Background

Therapeutic relationship has been recognized as fundamental to all nursing (Orlando, 1961; Peplau, 1952; Sundeen, Stuart, Rankin, & Cohen, 1989).
The essential qualities of the therapeutic relationship include respect, empathy and validation.
Much of the literature has focused on the elements of the relationship process: the qualities of the relationship; the sequencing of the process; the impediments to the process; and the outcomes of the process.

The qualities of the therapeutic relationship include: active listening, trust, respect, genuineness, empathy, and responding to client concerns.
Sequencing of the process: Forchuk (2000) and others have validated Peplau’s (1952/1988) phases of the therapeutic relationship (orientation, working, resolution), and discovered that some relationships go through a series of phases that are non-therapeutic (orientation, grappling and struggling, mutual-withdrawal).
Outcomes of the process: Research evaluating an approach to the therapeutic relationship has found reduced costs and improved quality of life for clients (Forchuk et. al, 1998abc)

Restructuring has had many impacts such as lower number of professional nurses to patients, replacement of professional with non-regulated health providers, increasing casual and part-time nurses, and decreased support mechanisms such as nurse educators and nurse managers.
These impacts have resulted in decreased patient and nurse satisfaction, emotional burnout, increased length of stay (Aiken et al., 2001), decreased quality of care as seen in outcomes such as functional independence, pain, social functioning and patient satisfaction (McGillis Hall et al., 2001).