Consumer-Nurse Relationships

Quality nursing is crucial in delivering contemporary health care, which is based on patient satisfaction and quality health outcome. In mental health, the empathic interaction between the nurses and clients makes nursing value centric, for deriving better consumer experiences (McAndrew et al., 2014). Therefore, it is vital for the nurses to acquire more knowledge and understanding about consumer perspectives of the services rendered,  especially when it is known there are service gaps in Australian  health services (Ewart et al., 2016).  It is imperative, in this context, to examine the Australian consumers’ experiences of mental health services, to know how their perceptions impact on patients’ recovery.

In mental health care, a nurse-patient relationship denotes a helping attitude developed through mutual trust, respect, expectation, and faith, by fulfilling the physical, emotional, and spiritual needs of the patient. This caring rapport grows up when a nurse and a patient associate in unison, to produce the essential healing. However, certain nurse, patient, and organizational elements can become the functional barriers against the origination of these relationships (Pazargadi et al., 2015). In such cases, an interaction with the patient can generate the desired learning experience in the nurse, for instigating an emotional corrective behavioral experience in the client. This change happens when nurses start displaying empathy, using powerful communication skills to control the thoughts, wants, and concerns of the clients.  With the establishment of the trust-relationships, the clients begin confiding their thoughts and feelings openly with the nurses, making the coping, therapeutic (Psychiatric Nursing, 2014).  Consumer Experience And Its Impact On Mental Health Recovery Discussion Paper

However, this sort of productive nurse-client relationship will work out only if the nurses are satisfied with the work environment. The lack of a well managed work environment will cause dissatisfaction in the workforce, which in turn will affect the quality of the nursing work, leading to lower quality of patient experiences. Currently, there are several inhibiting factors that tell upon the job satisfaction of the nurses, contributing negations on the patient experiences. Factors, like excess work load, cost-effectiveness policy, and transparency goals to maintain external accountability are detrimental to the motivation and efficiency of nurses, allowing the nurse-customer relationships to become strained relationships, in the end. The nurses will feel unnecessarily pressurized on the management’s pretext of increasing productivity through  a high administrative workload (Kieft, et al., 2014).

Within any health service system, care acquires quality only if it is safe, effective, and timely, as well as  competent, unbiased, and consumer-centered. Such a patient-centered care will respect and answer patient preferences, in terms of needs and values, during the clinical decisions. Ensuring the participation of patients and their families, a nurse can  share useful information, without jeopardizing the regulations of organizational settings. It is based on these accounts, the contemporary health care policies, now, value the clients as partners, and their interactions as the pillars of health care. The reforms of 2011 National Safety and Quality Health Service Standards (NSQHSS) and the 2012 Australian Safety and Quality Goals for Health Care (The Goals) are far sighted measures to realize these working concepts (Newell & Jordan, 2015).

Consumer-Centered Care

Nurses, in order to pursue their daily care delivery, embrace certain nursing theories for enhancing their nurse competence. Though they gain authority by means of knowledge and perception, it is  these nursing philosophies that propel their nursing practice.  It is because, without a compelling theory that enforces valuable communication, possible health care outcomes would become remote.  These theoretical relationships rely more on the patient’s exchange of thoughts, feelings, outlook, and actions with the nurse, and as a result, the needs of the patients will be fulfilled, enabling them to experience better health outcomes (Senn, 2013).

Since quality nursing is the deciding factor in delivering contemporary health and social care, patient satisfaction needs to be correlated to the quality of the received nursing care. A mental health nursing can be said to be effective only if it is able to predicate the lived experiences of the patients. In order to make it efficient and responsive, the mental health nurses must develop and maintain quality nurse-client relationships. This is to be done, by invoking empathy towards the service users through dialogue, enabling them to feel comfortable, so that they can share their experiences and distress (McAndrew et al., 2014).

