The Dynamic Nurse-Patient Relationship - Essay Example

?The Dynamic Nurse-Patient Relationship Essay Nursing practice is revolutionized by nursing theories which are intended to improve the performance of nurses and response to patients’ health care needs. Ida Jean Orlando is considered as one of the key thinkers who radically transformed the nursing profession. Her dynamic nurse-patient relationship has changed the way the nursing profession views the nature and impact of nurses’ response to patients’ needs on health and illness. This essay discusses Orlando’s nursing model, the dynamic nurse-patient relationship, and analyzes how this theory can be applied to nursing practice at the individual, family/group, and community/population levels. Introduction Ida Jean Orlando formulated her theoretical models of nursing in relation to her theory of dynamic nurse-patient relationship, and expanded them to involve the distinctive role of nursing in patient care. She examined the aspects that reinforced or hampered the incorporation of mental health doctrine in the curriculum of basic nursing. She developed the dynamic nurse-patient relationship model to provide nursing practitioners a model of efficient nursing practice. She investigated nursing patient care on medical-surgical settings, not individuals with psychiatric disorders in psychiatric facilities (Orlando, 1961). She recognized three aspects of nursing practice: the uniqueness and creation of nursing knowledge, the professional role of nurses, and the relationship between nurse and patient. A nursing context comprises the patient’s behavior, the nurse’s response, and all that does not alleviate the patient’s suffering. Patient distress is associated with the failure of the person to satisfy or express his/her needs. Orlando’s Nursing Model The dynamic nurse-patient relationship is derived from the assumption that the relationship between the nurse and patient is mutual, which means that the behavior or decision of one influence the other. Orlando (1961) argues that the nursing role is different from the medical role and that the response of nurses is based on the urgent needs, demands, and experience of the patient. Basically speaking, the theory claims that nursing is one-of-a-kind and autonomous because it focuses on the need of an individual for help or support, actual or probable, in an urgent condition. The manner by which nurses relieve this vulnerability is reciprocal and is performed in a closely controlled or profession way that requires education and expertise. Orlando (1961) argues that one’s behavior or response must be derived from reason, not set of rules. Her theory is regarded to be an interactive model for it suggests a particular practice of planned, purposeful one-to-one nurse-patient relationship to reinforce the best nursing care intended to take care of a patient’s needs. The nursing process is activated by the behavior of the patient. The behavior of a patient, regardless how trivial, should be seen as a call for help. Patient behavior could be expressed verbally and nonverbally. When a patient needs something that cannot be met without the aid of another person, vulnerability or helplessness arises. If the behavior of a patient does not clearly express a precise description of the need, then setbacks in the relationship between the nurse and patient may occur and make it hard for the nurse to sufficiently deal with the need of the patient. A better understanding, appreciation, or resolution of incapable patient behavior becomes a main concern for the nurse for the condition will probably deteriorate sooner or later and make sufficient care, or the delivery of required assistance or support, more and more problematic. The response, decision, and behavior of the nurse are aimed at alleviating unproductive patient behavior and satisfy urgent needs as well. Patient behavior triggers a nurse response, which is the beginning of the nursing process. Proper or correct nurse response is composed of several steps: the nurse knowingly thinks about patient role and personal responses so as to create professional care plans derived from rational evaluation rather than spontaneous responses; the nurse evaluates responses with the patient to determine whether observations or opinions are right or wrong; reflection creates a spontaneous emotion; the perception results in a spontaneous idea; and the nurse evaluates the behavior rationally (Orlando, 1961). A nurse may respond either deliberatively or spontaneously when giving care. Professional nursing behavior is nursing actions that stem from the nurse’s purposeful activity, rather than spontaneous responses. Actions that arise from spontaneous rather than purposeful responses do not satisfy the conditions for professional nursing behavior. Spontaneous responses arise from nursing actions that are carried out to follow an instruction or protocol rather than to address the needs of the patient. For instance, the nurse who administers a medication to a patient everyday because it is instructed by the doctor, without first explaining the importance of the medication to the patient, is exhibiting an involuntary behavior. This is because the medication is given to the patient more in accordance to the medical protocol rather than the patient’s urgent need for treatment. The standards for purposeful, rational behavior are the following: the nurse is not affected or interrupted by