Establishing Therapeutic Relationships
Purpose and scope
The purpose of this best practice guideline (BPG) is to address the therapeutic relationship and its central importance to nursing practice. Effective nursing practice is dependent on an effective therapeutic relationship between the nurse and the client. The guideline addresses the qualities and capacities of an effective therapeutic relationship, the state of knowledge, and the knowledge needed to be effective in a therapeutic relationship.
Please see also the supplement to this guideline which provides updated recommendations.
Main guideline (including 2006 supplement):
Registered Nurses’ Association of Ontario (2006). Establishing Therapeutic Relationships. (rev. suppl.) Toronto, Canada: Registered Nurses’ Association of Ontario
Recommendations
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Establishing Therapeutic Relationships.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Recommendation 1: The nurse must acquire the necessary knowledge to participate effectively in therapeutic relationships.
Recommendation 2: Establishment of a therapeutic relationship requires reflective practice. This concept includes the required capacities of: self-awareness, self-knowledge, empathy, awareness of ethics, boundaries and limits of the professional role.
Recommendation 3: The nurse needs to understand the process of a therapeutic relationship and be able to recognize the current phase of his/her relationship with the client.
Recommendation 4: All entry-level nursing programs must include in-depth learning about the therapeutic process, including both theoretical content and supervised practice.
Recommendation 5: Organizations will consider the therapeutic relationship as the basis of nursing practice and, over time, will integrate a variety of professional development opportunities to support nurses in effectively developing these relationships. Opportunities must include nursing consultation, clinical supervision and coaching.
Recommendation 6: Health care agencies will implement a model of care that promotes consistency of the nurse-client assignment, such as primary nursing.
Recommendation 7: Agencies will ensure that at minimum, 70 per cent of their nurses are working on a permanent, full-time basis.
Recommendation 8: Agencies will ensure that nurses’ workload is maintained at levels conducive to developing therapeutic relationships.
Recommendation 9: Staffing decisions must consider client acuity, complexity level, complexity of work environment, and the availability of expert resources.
Recommendation 10: Organizations will consider the nurse’s well-being as vital to the development of therapeutic nurse-client relationships and support the nurse as necessary.
Recommendation 11: Organizations will assist in advancing knowledge about therapeutic relationships by disseminating nursing research, supporting the nurse in using these findings, and supporting his/her participation in the research process.
Recommendation 12: Agencies will have a highly visible nursing leadership that establishes and maintains mechanisms to promote open conversation between nurses and all levels of management, including senior management.
Recommendation 13: Resources must be allocated to support clinical supervision and coaching processes to ensure that all nurses have clinical supervision and coaching on a regular basis.
Recommendation 14: Organizations are encouraged to include the development of nursing best practice guidelines in their annual review of performance indicators/quality improvement, and accreditation bodies are also encouraged to incorporate nursing best practice guidelines into their standards.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.
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Revision status
Current edition published: July 2002 with March 2006 supplement
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