The persuasive power of rapport

Research also supports the long-term, positive effects of therapeutic nurse-patient relationships on patient adherence to treatment.

It has been known for some time that patients who rate their therapists as more empathic experience substantially higher rates of treatment completion (Burns & Nolen-Hoeksema, 1992; Stockmann, 2018).  Empathy, however, must occur within the context of a therapeutic relationship.

The establishment of rapport allows nurses to strengthen therapeutic relationships to shape positive patient behaviors and motivate health change, including:

Element of Rapport	Patient Outcome(s)
Feeling understood (high perceived empathy)	Substantial improvement in treatment adherence (Derksen et al., 2013; Zolnierek & Dimatteo, 2009).Greater internal motivations to follow health provider’s advice (Morelli et al., 2014).Higher patient satisfaction and treatment effectiveness (Derksen et al., 2013, 2017).
Feeling trusted (high perceived trust)	Patients share information and communicate more openly (Minton et al., 2022; Phelan et al., 2015).Significantly improves quality of care and prevents adverse events, such as medication errors (Jeong & Park, 2022).
Developing shared goals (therapeutic alliance)	Higher patient-provider agreement within an inpatient psychiatric setting, and greater likelihood of treatment adherence following discharge (Moreno‐Poyato et al., 2018).Empowers the nurse to act on the patient’s behalf, adopting a more compassionate approach based on shared understandings of the patient’s needs (Jakimowicz et al., 2018).

CASE STUDY

Frances arrives late for her visit at a busy dialysis clinic.  Sally, a hemodialysis nurse, is surprised and notices that Frances also missed two other dialysis sessions this month.  Her serum sodium values are quite high, although Frances forget to bring her diet records to clinic for review.

Acknowledging this, RN Sally asks Frances if she is feeling sick or currently experiencing any challenges in her life.  Frances doesn’t answer her questions directly and instead talks about her recent experience of weight-gain and lower-leg edema after dialysis treatments.  Frances was initially told that hemodialysis would “make her feel better”, but that doesn’t seem to be case lately.

While hemodialysis patients generally place a high level of trust in their nursing provider, Ahmadpour et al. (2020) concluded that rapport is lost when hemodialysis nurses:

• Do not proactively share information with patients;
• Provide inaccurate advice and information; and,
• Do not manage weight gain and other treatment side-effects.

These low level misunderstandings are unlikely to produce disagreement, but often result in the erosion of a therapeutic nurse-patient relationship, which significantly predicts the avoidance of care and treatment adherence (Phelan et al., 2015).  This appears to have been Frances’ experience of care as well.

Practice Reflection: Introduction

Can a ‘single caring moment’ increase the amount of time available for care?

Let’s consider an example:

Shortly after arrival at the emergency department, the triage nurse apologized to Jack as the waiting room was quite full, saying: “Normally, you would be seen quicker, but today there are a lot of people who need to be seen before you… unfortunately”.

In this example, the triage nurse communicates concern for Jack’s situation.  Brief empathy interactions can significantly shift the direction of clinical conversations.

But, what do you think? 

Will a ‘single caring moment’ early in Jack’s clinical interaction build rapport and release time to care for Jack throughout their time in the emergency department? 

On the other hand, might this moment unveil a ‘pandora’s box’ of questions and concerns?

Practice Reflection: Debrief

Shortly after arrival at the emergency department, the triage nurse apologized to Jack as the waiting-room was quite full, saying: “Normally, you would be seen quicker, but today there are a lot of people who need to be seen before you… unfortunately”.

Research suggests that this brief interaction would likely improve the effectiveness of routine care interactions, reducing the time required to build rapport in future conversations with the patient (Howick et al., 2018).  Likewise, when health professionals demonstrate mastery of clinical empathy skills, research shows a significant improvement in therapeutic outcomes (Jani et al., 2012).

To save time, Pullyblank (2023) argues that a nurse can simply:

• Commit to a single caring moment;
• Intentionally connect with the patient during that moment; and,
• Attempt to help the patient in some way.

Brief empathy interactions allow nurses to build a less effortful style of communication.

With some practice, committing to a ‘single caring moment’ early in the nurse-patient interaction can reduce the risk of medication errors and improve the quality of care overall (Jeong & Park, 2022).

Why care sometimes lacks empathy

It feels good to understand our patients (Malezieux et al., 2023) and empathy strongly predicts the development of a therapeutic nurse–patient relationship (Moreno‐Poyato & Rodríguez‐Nogueira, 2021).  If this is the case, why would care sometimes lack empathy?

The answer lies in our environment for care, specifically whether our care environment prevents authentic connection and trust.

Two common barriers to empathy include:

• Burnout, exhaustion, and stress
• Stigma and discrimination