Behavioral Coaching Program in Enhancing Nurse-Patient Therapeutic Relationship

Research Proposal

Introduction

In the healthcare setting, therapeutic interpersonal relationships influence the effectiveness of treatment interventions administered to patients, which determines their outcomes in the long run. As such, clinicians strive to establish healthy relationships with their patients to understand their healthcare needs better and administer appropriate interventions. However, the clinicians’ effort to develop strong therapeutic relationships with their patients is often impeded by multiple barriers, including nurses’ lack of adequate emotional intelligence. Clinicians may fail to exhibit the capacity to understand, use, and manage their emotions positively to better communicate and empathize with patients. Such clinicians fail to develop appropriate interventional strategies for their clients as they deny them an opportunity to express their healthcare concerns. Eventually, the healthcare organization records poor patient outcomes as clinicians fail to address the patient’s health needs adequately. Poor therapeutic relationships also attract adverse implications such as medication nonadherence among patients and a negative organizational outlook and reputation. To address such a challenge, it is important to develop a strategy to improve clinicians’ emotional intelligence and enhance their capacity to develop good therapeutic relationships with their patients. The current study seeks to confirm whether introducing a structured behavioral coaching program for nurses could enhance nurse-patient therapeutic relationships.

Background

Past research studies have identified the role of therapeutic relationships in administering quality care services to patients. A study by Moreno‐Poyato, Rodríguez‐Nogueira, and MiRTCIME. CAT Working Group (2021) investigates factors contributing to establishing positive therapeutic relationships between nurses and their patients. The study identifies nurses’ empathy as the key factor for developing good therapeutic relationships. According to the study, empathy allows clinicians to establish with their patients characterized by trust (Moreno‐Poyato, Rodríguez‐Nogueira, & MiRTCIME. CAT Working Group, 2021). When nurses are empathetic to patients, they respect their health beliefs and points of view, which allows patients to trust them with their personal information and better express their healthcare needs (Ghaedi, Ashouri, Soheili, & Sahragerd, 2020). Eventually, the nurse develops the most appropriate therapeutic intervention for the patient based on the information they collect through therapeutic communication, which attracts positive patient outcomes in the long run. Another research conducted by Raghubir (2018) describes the role of emotional intelligence in establishing strong therapeutic relationships. If a patient feels that the nurse is judging their health illiteracy or health conditions, they tend to conceal some sensitive information concerning their medical history, current healthcare needs, and their overall satisfaction with care (Raghubir, 2018). To avoid such challenges, nurses ought to control their emotions and create a welcoming impression to their patients as a way to encourage greater interactions and the development of a strong and personalized therapeutic relationship (Raghubir, 2018). Therefore, empathy and emotional intelligence among nurses establish a foundation for strong therapeutic relationships.

Good therapeutic relationships have been praised for bringing about positive patient health outcomes. Fahlgren, Berman, and McCloskey (2020) investigated how the establishment of patient-centered Therapeutic Relationships impacts their health outcomes. According to the study, good therapeutic relationships encourage patients to share information concerning their healthcare needs and stimulate greater commitment to patients’ needs among clinicians (Fahlgren, Berman & McCloskey, 2020). As a result, the patient is administered the best care available, which helps to alleviate their health conditions and attract positive outcomes (Fahlgren, Berman & McCloskey, 2020). Patients also feel loved as the clinicians demonstrate empathy leading to increased patient satisfaction with care (Fahlgren, Berman & McCloskey, 2020). Therefore, the study associated good therapeutic relationships with improved health outcomes among patients and improved levels of satisfaction with care. Kingston and Greenwood (2020) identify the role of good therapeutic relationships in minimizing adverse events during care. Patients presenting with various mental health conditions and other health conditions may become irritated when there is a lack of trust between them and their clinicians (Kingston & Greenwood, 2020). Such patients may fail to comply with the clinicians’ instructions, which makes it difficult to administer treatments and develop prescriptions (Kingston & Greenwood, 2020). However, when clinicians develop good therapeutic relationships with such patients, they attract greater patient adherence and collaboration during care, which helps to avoid adverse events (Kingston & Greenwood, 2020). Therefore, good therapeutic relationships attract greater patient compliance and medication adherence, which results in positive health outcomes among patients.

Coaching for behavioral changes among nurses equips them with a greater capacity to develop good therapeutic relationships with their patients. According to Shao et al. (2018), engaging nurses in professional development programs that refine their behaviors is critical to improving the efficiency of the entire healthcare system. Such opportunities help nurses to identify any deficient skills and work towards acquiring them to develop personally and professionally (Shao et al., 2018). Coaching for behavioral changes also helps nurses to withdraw from behaviors that may potentially limit their capacity to complete their tasks and replace them with positive habits (Baby, Gale & Swain, 2018). Coaching for behavioral changes among nurses could help to enhance their interpersonal skills and emotional intelligence to develop good therapeutic relationships with their patients.

Significance of the Study

Good therapeutic relationships between clinicians and patients are associated with positive health outcomes. While the main objective of the healthcare delivery system is to implement strategies that alleviate adverse health conditions among patients, it is important to develop a strategy to optimize therapeutic relationships in the clinical setting. The current study will assess the feasibility of a structured behavioral coaching program for nurses in optimizing therapeutic relationships to attract positive health outcomes among patients.

Method

Aim of the study

The study aims to assess the effect of the structured behavioral coaching program on enhancing nurses’ knowledge and practice of therapeutic relationships.

