Keywords
Nurse-patient relationship
Therapeutic relationship
Indonesian’ framework
How to Cite
Abstract
Cancer care requires exceptional therapeutic relationships due to patients' complex physical and emotional needs, yet these relationships face unique challenges in resource-constrained settings. In Indonesian oncology units, where high patient volumes and limited resources strain nurse-patient interactions, understanding the current state of therapeutic relationships becomes particularly crucial. This study aims to explore the nurse-patient therapeutic relationship along with respect, genuineness, empathy, trust, and confidentiality, to identify problems and challenges encountered by nurses and patients related to their therapeutic relationship, and to develop a proposed nurse-patient therapeutic framework for cancer patients in Indonesian contexts. A descriptive phenomenology approach was used in this study. 17 nurses and 15 patients were recruited using a purposive sampling method. Data was collected through in-depth interviews, verbatim transcribed, and thematically analyzed. Total 11 themes and 24 sub-themes emerged in 5 aspects of the nurse-patient therapeutic relationship. Problems and challenges encountered by nurses and patients need to be solved by improving nurse communication and developing a trusting relationship with patients and improving patients’ comfort through improving hospital facilities. The proposed framework of the nurse-patient therapeutic relationship between nurses and patients may be used as the basis for developing a standard of nursing care for cancer patients.
References
AACN. (2008). The essentials of baccalaureate education for professional nursing practice. AACN.
Alligood, M. (2017). Pakar Teori Keperawatan Dan Karya Mereka (A. Hamid & K. Ibrahim (eds.); Edisi Indo). Elsevier.
Bafandeh Zendeh, M. Hemmati Maslakpak, M. Jasemi, M. (2022). Nurses’ perceptions of their supportive role for cancer patients: A qualitative study. Nursing Open, 9(1), 646–654. https://doi.org/https://doi.org/10.1002/nop2.1112
Balynska, O., Teremetskyi, V., Zharovska, I., Shchyrba, M., & Novytska, N. (2021). Georgian Medical News. 321, 147–153.
Bayat, M., Shahriari, M., & Keshvari, M. (2019). The relationship between moral distress in nurses and ethical climate in selected hospitals of the Iranian social security organization. Journal of Medical Ethics and History of Medicine, 12(8). https://doi.org/https://doi.org/10.18502/jmehm.v12i8.1339
Bazilainsky, S., Cohen, M., Holtmaat, K., Erlich, B., & Verdonck-de Leeuw, I. M. (2023). The impact of cancer on psychosocial function and quality of life: A cross-sectional study in 18 pan-European countries. Psycho-Oncology, 32(3), 383–392. https://doi.org/https://doi.org/10.1002/pon.6083
Bernardo, M. L. (1984). Developing the Professional Nursing Relationship. Nursing Forum, 21(1), 12–14. https://doi.org/10.1111/j.1744-6198.1984.tb01088.x
Borré-Ortiz, Miguel, Y., Prada-Reyes, Sandra, Arrieta-Paternina, Audit, De la Hoz-Pantoja, Y., Uranis, Jimenez-Maury, Yurisney, Santos-Puello, & Cristian. (2018). Importance of nursing care in patients with breast cancer: A narrative review. Revista Salud Uninorte, 34(2), 475–493. https://doi.org/https://doi.org/10.14482/sun.34.2.616.99
Bosek, M. . (2008). Respecting a patient’s religious values: what does this require? JONA’S Healthcare Law, Ethics and Regulation, 10(4), 100–105. https://doi.org/https://doi.org/10.1097/NHL.0b013e31818edd8b
Bottorff, J. L., Gogag, M., & Engelberg-Lotzkar, M. (1995). Comforting: exploring the work of cancer nurses. Journal of Advanced Nursing, 22(6), 1077–1084. https://doi.org/https://doi.org/10.1111/j.1365-2648.1995.tb03108.x
Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. ., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74(3), 229–263. https://doi.org/https://doi.org/10.3322/caac.21834
Bruine de Bruin, W., Parker, A. M., & Fischhoff, B. (2007). Individual differences in adult decision-making competence. Journal of Personality and Social Psychology, 92(5), 938–956. https://doi.org/10.1037/0022-3514.92.5.938
College of Nurses of Ontario. (2019). Therapeutic Nurse-Client Relationship. College of Nurses of Ontario.
