Maintaining a therapeutic relationship is particularly challenging within the com- munity because of the commonly intense nature of care, duration of contact and the non-clinical environment. Reflection with colleagues and clinical supervision become invaluable tools to facilitate the nurse in developing appropriate relationships with people.
INFLUENCE OF THE CURRENT AND FUTURE CONTEXT ON
103
Conclusion balance this with informed choice (Wilson, 2002; RCN, 2015b). There is a balance to be maintained between the rights of the child (dependent on their age and understanding) and the rights of the parents in decision making, against the risks of significant harm that might result from the treatment. The parents in the above scenario should be advised to ensure the advice regarding the complementary treatment comes from a registered practitioner. Community nurses need to assess their own knowledge base regarding complementary therapy and seek specialist advice if necessary. Within a therapeutic relationship the nurse will be aiming to facilitate an atmosphere where the parents feel able to be honest about the treat- ments the child is currently receiving, and should be able to direct children and their families to sources of appropriate information.
A final feature of the current context of care that may have an effect on the thera- peutic relationship is the fragmentation of care. It can be seen that the failure to deliver public service integration has resulted in dissatisfaction by service users who can at times experience services that appear confusing, fragmented and inflex- ible (Scottish Government, 2015; Wales Audit Office, 2014; DH, 2013). Despite the move towards integrated care, within the United Kingdom there is generally a divi- sion of health and social care (Wilson et al., 2009), this means that people within the community sometimes have to deal with a vast array of professionals, which can be an inhibitor in the development of a therapeutic relationship (Hyde and Cotter, 2001). The picture in Northern Ireland is different. Since 1973 Northern Ireland has had an integrated structure of health and social services. Nevertheless, ultimately strong leadership and clear vision by stakeholders throughout the United Kingdom are required to ensure a seamless service (Ham et al., 2013). The QNI (2013) also highlights the importance of a model for community nursing services facilitating strong leadership that promotes seamless and effective joined up care across profes- sions and agencies. The community nurse has a role to be mindful of the risk of fragmentation and to strive towards improved integrated working, liaison and pos- itive communication with relevant health professionals and agencies in order to build the potential for strong therapeutic relationships with service users. See Chapter 15 for more discussion on leadership.
CONCLUSION
In this chapter features and benefits of a therapeutic relationship have been identi- fied, leading to an exploration of some of the challenges community nurses face in establishing therapeutic relationships. In future community healthcare provision, challenges will be shaped by an increasingly multicultural, ageing and informed population. The growing provision of healthcare in the community only serves to reinforce the need to establish appropriate relationships with people receiving healthcare in the community, their families and other carers. Current government policy emphasises partnership in care at all levels; the challenge for the community nurse is to develop this opportunity in everyday working practice.
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Care across the lifespan
Helen McVeigh
INTRODUCTION
This chapter explores the concept of a lifespan approach to healthcare. It is an approach that is able to reflect on and adapt to changes in demographics, society and the expectations of individuals within the community. The health of an individual is influenced by a complex interaction of a range of factors including physiological, psychological, social, cultural and environmental issues. A sound understanding of the factors that influence growth and development across the lifespan can enable the community nurse to adopt a truly holistic approach in the assessment, planning, implementation and analysis of healthcare interventions; however, it is recognised that health professionals may have distinct roles in the community, often focused on specific stages of the lifespan (e.g. Health Visitor – child health 0–5 years). The importance of developing a broad viewpoint and an awareness of all aspects of the lifespan continuum should underpin effective care provision.