</ref></ref> Nurse explaining information in a brochure with a client. Picture was taken by Bill Branson (Photographer). The nurse–client relationship is an interaction aimed to enhance the well-being of a "client, " which may be an individual, a family, a group, or a community. Peplau  's theory is of high relevance to the nurse-client relationship, with one of its major aspects being that both the nurse and the client become more knowledgeable and mature over the course of their relationship. Peplau, Hildegard E. Interpersonal Relations in Nursing. New York: G.P. Putnam's Sons, 1952. Interpersonal Theory in Nursing Practice: Selected Works of Hildegard E. Peplau. New York: Springer Publishing Company, 1989. Peplau believed that the relationship depended on the interaction of the thoughts, feelings, and actions of each person and that the patient will experience better health when all their specific needs are fully considered in the relationship. The nurse-patient relationship enables nurses to spend more time, to connect, to interact with their patients as well as to understand their patient's needs. It assists nurses to establish a unique perspective regarding the meaning of the patient's illness, beliefs, and preferences of patients/families. Thus, the patients/families feel that they are being cared for and they feel more motivated to open up to the nurses as well as working together to achieve better outcomes/satisfaction.Duffy, J. R. (2005). Implementing the Quality‐Caring model in acute care. Journal of Nursing Administration, 35(1), 4-6. Therapeutic nurse-patient communication is a key aspect of the performance of the nurse's role. Therapeutic communication benefits not only the patient but the nurse as well. Nurses report higher job satisfaction connected with positive communication with patients. Fakhr-Movahedi, A., Rahnavard, Z., Salsali, M., Negarandeh, R. (2016). Exploring nurse's communicative role in nurse-patient relationships: A qualitative study. Journal of Caring Sciences 5(4), 267-276. URL 10.15171/jcs.2016.028 Improved communication with patients increases the nurses ability to do their job effectively, which in turn increases job satisfaction. Reports of increased job satisfaction reduces the reported instance of compassion fatigue. Increased compassion fatigue reduce the nurse's ability to communicate effectively and compassionately with the patient, impairing therapeutic behaviours and communication, and decreasing the effectiveness of the nurse-patient relationship, and safe care.   It is a cycle where therapeutic communication leads to a positive relationship that increases both patient and nurse satisfaction that improves the nurses ability to continue therapeutic behaviours. Self-awareness is an internal evaluation of one self and of one's reactions to emotionally charged situations, people and places. It offers an opportunity to recognize how our attitudes, perceptions, past and present experiences, and relationships frame or distort interactions with others. An example of self-awareness would be acknowledging that showing anger is not a sign of weakness, because there were emotions outside of your control.Antai-Otong, D. (2007). Perspectives and Principles of Therapeutic Communication. In Nurse-Client Communication (1st ed., pp. 16-17). Sudbury, Massachusetts: Jones and Bartlett. Self-awareness allows you to fully engage with a client and presence; being with the client in the moment, allows the nurse to know when to provide help and when to stand back. Until individuals can fully understand themselves they cannot understand others. Nurses need self-awareness in this relationship to be able to relate to the patient's experiences to develop empathy. A major obstacle to cultural sensitivity and good communication is ethnocentrism, which is the belief that one's ethnic group is superior to another; this causes prejudice and stops a nurse from fully understanding the patient. Another obstacle is stereotyping; a patient's background is often multifaceted, encompassing many ethic and cultural traditions. In order to individualize communication and provide culturally sensitive care it is important to understand the complexity of social, ethnic, cultural and economic factors. This involves overcoming certain attitudes and offering consistent, non-judgemental care to all patients. Accepting the person for who they are regardless of diverse backgrounds and circumstances or differences in morals or beliefs. By exhibiting these attributes trust can grow between patient and nurse. Nurses need to know the outcome of social, cultural, and racial differences, and how they can affect the therapeutic relationship. Nurses need to acknowledge the impact of culture in order to practice health in a way that respects a person's beliefs and values. Clients' perspectives Coatsworth-Puspoky, Forchuk, and Ward-Griffin conducted a study on clients' perspectives in the nurse–client relationship. Interviews were done with participants from Southern Ontario, ten had been hospitalized for a psychiatric illness and four had experiences with nurses from community-based organizations , but were never hospitalized . The participants were asked about experiences at different stages of the relationship. The research described two relationships that formed the "bright side" and the "dark side". The "bright" relationship involved nurses who validated clients and their feelings. For example, one client tested his trust of the nurse by becoming angry with her and revealing his negative thoughts related to the hospitalization . The client stated, "she's trying to be quite nice to me ... if she's able to tolerate this occasional venomous attack, which she has done quite well right up to now, it will probably be a very beneficial relationship".Coatsworth-Puspoky, R., C. Forchuk, and C. Ward-Griffin. "Nurse–client processes in mental health: recipient's perspectives." Journal of Psychiatric and Mental Health Nursing 13 (2006): 347–355. EBSCOHost. McIntyre Lib., UW-Eau Claire. 