Nurse Education Today 35 (2015) e1–e5

Contents lists available at ScienceDirect

Nurse Education Today

journal homepage: www.elsevier.com/nedt

Review

Nursing therapeutics: Teaching student nurses care, compassion

and empathy☆
Cliff Richardson ⁎, Marcus Percy, Jane Hughes
University of Manchester, School of Nursing Midwifery and Social Work, Jean McFarlane Building, Ox ford Road, Manchester, M13 9PL, United Kingdom

a r t i c l e i n f o s u m m a r y

Article history: Background: Debate continues regarding whether humanitarian values such as care and compassion can be
Accepted 19 January 2015 taught or are innate in individuals who wish to become nurses.
Objectives: To undertake a discursive review of the literature on caring, compassion and empathy. To understand
Keywords: the teaching and learning issues associated with these concepts. To design and implement an Undergraduate
Caring Unit of study which addresses the development of caring, compassion and empathy in student nurses.
Compassion
Methods/data sources: MEDLINE, CINAHL, and a wide range of literature including books and governmental
Empathy
Therapeutic relationship
reports were used for a discursive narrative review.
Nursing therapeutics Results: Caring, compassion and empathy are ill-defined; however healthcare users are clear that they know
when nurses use skills and attitudes associated with these concepts. Evidence is available to show that caring,
compassion and empathy can be taught and there are tools available to measure them in neophytes through
their training. Central to the androgogical embedding of these concepts into nursing curricula is the development
of therapeutic relationships.
Conclusions: It is possible to develop materials to enable student nurses to learn how to care using compassion
and empathy. Nursing therapeutics is a term devised to describe how student nurses can exploit the therapeutic
potential of any patient contact especially when related to specific and routine nursing interventions. Muetzel's
model for understanding therapeutic relationships is one framework that can be adopted to help student nurses
to appreciate how to build patient relationships and encourage them to move towards therapeutic advantage
using care, compassion and empathy.
© 2015 Elsevier Ltd. All rights reserved.

Background Method

There is much debate about humanitarian values such as caring,
compassion and empathy in nursing. In particular there are questions
about whether these values are innate or if they can be taught. Addition-
ally there is interest and discussion amongst nurse educators about how
to develop students to function therapeutically. This paper will describe
how one UK University is addressing this topical issue with nursing stu-
dents by asking them to explore the therapeutic potential underpinning
nursing interventions.
Objectives: To undertake a discursive narrative review of the litera-
ture on caring, compassion and empathy. To understand the teaching
and learning issues associated with these concepts. To design and
implement an undergraduate unit of study which addresses the devel-
opment of caring, compassion and empathy in student nurses.
☆ No funding was used for this paper.
⁎ Corresponding author. Tel.: +44 161 3067639; fax: +44 1613067077.
E-mail address: Clifford.richardson@manchester.ac.uk (C. Richardson).
Data sources: MEDLINE, CINAHL, and a wide range of literature
including books and governmental reports were used for this discursive
review. Individual and combined searches were undertaken using car*,
compassion, empathy, therapeutic relationship, learn* and androgogy.
The resulting literature were read and topics themed to ensure that all
areas could be linked together into a coherent collective that enabled
sufficient rigour to construct an undergraduate module of study based
on the subject matter. The following review incorporates literature
from Australia, Canada, Cyprus, Finland, Greece, New Zealand, Norway,
Republic of Ireland, Spain, Turkey, USA and all four countries of the UK.
Care, Compassion and Empathy
Kindness, concern, sensitivity, caring, compassion and empathy are
known to be the most valued activities of nurses (Attree, 2001). A recent
UK focus group study of 52 health service users overwhelmingly found
that the top requirement for nurses was a caring and professional atti-
tude (Griffiths et al., 2012). Although these health service users wanted
the nurse to be skilled technically, they valued non-judgemental and
patient-centred care more highly. Arguably, caring is the core business

http://dx.doi.org/10.1016/j.nedt.2015.01.016
0260-6917/© 2015 Elsevier Ltd. All rights reserved.
e2 C. Richardson et al. / Nurse Education Today 35 (2015) e1–e5

of nursing (Shields, 2013) but despite patients respecting nurses for their Nursing Therapeutics
caring nature, academically it has been difficult to produce a definition
that everyone will sign up to, potentially because it is hard to measure sci- The remit of the Nursing Therapeutics Unit Team was to apply the
entifically (McCrae, 2012). Additionally the inter-relatedness and nebu- principles of the therapeutic relationship to nursing interventions. In
lous nature of concepts such as caring, compassion and empathy make order to do this the team had to:
it difficult to be sure that everyone is talking about the same thing.