Dawson-Rose, C., Cuca, Y. P., Webel, A. R., Solís Báez, S. S., Holzemer, W. L., Rivero-Méndez, M., Sanzero Eller, L., Reid, P., Johnson, M. O. Kemppainen, J., Reyes, D., Nokes, K., Nicholas, P. K., Matshediso, E., Mogobe, K. D., Sabone, M. B., Ntsayagae, E. I., Shaibu, S., Corless, I. B., Wantland, D., & Lindgren, T. (2016). Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care. The Journal of the Association of Nurses in AIDS Care : JANAC, 27(5), 574–584. https://doi.org/https://doi.org/10.1016/j.jana.2016.03.001
Dikmen, Y., Karataş, H., Arslan, G. G., & Ak, B. (2016). The Level of Professionalism of Nurses Working in a Hospital in Turkey. Journal of Caring Sciences, 5(2), 95–102. https://doi.org/https://doi.org/10.15171/jcs.2016.010
Emich, C. (2018). Conceptualizing collaboration in nursing. Nursing Forum, 53(4), 567–573. https://doi.org/https://doi.org/10.1111/nuf.12287
Entwistle, V. A., & Watt, I. S. (2013). Treating patients as persons: A capabilities approach to support delivery of person-centered care. The American Journal of Bioethics, 13(6), 29–39. https://doi.org/https://doi.org/10.1080/15265161.2013.802060
Ferlay, J., Colombet, M., Soerjomataram, I., Parkin, D. M., Piñeros, M., Znaor, A., & Bray, F. (2021). Cancer statistics for the year 2020: An overview. International Journal of Cancer, 149(4), 778–789. https://doi.org/10.1002/ijc.33588
Foronda, C., Baptiste, D.-L., Reinholdt, M. M., & Ousman, K. (2016). Cultural humility: A concept analysis. Journal of Transcultural Nursing, 27(3), 210–217.
Friedman, M. M. (1998). Family nursing: Theory and practice (3rd ed.) (3rd ed.). Appleton & Lange.
Galleryzki, A. R., Sartika, M., Lubbna, S., Mahendra, D., Lamonge, A. S., Anggraini, Y., & Antonelda, A. (2023). Falsafah dan Teori Keperawatan. Yayasan Kita Menulis.
Giger, J. ., & Davidhizar, R. . (1995). Transcultural Nursing : Assessment and Intervention, 2nd Ed, Missouri (2nd Ed, Mi). Mosby Year Book Inc.
Griffith, R. (2013). Professional boundaries in the nurse-patient relationship. British Journal of Nursing (Mark Allen Publishing), 22(18), 1087–1088.
Haidrani, L. (2017). “Treat patients like family.” Emergency Nurse : The Journal of the RCN Accident and Emergency Nursing Association, 25(1), 41. https://doi.org/https://doi.org/10.7748/en.25.1.41.s27
Highfield, M. E. (2002). Providing spiritual care to patients with cancer. Clinical Journal of Oncology Nursing, 4(3), 116–120.
Jiang, D., & Shi, G. (2021). Research on Data Security and Privacy Protection of Wearable Equipment in Healthcare. Journal of Healthcare Engineering. https://doi.org/https://doi.org/10.1155/2021/6656204
Kant, I. (1789). Groundwork of the metaphysics of morals (J. W. Elli). Hackett Publishing.
Kant, I. (1949). Critique of practical reason. L. W. Beck (Trans.). University of Chicago Press.
Kav, S., Johnson, J., Rittenberg, C., Fernadez-Ortega, P. Suominen, T., Olsen, P. R., Patiraki, E., Porock, D., Dahler, A., Toliusiene, J., Tadic, D., Pittayapan, P., Roy, V., Wang, Q., Colak, M., Saca-Hazboun, H., Makumi, D., Kadmon, I., Ami, S. B., Anderson, E., & Clark-Snow, R. (2008). Role of the nurse in patient education and follow-up of people receiving oral chemotherapy treatment: an international survey. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 16(9), 1075–1083. https://doi.org/https://doi.org/10.1007/s00520-007-0377-x
KBBI. (2008). Peraturan Menteri Kesehatan Republik Indonesia Nomor 4 Tahun 2008. Indonesia : Kementerian Kesehatan RI.