12 November 2006. The "dark" side of the relationship resulted in the nurse and client moving away from each other. For example, one client stated, "The nurses' general feeling was when someone asks for help, they're being manipulative and attention seeking". The nurse didn't recognize the client who has an illness with needs therefore; the clients avoided the nurse and perceived the nurse as avoiding them. One patient reported, "the nurses all stayed in their central station. They didn't mix with the patients ... The only interaction you have with them is medication time". Neither trust nor caring was exchanged so perceptions of mutual avoiding and ignoring resulted. One participant stated, "no one cares. It doesn't matter. It's just, they don't want to hear it. They don't want to know it; they don't want to listen". The relationship that developed depended on the nurse's personality and attitude. These findings bring awareness about the importance of the nurse–client relationship. One client stated, "they were there for the smallest need. I remember one time where they repositioned me maybe five or six times in a matter of an hour". A good personality was stated by five participants as important. One said, "they were all friendly, and they make you feel like they've known you for a long time" (61) . Receiving adequate information was important to four participants. One participant said, "they explained things. They followed it through, step by step". The findings of this study show how trust is beneficial to a lasting relationship. Humour Humour is important in developing a lasting relationship. Astedt-Kurki, Isola, Tammentie, and Kervinen asked readers to write about experiences with humour while in the hospital through a patient organization newsletter. Letters were chosen from 13 chronically ill clients from Finland. The clients were also interviewed in addition to their letters. The interviews reported that humour played an important role in health. A paralyzed woman said, "Well you have to have a sense of humour if you want to live and survive. You have to keep it up no matter how much it hurts".Päivi Astedt-Kurki, Arja Isola, Tarja Tammentie, and Ulla Kervinen. "Importance of humour to client–nurse relationships and clients' well being." International Journal of Nursing Practice 7 (2001): 119–125. EBSCOHost. McIntyre Lib., UW-Eau Claire. 14 November 2006.
 Nurse explaining information in a brochure with a client. Picture was taken by Bill Branson (Photographer). The nurse–client relationship is an interaction between a nurse and "client" (patient) aimed at enhancing the well-being of the client, who may be an individual, a family, a group, or a community. Peplau Peplau 's theory is of high relevance to the nurse-client relationship, with one of its major aspects being that both the nurse and the client become more knowledgeable and mature over the course of their relationship. Hildegard Peplau believed that the relationship depended on the interaction of the thoughts, feelings, and actions of each person and that the patient will experience better health when all their specific needs are fully considered in the relationship. Peplau, Hildegard E. Interpersonal Relations in Nursing. New York: G.P. Putnam's Sons, 1952. Interpersonal Theory in Nursing Practice: Selected Works of Hildegard E. Peplau. New York: Springer Publishing Company, 1989. The nurse-patient relationship enables nurses to spend more time, to connect, to interact with their patients as well as to understand their patient's needs. It assists nurses to establish a unique perspective regarding the meaning of the patient's illness, beliefs, and preferences of patients/families. Thus, the patients/families feel that they are being cared for and they feel more motivated to open up to the nurses as well as working together to achieve better outcomes/satisfaction.Duffy, J. R. (2005). Implementing the Quality‐Caring model in acute care. Journal of Nursing Administration, 35(1), 4-6. Therapeutic nurse-patient communication is a key aspect of the performance of the nurse's role. Therapeutic communication benefits not only the patient but the nurse as well. Nurses report higher job satisfaction connected with positive communication with patients. Improved communication with patients increases the nurses ability to do their job effectively, which in turn increases job satisfaction. Reports of increased job satisfaction reduces the reported instance of compassion fatigue. Increased compassion fatigue reduce the nurse's ability to communicate effectively and compassionately with the patient, impairing therapeutic behaviours and communication, and decreasing the effectiveness of the nurse-patient relationship, and safe care. Fakhr-Movahedi, A., Rahnavard, Z., Salsali, M., Negarandeh, R. (2016). Exploring nurse's communicative role in nurse-patient relationships: A qualitative study. Journal of Caring Sciences 5(4), 267-276. URL 10.15171/jcs.2016.028 It is a cycle where therapeutic communication leads to a positive relationship that increases both patient and nurse satisfaction that improves the nurses ability to continue therapeutic behaviours. Self-awareness is an internal evaluation of one self and of one's reactions to emotionally