In the international literature, caring is often described in terms of, • ensure that the therapeutic relationship is appropriate to nursing
or associated with, aspects of the nurse patient/client interactions, • identify an evidence-based model for therapeutic relationship build-
such as having a sympathetic presence and person-centeredness ing
(McCance et al., 2009). It is seen as intrinsic to the core of nursing, shap- • make clear links between the internationally derived concepts of ther-
ing the nurse's therapeutic drive and is activated when patient-centred apeutic relationship, care, compassion and empathy
care is delivered by developing a therapeutic relationship (Welch, 2005, • understand whether (and how) caring, compassion and empathy can
Granados Gamez, 2009, Canning et al., 2007, Dewar and Mackay, 2010). be taught
As an illustration the most commonly utilised tool for measuring caring, • identify an androgogical strategy for implementation to second year
the Caring Behaviours Inventory (CBI), captures four elements; assur- student nurses.
ance of human presence, knowledge and skill, respectful deference to
others and positive connectedness (Wolf, 1986, Wu et al., 2006).
These four essentials for caring are clearly related to the features identi- Each of these was considered at length and a précis of the processes
fied by health service users, but it is unclear whether they are the same, involved in meeting these 5 criteria is given below.
as a pan-European study of patients (n = 1659) and nurses (n = 1195)
from 34 different hospitals identified many similarities in the descrip- Therapeutic Relationships
tors used for caring across the countries but also found some differences
too (Papastavrou et al., 2012). A full appreciation of the complexities of the therapeutic relation-
Despite being utilised frequently by a wide variety of contemporary ship remains elusive however nurses continue to publish on the individ-
professional and political stakeholders, compassion is also defined ual elements, the complexities and benefits of developing such
vaguely and often in terms of the human reaction to suffering relationships. In order to teach the development of therapeutic relation-
(Straughair, 2012). Compassion has been associated with the advance- ships we required a simple but effective model. One such model was
ment of nursing education in the 20th century and with the moral proposed by Muetzel and incorporates three components; partnership,
virtues of the technically competent nurse (Bradshaw, 2011). Expres- intimacy and reciprocity which coalesce to create a therapeutic relation-
sions such as dignity, kindness and humanity are used to describe ship (Muetzel, 1988). Muetzel illustrated the model by representing the
compassionate care (DH, 2010b, DH, 2010a, RCN, 2010) and recent in- three concepts as overlapping circles (Fig. 1) and suggested that the
ternational discussions suggest that, as part of ‘fundamental practice’ middle section where the circles signifying partnership, intimacy and
and ‘everyday nursing care’, compassion underpins professional nursing reciprocity overlap is the point at which a therapeutic relationship
(Straughair, 2012). One example where compassion influences care is occurs. An imbalance in any one would disrupt the potential for the
pain management where it is known that patients can often report therapeutic relationship to influence the care delivered (McMahon,
high satisfaction despite high levels of pain. If compassion is at the 1998).
centre of the nurses pain management care this may be able to explain Recent empirical research confirms that Muetzel's model continues
this dichotomy (Quinlan-Cowell, 2014, Slatyer et al., 2014). to resonate with the therapeutic relationship. Partnership is universally
As part of his ‘Core Conditions’ known as empathy, congruence and found to be important and is associated with other concepts such as col-
unconditional positive regard, Carl Rogers defined empathy as: laboration, trust, mutuality, respect, understanding, shared decision-
making and empowerment. In one mixed methods study, using focus
‘the capability to sense the client's private world as if it were your groups of nurses (n = 13) and service users (n = 13) followed by a sur-
own’ (Rogers, 1957) p99. vey constructed from the focus group discussions, shared participation
and partnership was clearly articulated as being important by both
Notwithstanding the simplicity of this definition, and the elegance of
the principle, in the context of talking therapies and the humanistic
approach, it is clear that during his lifetime Rogers felt the need to
return to his definition and to refine its qualities. In terms of contempo-
rary nursing practice whether empathy is a skill that can be taught and
tapped into or an innate quality that is then fostered and inserted into ev-
eryday professional behaviours continues to attract debate (Brunero et al.,
2010). Unlike caring and compassion, empathy is mostly designated as a
cognitive or emotional concept and is less likely to be described in terms
of behaviours; however user groups associate empathy with kindness
and warmth and have clearly stated that they recognise when it is not
present (Griffiths et al., 2012, Williams and Stickley, 2010).
