The nurses' views regarding the nurse-client relationship with children requiring long-term treatment

Abstract

In the literature, the therapeutic relationship is depicted as the negotiation of care between the child, the family and the nurse within professional boundaries. However, research shows that in pediatric long-term relationships, maintaining such a relationship is challenging for nurses; due to the various forces that affect its development and maintenance. This non-experimental, descriptive research study explores the views of twelve Maltese nurses regarding the nurse-client relationship with children requiring long-term care. These subjects were recruited by convenience sampling from three different wards which all care for children with long-term illnesses. Data was obtained by semi-structured, tape-recorded interviews, using a self constructed tool. The analysis of the qualitative data gathered was done by content analysis. Data findings revealed that nurses consider the need to develop such relationships of utmost importance; and are aware of its potential benefits on the clients' well-being. Trust, effective communication and interaction, and personal attributes of both the nurse and the clients, were described as chief influential elements in this relationship. In contrast, the physical environment was given the least consideration. This study also revealed that the longevity of the relationship may be an advantage as well as a disadvantage. It was found that nurses face difficulties in maintaining the right level of involvement, due to the increased sense of closeness and familiarity with their clients, as well as due to the subjectivity of emotional involvement. Thus, in order to maintain healthy relationships, this study recommends staff support through continuous professional development, sufficient manpower resources, encouraging reflection as well as professional guidance. It also advocates the need for defining and encouraging professional boundaries, and indicates that a joint effort from the nurses as a team, as well as good leadership in the ward may be beneficial for sustaining long professional nurse-client relationships. In order to explore further such relationships, recommendations for further research are also made.