Kim, K. S., & Kwon, S. H. (2007). Comfort and quality of life of cancer patients. Asian Nursing Research, 1(2), 125–135. https://doi.org/https://doi.org/10.1016/S1976-1317(08)60015-8
Kirana, S. A. C., Martyastuti, N. E., Lestari, A. S., Achjar, K. A. H., Nuryanti, Y., Gama, I. K., & Mustika, I. W. (2023). Falsafah & Teori Keperawatan. PT. Sonpedia Publishing Indonesia.
Koh, A. (1999). Non-judgemental care as a professional obligation. Nursing Standard (Royal College of Nursing (Great Britain) : 1987, 13(37), 38–41. https://doi.org/https://doi.org/10.7748/ns1999.06.13.37.38.c2612
Kupcewicz, E., Grochans, E., Kadučáková, H., Mikla, M., Bentkowska, A. Kupcewicz, A., Andruszkiewicz, A., & Jóźwik, M. (2021). Personalized Healthcare: The Importance of Patients’ Rights in Clinical Practice from the Perspective of Nursing Students in Poland, Spain and Slovakia-A Cross-Sectional Study. Journal of Personalized Medicine, 11(3), 191. https://doi.org/https://doi.org/10.3390/jpm11030191
Leininger, M. M. (1984). Care: The essence of nursing and healthNo Title. Nursing & Health Care, 5(3), 149–152.
Leininger, M., & McFarland, M. R. (2002). Transcultural Nursing : Concepts,Theories, Research and Practice (3rd Ed). Mc-Graw Hill Companies.
Leslie, J. L., & Lonneman, W. (2016). Promoting Trust in the Registered Nurse-Patient Relationship. Home Healthcare Now, 34(1), 38–42. https://doi.org/https://doi.org/10.1097/NHH.0000000000000322
Long, F. J., Chen, H., Wang, Y. F., He, L. M., Chen, L., Liang, Z. B., Chen, Y. N., Gong, X. HLong, F. J. Chen, H., Wang, Y. F., He, L. M., Chen, L., Liang, Z. B., Chen, Y. N., & Gong, X. H. (2020). Research on the effect of health care integration on patients’ negative emotions and satisfaction with lung cancer nursing activities. World Journal of Clinical Cases, 8(18), 4059–4066.
Mahfudh, S. S. (2011). Nurse’s role in controlling cancer pain. Journal of Pediatric Hematology/Oncology, 33(2), s146–s148. https://doi.org/https://doi.org/10.1097/MPH.0b013e318230dfd8
Makoul, G., Zick, A., & Green, M. (2007). An Evidence-Based Perspective on Greetings in Medical Encounters. Arch Intern Med, 167(11), 1172–1176. https://doi.org/doi:10.1001/archinte.167.11.1172
Marco, D., & White, V. M. (2019). The impact of cancer type, treatment, and distress on health-related quality of life: cross-sectional findings from a study of Australian cancer patients. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 27(9), 3421–3429. https://doi.org/https://doi.org/10.1007/s00520-018-4625-z
Mayeroff, M. (1971). On caring (1st U.S. e). Harper & Row.
Mayfield, E., Highfield, M. E. F., & Mendelson, S. (2020). Meaning of Courtesy and Respect. Journal of Nursing Care Quality, 35(2), 177–181. https://doi.org/10.1097/NCQ.0000000000000424
McEwen, M., & Wills, E. M. (2018). Theoretical basis for nursing (5th ed.) (5th ed). Lippincott Williams & Wilkins.
Mercer, S. W., & Reynolds, W. J. (2002). Empathy and quality of care. The British Journal of General Practice : The Journal of the Royal College of General Practitioners, 52, S9–S12.
Milton, C. L. (2005). The ethics of respect in nursing. Nursing Science Quarterly, 18(1), 20–23. https://doi.org/https://doi.org/10.1177/0894318404272103
Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making. International Journal of Environmental Research and Public Health, 17(3), 835. https://doi.org/https://doi.org/10.3390/ijerph17030835
Moudatsou, M. Stavropoulou, A., Philalithis, A., & Koukouli, S. (2020). The Role of Empathy in Health and Social Care Professionals. Healthcare (Basel, Switzerland), 8(1), 26. https://doi.org/https://doi.org/10.3390/healthcare8010026
Olejarczyk, J. P., & Young, M. (2022). Patient Rights And Ethics. StatPearls Publishing.
