Concept of Nurse-Patient Relationship Essay

Watson defined therapeutic nurse-patient relationship as “a helping relationship that’s based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patient’s physical, emotional, and spiritual needs through your knowledge and skill” ( as quoted in Pullen, 2010, p.4). Nurse’s are expected to portray and act professionally, legally and ethically in order to established an effective nurse-client relationship. The Nursing and Midwifery Board of Australia (NMBA, 2012) is a regulating body for nurses and midwives specifically in Australia had set and approved codes and guidelines to follow and source of basis to guide nurses in their professional practice.Concept of Nurse-Patient Relationship Essay

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Interestingly, not only do successful encounters improve patient outcomes they have also been shown to improve professional satisfaction. These skills lead to professional respect among the nurse and healthcare system. Benefits for an effective nursing care are positive outcome of care. Promoting an environment of nurse-patient collaboration serves also as a gateway to facilitate cooperation and more appreciation of the patients condition (Nursing and Midwifery Board of Australia, 2006). Constructing an effective nurse-patient relationship are integral to the success of patient health condition. There are various ways and technique on how we can convey and form an effective nurse-patient relationship. Establishing rapport and developing trust and respect is the initial part of good relationship. For instance, in your first meeting introduce yourself in a warm and polite manner. Calling your patient by her name is much comfortable than calling them in their last name. Smiling after introducing your name and giving handshake are also another way of conveying positive regard ( College of Nurses of Ontario, 2006). Good communication are another strategies to promote better understanding of the patients condition. Communication entails dynamic interaction between nurse and a patient. It comprises verbal and non-verbal cues that may contribute to the feelings, values and concerns of patient. In conversing with patient the nurse must be an active listener since  Concept of Nurse-Patient Relationship Essay

As suggested by Bungay (2005), the development of a strong nurse-patient relationship begins with nursing practices that demonstrate caring. The act of caring has been identified by Roach (1987) as involving five qualities that establish a caring nursing practice. Further, high quality nursing care must be competent and stem from various sources of knowledge such as empirical, ethical, personal, esthetic, and sociopolitical knowledge (Bungay, 2005). The context in which nursing care and knowledge are applied to patients in clinical settings also drastically influence the positive or negative direction of nurse-patient relationships. As in the case of Allison the nurse, caring using Roach’s caring qualities along with applying her nursing knowledge in specific contextual factors facilitate her ability to provide quality nursing care. In this paper, Allison’s scenario will be analyzed for her ability to care, apply ways of knowing, and how context hindered or facilitated nursing care.Concept of Nurse-Patient Relationship Essay

The five qualities of caring identified by Roach (1987) were evident throughout the case study involving Allison the nurse. Allison demonstrated competence in her nursing practice in multiple ways in the case study. Firstly, she gathered notes for any necessary information from report in order to provide herself a good foundation to provide good nursing care. Further, she constantly drew from her past experiences in order to make sense of the current happenings and thus, determined how to react appropriately. For example, in the case of Mr. Nelson, Allison was able to make sense of his anger and recognize the significance of his hospitalization and his current disposition by being a competent communicator and having “several short talks” with him.

Nursing is known as one of New Zealand’s most trusted professions (Ministry of Health, 2011). Nursing theorist Hildegard E. Peplau (as cited in Lakeman, R., 1999) defined nursing as “A significant, therapeutic, interpersonal process.” The idea of a helpful nurse-patient relationship and having a connection between nurse and patient aiding the healing of the patient is one nurses actively follow, and is written into the Nursing Council of New Zealand’s Code of Conduct (pg 5). Cultural differences play a part in the development of this relationship and can place barriers that can hinder the development of the nurse-patient relationship.
Stein-Parbury (2009) stated that because each nurse and each patient are individuals, the way they communicate and interact with each other will be different in each nurse-patient relationship. Hence, it depends on the participants and context what characteristics will be most effective. One characteristic of a helpful nurse-patient relationship is maintaining a professional relationship; others are mutuality and reciprocity.Concept of Nurse-Patient Relationship Essay
Maintaining a professional relationship, and knowing the difference between a professional and a social one, is essential in a helpful nurse-patient relationship. This relationship is set around the physical, mental, and spiritual needs of one participant, the patient. All interactions between patient and nurse are made being mindful of the patient achieving well-being in all senses (Webb & Holland, 2011). In contrast, a social relationship is not formed around a goal, nor restricted to a certain setting. Using friendships as an example, a social relationship is different from a professional nursing relationship in that it is not one-sided Concept of Nurse-Patient Relationship Essay

Taking care of patients can be rewarding and fulfilling. However, sometimes it can also be emotionally and physically draining. Nurses work in patient care, but also in customer service. Maintaining a professional, courteous interpersonal relationship can be challenging. However, it can be critical in a patient’s overall health and well-being.

