Building Nursing Relationships with Individuals with Reactive Attachment Disorder of Childhood

Abstract

In the United States alone, 800,000 children within the child welfare system will be diagnosed each year with severe attachment disorder because of serious abuse and neglect Most available treatment or methods of therapy involve psychiatric nurses working to build trust and the formation of healthy attachments and relationships with children with Reactive Attachment Disorder of Childhood (RAD). The purpose of this thesis was to explore relationship building between the psychiatric nurse and the child with RAD from the perspective of the nurse. Participants were four psychiatric nurses currently working in the field who had at least two years of adolescent psychiatric treatment experience. The participants were all asked about their experience forming relationships with children diagnosed with Reactive Attachment Disorder. Field notes and theoretical memos were written throughout the study. A theoretical model was developed to describe the basic social processes. Classic grounded theory analysis was used to analyze the data and discover categories. Transcripts were read, coded, and categories emerged. The core category identified from this study was “Developing a Relationship.” The supporting categories were “Recognizing Personal Weaknesses,” the nurses ability to objectively work with a patient while taking care of themselves, “Knowing their Behaviors,” recognizing the characteristics and expected behaviors of children with RAD, and finally “Initiating therapy,” when the relationship is formed successfully. A theoretical model was developed which describes the cycle of the therapeutic nursing relationship. This model can be used by nurses to gain an understanding of the phases of the therapeutic relationship between the nurse and patient, and can be modified to fit clinical practice.