Study Hypothesis

In-patient nurses who attended the structured behavioral coaching program will experience an improvement in their therapeutic relationship with their hospitalized patients.

Study Design

The study will adopt a quantitative pre-post test design to assess the effect of the structured behavioral coaching program on enhancing nurses’ knowledge and practice of therapeutic relationships. The design will compare the participants’ capacity to develop good therapeutic relationships before and after participating in the structured behavioral coaching program. Study inferences will be developed by assessing how much nurses’ cognitive-behavioral skills will have changed after the intervention.

Sampling Technique

The study will utilize a simple random sampling technique. It will involve selecting a subset of participants from the population and grouping them into sizable samples for easier analysis. Since the participants who make the subset participating in the study will be randomly chosen, the sampling method will facilitate the development of inferences that present the actual situation in the study population (Mendoza, Contreras-Cristán & Gutiérrez-Peña, 2021). Therefore, the sampling technique will result in unbiased estimates of the population.

Population

The population in the study will include all staff nurses who are involved in direct patient care at the inpatient units. A sample will be randomly drawn from the population to participate in the study. Generalized inferences will be developed based on the sample dynamics identified during the study.

Data Collection and Tools

The data collection strategy will involve the administration of a self-reporting survey to assess the nurses’ caring capabilities before and after the intervention. A Nyberg’s Caring Assessment (NCA) scale will be used to develop percentage scores in the nurses’ caring capabilities. An internal consistency method will be used to test content validity and reliability.

Data Analysis

A correlational data analysis will be used to assess the impact of the intervention on the nurses’ caring capabilities. The data analysis strategy will help to investigate the magnitude and significance of the structured behavioral coaching program in stimulating caring capabilities among nurses. Findings from data analysis will be used to develop a conclusion concerning the effectiveness of the structured behavioral coaching program in enhancing nurses’ capacity to develop good therapeutic relationships with patients.

Ethical Considerations

Ethical considerations during the study will include ensuring access to justice, informed consent, and confidentiality. A simple random sampling technique will be used to select study participants and ensure that each member of the population has an equal chance of being selected. The participants will be provided with sufficient information concerning the intentions of the study, their role in the research, and their expectations. Personal information shared by the participants will not be accessed by third parties to guarantee confidentiality.

Conclusion

The current study seeks to assess the effectiveness of a structured behavioral coaching program in enhancing cognitive and behavioral capabilities among nurses to develop strong therapeutic relationships with their patients. The study will adopt a quantitative pre-post test design to assess the effect of the structured behavioral coaching program on enhancing nurses’ knowledge and practice of therapeutic relationships. It will utilize a simple random sampling technique to select participants from a population comprising staff nurses who are involved in direct patient care at the inpatient unit. The data collection strategy will involve the administration of a self-reporting survey to assess the nurses’ caring capabilities before and after the intervention. A correlational data analysis will be used to assess the impact of the intervention on the nurses’ caring capabilities. Ethical considerations during the study will include ensuring access to justice, informed consent, and confidentiality.

References

Moreno‐Poyato, Antonio R., Óscar Rodríguez‐Nogueira, and MiRTCIME. CAT Working Group. “The association between empathy and the nurse–patient therapeutic relationship in mental health units: a cross‐sectional study.” Journal of Psychiatric and Mental Health Nursing 28, no. 3 (2021): 335-343. https://onlinelibrary.wiley.com/doi/abs/10.1111/jpm.12675

Ghaedi, F., Ashouri, E., Soheili, M., & Sahragerd, M. (2020). Nurses’ empathy in different wards: A cross-sectional study. Iranian Journal of Nursing and Midwifery Research, 25(2), 117. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055183/

Raghubir, A. E. (2018). Emotional intelligence in professional nursing practice: A concept review using Rodgers’s evolutionary analysis approach. International journal of nursing sciences, 5(2), 126-130. https://www.sciencedirect.com/science/article/pii/S2352013217303812

Fahlgren, M. K., Berman, M. E., & McCloskey, M. S. (2020). The role of therapeutic alliance in therapy for adults with problematic aggression and associated disorders. Clinical psychology & psychotherapy, 27(6), 858-886. https://onlinelibrary.wiley.com/doi/abs/10.1002/cpp.2475

Kingston, M. A., & Greenwood, S. (2020). Therapeutic relationships: Making space to practice in chaotic institutional environments. Journal of Psychiatric and Mental Health Nursing, 27(6), 689-698. https://onlinelibrary.wiley.com/doi/abs/10.1111/jpm.12620

Shao, Y. N., Sun, H. M., Huang, J. W., Li, M. L., Huang, R. R., & Li, N. (2018). Simulation-based empathy training improves the communication skills of neonatal nurses. Clinical Simulation in Nursing, 22, 32-42. https://www.sciencedirect.com/science/article/pii/S1876139918300537

Baby, M., Gale, C., & Swain, N. (2018). Communication skills training in the management of patient aggression and violence in healthcare. Aggression and violent behavior, 39, 67-82. https://www.sciencedirect.com/science/article/pii/S1359178916301288

Mendoza, M., Contreras-Cristán, A., & Gutiérrez-Peña, E. (2021). Bayesian Analysis of Finite Populations under Simple Random Sampling. Entropy, 23(3), 318. https://www.mdpi.com/1099-4300/23/3/318