charged situations, people and places. It offers an opportunity to recognise how our attitudes, perceptions, past and present experiences, and relationships frame or distort interactions with others. An example of self-awareness would be acknowledging that showing anger is not a sign of weakness, because there were emotions outside of your control.Antai-Otong, D. (2007). Perspectives and Principles of Therapeutic Communication. In Nurse-Client Communication (1st ed., pp. 16-17). Sudbury, Massachusetts: Jones and Bartlett. Self-awareness allows you to fully engage with a client and presence; being with the client in the moment, allows the nurse to know when to provide help and when to stand back. Until individuals can fully understand themselves they cannot understand others. Nurses need self-awareness in this relationship to be able to relate to the patient's experiences to develop empathy. A major obstacle to cultural sensitivity and good communication is ethnocentrism, which is the belief that one's ethnic group is superior to another; this causes prejudice and stops a nurse from fully understanding the patient. Another obstacle is stereotyping; a patient's background is often multifaceted, encompassing many ethic and cultural traditions. In order to individualise communication and provide culturally sensitive care it is important to understand the complexity of social, ethnic, cultural and economic factors. This involves overcoming certain attitudes and offering consistent, non-judgemental care to all patients. Accepting the person for who they are regardless of diverse backgrounds and circumstances or differences in morals or beliefs. By exhibiting these attributes trust can grow between patient and nurse. Nurses need to know the outcome of social, cultural, and racial differences, and how they can affect the therapeutic relationship. Nurses need to acknowledge the impact of culture in order to practice health in a way that respects a person's beliefs and values. Clients' perspectives Coatsworth-Puspoky, Forchuk, and Ward-Griffin conducted a study on clients' perspectives in the nurse–client relationship. Interviews were done with participants from Southern Ontario, ten had been hospitalised for a psychiatric illness and four had experiences with nurses from community-based organisations , but were never hospitalised . The participants were asked about experiences at different stages of the relationship. The research described two relationships that formed the "bright side" and the "dark side". The "bright" relationship involved nurses who validated clients and their feelings. For example, one client tested his trust of the nurse by becoming angry with her and revealing his negative thoughts related to the hospitalisation . The client stated, "she's trying to be quite nice to me ... if she's able to tolerate this occasional venomous attack, which she has done quite well right up to now, it will probably be a very beneficial relationship".Coatsworth-Puspoky, R., C. Forchuk, and C. Ward-Griffin. "Nurse–client processes in mental health: recipient's perspectives." Journal of Psychiatric and Mental Health Nursing 13 (2006): 347–355. EBSCOHost. McIntyre Lib., UW-Eau Claire. 12 November 2006. The "dark" side of the relationship resulted in the nurse and client moving away from each other. For example, one client stated, "The nurses' general feeling was when someone asks for help, they're being manipulative and attention seeking". The nurse didn't recognise the client who has an illness with needs therefore; the clients avoided the nurse and perceived the nurse as avoiding them. One patient reported, "the nurses all stayed in their central station. They didn't mix with the patients ... The only interaction you have with them is medication time". Neither trust nor caring was exchanged so perceptions of mutual avoiding and ignoring resulted. One participant stated, "no one cares. It doesn't matter. It's just, they don't want to hear it. They don't want to know it; they don't want to listen". The relationship that developed depended on the nurse's personality and attitude. These findings bring awareness about the importance of the nurse–client relationship. One client stated, "they were there for the smallest need. I remember one time where they repositioned me maybe five or six times in a matter of an hour". A good personality was stated by five participants as important. One said, "they were all friendly, and they make you feel like they've known you for a long time" . Receiving adequate information was important to four participants. One participant said, "they explained things. They followed it through, step by step". The findings of this study show how trust is beneficial to a lasting relationship. Humour Humour is important in developing a lasting relationship. Astedt-Kurki, Isola, Tammentie, and Kervinen asked readers to write about experiences with humour while in the hospital through a patient organisation newsletter. Letters were chosen from 13 chronically ill clients from Finland. The clients were also interviewed in addition to their letters. The interviews reported that humour played an important role in health. A paralyzed woman said, "Well you have to have a sense of humour if you want to live and survive. You have to keep it up no matter how much it hurts".Päivi Astedt-Kurki, Arja Isola, Tarja Tammentie, and Ulla Kervinen. "Importance of humour to client–nurse relationships and clients' well being." International Journal of Nursing Practice 7 (2001): 119–125. EBSCOHost. McIntyre Lib., UW-Eau Claire. 14 November 2006.
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