Concept of Nurse-Patient Relationship - Case Study Example

Concept of Nurse-Patient Relationship Introduction Nurses play an important role in the health promotion of an individual due to their direct contact and proximity with the patients. The 3 basic roles of a nurse are that of a practitioner, leader and researcher. As a practitioner, the nurse attends to all the medical needs of the patient and as a leader she takes decisions which relate to, influence and facilitate the actions of others with an aim to achieve a particular goal. As a researcher, the nurse aims to implement studies to determine the actual effects of nursing care and to work towards further improvement in nursing care (Nettina, 2006). The role of nursing is authenticated in helping people move towards independence in all activities of daily living. They take up the role of a family member. Their actions have an impact on the individual and affect their levels of dependence/independence and these include biological, psychological, socio-cultural, environmental and politico-economic variables (Roper et al, 2002). This essay presents the relationship between nurse and patient through an example. Case Jane (named changed), a 55 year old woman was brought to the hospital by some stranger who saw her sweating profusely and with chest pain. On arrival to the hospital, the emergency doctors examined her and declared that she was suffering from myocardial infarction and required immediate admission into cardiac ICU and angiography. Susan (name changed), the nurse-in-charge of the emergency room could sense tension in Jane. She came to Jane, held her hands and asked her “Who is there with you?” Jane almost burst into tears. “I came to the shop to buy some bread and landed up in the hospital. My husband has gone for work and he needs to be called. Please could you inform him that I am in the hospital? Also please do not panic him by mentioning about heart attack. My children are not in town right now.” Susan gently took the phone number of Jane’s husband from her and called him. She tactfully mentioned to him that his wife had some brief illness and that he needs to come to the hospital. She did not mention to him about myocardial infarction. Until Jane’s husband came, Susan paid special attention to Jane. She gave her comfort and moral support. Jane, who was much tensed earlier, had some relief. As she was shifted to the cardiac ICU, Jane requested Susan to accompany her and be with her. Although this could not be done due to the rules of the hospital, Susan smiled and nodded saying “I will make suitable arrangements for your safe care and I will be visiting you frequently. Now you sleep and rest until your husband comes.” The angiography revealed blocks in the left ventricular artery prompting CABG. A couple of days later CABG was done. Jane requested the chief nurse to call for Susan before surgery. Susan came and gently said “Jane, you will be alright. It is only a matter of few hours. I have my friends in the operation theatre and in the post-op care. They will take good care of you.” Post- CABG, Jane recovered soon and got discharged as soon as she recovered. She however did not forget the help she got from Nurse Susan. She sent her a bouquet of roses thanking her for her moral support all though her stay in the hospital. This case study is an excellent example of good nurse-patient relationship, the features of which will be discussed below. Concepts of nurse-patient relationship The relationship between a nurse and a patient is of therapeutic nature and based on the provision of care, guidance and assistance of the patient (Neal, 2007). It is shaped mainly by four concepts namely, trust, power, intimacy and respect (Neal, 2007). Trust is a critical concept in the nurse-patient relationship because, the patient is in a vulnerable position and the patient places trust in the nurse as soon as he or she enters the health care setting. As such, illness makes an individual vulnerable and this is exaggerated in the presence of unfamiliar surrounding, relationships and situations. In the example presented, Jane was in a vulnerable situation and she put trust in Susan. Trust in this relationship is largely based on the assumption of the fact that the nurses are skilled and knowledgeable and will excise these aspects in dealing with the patient. During the initial stages of relationship with the patient, the nurse needs to instill confidence into the patient about confidentiality and must ensure that the information about the patient will be divulged on a need to know basis only. Nurses must maintain confidentiality about the nature of the patients disease and other aspects. If the patient wishes not to divulge any information to the relatives, family and friends, the nurse must cooperate in doing so. Susan did not mention to Jane’s husband about heart attack as requested by Jane (Neal, 2007). Trust in a nurse-patient relationship improves care and reduces stress. In most of the cases, consent will be taken for divulging information. In cases where the patient is not in a position to give consent, the multidisciplinary team takes a consensus decision about divulging information (NMC 2002). Nurses must make all efforts against improper disclosure of information. The major source of potential disclosure is verbal overhearing. Another important concept is power and this is not equal in the nurse-patient relationship. The patient is in a vulnerable position and the nurse is skilled and privileged with information and specialist knowledge. It is because of these qualities that it becomes paramount for the nurses to perform duty with the interests of well-being of the patient. It is often not easy to use professional power easily by the nurses. This is because, nurses have varying traits and values. At the same time, different patients demand needs in a different way. Thus a nurse must ascertain the needs of the patient and respond in a manner that is sensitive and acceptable. Nurses must respect the patient and their decisions about health care, keeping in mind that there are many restrictions. Respect can be developed by recognizing the worth of the patient. They must however not support illegal practices (Neal, 2007). In a nurse-patient relationship, intimacy relates to the various activities and procedures that the nurse does to the patient. The activities can be psychological, emotional, spiritual or social. The activities are definitely not sexual (Neal, 2007). Interpersonal skills Nursing theorists have considered interpersonal skills and personal attributes as integral to