What is Relationship-Centred Care©?
What is Relationship-Centred Care© ? After years of having worked as a nurse, I have realised that all types of healing–physical, mental and emotional–require good relationships to be built. Whether it’s between a patient and their doctor, or even the patient’s relationship with their own self, these connections are an important and integral part of quality healthcare. This concept is known as Relationship-Centred Care©.
An inspirational study I came across some time ago was Pew-Fetzer’s Task Force on Advancing Psychosocial Health Education, published in 1992. In this study, Pew-Fetzer establishes the concept of Relationship-Centred Care© with a goal to analyze how healthcare systems had changed and how they were going to evolve going forward.
In 1969, the term “patient-centred care” was coined to mean a medical approach that sought to focus more on the needs of the patient rather than the needs of the system. According to Pew-Fetzer, this concept should be developed further to focus on the the caregiver-patient interaction. This interaction should become more relationship based rather than transactional, as it had been in the past. Moreover, the Relationship-Centred Care© approach should also include the manifold relationships that link patient, clinician, team, organizations, and community.
What are the constitutive parts of a Relationship-Centred Care© approach?
Emotion and affect are both integral parts of the process.
Showing genuine emotion is important in creating and maintaining any kind of relationship, and it also builds trust. Patient-clinician relationships are no different. Why? Showing understanding and empathy to the patient can help the patient express themselves better, and in turn potentially help the clinician with diagnosis and treatment. This would likely create a better outcome and quality of life for the patient.
Genuine relationships are valuable in healthcare because they help clinicians gain the trust and respect of the patient. If a physician is doing their job and acting as a “human participant” rather than providing a customer service-type relationship, it makes both parties invested in getting the best possible outcome in an honest, genuine way.
A colleague shared a touching story with me about how she was nursing a terminally ill patient and his wife simply wished for a cuddle from her husband, but they were finding it quite difficult. He had an infusion pump and it wasn’t easy to get him comfortable in his bed. With the help of a slide sheet she managed to get him on his side, then helped his wife get in bed behind him so they could spend some time together and cuddle during the night. A sweet gesture of understanding that made both of their experiences substantially different.
All healthcare encounters relate to one another.
Every time a patient sees a doctor, it is not an isolated incident: a relationship is formed. While the obvious goal of any healthcare encounter is to get proper treatment or improve health, letting the patient develop that relationship with their doctor(s) can help create a more balanced relationship between the patient and the caregiver. Moreover, developing long lasting relationships endows all the parties with a sense of continuity: patients receive consistent care from people they know; staff have consistent positive work assignments; family has the opportunity to talk to professionals they know and value.
Recently I read a very touching account of a family member whose terminally ill mum was cared for at home by a professional nurse, Margaret-Ann. The daughter remembered how Margaret-Ann helped the whole family to go through a difficult time and connect with each other:
“When Margaret-Ann came for the first time she just clicked with Mum. They formed a close bond. She wasn’t a stranger in the house. She was part of the family. She would come in and have a cup of tea, biscuits, and we would chat. We felt safe in the knowledge that she was here.”
Relationships among everyone involved in care
Finally, and most importantly, Relationship-Centred Care© not only regards the relationship between patient and clinician, but includes reciprocal and interdependent relationships among everyone involved in care, including the patient, family members, and the staff. And I’m convinced that relationships between co-workers, between doctors and nurses, between nurse managers and RPNs, must also be considered integral to the Relationship-Centred Care© framework.
I believe that framing healthcare delivery around Relationship-Centred Care© keeps the patient-centred care at the forefront, but also strongly enhances the care experience for patients, family and caregivers alike, while considering the emotions and mindset of all the parties involved, and gives everyone a sense of purpose. Patients feel recognized and valued; nurses and doctors feel like their work matters; family feels that their care role is valued by the staff. A positive mindset is healthy for everyone.
I have also discussed the importance of positive relationships with the nurses at the Dermatology Ward at Groote Schuur Hospital in Cape Town. They routinely deal with patients that have had to go through severe dermatological issues. This is what they shared with me:
“We give all our energy and our smiles to our patients. Everyone that comes in through the doors of our department gets a look at healthy, vibrant, happy staff members. And that is so important because these patients deal with emotional and psychological damage.”
Sister Judy Wallace is one of those nurses. I’m honoured to announce that she will be in Toronto, on November 14th, at Leading from Humanity to share her own experience as Operational Nurse Manager in charge of the Dermatology Ward, and how she works every day with the challenges of humanity in the workplace.
Learn more about Leading from Humanity here.