nurses can integrate acts of service into their daily lives as they care for and nurture trust in their relationships with patients.
Nurses can demonstrate service to their patients by treating their patients like guests, not like “another day at the office.” By identifying the needs, wants, and expectations of patients, creating a plan to help patients through poor experiences, and having service features that mimic the “customer first” retail idea, nurses can elevate how they serve their patients on a personal level.
Although this may seem like a no-brainer, nurses who are fair, ethical, and equitable demonstrate excellence in their service to their patients. Simply treating patients like the whole-human beings that they are instead of being condescending, unfair, or worse still, unethical, makes a huge difference in elevating patient care to a new level.
Informing and empowering the patient and family of the patient is another thoughtful way to serve your nursing patients with excellence. Educating patients on their rights and encouraging them to be self-advocates is one of the best gifts you can give a patient in your care. It truly is a gift that keeps on giving. Involving the patient’s family in this is especially helpful in creating an environment that rallies around the patient and uplifts them beyond what you could do as a single nurse.
Sharing honest, consistent, and current information with a patient keeps the patient informed and serves them while also building upon a foundation of trust. One way to go above and beyond is to share information and make it available in an easy-to-understand, easy-to-share format that can aid understanding for your patients when they may be in a vulnerable or fragile state.
Do you think you would be a good fit in fostering thriving nurse-patient relationships?
If you are reading this and thinking about providing high-quality, compassionate care and bringing in an element of human connectedness – nursing may be the profession for you. There are nursing programs all over the US. From RN degrees to Online MSN degrees, such as the one available from Spring Arbor University, which offers the opportunity to learn about nursing online.
Most degree programs are outfitted not only with the book knowledge anatomy classes and clinical rotations that give you hands-on experience but also include blocks of study that share about bedside manners and nurse-patient relationships. Because these relationships are the core of the nursing profession, it is so important to practice and foster environments that create safety and vulnerability with your (future) patients. Do not skip those modules or class days! They are just as important as learning how to start an IV drip.
Nurses truly do have the power to make or break a patient’s experience during their visit to a medical care facility. Nurses are advocates. They are educators, caregivers, compassionate, and empathetic. They desire the best for their patients and do everything in their power to help them reach their healthcare goals. Truly all they do during their daily routine at work is an act of service and an avenue of building trust.