Peplau (1952) observed the nurse as a fundamental tool for change whilst explaining how powerful the nurse-patient relationship is. The nurse approaches the relationship with understanding and experience obtained personally through their lives but also through their training and work. Generally, it is considered the more training and work experience a nurse has, the more therapeutically effective they are likely to be but this is not always the case. Stuart and Sudeen (1997).
There are many influences on the relationship that can both obstruct or benefit the nurse-patient relationship. Having a supportive, open, non-judgmental nature aids effective patient-nurse interactions which are important to reduce patient’s vulnerability and distress. Being there for patients reflects not only a positive, welcoming attitude of the nurse, but shows commitment, respect and value to the patient. Presence is defined as physical and psychological being so a nurse ‘being’ with a patient is essential for the purpose of meeting the patient’s health care needs.
A nurse must take time to listen and understand the patients experience without being non judgmental, and to deliver the care needs of the patient. A central aim of building a relationship includes initiating supportive interpersonal communication in order to understand perceptions and needs of others. Reynolds and Scott (1999)This assignment will explain how aspects of the nurse-patient relationship are necessary for the provision of patient-focused care within any branch of nursing. The nurse patient relationship depends on the attitude and personality of the nurse.
As a mental health nurse student, forming a positive, trusting relationship firstly involves the process of relaying information and paying attention to non-verbal cues such as body language and eye contact. Both the NICE guidance and the NHS Constitution () stress the importance of good communication between healthcare professionals and patients. Non verbal messages transfer both positive and negative signals. From the patients point of view, positive signals can express that the nurse is approachable, trusting and has an interest to care and communicate appropriately with their needs.
This is indicated via listening without judging and responding whilst understanding to help create therapeutic relationships. Even without the patient being vocal or asking for anything, the art of the nurse profession is noticing when something is wrong and delivering good practice based on respect and dignity. Both nurses and patients may adapt non verbal negative cues such as bad posture, facial expression, or space boundaries which indicate at first impression vulnerability or distress. Using body language plays an important role in building rapport with patients as some body postures may not facilitate certain patients.
Evaluating body language is also part of the nurse accessing the patient, whilst considering their future clinical relationship as it involves data collection, both physically and psychologically that may be useful in assessment, diagnosis, treatment and care plans. every interaction whether verbal or non verbal between the nurse and patient is placed within the overall context of a relationship. Throughout the course of a student nurses training, social interactions are part of learning to become a skilled nurse.
As such, nursing is a social activity and nurses need to be socially competent. They must be skilled in the art of interpersonal communication and human relationship building. Professional codes of practice dictate that nurses are capable of relating therapeutically with patients as more than passive recipients of care. Relationships between patient and nurses humanise healthcare because they are part of the vehicles of which nurses respond to patient’s subjective experience through building rapour and knowing exactly what the patient’s needs are.
As well as the strong relationships with patients, nurses express concern, care and commitment The profession of nursing is both an art and a science. While nursing Practice links the art and science of nursing, nursing education focuses on The scientific behavioural outcomes of learning content knowledge and nursing Skills. As Communication with patients is a primary responsibility for a nurse, it is imperative nurses can communicate with different patients hat require different approaches to communications.
Depending on a patient’s age, personality, culture,, current medical condition, and other factors, nurses often find their normal methods of communication are ineffective. In these situations, and for patients health needs, knowing a variety of communication techniques is invaluable. Cultural background, race, and ethnicity play an important role in a patient’s life. Not only do these factors play a part treatment and diagnoses, but also in their state of mind and emotional approach to nursing care which could cause problems with the nurse-patient relationship..
Understanding differences socially such as family life, and cultural habits, physical differences, and other defining attributes helps nurses understand how best to help their patients. Sensitivity and knowledge cultural diversity makes in building a healthy nurse-patient relationship. The age of a patient also has a significant impact on the nurse-patient relationship. Children and the elderly require different treatment options and approaches to the relationship than middle-aged adults.