professional bonding. According to a study on the themes and variations of the nurse-patient relationship by Ramos (1991), relationships characterized by mutuality and reciprocity had the most intense levels of attachment. Professionally, nurses interact with a variety of people for various reasons and contexts. This requires effective interpersonal communication and good relation with other people. According to Rask and Brunt (2007), there are six categories of nurse-patient interactions which are: building and sustaining relationships, supportive/encouraging interactions, social skills training, reality orientation, reflective interactions and practical skills training. Nursing is actually a social activity demanding the professionals to be socially competent. Thus interpersonal skills of communicating and relating are pivotal for the development of social competence of the nurses. Nurses need to spend time and listen to the needs of the patient and understand the experience of the patient. The central aim should be to initiate supportive interpersonal communication in order to understand the perceptions and needs of the others (Reynolds and Scott, 1999; qtd. in Stein- Parbury, 2005). According to Benner et al, qualities that should be present in an experienced clinician are calculative reasoning, consulting research, analysis of particular situations and theoretical literature. Principles underpinning the nurse-patient relationship Like any other profession, nursing has a distinct body of evidence and extensive education involving both theory and practical components. All nurses share a common identity, attitudes, behaviors and values (Neal, 2007). There are four important principles underpinning the nurse-patient relationship. These include self-regulation, professional competence, teamwork and continuing professional development. The nursing profession has a self-regulation policy to serve the public. It has a Code of professional conduct defined and all nurses must abide by this. The nursing midwifery council registers only those with professional competence. It establishes from time to time training aspects, standards of education, conduct and performance for the nurses. The ultimate aim is to possess skills and abilities which allow the nurse to practice safely without supervision. Nurse is a part of multi-professional team. The focus of activity of this team is the patient (Neal, 2007). Dreyfus Model of Skill Acquisition Nursing theories or models are important teaching aspects of nursing practice. They provide information about definitions of nursing and nursing practice, the aims, objectives, goals and functions of nursing practice and also the details about principles that form the basis of this practice (Wesley, 1995). I have chosen Dreyfus model to discuss on the acquisition of skills to enhance nurse-patient relationship. According to this model of nursing theory, acquisition of skills through external instruction by individuals passes 5 important stages which are Novoice, Competence, Proficiency, Expertise and Mastery (Benner, 1984). This model was first proposed by famous theorists Stuart Dreyfus and Hubert Dreyfus in 1980 (Benner, 1984). The theory gained much attention due to the works of Benner who used this theory to define stages of clinical competence. The first stage of skill acquisition is the Novoice Stage. In this stage, the individual mainly concentrates on following rules that are free of context. He does not feel responsible for anything else other than following the rules properly. In this stage, competence is demonstrated by active decision making. Those who formulate their own rules and use intuitions in decision making exhibit proficiency (Benner, 2004). The next stage is that of Advanced beginner. In this stage, the individuals perception of situation is still limited. He treats all aspects of work equally and separately. In the next stage, the learner becomes Competent. He is able to perform many activities at a time. He is also able to perceive various information well. On the whole he is able to cope with crowdedness. The individual plans deliberately for longer term goals (Benner et al, 1996). In the next stage, the individual becomes proficient. In this stage, the individual views situations in a holistic way, and first addresses the most important aspect of situation. The final stage is that of an Expert. An expert does not rely on guidelines or rules or maxims. As soon as the situation she is able to act with intuition and tacit knowledge. The expert has a vision of what is possible (Benner et al, 1996). Conclusion Nurses are the backbone of any health care setting. The quality of care depends on the nurse-patient relationship. There are four main concepts which affect the relationship: trust, power, respect and intimacy. Interpersonal skills of nursing may be enhanced by training and study of various nursing theories. The skills are achieved in stages and as Benner (1984) put it: the journey goes from novice to expert! References Baillie, L. (ed.) (2005). Developing Practical Nursing Skills. (2nd ed.). London: Hodder Arnold. Benner, P., Tanner, C., and Chelsa, C. (1996). Expertise in Nursing Practice: Caring, clinical judgment. New York: Springer Publishing Company Benner, P. (1984). From novice to expert: excellence and power in clinical nursing practice. California: Addison-Wesley Publishing Company. Benner, P. (2004). "Using the Dreyfus Model of Skill Acquisition to Describe and Interpret Skill Acquisition and Clinical Judgment in Nursing Practice and Education". Bulletin of Science, Technology & Society, 24 (3): 188-19 Neal, K. (2007). Nurse-Patient relationships. http://www.nursing-practice.co.uk/docs/newCh5.pdf Nettina, S.M. (2006). Manual of Nursing Practice. (8th ed.). New York: Lippincott Williams & Wilkins. Nursing & Midwifery Council 2002. The Code: Standards of conduct, performance and ethics for nurses and midwives London: NMC. Ramos, M.C. (1991). The nurse-patient relationship: theme and variations. Journal of Advanced Nursing, 17(4), 496- 506. Rask, M. and Brunt, D. (2007). Verbal and social interactions in the nurse-patient relationship in forensic psychiatric nursing care: a model and its philosophical and theoretical foundation. Nurs Inq. 14(2), 169- 176. Roper, N., Logan, W. & Tierney, A. (1996). The Elements of Nursing Model for nursing based on a Model for Living. (4th ed.). Edinburgh: Churchill Livingstone. Stein-Parbury, J. (2005). Patient and Person. Elsevier: Australia. Wesley, R.l. (19950. Nursing theories and models. Springhouse, PA: Springhouse Corporation. Read More