Despite the complications arising from the vagueness of the defini-
tions of caring, compassion and empathy, it is clear that health service
users can detect these and other related qualities in nurses' behaviours
and attitudes. This evidence was used for the development of a unit of
study intended to help student nurses learn about and explore the
nature of care, compassion and empathy in nursing. The following
sections describe how an international evidence-based approach was
utilised to identify frameworks to confirm the educational validity of
helping the students to learn about these essential nursing concepts.
The unit of study was entitled ‘Nursing Therapeutics’. Fig. 1. Muetzel's model of therapeutic relationships.
 C. Richardson et al. / Nurse Education Today 35 (2015) e1–e5
groups (McCloughen et al., 2011). Another study interviewed mental
health nurses to find out their impressions of what makes a therapeutic
relationship (Welch, 2005). Partnership development was inherent in
the identification of the need for trust, congruence and mutuality
which is confirmed by other studies (Canning et al., 2007, Scanlon,
2006). Indeed these key active ingredients are also noted in studies
where the nurse is working with vulnerable or stigmatised clients
such as criminals, single mothers or people with eating disorders
where connections between nurse and client may be a greater chal-
lenge (Snell et al., 2010, Porr et al., 2012, Rose et al., 2011, Ramjan,
2004).
The need for intimacy was identified by (Maslow, 1970) in the con-
text of love and belonging. Stickley and Freshwater offer that Rogers'
idea of unconditional positive regard is equivalent to altruistic love
which they propose is fostered in an alliance with the client that is ther-
apeutic (Stickley and Freshwater, 2002). Therefore in the context of the
therapeutic relationship, recognising the other person creates a bond of
professional intimacy. Recent evidence captures intimacy within con-
cepts such as nurse presence, providing comfort, empathy, befriending,
care and compassion. Shattell et al (2007) interviewed 20 health care
users asking them for their experiences of the therapeutic relationship.
Intimacy was reflected within two of the three overarching themes
identified from those interviews. Theme 1 was called ‘Relate to me’
and included elements such as self-disclosure, openness, genuineness
which made them feel special whilst theme 2 ‘Know me as a person’
included genuine concern, sincerity and understanding (Shattell et al.,
2007). In a larger grounded theory interview study (n = 145) of day-
case patients 4 core categories of the therapeutic relationship were
identified (Mottram, 2009). These were: nurse presence; being made
to feel extra special; befriending; and comfort-giving. All four categories
have intimacy as a fundamental element. The interesting aspect of
Mottram's study was that the nurse was able to introduce the essential
components of the therapeutic relationship with fleeting contact time,
and once introduced the patients considered that their effect persisted
even when the nurse wasn't present in person. Therefore, at the thera-
peutic encounter, the nurse recognises an interconnection and is able to
look beyond the mundane and superficiality to the person and their
humanity.
Muetzel's third contributor to the therapeutic relationship, reciproc-
ity, is a little harder to find within the recent literature. The principle
that relationships are two-way and that the nurses should recognise
that they receive benefit from the nurse/patient relationship is arguably
found within concepts such as collaboration, mutuality, congruence,
reciprocal exchange and the sharing of values and beliefs. Shattell and
colleagues' third theme ‘get to the solution’ included the need for prac-
titioners to work together to achieve agreed goals. The service users
identified that the agreement within these goals is suggestive that the
nurse/practitioner has as much investment in the achievement as the
service user (Shattell et al., 2007).
Complementary to those results a care home constructivist case
study which included observation, focus groups and interviews found
that reciprocal exchange and shared values were important to create a
therapeutic relationship (Brown Wilson, 2009). In addition joint experi-
ential learning was identified as one constituent of therapeutic relation-
ships by a grounded theory study which interviewed mental health
nurses (Scanlon, 2006).