Other family members are routinely involved to varying degrees, and heavily influendepending on the age of the patient. For example, the relationship between a nurse and a patient who suffers from dementia will greatly rely on the relationship between nurse and family members to gain information to contribute towards holistic care. Not only will the care of a patient vary with their age, but so does their ability to communicate and participate in decision-making, which also affects the nurse-patient relationship. By its very nature, the nurse-patient relationship demonstrates a difference of power.
The nurse is viewed to have a more extensive knowledge base in terms of care and treatment options and so the patient must rely on their nurse to advice and guide them through the best treatment options for their needs whether mental or physical. This is why it is essential to be naturally compassionate, empathetic, approachable, trustworthy, emotionally strong, caring, and motivated towards treatment and recovery. As well as having particular personal skills, the nurse should involve the patient, whilst giving choices in everyday care in a holistic way.
Holism is defined within nursing to consider the physical, emotional, social, economic, and spiritual needs of patients, their response to their illnesses, and the effect of illness on patients’ abilities to meet self-care needs Mosby (2001). For example, it is a nurses duty to discuss and provide information about treatment, therefore it is important for patient participation at all times, allowing the patient, choice, respect, dignity and involving them in their care plan taking into consideration their social pattern which could include daily routine, mobility and diet. pirituality and fulfilment are also important factor of the nurse patient relationship as this includes important areas such as respect/knowledge for religion, hobbies, belongingness and self expression.. if these core factors are engaged and attained successfully, the relationship is trusting, informative and also beneficial to not only a patient mental but physical health..
If the nurse-patient relationship shows no rapport or the nurse has failed to interact without using a holistic approach, then the patient may rebel to accepting treatment which could lead to a lengthened time for recovery causing further distress. it is important to understand patients may be feeling venerable and so nurses should never assume control and feelings of the patient as this does not promote the correct therapeutic trusting relationship, it promotes empowerment and discomfort.
As a mental health nurse student, situations like this have been observed and this type of practice and lack of intervention with patients can easily arise causing much psychological distress and an uncooperative relationship for future treatment. Having previous experiences with a particular patient group, (even though all patients are unique and individual) can also contribute effectively towards the care and goals a nurse aims to achieve collaboratively with their patient and other health care professionals.
Being focused on patients whilst offering professional judgement and care through personal experiences indicate the nurse is not only professional about her role but also empathetic towards her patients. Caring is a vital human interaction. In nursing, caring articulates how the nurse delivers the skills and knowledge of the professional interactions between the nurse and the patient.
Being both empathic and sympathetic will reduce the patient’s distress and resolve difficulties as the relationship is based on a helping relationship engaging in mutual endeavours. A nurse who has built a good relationship with a patient by informing and allowing them to make choices will also to be in a strong position to have a non-judgemental conversation with them, whilst applying good clinical judgement that is in the best interest of the patient based on the relationship that has been formed.
Given the close, personal nature involved in the role of a nurse,, it is easy to let professional boundaries blur. Nurses today are encouraged to take a more human, holistic approach to patient care. That increased sensitivity and attention to the emotional side of a patient’s treatment can easily lead to a loss of the professional distance nurses must maintain. Learning to balance care and compassion, while maintaining a professional distance is a difficult task to master, even for experienced nurses.
However, it is imperative that nurses find and maintain that balance. Government regulations, malpractice insurance and disciplinary measures ensure that nurses who routinely cross the line and inappropriately blur professional boundaries no longer practice. Nursing Practice Standards state is it normal for a patient to feel gratitude towards a nurse who has helped them through a difficult medical treatment.
However, there are standards nurses must follow when giving and receiving gifts, or other instances that may blur the line between personal and professional involvement. In small communities or in cases where a nurse cares for close friends or family, it is even harder to maintain professional standards. However, there are rules and standards for every profession, including nursing. There are ethical codes of conduct and actions for which all nurses are held accountable, no matter the patient.
Courtney from Study Moose
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