factors not related to the need of the patient; the nurse confirms the action’s appropriateness and outcome after accomplishing it; the nurse evaluates the action’s importance with the patient and its significance to satisfying his/her need; and purposeful action originates from the accurate recognition of patient needs by confirmation of the nurse’s response to the behavior of the patient. It may be assumed that nursing behavior is aimed at helping the patient and must be deemed purposeful and rational. Nevertheless, for a response to have been genuinely rational, it should go through reflective assessment to ascertain if the response aided the patient by dealing with a need as identified by the patient and the nurse in the urgent situation. Principles that are embedded in the dynamic nurse-patient relationship are as follows: appropriately attending to a patient’s need is essential because how long a need remains unfulfilled affects the level of distress; steps to alleviate distress is established by the patient’s noticeable behavior; the actual interaction between nurse and patient is a primary basis of nursing knowledge; the relationship between the nurse and patient makes up an interactive whole; self-reflection enhances nursing practice; every nurse-patient relationship is one-of-a-kind; the nurse’s reasoning ability is the most important helping instrument; professional or rational nursing has a distinctive outcome; and nursing is related to medical practice and is also an independent profession distinct from other medical jobs (Orlando, 1972). To sum up, Orlando rightly explains her dynamic nurse-patient relationship theory along these lines (Orlando, 1961, 67): A deliberative nursing process has elements of continuous reflection as the nurse tries to understand the meaning to the patient of the behavior she observes and what he needs from her in order to be helped. Responses comprising this process are stimulated by the nurse’s unfolding awareness of the particulars of the individual situation. Application of the Dynamic Nurse-Patient Relationship to Nursing Practice The contribution of Orlando to the profession of nursing assisted nurses in focusing on the patient as an individual, rather than on the disorder or medical protocols; her dynamic nurse-patient relationship model is still applicable today, and recent studies substantiate her theory. The method of Orlando obliges the nurse to confirm a patient’s need before performing any measures to address it. Orlando’s nursing model can be applied to nursing practice at the individual, family, and community levels. The need for nurses to be aware of and responsive to patients is growing as people become more conscious of the multifaceted relationship between patients and nurses and how these relationships may influence the wellbeing of the patient. The dynamic nurse-patient relationship will help nurses be conscious of factors that influence health, disease, and nursing practice in individual, family, or community contexts. A number of assessment instruments or guidelines were identified by Orlando that provide inclusive paradigms to help nurses in the evaluation of various factors in nursing practice at the individual, family, and community levels. Most of the assessment instruments are focused on individuals and at times on families and communities. Since individual patients and their families make up bigger communities, nurses should identify and understand relevant issues as they interact with individuals, families, and communities. Using the dynamic nurse-patient relationship model, when evaluating individuals and families, the nurse must thoroughly look at the following: social networks, and how they affect health and disease; patterns of everyday life, such as leisure and work habits; health-related practices and beliefs relevant to the diagnosis and treatment of disorder; and family roles, usual family dynamics and structure, especially approaches to decision making and communication. Orlando’s nursing model recognizes the fact that one aspect common to all members of ‘normal’ families is a concern for the wellbeing of every individual within the household since the family has the main obligation to meet its members’ health requirements. The nurse not only should evaluate the health of every member of the family, but also identify how effectively and sufficiently the family can address the needs of its members. Just how effectively families perform with regard to this will establish where, when, and how nursing care will happen, and what the appropriate approach to the individual and family will be. Conclusions Ida Jean Orlando presented several ways of classifying the responses of nurses to the needs of patients—professional, purposeful, rational, and spontaneous/ involuntary. The rational, purposeful, and professional nursing practice is considered to be the most important mechanisms through which nurses can knowingly attend to patients’ urgent needs by identifying and understanding patients’ actual experiences and related beliefs, sentiments, and ideas and responding to them dynamically. The dynamic nurse-patient relationship theory demonstrates that nursing is exceptional in meeting patients’ urgent needs through interactive practices. References Orlando, I.J. (1961). The Dynamic Nurse-Patient Relationship. New York: Putnam. Orlando, I.J. (1972). The discipline and teaching of nursing process. New York: Putnam. Read More