Overall therefore, Muetzel's model is verified by recent research
findings and could be utilised as an androgogical framework for under-
standing and developing therapeutic relationships. Further support of
the utility of developing therapeutic relationships arises from findings
that patient outcomes are improved when a therapeutic relationship
has been developed. Unravelling the therapeutic relationship from the
health treatment or therapy is often challenging, with many studies
appearing to rely upon narrative or description to convey the improve-
ment. There is an urgent need for more research in this area. Mixed
methods to triangulate and specifically identify the therapist effect
e3
rather than deliberately controlling it out, as undertaken by randomised
controlled trials, would be an appropriate strategy.
Even so there is some evidence to suggest that outcomes are
improved by developing the therapeutic relationship. A literature
review evaluating the benefit of using the therapeutic relationship
with people with enduring mental health problems concluded that
when the practitioner/client relationship becomes therapeutic, out-
comes are improved (Hewitt and Coffey, 2005).
Further evidence of the effect of therapeutic relationships arises
from a two-part survey and interview study of specialist palliative
care nurses (n = 74) which identified the development of the ther-
apeutic relationship as the most important aspect of practice
(Canning et al., 2007). The specialist nurses identified all of the key
elements of Muetzel's model and were clear that outcomes were
improved when the therapeutic relationship was established.
Pain studies have shown that nurses endorse more potential thera-
pies than any other professional group (Brown and Richardson,
2006) and a more recent study suggests that they may use non-
pharmacological methods of pain relief as a way to develop thera-
peutic relationships (Svendsen and Bjørk, 2014). Building such rela-
tionships improved pain, mood and relationship satisfaction in a
randomised study of couples (n = 47) where one of the pair was
experiencing chronic pain (Miller et al., 2013). Although more stud-
ies to confirm improved outcomes are needed, these examples in
addition to the tacit nursing agreement that therapeutic relation-
ships are a positive thing suggested that they should be encouraged
in nursing students. Before embedding this into the curriculum the
Nursing Therapeutics team required links between the therapeutic
relationship, caring, compassion and empathy and contextual
markers that could be used to create learning resources targeted
towards the development of caring, compassionate and empathetic
nurses through therapeutic relationships.
Caring, Compassion, Empathy and Therapeutic Relationships
Following another critical health care inquiry and report in the
UK there has been a search to establish what needs to change to pro-
duce a culture of care and compassion. The Francis report (2013)
identified areas where care delivery had been poor (Francis, 2013)
and in response, the Chief Nursing Officer of England championed
the 6C's initiative (Care, Compassion, Communication, Competence,
Courage and Commitment). Although not explicitly mentioned in
the consultation document it is heavily implied that incorporating
the 6C's into nursing care will make a difference to the nurse/patient/
client relationship (DH, 2012). So alongside Rogers' core conditions
the 6C's could be utilised as a compass point for the core values of
nurses and provide a useful landmark from which to orientate the
therapeutic relationship.
Several authors make the link between care, compassion and empa-
thy and the therapeutic relationship. In an observational study of nurses
working in three emergency departments in Australia, compassionate
caring was found to be central to experienced nurses' everyday practice
(Fry et al., 2013). Technical nursing functions were found to be no bar-
rier to caring, indeed Fry and colleagues suggest that compassionate
caring itself is a highly skilled and technical undertaking which allows
a nurse to make a difference.
Another study using focus-groups of experienced paediatric nurses
(n = 14) found that non-pharmacological approaches to pain manage-
ment were utilised at least in part to enable the nurse to build a
therapeutic relationship (Svendsen and Bjørk, 2014). Additionally moti-
vational therapeutic assessment of couples (n = 47) in which one
spouse had chronic pain showed that spousal empathy increased in
those randomised to the therapeutic arm of the study (Miller et al.,
2013). Care, compassion and empathy can therefore be said to be linked
to therapeutic relationships (Granados Gamez, 2009).
e4 C. Richardson et al. / Nurse Education Today 35 (2015) e1–e5
Links Between Care, Compassion, Empathy, Therapeutic Relation-
ships and Education
In the UK the requirement for all nurses to be trained to degree level
has only recently been adopted. This however has sparked a debate
about whether the move towards degree trained nurses has been partly
responsible for the ‘crisis’ in care identified by the Francis Report
(Darbyshire and McKenna, 2013). Whilst this debate has been
popularised by a number of key stakeholders, in essence the argument
revolves around the potential that as nurses become more highly edu-
cated, and take on ever more complex technological duties, they
increasingly delegate and move away from the patient and care
delivery.
