The nurse practitioner-client therapeutic encounter: an integrative review of interaction in aged and primary care settings

Aims: To review the key features of the nurse practitioner-client interaction in the thera-peutic encounter to inform the development of nurse practitioner-led memory clinics.

Background: Nurse practitioners spend significant time interacting with clients and their families/caregivers yet there is limited research on this interaction during therapeutic encounters in aged and primary care contexts.

Design: Integrative review.

Data sources: Electronic search of CINAHL, Embase, Medline, PsychINFO, PubMed, Scopus, Web of Science 2004-2013; hand search of the Journal of Advanced Nursing, Journal of the American Academy of Nurse Practitioners and Journal of Clinical Nursing.

Review methods: Integrative literature review using Whittemore and Knafl's methodology.

Results: Ten published studies were included, representing over 900 nurse practitioners and their clients. Three key factors of nurse practitioner-client interaction were identified: nurse practitioner expertise and the influence of the therapeutic encounter context; affirming exchange as a bedrock of communication; and high levels of client engagement. In aged and primary care settings, where the therapeutic encounter requires and allows longer consultations, such as nurse practitioner-led memory clinics, patient-centred approaches can engage clients in consultations using a biopsychosocial framework, resulting in improved client satisfaction and, potentially, increased adherence to treatment plans. Nurse practitioners who are open and respectful, who encourage patients to provide more information about their lives and condition and are perceived by the client to be empathetic, are providing affirmation to the client.

Conclusion: Affirming interactions are a key feature of successful therapeutic encounters when time and context do not allow or warrant the full repertoire of patient-centred communication.