Bowlby’s evolutionary theory of attachment proposes that children are naturally pre-programmed to create relationships with others to survive (Wu, 2019). Monotropy refers to a child’s intrinsic urge to bond to one major attachment figure, implying that one relationship is more essential than all others. According to Wu (2019), there is a key phase for attachment development (2.5 years). If an attachment does not form during this time frame, it is possible that it will not form at all. Bowlby later advocated a 5-year sensitivity period. According to Bowlby’s maternal deprivation theory, ongoing disturbance of the relationship between newborn and primary caregiver can lead to long-term cognitive, social, and emotional problems in the child (Barbaro, 2020).
The mother-child connection and the nurse-patient interaction have certain commonalities. Because the baby requires the mother’s assistance and protection to survive risky situations, attachment behavior (proximity seeking) develops when the child is in a stressful or unpleasant scenario (Hooper et al., 2022). Similarly, patients have a natural need to associate with a caring figure (the physician or nurse) to sustain their health during a period of pain and suffering. As a result, nurse-patient bonding is subconsciously linked to the early attachment connection.
Secure attachment is the first behavior that nurses should try to stimulate when working with parents to promote healthy attachment. According to Fitzgerald (2021), patients who have a secure attachment style have the most advantageous and productive interactions with their practitioners. These patients believe they deserve care and have faith that others will provide them with satisfactory and relevant health care. They can also seek and accept medical assistance. These people’s mental representations include the perception that help will be satisfactory and that health workers can be relied on for assistance during a crisis. Patients who define themselves as securely attached report higher patient-physician relationship quality (Fitzgerald, 2021). This attachment style enables healthcare professionals to develop positive, constructive clinical relationships with their patients.
The second behavior a nurse attempt to stimulate when working with the parent to promote health attachment is communication. Patients tend to engage more and have more autonomy when clinicians fully grasp their clients’ attachment types and give appropriate empathy, compassion, and support (Green et al., 2021). This increases treatment adherence. Patients’ behaviors and communication techniques are often compatible with certain attachment types. Clear, good patient-physician communication is connected with improved health as evaluated by physiological, behavioral, or subjective measurements (Green et al., 2021). To create beneficial interactions and communication patterns, physicians must understand their patients’ attachment types. Communication is a critical element of the health result of the patient.
Attachment style is acknowledged as a factor that influences individual performance and may be associated with enhanced nurse-patient relationships and patient outcomes. Nurses’ attachment styles and reactions to patients’ attachment styles may influence the nurse-patient connection; nurses’ attachment styles can also influence the type of relationship they create with others. According to Ainoutdinova and Ainoutdinova (2019), the quality of early attachment ties with the main caregiver and empathy is cultivated in the early rearing environment. Empathy has been described in various ways, but it generally refers to an individual’s emotions toward the experiences of another. Empathy aids in client relations, the support of community activities, and group cohesiveness. Empathy is a necessary component for impactful interpersonal behavior and plays a vital role in the nurse-patient partnership because it fosters comprehension of the patient’s emotional status and perception and enables the nurse to successfully share and partake in the patient’s experience (Ainoutdinova & Ainoutdinova, 2019). The capacity to perceive and comprehend others’ emotions, as well as successfully express one’s understanding of others’ emotions to them, is especially important in clinical meetings between nurse and patient.
The theory of attachment posits that attachment is the result of strong affectionate bonds among human beings with their special others (Bretherton, 1992). An example is an attachment that occurs between an infant and his/her mother or caregiver. In the nursing setup, attachment between the nurse and their patients is encouraged to foster empathy, offer comfort by reducing the level of anxiety of the patient (Khodabakhsh, 2012), and ultimately improve patient outcomes through significant stress reduction. According to Khodabakhsh (2012), attachment styles are categorized as being high or low in anxiety and high or low in comfort. The attachment style with both these variables (comfort and anxiety) high is termed the secure attachment style. The other attachment styles (dismissing, preoccupied, and fearful) are considered as being insecure attachment styles (Khodabakhsh, 2012).
When working with patients, the behaviors that the nurse should stimulate to promote a healthy attachment entail learning more about the patient, offering hope to the patient, and demonstrating faith and confidence that the patient’s condition will be resolved. If the patient in question is a parent or a new parent, the nurse should demonstrate nurturing and play so that the parent finds it easier to learn more about their children and the need for attachment to their children throughout life. It is important for nursing caregivers to understand the infant’s basic needs and to continue learning more about the parents and their family behaviors daily for the nurse to offer relevant remedies to the family’s problems.
Learning more about the patient calls upon the nurse to spend time with the patient asking questions about them even those that do not necessarily relate to the illness being treated; to create a rapport. This information should be used to build on the nurses’ knowledge about the patient’s condition hence making inferences and conclusions to better the treatment approach. Learning also improves the nurses’ level of interaction with the patient and the patient feels more secure sharing their deepest insecurities with the nurse; an act that is in itself a stress reliever. After learning comes hope. The nurse should be an instrument of hope and optimism to the patient. This takes the nurse-patient attachment further onto the next level because the vulnerable patient can remain hopeful amidst discomfort. Offering hope also develops trust and a new lease of strength for the patient to be in the right mental state to face whatever illness they could be dealing with. Once the patient feels their nursing caregiver’s magnitude of faith in the patient’s ability to recover from their illness, it becomes a game changer for them on their wellness journey as well because the zeal to fight the illness is renewed on each encounter with the caregiver; an aspect that improves overall patient wellness and outcomes. For instance, Kelly, Tsilimigras, Hyer, and Pawlik (2019) acknowledge that different individuals react differently to a cancer diagnosis. The type and level of attachment they develop with their caregiver are therefore important in helping those that need a little push to fight it to recovery (Kelly et al., 2019).
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