|Date published:||26 Sep 2018|
This essay will focus on the nurse- patient relationship or rather the nurse-client relationship in the day to-day interactions that take place day in day out in our health care facilities. While in practice as a nurse conducting my daily chores, I happened to have heard a conversation between a nurse and Abdul who was a gentleman aged twenty two years with an Asian background and who had Austim and a mild learning disability. Abdul used to live with his mother before she passed away where Abdul had to be placed in a supportive environment where he shared with seven other residents. Abdul had a history of challenging behaviors which lead to his detention as postulated under section 2 of the mental health act (1983). Abduls’ behavior resulted in agitation, aggression towards staff, Self harm, and environmental destruction among others. On that fateful morning, Abdul had gone to make enquiries concerning his visiting the mosque which was a routine on every Sunday where the mum used to accompany him. From the conversation highlighted in the appendix, there arise themes such as power and control where I’ll discuss the nurses’ control and power over the patient. Other themes which are identified also include person centeredness of both the parties that is the patient and the nurse, values, beliefs and attitude. These are but some of the themes that arise from the conversation I observed from the patient and the nurse who for purposes of confidentiality I will refer to as Stephanie (fictitious) (Hildegard, 2014).
It is very vital to examine the nurse-patient partnership in a broader way and understand its significant. This relationship is paramount and therefore it should be accorded the magnitude it deserves as it affects the patient in one way or the other. A theme that is highly exhibited in the appendix is a theme of values where the terminologies used by the nurses can have detrimental effects on the quality of services rendered to the patients. In my case of study, Stephanie uses abusive language while addressing the patient, she says,” don’t be silly”. This makes the patient to storm out of the room very angered while instead the nurse ought to have approached him in a friendly manner to sort out the issue. Nurses’ values should be of the best quality while at work in order to exhibit boundaries between the patients which ensure that the client’s needs are given the utmost focus they require as identified by the College of Nurses of Ontario (CNO). Another core value that is paramount in the nurse-patient relationship is confidentiality which renders the relationship safe and establishes trust which enables the patient to be able to disclose all the relevant information needed for treatment purposes. Nurses should also exhibit some respect in their relationship with the patients whereby they should respect the patient’s culture and incorporate open-mindedness throughout the relationship until termination stage. For example in my case of study, Stephanie and her colleague did not show some respect to Abdul since they took it as if it was not necessary for him to visit the mosque yet it was a culture which was cultivated in his mind by his late mother (Arnold, 2011).
Power and control is another that arises from my observed interaction case study. The nurses are perceived to be powerful in their field of work while the patients are perceived to be powerless. The nurses are believed to possess a handful of attributes which include professional knowledge, professional status, being free of illness and fear, being in a position to stand rather than lying on the bed which place them in powerful position. This makes the nurses to gain most control if not all over the patients (Hart, 2007).
In the observed case, Stephanie is seen to exhibit full control and power over Abdul who has Autism and mild learning disability. Stephanie who is sort of the superior one in this case uses the powers vested to her to deny Abdul a chance to visit the mosque. However, even if the matter was left as Stephanie’s decision to make, she exercised her powers without consideration of the patients’ cultures and beliefs. Following misuse of the powers and control that should be exercised by the nurses, it should therefore be incorporated in their constitution the extent to which they should exercise it to protect patients’ rights. Stephanie also portrays power and control over the patient where she prepared Risperidone as per the protocol to feed the patient in order to cool him down and to counter his escalating behavior. On the hand, as seen earlier the patients have minimal power and control in their position as patients hence are subject to whatever they are told. This is evident from our case where Abdul is denied a chance to visit the mosque and the only thing the poor kid could do is become agitated and runs back to his room where he only paces up and down (Coatsworth, 2010).
