Case Study 1 – Therapeutic Relationships 
Therapeutic communication is a purposeful communication between a patient and their healthcare provider in order to achieve a positive health outcome (Fite, Assefa, & Demissie, 2019). In this case study J.R a nurse practitioner works in a primary care facility. J.R works diligently to foster a therapeutic relationship with his patients by using effective communication skills. Most of J. Rs patients have some form of altered sensory perception such as deafness or blindness and he finds that by using humor and showing respect helps him bond with his patients. Building a good rapport with his patients, J. R can also promote health practices that will then reduce their rates of mortality.  
Therapeutic communication is based upon faith, emotional fulfillment, respect, hope, spiritual and physical needs, and most importantly trust (Fite et al., 2019). A lack of therapeutic communication impacts patient’s satisfaction and increases hospital stay length (Fite et al., 2019). Therefore, as healthcare providers we should always strive to have therapeutic communication with our patients. Some of the strategies we as providers can use are by listening attentively to their concerns, being non-judgmental, being patient, and by providing feedback.  
Moral distress is very common in all aspects of healthcare. Moral distress occurs when a healthcare provider feels as if they are unable to take ethically appropriate actions for their patients (Almutairi, Salam, Adlan, & Alturki, 2019). Healthcare providers around the globe are often faced with complex ethical dilemmas in their daily practice which can lead to burn out. In situations where two ethical decisions compete, healthcare providers must then rely upon their morals to try and make the right decision for their patients (Almutairi et al., 2019).  
There are many factors that hinder the ability of healthcare providers to act upon their moral agency. These factors include excessive workloads, lack of time and resources, conflicting patient and family needs, patient care concerns, patient high acuity, and professional conflict (Almutairi et al., 2019). These factors can make the healthcare provider feel powerless, which eventually leads to a psychological reaction known as a moral distress (Almutairi et al., 2019). Moral distress can be a serious problem leading to nightmares, depression, and sorrow (Almutairi et al., 2019). 
My personal sense of moral distress is often linked to inadequate resources. An example of this is when I am caring for a patient and their clinical condition is deteriorating and the patient needs to be transferred to ICU for closer and better management. If ICU then does not have enough nurses or beds and I must wait to transfer the patient. I often find myself feeling powerless because I still have my other patients that need attention that I cant give them because I am working hard to manage the more critical patient. Communication in this situation plays an important role. I must communicate with my team member and supervisors to make sure that my other patients are cared for. I must also communicate with the provider to receive orders for my critical patient. Additionally, I must communicate therapeutically with the critical patient as well as their family members.  
References 
Almutairi, A. F., Salam, M., Adlan, A. A., & Alturki, A. S. (2019). Prevalence of severe moral distress among healthcare providers in Saudi Arabia. Psychology research and behavior management, 12, 107“115. https://doi.org/10.2147/PRBM.S191037 (Links to an external site.) 
Fite, R. O., Assefa, M., Demissie, A., & Belachew, T. (2019). Predictors of therapeutic communication between nurses and hospitalized patients. Heliyon, 5(10), e02665. https://doi.org/10.1016/j.heliyon.2019.e02665 (Links to an external site.)