For the focus of this essay will be discussing how aspects of the nurse-patient relationships are important for the delivery of patient-focused care; this will be achieved by using the appropriate relevant literature.
The Nurse-patient relationship is often described as ‘therapeutic’; this relationship is built on a mutual respect between a nurse and the patient. It is a relationship which is normally developed over time and requires a number of important interactions, ‘trust’ being one of the most important and influential factor. Trust is paramount in order for any relationship to be able to develop. The relationship between a nurse and her patient demands the nurse to possess excellent communication and interpersonal skills. This relationship differs from other relationships as it is designed to focus around the health and wellbeing of the patient only. There are several types of nurse-patient relationships all of which will depend on the length of patient contact with the nurse, the patient’s illness, requirements and dependency. Regardless of the type of relationship, the patient must feel respected, important and confident to communicate any concerns and be able to trust the nurse. Smith (1992)
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In order to build relationships you must be able to communicate and interact to the best of your ability. In a nurse-patient relationship, there are several personal qualities you must possess that will play a crucial part your development as a nurse. These are compassion, caring, empathy, respect, trust, honesty, friendly and excellent communication skills. Smyth (1996) suggests that the personal experiences of a nurse may help them connect emotionally and empathize with the patients. It is easier to appreciate what another person is going through if you have experienced the same situation yourself. Nurses today are taught how important communication is and the necessity to build good relationships with patients, patients families and fellow colleagues. Effective communication underpins good healthcare. Alexander ()
This wasn’t always the case as in previous years there were several barriers which prevented good nurse-patient relationship developing. Nurses were encouraged to maintain a ‘professional relationship’ this prevented any emotional involvement and showed little compassion for the patients and the nurses concentrated on the tasks at hand. Communication was often limited which sometimes prevented ‘holistic’ care. As time went on the barriers built started to come down and nurses became more approachable and patients began to address the ‘nurse’ with their first names and a closer relationship between healthcare professionals and patients was encouraged McQueen (2000)
In 1991 the Department of Health developed a strategy to promote patient focused care, which would allow the patient to become more involved in the healthcare they receive. This looks at the patient’s healthcare experience as a ‘whole’, meeting not only the physical requirements but the right to receive their care in a safe, comfortable and clean environment. It looks at offering the patient all the information required to make informed choices regarding their healthcare, information on waiting times for treatments and identifies the need to build closer relationships between patients and healthcare professionals. DOH (1991)
The Nursing and Midwifery Council exist to safeguard the health and wellbeing of the public. The following standards have been set by the NMC (2008) and are essential in the patient care experience.
Trust is one of the most important standards, without trust relationships are hard to develop. Patients and their family need to be able to rely on the nurse and have confidence in the work your doing. A nurse must remember they hold a very powerful position and most patients without question place their trust in a nurse merely because that’s what a ‘nurse’ is associated with. A sick patient depends on the nurse to nurse them back to health. The nurse knowing patient’s information and being in unfamiliar surrounding afraid of the unknown can often leave a patients feeling vulnerable, this is why ‘trust’ is extremely important. Unfortunately in the past this trust has been broken by people in trusted positions such as the famous Beverly Allitt who…..
Treat people as individuals. A nurse has a responsibility to treat each person as unique and remember never to stereotype or be judgemental of the person no matter what. Every patient will have unique requirements, from the foods they like to how many pillows they normally sleep on, this must observed and implemented in order to make the patients care or hospital stay as comfortable as possible. Cultural beliefs and requirements must be met. Avoid being stereotypical not all ethnic patients like to eat curry, try not to make assumptions of a patients sexual orientation and always respect their beliefs no matter what and no matter how difficult to understand they may be, for instance a Jehovah witness refusing blood when you both know it is the only way to save their lives. ( ref) If a patient has physical or mental disabilities (enhance)
Always be respectful paying attention to how the patient would like to be addresses, most patients are quite happy to be called by their Christian names, but sometimes that is not the case .Respect patient’s wishes and treat them with dignity. Imply discretion in keeping secret information.
Confidentiality must be obtained at all times unless sharing information with other healthcare professionals when information is required. A patient should never be discussed in public places.
Collaboration has been recognised as a fundamental step in healthcare. When a nurse and patients work together, through mutual cooperation and good communication, the health care goals will have a greater chance of being successful.
Consent or permission must always be gained by the nurse prior to any procedure or information sharing from the patient involved, this of course would depend on the condition or the capability of the patient.
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Boundaries and limitations of a nurse-patient relationship should be made addressed, always remaining open and honest with the patient. Be mindful of your own boundaries and know that limitations of gift giving no matter what. (NMC 2008)
Nurse-patient relationships alike other relationships will always face hurdles as after all we are only human and everyone will not always get along with everyone else. In order to build a good nurse-patient relationship all of the possible barriers must be addressed. “Communication is the process by which information, meanings and feelings are shared by persons through the exchange of verbal and non-verbal messages.” Brooks, Heath 1995) look up book XXX Communication issues can lead to massive barriers, can the patient speak English, is the patient deaf or hard of hearing, is the patient blind or short sighted, could the patients posses speech difficulties.
