Relationships, like the handwritten letter, are rapidly becoming a thing of the past.
Gone are the days when the bank teller knew you, your children and your pets (no more lollipops and dog treats); the grocery check out, site of many conversations about the goings-on at the high school, whose son was dating whose daughter, and local politics, is now a machine with an electric eye that only recognizes bar codes, not your face.
From this isolated, impersonal climate, healthcare receives its clients.
People who are at their worst - fearful, tired and sick - come flooding into the emergency department. It literally may have been days since this person had any human contact, and now it is the expectation that a trusting relationships will spontaneously flourish between healthcare providers and the client.
Of course, it is imperative to note that the two participants in the relationship are total strangers with no past history or connectedness.
Among all the people patients will interact with, nurses are the most consistent presence during the hospital admission. From the admission process through discharge, it is the nurse who gains the insight into the needs, expectations and anticipated outcomes that exist.
The admission database requires the nurse learn personal information about the patient and its impact on admission. Once shared, this intimacy provides the foundation from which a trust relationship is built between nurse and client, interlocked with confidentiality, which cements the trust factor and allows an atmosphere of safety and security to form.
Mary Ferguson- Paré, vice president, professional affairs and chief nurse executive, UHN Health Network, Toronto, perhaps best articulates the definition of a transpersonal nursing relationship in her vision statement:
"Nursing is a caring, relationship-based practice. [Nurses] bring their unique knowledge, based on human science and nursing science, to their relationship with patients/families to support them in making decisions and choices about their health to achieve quality of life."1
It is here in this statement that nurses and patients have an identity in the relationship; one is the healthcare provider, the nurse, while the other is the recipient of the healthcare, the patient. With nomenclature attached, roles are created and with roles come expectations, customary behavior, and an anticipated set of values of which both are aware.
Jean Watson, PhD, RN, AHN-BC, FAAN, founder of the Original Center for Human Caring at the University of Colorado Denver, College of Nursing, Aurora, CO, offers her Theory of Human Caring as a foundation to accentuate the client relationship and caring aspects of the nursing profession.
Watson states, "Transpersonal caring seeks to connect with and embrace the spirit or soul of the other through the processes of caring and healing, and being in authentic relationship, in the moment."2
Care Delivery Model
Recognizing the fundamentals of her theory, in March 2007 the nurses at Mary Washington Hospital in Fredericksburg, VA, voted to adopt Watson's theory as a basis for the care they were providing. The focus on nurses and their caring relationship with patients was the driving force for that election.
As a group, the nurses verbalized the importance of the client relationship as critical to their being able to meet the needs of the patient. The nurses did not want to be simply task-oriented in their care.
While not minimizing the significance of skill sets and a strong knowledge base, these nurses believed that connectedness with the patient intertwines the needs and expectations of the patient with the plan of care and therefore the outcome is patient centered and quality driven.
Understanding the foundational theory of the organization directs caring initiatives and provides the nurses with a structure and goals to be achieved. This level of caring demands that nurses be able to relate to the person in their care and establish a professional link that intensifies as the sharing continues.