Note from the National Guideline Clearinghouse (NGC): In March 2006, the Registered Nurses Association of Ontario amended the current practice recommendations for this topic. Through the review process, no recommendations were added or deleted, however one recommendation was reworded to reflect new knowledge. The recommendations have been noted below as "changed" or "unchanged."
The Guideline Development Panel for the nursing best practice guideline for "Establishing Therapeutic Relationships" strongly urges organizations or practice settings to pay considerable attention to the recommendations under the heading Organization and Policy Recommendations (see Recommendations 5 to 14). Implementation of strategies to support the establishment of the therapeutic relationships between nurses and clients requires strong organizational support. Without such support, the journey towards meeting therapeutic relationship goals will be difficult. The Panel recommends organizations/practice settings conduct an organizational readiness assessment, plan and commence implementing initiatives that will establish the desirable supports. An organizational readiness assessment tool has been developed based on the recommendations in this guideline. See Appendix A in the original guideline document for the assessment tool.
Practice Recommendations
Requisite Knowledge
Recommendation 1 (Unchanged)
The nurse must acquire the necessary knowledge to participate effectively in therapeutic relationships.
Reflective Practice/Self-Awareness
Recommendation 2 (Changed March 2006)
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.
The Process of Developing a Therapeutic Relationship
Recommendation 3 (Unchanged)
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.
Education Recommendations
Basic Nursing Education
Recommendation 4 (Unchanged)
All entry-level nursing programs must include in-depth learning about the therapeutic process, including both theoretical content and supervised practice.
Professional Development
Recommendation 5 (Unchanged)
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.
Organizational and Policy Recommendations
Continuity of Care and Caregiver
Recommendation 6 (Unchanged)
Health care agencies will implement a model of care that promotes consistency of the nurse-client assignment, such as primary nursing.
Recommendation 7 (Unchanged)
Agencies will ensure that at minimum, 70 percent of their nurses are working on a permanent, full-time basis.
Time for Care
Recommendation 8 (Unchanged)
Agencies will ensure that nurses' work-load is maintained at levels conducive to developing therapeutic relationships.
Matching Patient Complexity with Appropriate Clinical Expertise
Recommendation 9 (Unchanged)
Staffing decisions must consider client acuity, complexity level, complexity of work environment, and the availability of expert resources.
Prevention of Stress and Burnout
Recommendation 10 (Unchanged)
Organizations will consider the nurse's well-being as vital to the development of therapeutic nurse-client relationships and support the nurse as necessary.
Evidence-Based Practice
Recommendation 11 (Unchanged)
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.
Nursing Leadership
Recommendation 12 (Unchanged)
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.
Clinical Supervision and Coaching
Recommendation 13 (Unchanged)
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.
Accreditation
Recommendation 14 (Unchanged)
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.