When communicating with a patient there are many issues to address. The environment you’re in must be allow privacy, be free from noise, distraction and allow the patient enough physical space. There can often be physical factors which may prevent affective communication such as the patient being hungry, tired or in pain. Emotional factors also have to be considered as the patient may find it hard to listen and communicate if they are emotional, scared, anxious or maybe just don’t understand the way things are being explained or lack of percievment of the situation.
If all these possible issues which may ponder the ability to communicate with the patient to maximum effect the when communicating you must always think about the patients physical proximity, no-one likes to feel intimidated because you’re a bit to close. The way your body posture is also important you need to sit facing the patient with an open posture and give suitable eye contact, always look interested, attentive, empathise with the patient and take your time to listen and observe because very often what a person tells you may not give the same message to their actual physical appearance or facial expressions. Remember to be careful how you say things because it cannot just be the things you say but in the way in which there said that makes the difference to how the words are understood. If every factor preventing developing good nurse-patient relationship has been addressed then the relationship will have a positive overall effect on a patients care experience, because in a good relationship the patient and their relatives are happy with every element of the care received
A good nurse must posses valuable characteristics such as being genuine, warm, helpful, caring and one of the most important contributes is excellent communication skills. Communicating with patients can be extremely difficult for many reasons, some may being the environment, if too noisy it may cause distractions making it difficult to listen, lack of privacy or just sheer physical space or lack of it. The nurse must also consider the patient’s physical state, if their tired, hungry, in pain, deaf or learning disabilities. The patient could be very emotional, scared, and anxious or misunderstood the situation, all of these must be considered before communication. When communicating with a patient they must be made to feel at ease, use appropriate eye contact, and take your time to listen and explain and remember to use open body posture .Being thorough and reliable helps you cope with the demands of a busy ward and is extremely important for building trust with patients. Renforth & Norman (1998).
A poor nurse will show the patient very little respect, deliver inadequate care, be insensitive to patient’s requirements and could become complacent, allowing room for unnecessary and potentially harmful mistakes being made.
On my recent work placement in a surgical ward in an NHS hospital I had to build up several nurse-patient relationships whilst admitting patients onto the ward for the procedure ahead. It was challenging to build quick relationships as most of the patients coming on the ward have attended a pre op assessment prior to being admitted onto the ward then a lot of the procedure performed are elective surgery and only require a short stay. This meant i only had one chance to get this right and make the patient comfortable and confident in me as a student. It has been questioned that a shorter contact time between patients may make forming a good relationship harder to achieve (McQueen 2000). To admit patients I would take the patient to their room, which were all single cubicles with on suit shower rooms which gave the great surroundings for privacy and communications. After introducing myself to the patient I would ask the how they wish to be addressed and make a note of any preferred name on the patients admission notes and my handover sheet, I found that it was quite common for patients to wish to called by a totally different name to which they were christened and hugely important if any communication made. I always orientated the patients around the ward and the room firstly, allowing them feel comfortable whilst asking all the relevant information needed for the admission. Although I spent six weeks on placement and had many wonderful experiences the one bad experience is the one that i remember the most. I was asked by a member of staff to shower a patient who had recently fainted and soiled herself, I did question was the patient ok to be stood up and was told just to put a chair in the shower and carry on with what i was asked. Whilst i was getting the shower chair and the towels for the patient the consultant had visited the patient and requested we prepared her for theatre again. The consultant went and i returned to the patient’s room and asked another nurse if it was really necessary to shower this patient as i knew she didn’t look to good but was told again if you’ve been told to shower the patient then i should just do it. I helped the patient into the shower cubicle who continued to tell me she was fine, she had just got into the shower for a minute and the consultant came in screaming “where is she “i told him and he screamed at me to get her out and that she needed to return to the theatre immediately. I tried in my defence to say i was only doing as i was told but he didn’t hang around long enough to listen. I helped the lady out the shower, helped her get dried and dressed and apologised to her. In reflection of the events i felt belittled and upset and although i didn’t feel it was necessary to speak to me in that manner i knew he was concerned for the patients wellbeing and although i was upset i thought i could learn from this experience and make sure i never made the same mistake again, but i did feel my confidence had been knocked. I only wish i had the confidence to question the first nurse’s decision but then I am the student and i am supposed to follow orders within reason. If i was faced with that situation i would discretely go to a more senior nurse and double check i am doing the right thing before i take such action again, in order to achieve this i need to learn the art of reflection.
Self-awareness and analysis are key components in refection, and reflection is a skill that needs to be acquired, developed and maintained; being self aware allows us to take control of the situation as to which we are placed in, and become less vulnerable. (Wilding 2008). Reflecting on both good and bad experiences will ultimately influence my ability to learn and develop my ability to care for patients the best i can. Failure to reflect or recognise any weakness or shortcomings I have as a student nurse, may affect my ability to develop to the best of my ability.
If i am unaware of my strengths and weaknesses, it is more likely that i will be unable to help others (Burnard 1992).
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