The nurse-patient relationship has always been considered to be an essential aspect of the nursing profession, which has an impact on the wellbeing of both sides. The nurse-patient relationship has a unique purpose and is extremely complex and often difficult to understand from an outside perspective. The role played by the nurse is pivotal in patient care, as establishing a good relationship can be vital in helping the patient make clinical and psychological process.
In the discussion that follows, I will explore the nature and relevance of the nurse-patient relationship and evidence why that it is fundamental in nursing as supporting the well-being of the patient, promoting recovery. Following on from this, I will reflect on my own experience of the nurse-patient relationship applying the knowledge I have acquired and consider how this affects my own personal and professional development. As stated the nurse is a pivotal figure in patient care, therefore it is important to understand the nature and relevance of the nurse-patient relationship.
Chiu and Mok (2004) suggest that nurses who develop trusting relationships demonstrate a holistic approach to caring; they are reliable, proficient, competent and dedicated in their care. This holistic nature of working is achieved through the Nursing and Midwifery Council’s Code of Professional Conduct (2002); they believe that nurses are responsible for developing appropriate relationships and safeguarding the interests of their patients as this allows the patient to be supported and protected in a trusting and secure atmosphere.
The NMC code of conduct consists of six main principles; trust, respecting individuality, collaboration, consent, confidently and boundaries; each being fundamental for forming an effective nurse-patient relationship. Trust is an essential principle in the development of the nurse-patient relationship; this is because the balance of the power lies with the nurse and this makes the patients and their family feel extremely vulnerable. The patient is exposed to an unfamiliar environment and that creates dependency, making trust vital in order to eradicate the patient’s fear and anxieties. Raeve, 2002) suggests that the qualities of a nurse such as; friendliness and confidence are vital in developing the fragile trust which patients have developed in the health care service due to assumptions of skills and knowledge. Trust is a large aspect in the nature of the nurse-patient relationship as this makes the patient accessible to the nurse and, therefore, the healthcare which is needed. (Reave, 2002) The importance of individuality is suggested by Castledine (2004) who believes that the key to a successful nurse-patient relationship is being non-judgemental, listening and the ability to treat each patient as a unique individual.
This is a key aspect in the nurse-patient relationship as it develops trust and co-operation if the patient is treated with respect. Another important principle of the nurse-patient relationship and the NMC Code is collaboration with the patient; collaboration enables the patient to be involved with their health care which relieves the stress and anxieties that can created from the alien ‘medical’ environment.
Empowering patients to participate in their care was suggested by Pembrey (1984) who acknowledged that the nurse working in partnership with the patient, and their careers, deliberately transferred some of their knowledge and skills; this allowed the patient to increase their competence and control, and preserve their dignity. Castledine (2005) also outlines the importance of collaboration, he suggests that it increases the likelihood of co-operation and makes the patient more responsive to their care plan and treatment.
Collaboration is an important aspect of the nurse-patient relationship as it ensures the patient never feels inadequate it allows the patient to be involved with their own treatment; it also confirms the patients understanding and consent and adopts a person centred approach to care. The attainment of consent is another critical principle of the nature of the nurse-patient relationship, as it is a fundamental right for the patient to give informed consent to all medical inventions and procedures.
Consent is required as it makes the patient feel secure as they are given control. (NMC, 2002) Should there be concerns about an individual’s cognitive ability to understand the decision for which consent needs to be obtained, a mental capacity assessment may be required and a best interest decision made on behalf of the patient. Confidentiality is a fundamental principle within the nature of the nurse-patient relationship; this is because without honest and open communication the health of the patient cannot be ensured.
Fullbrook (2007) suggests that confidentiality is the cornerstone of trust and therefore it is crucial to respect the patient’s privacy to preserve their confidence in their nurse and the health service. Confidentiality enables the patient to confide in their nurse and reveal important details regarding their health, this aspect of the nurse-patient relationship are vital as this information could be essential in determining what treatment is given, ensuring the patient receives the best possible treatment.
It is important that the patient is aware that any personal information is only shared with appropriate professionals at appropriate times, consent to share information with the family is also key because it enables the patient to have some control and maintain their dignity. (NMC, 2002) Another important principle in the nature of the nurse-patient relationship is the aspect of boundaries, as they provide the patient with structure. The intensity of the nurse-patient relationship makes it like a friendship, however, unlike a friendship the relationship demands coaching to complete a joint goal and is not based on mutual attraction.