Person centeredness is clearly another theme that is evident in my observed interaction case study. This comprises of situations whereby a person who is centered focuses on the individuals personal needs, goals, desires and wants so that they become central to each and everything undertaken. It is vital to examine Stephanie’s case so closely where this theme is exhibited by both the patient and the nurse (Sheldon, 2009). Abdul portrayed person centered where he became easily agitated just because he could not be taken to the mosque. He could not comprehend the fact that that there was no one to accompany him. He only put in his mind the thoughts of it was a must for him to visit the mosque. Stephanie also exhibits this theme of person centeredness whereby she just sent Abdul away denying him a chance to visit the mosque without even considering that it was his culture and belief. Besides, she did not even bother to make the patient clearly understand the reasons as to why it was not possible for him to visit the mosque.
Person centeredness in nursing however is aimed at increasing the understanding of the principles and practices by nurses. It helps the nurses to focus on the patients’ needs and medical attention regardless of the situation. It is useful in eliminating self interests concerned with individual nurses hence all their focus is channeled towards the patient as required by the code of ethics and regulations relating to the nursing profession.
However, despite the fact that high values are necessary to sustain the nurse-patient partnership, there exist barriers. Some of these barriers to effective communication between the nurse and the patient comprises of misunderstandings about treatment requirements. This might arise from patients having perceptions of unfair treatment arising from a past treatment, differences in health beliefs between patents and nurses such as belief in traditional medicine, miscommunications where the information given by the nurses may not be properly understood (Rasheed, 2015). Another hindrance to this partnership is coercion whereby the nurses might end up using force to make the patients comply as they might be perceived as being powerful whereas the patients might be seen as powerless. Job problems such as professional nursing problems work environment and ignorance of the nurses to professional ethics greatly hinder the nurse-patient relationship. However, the nurses should put themselves in the shoes of the patients to enable them to render and practice good quality care to the patients (Otong, 2007).
In my observed interaction case between Stephanie and Abdul, there arises values and attitudes such as, ridicule where Stephanie uses a language that is hurting to Abdul and that is abusive that makes him to start banging his head on the door. There exists a n attitude of choleric which is evident when Abdul is quickly aroused to anger by just the hearing of the fact that he would not visit the mosque on that fateful morning without even considering the fact that there was no one to accompany him. The nurse showed condescension in that she showed arrogance to Abdul by the mere fact that he was inferior and a person with disability (Forchuk, 2010).
Anxiety is also suppressed by the patient where he becomes easily agitated and even starts hurting himself by banging his head on the door. This is a bad attitude as it makes him to hurt himself with no good reason. Stephanie fails to show the value of understanding of the patient. She fails to comprehend that going to the mosque was a thing which already existed in Abduls’ mind. She treats him with cruelty which he did not deserve and which was not right also for the nurse (Isola, 2010).
According to London: Nursing and Midwifery Council of England; 2004, core values such as trust, proper responsibility, precise care and accuracy, altruism which involves proper attention while practicing nursing and social justice are very vital in the field of nursing and should be upheld accordingly. Others values and attitudes supported by the various nursing policies available comprises of sympathy which entails the nurses’ understanding of the patients and their needs, trust which is defined by traits of honesty and the ability to keep the personal information given private and confidential (Williams, 2008).
The rules and regulations governing the nursing profession in general highly give a supportive hand to the theme of personal centeredness. The rules outline the significant of a nurse being personal centeredness in devoting oneself as a whole to the service of patients fully focusing on the patients’ needs and requirements. This aims at ensuring that individual indifferences do not give any room for incompetency and poor quality services (Nambiar, 2011).
According to, nurses contain in their possession power and control and hence are regarded as being powerful compared to the patients. This theory supports the theme of power and control in which the nurses are vested the power to gain control over the patients as postulated in my case of observation where Stephanie has control over what the patients like Abdul demand. Power and control of this manner allows for supervision and handling of the patients hence a serene environment in the place of placement of the patients (Burnard, 2008).