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In every successful counselling and psychotherapy in a mental health discipline, the origination of a powerful bond is critical for the patient healing,  especially in the case of clients, having problems with relationships and traumatic experiences in their past. The client-patient relationship will allow such clients chance to reconsider their relational attachments and experiences, through their therapists. The nurse-client relationships will create a real world for the clients, which is impartial, and without having any judgements and dynamics relating to the external relationships (Miles, 2015).

In all health care settings, the service users weigh nurses’ positive attitudes, patience in listening to them, and trustworthiness. All the while, the nurses value  own nursing capability by relating it to their proficiencies in talking, listening, and conveying empathy. However, research evidence shows that a large amount of a nurse’s time is spent in other activities, rather than in building up relationships with the service users (McAndrew et al., 2014).

Quality is a predominant strategic tool for sustaining competitive edge in every field, especially in mental health care, where it is indefinable, due to its intangibility and  heterogeneity. This makes its assessment more difficult, and the only way to measure it is by evaluating the interactions and experiences of the customer and service providers, which always differ greatly in their intensities. Consumers enjoy the right to question about their health treatment and services, and hearing their voices gives solutions to improve the quality of their services. The quality and length of the treatment decide the quality of the consumer’s physical and social wellbeing. Therefore, it is essential to assess the patients’ experience  and satisfaction levels for identifying the areas where improvements are needed.

The first step in eliciting customer satisfaction is by taking into account their needs and priorities. More often, the situation warrants customer segmentation for getting into the customers’ perspectives and priorities on the services availed, without which the efforts will become futile. So, it is necessary to collect information from the customers regarding the benefits and priorities, as well as perceived and expected values of the services, for tallying them with that of the service provider. Managing this information and the conflicts therein, is complex and time consuming, but it is mandatory for finding out the factors that lead to the customers’ negative  experiences, as well as the areas of conflict, where interventions are needed (Azeez, 2015).

Efficacy Of Quality Nursing And Quality Mental Health Care Delivery

Another  leading factor of a negative experience is the stigma a consumer receives  from a mental health service, impeding patient’s recovery.  The stigma level varies depending on the customer’s diagnosis and the discipline of the service professional who delivers the treatment (MHCA, 2011).  Several researches on this aspect have revealed that there is uncertainty in consumers and health service providers about the discriminatory attitudes towards mental illness.  Most public also view the mental patients with fear and dislike, alienating them from the social mainstream. Such outlooks of people have its base in believing that mental illness is self-inflicted, and that mental patients are violent and non communicative.  Things will tend to become more difficult when mental health professionals hold similar attitudes, which amounts to a biased behavior interpretation (Knox, 2013).

Recent studies have unequivocally proved that many mental health providers mention the mental consumers as abnormal or stupid. There is enough evidence that  the consumers used to perceive and experience stigma from all levels of health professionals, including mental health nurses, psychiatrists, general practitioners, psychologists, and medical students. The reason for this widespread negative attitude is the lack of knowledge and concern about the difficulties of this vulnerable population, who emotionally and commonly react to stigma with anger, hurt, sadness, and discouragement. As a result, the consumers develop low self-esteem and self-confidence, self alienation, and reluctance to disclose, leading to anxiety and depression, which ultimately end in reduced levels of satisfaction (Knox, 2013). Many of these shortcomings and negations in customer experience can be avoided, if the treatment is implemented within the purview of Recovery-oriented services (Hungerford & Fox, 2014).

The term ‘recovery’ denotes an intense process of changing a person’s  feelings, attitudes, worths, goals, skills, and roles, for living a satisfying, and contributing life. It involves growing beyond the appalling effects of psychiatric incapabilities. Accordingly, the integration of mental health services is achieved through community-based, residential, and acute health care settings. These arrangements have brought in new challenges, such as staffing changes, workforce flexibility, role diversifications, workloads, and competition in care delivery and its content. The situation, therefore, demands designing facility aesthetics  components for making the patients feel safe in these environments, having enough access to staff and amenities (Rickwood & Thomas, 2017).