Boundaries are important as it provides the patient with a independent figure who can provide support and advice, without the patient having to put on a persona. The nature of the nurse-patient relationship is mainly focused on the principles of the NMC Code of Conduct (2002); however these aspects are improved with effective communication skills and individual interpersonal skills; this builds a relaxing and trusting atmosphere for patients.
Burnard (2002) suggests the key personal qualities requires for a therapeutic relationship are; warmth and genuineness, empathic understanding and unconditional positive regard. Warmth in a nursing relationship denotes being approachable and open to a patient. Genuineness is another important aspect in a therapeutic relationship; nurses must take an interest in their patient to be able to offer the best possible care. McQueen (2004) suggests that a genuine relationship is one that involves concern and commitment and has a high emotional content.
Positive regard makes patient feel respected as it requires the nurse to view the patient with dignity and as individual, and therefore encourages trust and cooperation. Burnard (2002) suggests that empathic understanding is vital, as he believes developing empathic understanding is accompanying patients through their emotional journey being able to empathise with their feelings, which gives the patient someone to trust and confide in.
The nurse-patient relationship is also developed through communication skills; Egan (2002) suggests that the best way to establish a relationship is with the use of ‘SOLER’. This emphasises the importance of appearing interested in the patient through verbal and non-verbal communication, having an open posture and maintaining eye contact, this displays a relaxed, yet interested, approach and makes the patient feel comfortable and important which enables a relationship to develop.
The NMC Code of Conduct (2002) provides an important foundation for the development of an effective nurse-patient relationship; this is relevant as nurses are the front line staff and the main contact within the healthcare system for the majority of patients. They are the first source of contact for the majority of patients and therefore it is their responsibility to ensure that a trusting relationship is developed so that the patient can feel secure.
Castledine (2004) suggests that patients find it hard to adapt in the alien environment of the hospital, hence it is crucial that the nurse-patient relationship is established quickly to help the patient cope and understand. Nurses are also often the last source of contact which can be an emotional charged time for individuals and their families; this makes the nurse-patient relationship vital as it enables families to have someone familiar whom they can find comfort. The relevance of the nurse-patient relationship is also identified by Raeve (2002) who suggests that nurses are measured as the proxy for the quality of healthcare received.
The nurse-patient relationship is extremely important and often considered as vital aspect of nursing; this is mainly due to the positive contribution that it has on a patient’s health. The relationship which is formed between a nurse and a patient is often therapeutic; the relaxed nature of this relationship has a major impact on the patient’s well-being. The therapeutic relationship contributes positively to the patient as it makes them feel valued and an integral part of their own healthcare, which greatly increases their self-esteem.
This point is emphasised by Peplau (1988) who suggests that nursing is an interpersonal process which is often therapeutic and this interpersonal interaction between the patient and a nurse often has more of an effect on the outcome of a patient’s problem than many routine technical procedures. Another advantage of the nurse-patient relationship is that it allows the patient to deal with the alien environment of the hospital, this is vitally important as it enables the patient to be comfortable and therefore more cooperative in their communication and their treatment.
The trusting nature of the nurse-patient relationship makes the patient feel secure in the care of their nurse, as the patient feels genuine compassion from their nurse, which can result in a faster recovery rate. The nurse-patient relationship also contributes positively to the patient as it allows the nurse to advocate for those who are vulnerable; this is a major benefit as it ensures that everyone gets the best possible care regardless of their physical or mentally ability. Raeve (2002) suggests that the nurse and patients relationship is the middle of trust and reliance.
From this, Raeve implies that those who are vulnerable trust the warmth of the nurse-patient relationship, this gives them faith and confidence in the nurse’s judgement, as they are secure in the knowledge that it would be concerning their best interests. Furthermore, the nurse-patient relationship contributes positively to the patient as it provides them with a companion in whom to confide their concerns and fears; this benefit enables the patient to feel supported throughout their treatment.
This point is reiterated by Chiu and Mok (2002) who suggests that this companionship for the patient not only improves their physical and emotional state, but also reduces the anxiety caused by invasive procedures and eases the adjustment to their illness. The nurse-patient relationship is also vitally important as it promotes independence; nurses are able to coach and engage with their patient so that they become less dependent and therefore able to retain their dignity. Gaining independence is importance as it enables the patient to feel that they are useful, which increases their self-esteem.
Casledine (2005) suggests that treating the patient as individual actively encourages the patient to engage in problem solving, these are the factors that are associated with increased patient satisfaction. He also infers that the patients who take on more of an active role and are less dependent in their care plan recover faster. Moreover, the nurse-patient relationship empowers the patient as it enables the nurses to educate the patient on the important aspects of their illness, this enhances the patient’s well-being and reduces their recovery time as they are less dependent and are aware of how to manage their own care plan.