Influence on the nurse-patient partnership
The issues discussed above might influence the nurse-patient partnership in one way or the other. To start with, values and attitudes exhibited by the nurses have detrimental effects on the nurse-patient relationship. For example, a core value such as trust affects the manner in which the patient will open up to the to give the necessary information required for treatment purposes. In an instance where the nurse might have been involved in revealing private and confidential information to unauthorized persons, the patient will find it hard to share critical information for fear of being exposed. On the other hand, a nurse with a clear record of keeping information confidential is found to be suitable to be given all the required information by the patient (Holland, 2011). A clear understanding of the patient and proper as well as precise handling of the patient are vital and greatly influences how the stay of the patient at the place of placement will be like. A nurse who swiftly understands the patient enables the patient to accept their conditions and keep their self esteem high. Once the patients are in a position to accept the conditions they are in, it becomes very easy to monitor them as well as their medications hence they are able to recover soonest possible. Thus, the values and attitudes in which the nurses approach the patients with have very many impacts both positive and negative that greatly influence the performance of the patients at large (Erickson, 2012).
The cultural beliefs of the patients must also be met no matter how difficult it might seem to be. The nurses should avoid being stereotypical and try their level best to avoid making assumptions about the patients and hence respect their beliefs for instance a member of the Jehovah witness church refusing to take blood while it is the only way to save their lives should be handled with lots of knowledge such that it does not influence the patient (McConnell, 20I2).
The nurse-patient relationship may also be influence by the person centeredness. This is a two way relationship in which two parties are the players and thus either party should deliver its best. In circumstances where the nurses’ personal centeredness is wholly based on the patients’ needs, the patients are influenced positively in that they tend to get lump sum attention and thus are able to benefit (Shirley, 2011). However, in situations where the nurses highly regard their individual wants, needs and requirements as being important at the expense of the patients’, the patients tend to be negatively influenced. They obtain little attention and are left to conduct most of the staffs on their own and thus their recovery process retards (Brown, 2010).
Another factor that influences the nurse-patient relationship is the power and control issue. Nurses have power over the patients which they have a right to exercise accordingly. Once the powers vested to the nurses are exercised in the best manner, the powers benefit the patients as their actions are highly controlled and thus detrimental effects such as self harming, environmental destructions, hurting of others physically or mentally among others are prevented as prevention is always better than cure. However, in instances where the nurses exercise the powers in their favors at the expense of the patient’s interests, the patients tend to be influenced negatively like in my case of observation where Abdul went ahead to hurt him simply because he was denied a chance to visit the mosque (Duffy, 2005).
Influence on Future Practice
From the observed case discussed above, as a nurse in making, I learnt a lot of fundamental lessons which I ought to apply in my practice in my field work. As a nurse I have learnt about the significances of building a strong foundation on the core values and attitudes that I should apply while interacting with the patients. I have also known the essence of creating trust with your clients such that they won’t shy off on addressing their problems with you (Wiseman, 2013). Letting go off your working stress is very fundamental in a nurse’s life, you might treat a patient who later succumbs to the disease and this can be very stressful. Practicing power in control is very essential in a nurse’s life in the medical practice; it means that as a nurse in control I have to exhibit my power when on duty. For instance, if the visiting time is over I shouldn’t let people extend or move in. By this I will be able to make firm decisions when required. I also learnt that as a nurse I was expected to be very courteous and be around person not a racist at all this because I was expected to be dealing with a lot people from different places. Similarly, I learnt that being honest was very appropriate in my profession, since I was supposed to tell the patient their diagnosed problem even if it would stress them up but in a crafty way (Eureka, 2012).
The nursing profession is entailed with very many values which must be followed closely by a nurse for a successful career. This means that an honest nurse is very crucial that they will value the client’s freedom to a confidential treatment by the doctors and properly treated by the doctors and nurses. The people should be given a freedom to choose the way to be treated allowed making sound judgments when there is a major crisis in their health and they are required to have risky procedures done on them like the operations where there is no guarantee of the outcome. The nurse is expected to have the personal centeredness, they are expected to concentrate with one patient at a time and give them the best service as possible keeping their matters at a bay. This will avert the likes of mistaken diagnoses which are often in an absent minded doctors and nurses. Notably the client should relate with the clients professionally so that they cannot ruin their future relations with the patients. It would be very hard for the patient to open up to the nurse on their problems considering their past. Therefore I have learnt a lot of what is expected from me.