The recovery paradigm must be aligned to patients’ cultural background, as in the case of  Aboriginal and Torres Strait Islander Australians, with sufficient provisions for women work orientation. Moreover, there is a need to implement tailored care and support for people with problems of sub-acute symptoms, by incorporating opportunities to learn daily living skills, symptom management techniques, and socialization. The recovery-based care should prioritize the services, by the inclusion of  psychosocial rehabilitation facilities to promote patient empowerment, hopefulness, and universal well-being. Without integrating the health care settings with these facilities, consumer recovery will remain obscure (Rickwood & Thomas, 2017).

The main challenge of recovery-based services in all settings is the inconsistency in understanding the shared meaning of recovery, leading to peoples’ hesitation in accessing services. The primary perspective must originate from the symptom-reduction-based medical model, that works towards patients’ sustained remission, wherein personal recovery is perceived through consumer narratives about satisfying, positive, and contributing life, irrespective of the limitations of the illness. As such, measuring recovery includes the customer’s personal outcome measures and the monitoring of the effectiveness, efficiency, and quality of services (Rickwood & Thomas, 2017).

Factors That Affect The Consumer Experience

The 2013 review of outcome measures, relating to the Australian community mental health organizations, has revealed that 136 different measures of outcome are in force in the country, drawn under seven domains, namely recovery, cognition, social inclusion, life quality, service provision experience, multidimensional measures, and functioning that pertains to daily living and interpersonal relationships.  The critical problem in measuring the recovery field is the failure in defining the recovery means for the young, and for those in the initial stages of mental illness  (Rickwood & Thomas, 2017).

Universally, patient experiences are monitored to gather information about the quality of health care delivered. It is because, patient experiences are the most reliable  reflections of what actually occurred, during the delivery of health care, by the healthcare workers.  Assessment of such patient experiences about the quality of care not only gives significant information about the patient’s real experiences, but also provides an insight on the quality elements the patients prioritized. The existing national performance framework for evaluating the quality of health care envisages a set of quality indicators, known as Consumer Quality Index (CQI) for measuring the standard of patient experiences (Kieft, et al., 2014).

Some of the major indicators of patient experiences are: respect for preferences and decision involvement, clear information and support for self-care, empathy and emotional support, easy access to health care, efficient treatment, recognizing physical needs, involvement of family and supporting them, care continuity and care transition. Since nurses spend more time with patients, they influence more on the patient experiences, which corresponds to the nursing work environment.  This is why the nurses put forward their eight essentials of magnetism for making their work environment compatible for high quality nursing care. Some of the essentials are: sufficient staffing, good nurse-doctor relations, self-regulating nursing practice, efficient nurse manager support, educational support, and a patient oriented culture (Kiet, et al., 2014).

Notwithstanding what is stated above, while arguing for a salient work environment, there is an equal need for the health care providers to restrain and seclude in limited circumstances, avoiding aggravation of internal problems, if there is any, for the sake of consumers, supporters, and other staff in mental health practice. The transition to taking a recovery oriented approach is a reality to augment consumer-nurse relationships, patient recovery, and patient experience (Brophy et al., 2016).

Maintaining a good nurse-patient relationship can be articulated as a process across three identifiable phases, namely the orientation phase, the working phase, and the termination phase, in which the nurse-patient relationship reflects the behaviors and purposes of the nurse and the patient. In this process, the nurse utilizes the relationship for ascertaining the psychological, emotional, and spiritual requirements of the patients, with the help of communication skills, personal competences, and understanding of human behaviors. In the many patient settings, trust occurs in proportion with the patient’s confidence in the nurse’s transference of integrity, credibility, and empathy (Senn, 2013).

Another element that can improve the patient experiences is the therapeutic alliance in contemporary mental health care, as it is a consumer oriented and collaborative relationship, focusing on individual consumer well-being. It is identified as the most humanistic healthcare culture, developed through mutual partnership of the nurses and consumers, and is connected with improved consumer outcomes in health care (Zugai et al., 2015).