At the same time there is an increasing body of literature exploring
how to teach care, compassion and empathy. Using transformational
learning one study of 108 nursing units eloquently describes how caring
can be taught and how such a training programme can affect change in
attitude and care (Herbst et al., 2010). Another study used Action
Research to identify practical processes and issues which enable nurses
to deliver compassionate care (Dewar and Mackay, 2010). This four
phase project used observation, interviews and discussion groups with
nurses, patients and family members to identify action plans which
aimed to assist with enhancing the compassionate approaches within
an elderly care unit. From the results it is clear that being supportive,
valuing relationships and reflection are pivotal to conveying compas-
sion, all of which could be taught and embedded into nursing registra-
tion programmes.
A review of the effectiveness of empathy education in nursing found
17 studies (Brunero et al., 2010). The majority (n = 11) found that
empathy scores were statistically higher following education. Another
paper, published after Brunero and colleagues' review, utilised two dif-
ferent empathy tools on pre-registration nurses in Turkey and found a
statistical improvement in empathy communication skills (p b 0.05) at
the end of the programme (Ozcan et al., 2010). Overall the majority of
evidence suggests that empathy can be taught; however the best educa-
tion method and empathy assessment tool have yet to be elucidated
(Larocco, 2010). Nevertheless, the likely content of any course will
need to focus on a number of areas including the process of nurse
socialisation (Mackintosh, 2006) any dissonance between professional
idealism and practice realism (Curtis et al., 2012), the relief of loneliness,
providing comfort and meeting the need to be understood (Williams
and Stickley, 2010).
Introducing Nursing Therapeutics Into the Curriculum
Having clearly established that care, compassion empathy and the
therapeutic relationship are fundamental to nursing and that these
concepts can be taught we then turned to how they would be delivered
to undergraduate nurses. The Nursing Therapeutics Unit of study was
designed to allow second year student nurses to explore caring, com-
passion and empathy whilst undertaking common nursing interven-
tions such as bed-bathing or catheter insertion. Within small group
seminars Muetzel's model is used as a prism through which the stu-
dents explore Field specific (Adult, Child and Mental Health) content
using case scenarios and vignettes. The facilitator for the sessions
encourages students to consider the scenarios and interventions from
alternative perspectives rather than pure delivery of the intervention.
For instance the students are asked to consider questions such as
‘How do you make a difference?’ ‘What must it feel like?’ ‘What would
you do or think?’ and ‘How would you like to be treated if you had
this intervention undertaken on you?’ The term nursing therapeutics
was coined to establish the connection between a nurse's actions and
patient outcome.
For the assessment each student produces a poster incorporating 4
sections. Section 1 identifies a nursing intervention and requires the
student to state clearly why the intervention is important to nursing.
It explores the assessment element underpinning the need for the inter-
vention and then feeds into section 2 which requires the student to
appraise the evidence supporting the intervention and asks then to
identify any competing interventions. For example if the intervention
is mouth care the appraisal should include comparisons between agents
used to clean the mouth. Section 3 reviews the literature on therapeutic
relationships and section 4 links the therapeutic relationship with the
intervention chosen. The student is asked to show how the principles
of relationship building can be incorporated into the delivery of their
chosen intervention. An example would be to explore partnership, inti-
macy and reciprocity (Muetzel, 1988) whilst helping a patient to repo-
sition. The poster enables students to identify the ‘science’ and ‘art’ of
nursing and envisions them to create potential therapeutic advantage
in all nurse/patient/client interaction.
Conclusions
Caring, compassion, empathy and the therapeutic relationship can
all be taught. We have chosen to use Muetzel's model as a framework
to allow students to consider how they would exhibit caring, compas-
sion and empathy whilst undertaking common nursing interventions
and to use these traits to develop a therapeutic relationship. Our inten-
tion is to utilise the strong nursing posters to publish papers, with the
students, showing how to become ‘therapeutic’ whilst delivering
‘basic’ or fundamental nursing care. This will enable the student to
develop skills of academic writing and dissemination, whilst also build-
ing the nursing therapeutics curriculum for future student cohorts. Fur-
ther evaluations are ongoing and we hope to use these to publish
further in this area.
