Scenario: The RN is caring for a group of patients with two individuals who present a challenge in developing a therapeutic relationship. One is a 15-year-old male who experienced a head injury after being thrown from the back of an all-terrain vehicle (ATV). The patient was placed on a ventilator. On the third day of hospitalization he begins to be more responsive, opening his eyes on request and following the movement of people in the room. The other patient is an elderly woman who does not speak English as her primary language. She had just received a diagnosis where she will need to make serious decisions about her care. Her adult son wants to be her interpreter. There are some very personal questions the RN will need to ask and is uncertain about the son’s involvement.

• Describe how the RN establishes a caring, therapeutic relationship with these patients.
• Can the RN approach these situations in the same manner as with patients who are awake, alert, and speak the same language?
• What strategies may the RN use to provide culturally sensitive nursing care that reflects the patient/family health- illness beliefs and healthcare practices?
• Discuss how the RN knows when therapeutic relationships are established (i.e., what evaluation criteria are met).

Consider these questions as you post your initial response to the discussion board. As you respond to your classmates, can you offer suggestions to them to enhance therapeutic communication and prevent barriers from occurring?