There is substantial evidence that good quality psychosocial care makes a difference. For example, thirty years of research has confirmed that the provision of information, counselling and supportive care improves health outcomes and wellbeing for women with breast cancer (Redman, Turner & Davis 2003). In other words, good psychosocial care doesn’t just make patients feel better emotionally; it can also influence their physical health! Despite this evidence, Redman et al (2003) note that many psychosocial interventions proven to be of worth have not been routinely adopted into clinical practice. This was the case with Jenny. She acknowledges that her physical care has been excellent and notes the kindness of all those nurses caring for her. And yet, she hasn’t had the opportunity with any of these professionals to really talk about how she is feeling.

In one Australian study (Irurita 1999), patients identified many factors which affected whether they felt well cared for or not. These factors included environmental issues, such as perceptions of ageism from some nurses, lack of funding and related staffing levels, and early discharge policies. Organisational factors included the quality of services offered by the health service, such as quality of food, communication and coordination between the different caregivers, information to patients, consistency in caregivers, and time available and how this influenced the nurse–patient relationship. Finally, the personal qualities of each health professional were seen to influence the quality of care patients received. As one participant in Irurita’s study noted (p 93), ‘I think all of the staff are trained to a very high level, but the level of compassion varies.’ In our case study, when Jenny finally got the opportunity to talk with Anne, the breast care nurse, Jenny not only received compassion but by being attentive, open and non-judgmental, the nurse empowered Jenny to share her experience and story in a manner that met Jenny’s need at that time. Jenny felt very relieved that she could finally talk about her feelings.

A qualitative research project investigating nurses’ perceptions of quality care revealed that the registered nurse participants saw psychosocial nursing as ‘being there’ in a supportive role (Williams 1998). Core skills in psychosocial nursing were seen to be communicating effectively, giving information, caring and being an advocate for the patient and family. A high level of care, termed therapeutically effective care by Williams, occurred when ‘therapeutically conducive relationships’ were established between nurses and their patients (1998 p 810). Trust and rapport were essential aspects of these relationships and evident in the case study relationship between Jenny and the nurse. The registered nurses who participated in William’s study argued that therapeutically conducive relationships underpinned the provision of effective nursing care. That is, patients’ needs could only be properly assessed once these relationships were established. Jenny may have been experiencing a sense of guilt for the burden that her illness had brought to her family, but this could only be identified and addressed after the establishment of a therapeutic relationship between Jenny and her nurses.