Opland, C., & Torrico, T. (2024). Psychotherapy and Therapeutic Relationship. Treasure Island (FL): StatPearls Publishing.
Ozturk, H., Torun Kılıç, Ç., Kahriman, İ., Meral, B., & Çolak, B. (2022). Assessment of nurses’ respect for patient privacy by patients and nurses: A comparative study. Journal of Clinical Nursing, 30(7–8), 1079–1090. https://doi.org/090. https://doi.org/10.1111/jocn.
Pavedahl, V., Muntlin, Å., Summer Meranius, M., Von Thiele Schwarz, U., & Holmström, I. K. (2022). Prioritizing and meeting life-threateningly ill patients’ fundamental care needs in the emergency room-An interview study with registered nurses. Journal of Advanced Nursing, 78(7), 2165–2174. https://doi.org/https://doi.org/10.1111/jan.15172
Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of nursing (9th ed (9th ed). Mosby Year Book Inc.
Putri, D. M. P. (2018). Keperawatan Transkultural ; Pengetahuan dan Praktik Berdasarkan Budaya (Cet. I). Pustaka Baru Press.
Rahmani, A., & Ghahramanian, A. Alahbakhshian, A. (2010). Respecting to patients’ autonomy in viewpoint of nurses and patients in medical-surgical wards. Iranian Journal of Nursing and Midwifery Research, 15(1), 14–19.
Rajcan, L., Lockhart, J. S., & Goodfellow, L. M. (2020). Generating Oncology Patient Trust in the Nurse: An Integrative Review. Western Journal of Nursing Research, 43(1), 85–98. https://doi.org/https://doi.org/10.1177/0193945920930337
Rao, T. S., Radhakrishnan, R., & Andrade, C. (2011). Standard operating procedures for clinical practice. Indian Journal of Psychiatry, 53(1), 1–3. https://doi.org/https://doi.org/10.4103/0019-5545.75542
Royal College of Nursing. (1994). “Genuine” nurses provide better care. Nursing Standard, 8(50), 11. https://doi.org/https://doi.org/10.7748/ns.8.50.11.s24
Shanahan, T., & Cunningham, J. (2021). Keys to Trust-Building with Patients. Journal of Christian Nursing : A Quarterly Publication of Nurses Christian Fellowship, 38(2), E11–E14. https://doi.org/https://doi.org/10.1097/CNJ.0000000000000823
Sharma, N., & Grupta, V. (2022). In StatPearls. StatPearls Publishing.
Tariq, R. A., & Sharma, S. K. (2022). Patient Confidentiality. In StatPearls. StatPearls Publishing.
Thakur, K., & Shama, S. K. (2021). Nurse with smile: Does it make difference in patients’ healing? Industrial Psychiatry Journal, 30(1), 6–10. https://doi.org/https://doi.org/10.4103/ipj.ipj_165_20
Valizadeh, L., Zamanzadeh, V., Azimzadeh, R., & Rahmani, A. (2012). The View of Nurses toward Prioritizing the Caring Behaviors in Cancer Patients. Journal of Caring Sciences, 1(1), 11–16. https://doi.org/https://doi.org/10.5681/jcs.2012.002
Vatn, L., & Dahl, B. M. (2022). Interprofessional collaboration between nurses and doctors for treating patients in surgical wards. Journal of Interprofessional Care, 36(2), 186–194. https://doi.org/https://doi.org/10.1080/13561820.2021.1890703
Wensley, C., Botti, M., McKillop, A., & Merry, A. F. (2020). Maximising comfort: how do patients describe the care that matters? A two-stage qualitative descriptive study to develop a quality improvement framework for comfort-related care in inpatient settings. BMJ Open, 10(5), e033336. https://doi.org/https://doi.org/10.1136/bmjopen-2019-033336
Wilkes, L. M., & White, K. (2005). The family and nurse in partnership: providing day-to-day care for rural cancer patients. Australian Journal of Rural Health, 13(2), 121–126. https://doi.org/https://doi.org/10.1136/bmjopen-2019-033336
World Health Organization. (2022). Global report on patient rights and healthcare governance. Geneva : Switzerland : WHO.
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