Establishing a healthy nurse-patient relationship is vital. Nurses should greet the patient by name, make eye contact, and display confidence and professionalism. They should explain everything they will be doing and review the plan of care, making sure to involve them in decision making. Maintaining patient privacy is also essential. For some patients, touch is a way to demonstrate compassion and caring, but nurses should be aware of personal boundaries, as some patients prefer not to be touched. Remaining culturally sensitive as well is vital; providing handouts and patient information in a patient’s primary language should be offered, as well as an interpreter if needed. These essential items help to develop trust and open the lines of communication.Concept of Nurse-Patient Relationship Essay

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So how does trust and communication help patients? When patients seek health care services or are hospitalized, many are not familiar with the process or what to expect. They may be apprehensive about what’s to come, and not understand the medical jargon being spoken. For some, being spoken to using medical terminology is like a foreign language. Imagine being in a foreign country with people speaking to you and you have no idea what is being said. One can feel helpless and out of control, which may lead to anger or resistance to learning. If a healthy nurse-patient relationship is established from the get-go, the nurses can help the patient feel more at ease in their situation and encourage questions and participate in their care.

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Nurses must get buy-in from patients when it comes to their care. As any nurse will tell you, it’s nearly impossible to work with a non-compliant patient. Little to no improvement is made. Encouraging participation and educating patients is paramount. As stated earlier, establishing a healthy nurse-patient relationship is essential as the first step to open the lines of communication. Communication must be ongoing and involve patient education. For example, a non-compliant diabetic may believe that skipping meals helps to lower blood sugar. A nurse can take the opportunity to explain the importance of regular meals and snacks and explain what happens physiologically when meals are skipped in diabetic patients. The patient may just not know. Education can lead to better compliance and patient engagement and therefore improved patient care outcomes. In this example, improved blood sugar and A1C levels.Concept of Nurse-Patient Relationship Essay

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Nurses are on the front lines of health care. They become experts at establishing relationships with patients and can do so without a second thought. A healthy nurse-patient relationship built on trust and respect goes a long way in improving a patient’s overall health.Concept of Nurse-Patient Relationship Essay

A nurse with good communication skill is someone who really listens to the patients, understands their problems and queries and answers in a way the patients will understand. Communication in nursing profession can be a complicated process, and the possibility of sending or receiving incorrect messages frequently exists. It is important to know the key components of the communication process, how to improve the nursing skills and the potential problems that exist with errors in communication. In this case, we take a nurse as an example. A nurse who can explain in a simple manner to a sick man why a particular diet is very useful to get well soon, is said to have good communication skills. Both verbal and non-verbal communication plays a very important role in communication in nursing.Concept of Nurse-Patient Relationship Essay

For most patients, the nurse becomes the primary contact in the medical world. The nurse serves as the liaison between doctor and patient. She must understand the doctor’s instructions and the patient’s concerns. Her communications skills focus on both giving and receiving information as well as creating an environment of confidence.

The relationship between nurse and patient should be a therapeutic nurse-patient relationship. According to Pullen and Matthias (2010), a therapeutic nurse-patient relationship is defined as a helping relationship that is based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patients physical, emotional, and spiritual needs through your knowledge and skill. In other words, a therapeutic nurse-patient relationship focuses mainly on the patient.Concept of Nurse-Patient Relationship Essay

Today, it is sad to say that there are many nurses who fail to grasp the importance of good communication between the nurses and the patients and therapeutic nurse-patient relationship. They neglect their duty to keep the needs of the patients as their first priority.

Poor communication is dangerous as misunderstandings can lead to misdiagnosis and even medication errors.

This area is also one of the main sources of complaints made to the health service ombudsman every year and some believe that a separate module for communication should be used in nursing training instead of being subsumed into the general curriculum.

The barriers to good communication skills are many and include time pressures (nurses are so busy ad may not be able to get time to sit and talk with patients); lack of privacy; skills mix on the wards can mean there is a shortage of qualified nurses who are available to talk to patients; lack of training; and different languages.Concept of Nurse-Patient Relationship Essay

There are also several useful things to remember in having good communication including being prepared and know what you are going to say; having the right information to give when patients ask questions; maintain eye contact and observe the patient’s body language; listen properly; pick up on the non-verbal signs as well as the verbal ones; avoid the use of medical jargon; and in cases of breaking bad news, be emotionally prepared, try to find the right environment, and be sensitive, honest and compassionate.

In this assignment, however, I will only discuss on factors that lead to poor communication in nursing.

Research Problem
1. Problem Statement
The problem statement for this research is ‘To determine the factors that lead to poor communication skills in nursing’.Concept of Nurse-Patient Relationship Essay

Poor communication skills in nurses are a major problem today and can be widely seen in most hospitals and clinics. There are many cases where the nurses speak rudely to the patient and ignore any questions asked by them. They are more concerned with their own welfare than that of the patient and many nurses hesitate and feel embarrassed to ask questions when there are things they do not understand. Their ignorance and poor communication skills can be due to several factors such as emotional stress, language barriers, overworking, fear and education or experience gaps.