References
Attree, M., 2001. Patients' and relatives' experiences and perspectives of ‘Good’ and ‘Not
so Good’ quality care. J. Adv. Nurs. 33, 456–466.
Bradshaw, A., 2011. Compassion: what history teaches us. Nurs. Times 107, 12–14.
Brown, C.A., Richardson, C., 2006. Nurses' in the multi-professional pain team: a study of
attitudes, beliefs and treatment endorsements. Eur. J. Pain 10, 13–22.
Brown Wilson, C., 2009. Developing community in care homes through a relationship-
centred approach. Health Soc. Care Community 17, 177–186.
Brunero, S., Lamont, S., Coates, M., 2010. A review of empathy education in nursing. Nurs.
Inq. 17, 65–74.
Canning, D., Rosenberg, J.P., Yates, P., 2007. Therapeutic relationships in specialist pallia-
tive care nursing practice. Int. J. Palliat. Nurs. 13, 222–229.
Curtis, K., Horton, K., Smith, P., 2012. Student nurse socialisation in compassionate prac-
tice: a grounded theory study. Nurse Educ. Today 32, 790–795.
Darbyshire, P., Mckenna, L., 2013. Nursing's crisis of care: what part does education own?
Nurse Educ. Today 33, 305–307.
Dewar, B., Mackay, R., 2010. Appreciating and developing compassionate care in an acute
hospital setting caring for older people. Int. J. Older People Nursing 5, 299–308.
DH, 2010a. Front Line Care: Report by the Prime Ministers Commission on the Future of
Nursing and Midwifery in England. In: UK, D.O.H. (Ed.), The Stationary Office, London.
DH, 2010b. The NHS Constitution. In: UK, D.O.H. (Ed.), The Stationary Office, London.
DH, 2012. Compassion in practice: Nursing, Midwifery and care staff, our vision and strat-
egy [Online]. Available:. http://www.england.nhs.uk/wp-content/uploads/2012/12/
compassion-in-practice.pdf.
Francis, R., 2013. The Mid Staffordshire NHS Foundation Trust Public Inquiry. In: UK,
D.O.H. (Ed.), HM Stationery Office, London, UK.
Fry, M., Macgregor, C., Ruperto, K., Jarrett, K., Wheeler, J., Fong, J., Fetchet, W., 2013. Nurs-
ing praxis, compassionate caring and interpersonal relations: an observational study.
Australas. Emerg. Nurs. J. 16, 37–44.
Granados Gamez, G., 2009. The nurse–patient relationship as a caring relationship. Nurs.
Sci. Q. 22, 126–127.
Griffiths, J., Speed, S., Horne, M., Keeley, P., 2012. ‘A caring professional attitude’: what ser-
vice users and carers seek in graduate nurses and the challenge for educators. Nurse
Educ. Today 32, 121–127.
Herbst, A.M., Swengros, D.I., Kinney, G., 2010. How to teach human caring: nurse educator
role in transformational learning for a large healthcare system. J. Nurses Staff Dev. 26,
E6–E11.
Hewitt, J., Coffey, M., 2005. Therapeutic working relationships with people with schizo-
phrenia: literature review. J. Adv. Nurs. 52, 561–570.
Larocco, S.A., 2010. Assisting nursing students to develop empathy using a writing assign-
ment. Nurse Educ. 35, 10–11.
Mackintosh, C., 2006. Caring: the socialisation of pre-registration student nurses: a longi-
tudinal qualitative descriptive study. Int. J. Nurs. Stud. 43, 953–962.
Maslow, A., 1970. Motivation and Personality. Harper and Row, New York.
 C. Richardson et al. / Nurse Education Today 35 (2015) e1–e5
Mccance, T., Slater, P., Mccormack, B., 2009. Using the caring dimensions inventory as an
indicator of person-centred nursing. J. Clin. Nurs. 18, 409–417.
Mccloughen, A., Gillies, D., O'brien, L., 2011. Collaboration between mental health con-
sumers and nurses: shared understandings, dissimilar experiences. Int. J. Ment.
Health Nurs. 20, 47–55.
McCrae, N., 2012. Whither nursing models? The value of nursing theory in the context of
evidence-based practice and multidisciplinary health care. J. Adv. Nurs. 68, 222–229.
McMahon, R., 1998. Therapeutic Nursing — Theory, Issues and Practice. In: PEARSON, A.