Pembrey (1984) emphasises the positive contribution made by the education of the patient by suggesting that the transfer of knowledge provides the patient with confidence and regains their dignity. From this previous discussion regarding the nature and relevance of the nurse-patient relationship and how this contributes to the patient positively, I will now reflect on my own experiences of the nurse-patient relationship and this how this has impacted on my own personal and professional development.
Reflection is described by Ghaye and Lillyman (2000) as transformative process that changes individuals and their actions. From my own experience of the nurse-patient relationship and the research I have collated, I can identify with Ghaye and Lillyman’s description, as from reflection I have recognised key areas in which I need to build upon and develop. Researching the nurse-patient relationship has provided me with an essential knowledge base which will only continue to grow.
Lifelong learning is a vital aspect of being nurse, the process is described by Jarvis (2004) as a process of learning that is about reflecting and developing your understanding across the spectrum of life. The knowledge I have gained has also linked theory to practice, and this enabled me to include important features of good practice in my nursing. For example, I am aware of the impact of good communication skills so0 made an effort to actively listen to my patient, maintaining good eye contact throughout any face to face communication, this ensured they were comfortable in my presence and showed that I was interested in them.
Whilst on placement I have also witnessed poor nurse-patient relationships, showed that I observed how a patient felt vulnerable and anxious and recognised the impact of an open posture and the importance of warmth and genuineness. On reflection, I felt that my confidence has greatly improved and I am able to develop a positive nurse-patient relationship with all my patients. I have learnt a number of good lessons from role models in practice, and want to replicate some of their strengths, such as the calm and collective manner in which they speak to a patient in distress.
As well as my confidence, interacting with patients has greatly increased my passion and motivation for nursing. When developing the nurse-patient relationship you are aware of all the small differences that can have an impact on your patient and their well-being, any improvement makes you feel proud of the achievement they have made, even if it is just a more positive outlook. There are areas in which I know I could greatly improve as sometimes found communicating a challenge hence I struggled to develop a relationship.
Also the complexity of the relationship is often difficult as you become very self-aware. Despite this, I am now aware of the importance of building strong relationships as they are essential for achieving the best possible outcomes for your patient. A patient needs to cooperate with you, as without it the process is a great deal harder and you can sense the patients fear and anxieties. The development of the nurse-patient relationship is an extremely difficult skill to master as it can be complex and challenging.
On reflection I appreciate that I have to improve my skills and aim to make my patients have a positive experience. Moreover, I feel I need to incorporate the NMC code of conduct into my nursing as it will provide me with a platform to work from. Being able to apply my learning to practice has been a period of consolidation. In conclusion, the nurse-patient relationship is extremely complex and can be difficult to achieve but it has to be acknowledged as it is essential in the nursing profession.
The nature of the nurse-patient relationship is formed from the combination of the principles of the NMC code of conduct, effective communication and the use of therapeutic skills; this combination enables establishment of a strong effective relationships that contribute positively to a patient’s well-being. The nurse-patient relationship is extremely significant as nurses are often the main contact with the patient and therefore a trusting relationship must be developed. From this research and my own experiences, I have reflected on the nurse-patient relationship and iscovered it’s importance for the delivery of patient focused care; each aspect of the nurse-patient relationship is essential as it provides the patient with some comfort and support. Thus, from research and reflection of my own practice experience, I have evdienced that the nurse-patient relationship is a vital aspect of nursing care that is crucial in giving the patient the finest health care experience. ? References Burnard, P. (2002) Learning Human Skills. 4th edition. Oxford: Butterworth-Heinemann. Castledine, G. (2004) ‘The importance of the nurse-patient relationship. ’ The British Journal of Nursing. 13(4), p. 31. Castledine, G. (2005) ‘Nurses must strengthen the nurse-patient relationship’. The British Journal of Nursing. 14(1), p. 55. Chiu, P. and Mok, E. (2004) ‘Nurse-patient relationships in palliative care’. Journal of Advanced Nursing. 48(5), p. 475-483. Egan, G. (2002) The Skilled Helper: A problem management and opportunity approach to helping. CA: Brooks/Cole, Pacific Grove. Fullbrook, S. (2007) ‘Regulatory codes of conduct and the common law. Part 2: confidentiality’. The British Journal of Nursing. 16(15), p. 946. Ghaye, T. and Lillyman, S. (2000) Reflection: Principles and practice for healthcare professionals.
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