Apart from setting a positive and soothing work environment for the nurses and other workforce, for eliciting patient satisfaction, it is argued that embedding a recovery orientation throughout the Austalian mental health system can be acquired only through institutionalizing consumer leadership. The positivity of the consumer leadership is that it becomes a necessity for all the leaders and stakeholders to improve the health care services. The consumer movement could augment consumer empowerment values, equity, and self determination, which are the foundation of a recovery oriented health system. A consumer leadership can, therefore, expand to cover a wide range of mental health service users    (Rickwood & Thomas, 2017).

Australia has been boasting of a well-intentioned strategy and planning, making patient recovery the top most and prioritized component of the mental health system in all its policies and plans, at all levels. It is not yet known how far the current national reforms in health care can bring a concrete change in the system, as the incorporation of the consumer recovery orientation into the system framework is  a Pandora box. A careful monitoring of mental health care services is, therefore, essential to affirm the  quality of care as perceived and experienced  by service users and their families (Rickwood & Thomas, 2017).

A bad integrated health care system drains people’s well-being and  community participation, and also thwarts the productivity and economic growth of a country. In the case of Austrialia, in spite of an expenditure of  $10 billion, each year, on mental health, the health outcomes are poorer.  To facilitate system reform, it is necessary to impart changes in the  mental health system’s sustainability, adhering to person centric design principles, innovative system architecture, and effective funding to ‘upstream’ services and supports. In addition, there is an urgent need to construct a translucent and collaborative governance to work with communities and people, and also the health care professionals (NMHC, 2014).

Conclusion

Nurses have the ability to interact with patients, by developing trust, mutual goals,  reliance, respect, and empathy, thereby improving the learning experience for both patient and  nurse. Fostering nurse-client relationships can contribute much to mental health recovery of the patients. However, discrepancies are rampant in performing relationships between the client and the nurse, which ultimately jeopardize the health outcomes in mental health care. The adverse experience that evolves in the consumers can alienate them from the mainstream health care service.  At the societal level, it harms the community wellbeing, while it thwarts the economic progress of a country.

Nurses, being the primary contacts with mental health care shall develop positive client relationships, through efficient learning skills, flawless behavior, honesty, reliance, and empathy. Since consumer satisfaction is the pillar of health care services, the patient recovery in mental health lies deep in patient experience. So, low perceptions can harm the recovery of mental patients. Therefore, Primary Health Networks should demonstrate how to prioritize the recovery orientation through planning and implementation.

References

Azeez, W. (2015). Improving Customer Experience in Mental Health Service: A case Study of Ivy Willis House. International Journal of Advanced Multidisciplinary Research and Review Volume 3, No.: 5, 2015 Summer. Retrieved May 30, 2017 from https://opendepot.org/2615/1/5.pdf

Brophy, L. M., Roper, C. E., Hamilton, B. E., Tellez, J. J., & McSherry, B. M. (2016). Consumers and Carer perspectives on poor practice and the use of seclusion and restraint in mental health settings: results from Australian focus groups. International Journal of Mental Health Systems, 10, 6. Retrieved May 30, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744440/

Ewart, S. B., Bocking, J., Happell, B., Platania-Phung, C., & Stanton, R. (2016). Mental Health Consumer Experiences and Strategies When Seeking Physical Health Care: A Focus Group Study. Global Qualitative Nursing Research, 3.  Retrieved May 30, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342294/Goulter, N. (2015). Patterns of Care: Primary Research in mental health nursing. Retrieved May 23, 2017 from https://eprints.qut.edu.au/90853/1/Nicole_Goulter_Thesis.pdf

Hungerford, C., & Fox, C. (2014). Consumer’s perceptions of Recovery-oriented mental health services: an Australian case-study analysis. Nurs Health Sci. 2014 Jun;16(2):209-15. Retrieved May 30, 2017 from https://www.ncbi.nlm.nih.gov/pubmed/23991865

.Kieft, R., de Brouwer, B., Francke, A. L., & Delnoij, D. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Services Research   14:249. Retrieved May 30, 2017 from https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14- 249 . Consumer Experience And Its Impact On Mental Health Recovery Discussion Paper