(Ed.), MCMAHON, R. Nursing as Therapy. Cheltenham, Stanley Thornes.
Miller, L.R., Cano, A., Wurm, L.H., 2013. A motivational therapeutic assessment improves
pain, mood, and relationship satisfaction in couples with chronic pain. J. Pain 14,
525–537.
Mottram, A., 2009. Therapeutic relationships in day surgery: a grounded theory study.
J. Clin. Nurs. 18, 2830–2837.
Muetzel, P.-A., 1988. Therapeutic nursing. In: Pearson, A. (Ed.), Primary Nursing: Nursing
in the Burford and Oxford Nursing Development Units. Croom Helm, Beckenham.
Ozcan, C.T., Oflaz, F., Sutcu Cicek, H., 2010. Empathy: the effects of undergraduate nursing
education in Turkey. Int. Nurs. Rev. 57, 493–499.
Papastavrou, E., Efstathiou, G., Tsangari, H., Suhonen, R., Leino-Kilpi, H., Patiraki, E., Karlou,
C., Balogh, Z., Palese, A., Tomietto, M., Jarosova, D., Merkouris, A., 2012. A cross-
cultural study of the concept of caring through behaviours: patients' and nurses' per-
spectives in six different EU countries. J. Adv. Nurs. 68, 1026–1037.
Porr, C., Drummond, J., Olson, K., 2012. Establishing therapeutic relationships with vulner-
able and potentially stigmatized clients. Qual. Health Res. 22, 384–396.
Quinlan-Cowell, A., 2014. Understanding the paradox of patient pain and patient satisfac-
tion. J. Holist. Nurs. 27, 177–182.
Ramjan, L.M., 2004. Nurses and the ‘therapeutic relationship’: caring for adolescents with
anorexia nervosa. J. Adv. Nurs. 45, 495–503.
RCN, 2010. Principles of Nursing Practice: Principles and Measures Consultation Summary
Report for Nurse Leaders. Royal College of Nursing, London.
e5
Rogers, C., 1957. The necessary and sufficient conditions of therapeutic personality
change. J. Couns. Psychol. 21, 95–103.
Rose, D.N., Peter, E., Gallop, R., Angus, J.E., Liaschenko, J., 2011. Respect in forensic psychi-
atric nurse–patient relationships: a practical compromise. J. Forensic Nurs. 7, 3–16.
Scanlon, A., 2006. Psychiatric nurses' perceptions of the constituents of the therapeutic re-
lationship: a grounded theory study. J. Psychiatr. Ment. Health Nurs. 13, 319–329.
Shattell, M.M., Starr, S.S., Thomas, S.P., 2007. ‘Take my hand, help me out’: mental health
service recipients' experience of the therapeutic relationship. Int. J. Ment. Health
Nurs. 16, 274–284.
Shields, L., 2013. The core business of caring: a nursing oxymoron? Collegian. J. Royal Coll.
Nursing Aust. http://dx.doi.org/10.1016/j.colegn.2013.03.001.
Slatyer, S., Williams, A.M., Michael, R., 2014. Seeking empowerment to comfort patients in
severe pain: a grounded theory study of the nurse's perspective. Int. J. Nurs. Stud. 52,
229–239.
Snell, L., Crowe, M., Jordan, J., 2010. Maintaining a therapeutic connection: nursing in an
inpatient eating disorder unit. J. Clin. Nurs. 19, 351–358.
Stickley, T., Freshwater, D., 2002. The art of loving and the therapeutic relationship. Nurs.
Inq. 9, 250–256.
Straughair, C., 2012. Exploring compassion: implications for contemporary nursing. Part
2. Br. J. Nurs. 21, 239–240.
Svendsen, E.J., Bjørk, I.T., 2014. Experienced nurses' use of non-pharmacological ap-
proaches comprise more than relief from pain. J. Pediatr. Nurs. 29, e19–e28.
Welch, M., 2005. Pivotal moments in the therapeutic relationship. Int. J. Ment. Health
Nurs. 14, 161–165.
Williams, J., Stickley, T., 2010. Empathy and nurse education. Nurse Educ. Today 30,
752–755.
Wolf, Z., 1986. The caring concept and nurse identified caring behaviours. Top. Clin. Nurs.
8, 84–93.
WU, Y., Larrabee, J., Putman, H., 2006. Nurs. Res. 55, 18–25.