Collaborative Nurse-Client Relationship: Benefits and Barriers

Introduction

The collaborative nurse-client relationship (CNCR) is vitally important in achieving high quality of care in the field of nursing. However, as Feo, Rasmussen, Wiechula, Conroy, and Kitson (2017) point out, developing these types of therapeutic relationships is not without its challenges. Putting the patient at the center of the care process and working with the patient so that the client takes ownership of his or her own care and is involved in the decision-making process is the best way to ensure optimal outcomes.

Collaboration is a crucial concept in nursing (Trautman, 2017), and when it comes to developing the nurse-client relationship it is no less vital than it is when collaborating with other healthcare professionals. As Burger (2018) puts it, "Nurses must get buy-in from patients when it comes to their care. As any nurse will tell you, it's nearly impossible to work with a non-compliant patient. Little to no improvement is made. Encouraging participation and educating patients is paramount." This paper reflects on the nature of the collaborative (therapeutic) nurse-client relationship, examining what it is, what it should look like, why it is advantageous, when it might be disadvantageous, how it is established, and whether there are any barriers to this care approach.

What Is the Collaborative Nurse-Client Relationship?

Pullen and Mathias (2010) define the therapeutic nurse-patient relationship as "a helping relationship based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patient's physical, emotional, and spiritual needs through your knowledge and skill" (p. 4). Because every patient and client is different, the nurse should be aware of each individual's personal tastes and needs. The nurse may ask questions to identify likes and dislikes, but should do so in a way that is respectful rather than pushy.

The nurse should not come across as invasive but should instead use empathy, emotional and social intelligence, and communication skills to evaluate the patient's preferences before engaging the patient in a manner that may not align with the client's particular values. For instance, some patients may prefer to be comforted through words, touch, or the sharing of information. Others may prefer time to think in silence, reflect privately, or talk with others in their support system. All of these are acceptable within CNCR, but the nurse must recognize which approach is preferred by the client at any given time, because that awareness of patient preferences is precisely how trust and respect are developed.

Pros and Cons of CNCR

Pros

The benefits of CNCR are that it allows the nurse to get to the heart of patient-centered care, which Chiaramonte et al. (2018) note is very helpful in building trust and empowerment among clients. CNCR focuses on putting the patient's needs first and foremost in the care-providing process. It means that the patient is likely to have questions, cultural inputs, unique wants, and ideas about what care means to him or her. By collaborating with the patient to develop a unique and personalized care approach, the nurse can empower the patient and make the patient feel that he or she is truly part of the decision-making process.

The aim is to involve the patient in taking care of his or her own health to such an extent that the patient becomes empowered to do more, know more, and be healthier overall. Increasing the patient's health literacy through collaboration is one of the best ways to ensure this goal is reached on a patient-by-patient basis year-round. CNCR can also help to overcome non-compliance in patients through communication, respect, trust-building, and support.

Cons

There are no real cons to CNCR as it is the essence of nursing. However, there are cases in which it may be inappropriate. Not every patient will want to develop a nurse-patient relationship. This must be understood, and such cases must be identified quickly so that the patient is not offended or does not feel intruded upon by a nurse who attempts to engage the client in too many matters. Some clients will not be in a physically healthy enough state to develop such a relationship, lacking either the mental or physical capacity to acknowledge their own role in the care process. In these cases, the nurse should focus on attending to the patient's most basic needs and let the client know that she will be available to assist in whatever is necessary.

There may also be a temptation to establish a personal relationship with a client: this is to be avoided, and if a nurse is unable to resist this temptation, CNCR could become problematic for that particular care provider. Over-involvement is always a risk with CNCR. The nurse must be careful to maintain professional lines and boundaries, and must not engage in selective reporting, the sharing of overly personal information, or paying more attention to one client over others who are equally in need (Holder & Schenthal, 2007).

How CNCR Is Established

CNCR is established when the nurse and patient come together "in the moment" in a collaborative spirit in which both offer input to the decision-making and care process (Pullen & Mathias, 2010, p. 4). The two view themselves as partners in the process rather than as one having an active role (the nurse) and one having a passive role (the patient). CNCR is established through a few basic, routine steps that allow the nurse to gain an understanding of the patient's needs and open a doorway into the patient's circle of trust. Active listening is a must—but it is also critical to take notice of the patient's cultural background and beliefs before making assumptions about the type of care the patient would like to receive.

To begin, the nurse should greet the client by name, make eye contact, and demonstrate confidence and a professional manner. The nurse should take a moment to explain why she is there, what she will be doing with the patient, and include the patient in the decision-making process while reviewing the care plan. This occurs by asking for the patient's preferences and explaining the available options. The patient's privacy should always be maintained and cultural sensitivity should be a top priority. The nurse, therefore, should be trained in transcultural nursing or have some degree of cultural competency in order to be proficient in this respect. By listening actively to what the patient is saying and using both social and emotional intelligence to establish rapport, the nurse can build on the client's trust and create a positive and healthy nurse-client relationship.

Conclusion

The collaborative nurse-client relationship is helpful in providing client-patients with the quality of care they require throughout the care process. Nurses can use CNCR to give patients support, information, education, and ownership in the care process by including them in decision-making. This approach can be especially helpful in cases of non-compliance, but it is not effective with every population—particularly those patients who are incapable of engaging or interacting with the nurse due to incapacitation. Barriers to CNCR include a nurse's lack of training, lack of emotional or social intelligence, lack of cultural competency, and the patient's lack of education. Focusing on overcoming these barriers can help to enhance the overall quality of care.

References

Burger, C. (2018). The importance of the nurse-patient relationship for patient care. Retrieved from

Chiaramonte, D., Kaiser, A., McMath, G., Simone, C. B., Regine, W. F., & Berman, B. (2018). Integrative wellness for patients receiving proton therapy: A patient-centered collaboration. The Journal of Alternative and Complementary Medicine, 24(9–10), 1012–1013.

Feo, R., Rasmussen, P., Wiechula, R., Conroy, T., & Kitson, A. (2017). Developing effective and caring nurse-patient relationships. Nursing Standard (2014+), 31(28), 54.

Holder, K. V., & Schenthal, S. J. (2007). Watch your step: Nursing and professional boundaries. Nursing Management, 38(2), 24–29.

Mulder, B. C., Lokhorst, A. M., Rutten, G. E., & van Woerkum, C. M. (2015). Effective nurse communication with type 2 diabetes patients: A review. Western Journal of Nursing Research, 37(8), 1100–1131.

Pullen, R. L., Jr., & Mathias, T. (2010). Fostering therapeutic nurse-patient relationships. Nursing Made Incredibly Easy! 8(3), 4.

Trautman, D. (2017). Collaboration: The key to healthcare transformation. Retrieved from