This problem of poor communication, if it is not dealt with at its earlier stage may lead to the destruction of the delicate relationship between the patients and the nurses. The patient will no longer trust the nurses and this may not only give a bad name to the nurses but also to the hospital.Concept of Nurse-Patient Relationship Essay

I believe that, when the root of this poor communication in nurses has been identified, we can take immediate action to correct and improve the current communication between the nurses and the patients.

In this research, our scope is within the Miri General Hospital. The nurses in the hospital act as a mediator between the doctor and the patients. Nurses are the group of hospital staff that are the eligible to explain any queries of the patients and give comfort to patients. This is the main reason why good communication skill is a compulsory trait that all nurses must possess.

It is from this research that I hope, we will get a better understanding of the cause of poor communication in nurses and from there, and we will be able to take necessary steps to overcome this problem.Concept of Nurse-Patient Relationship Essay

2. Research Objectives
(a) To understand the importance of good communication skills in nursing.
The best relationship between a nurse and her patient is the therapeutic nurse-patient relationship. Therapeutic nurse-patient relationships are based on mutual trust, nurturing, and sensitivity to the patient’s needs. In this research, we wished to determine why good communication is very important in the nursing field. What are the advantages of good communication in nursing and what are the drawbacks of poor communication in this field.

(b) To determine if overworking is the cause of poor communication in nursing.
Nurses today have more responsibilities compared to nurses of previous times. Today, nurses not only are responsible for the welfare of their patients but their paperwork load has increased. Nurses also need to ensure the cleanliness of the ward especially if the housekeeping staffs are not around. They need to be able to fix the machineries if the technicians are not available. All these additional responsibilities lead to the overworking of nurses and thus leads to them not having the time to communicate and interact well with the patients.Concept of Nurse-Patient Relationship Essay

(c) To determine if shortage of nurses is the cause of poor communication in nursing.
With each passing year, there are more sick patients that require a lot of time and attention from the nurses. But due to lack of nurses, there is only very limited things a nurse can do for each patient. The nurse allocates a very short while to attend her patients, not having time to talk or listen to the patient’s questions or doubts. This will make the patient feel neglected and unattended to. This high nurse to patient ratio may also be a reason that contributes to the poor communication between nurses and patients and also degradation of therapeutic nurse-patient relationship.

(d) To determine whether language barrier is leading to poor communication in nursing.
Language plays an important role in communication. The inability to understand a language can lead to misunderstanding and miscommunication, worst still, misdiagnosis. In nursing, it is very important that the nurse should understand what the patient tries to convey to them and vice versa. If both the nurses and the patients cannot understand each other due to use of different language, it will lead to many problems and misunderstandings. Language may also be a factor that leads to poor communication in nursing.Concept of Nurse-Patient Relationship Essay

(e) To determine if fear is one of the contribution to poor communication in nursing.
One common reason for poor communication is that it has to do with a nurse having a lack of comfort or fear in communicating with another nurse or doctor. These type of issues usually occurs when a nurse feels threatened by a co-worker, fears the possibility of making a mistake and doesn’t say anything to avoid judgement or lacks confidence in her abilities as a competent nurse.

(f) To determine if education and experience gaps leads to poor communication in nursing.
An education or experience gap can occur when a less educated/experienced nurse works with another senior nurse who is much more educated and/or experienced and the junior nurse has trouble understanding the concepts, procedures and/or medical terminology used by the more experienced nurse. These types of gaps can lead to confusion, misinterpretation, inaction and errors due to the inability to communicate effectively and fully understand what is being communicated.Concept of Nurse-Patient Relationship Essay

(g) To determine whether emotional stress leads to poor communication in nursing.
Nurses who are experiencing a lot of emotional stress or a trauma may have difficulty focusing or expressing or communicating their feelings, perceptions, beliefs and attitude towards certain situations. This can lead to mistakes being made and/or reduce the amount of attention they are able to put towards their work, patients and co workers.

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3. Hypothesis/ Research Questions
I have come to believe that modern day nurse-patient relationship is undergoing serious strain due to poor communication between the nurses and the patients. There are several factors that might contribute to this problem.Concept of Nurse-Patient Relationship Essay

Firstly, the modern nurses are being overworked, causing them to lack in their communication skills. When nurses work long shifts for extended periods of time it can cause fatigue, which lowers their focus, effectiveness and ability to communicate effectively with patients and staff. Today, nurses must spend an inordinate amount of time completing redundant documentation in several different places, hunting for supplies, wearing multiple hats and performing other tasks. For instance, if the need for a cleanup arises and the housekeeping staffs are not present, nursing staff must address it. If the remote control is not functioning properly and the maintenance staffs are nowhere to be found, the nurse is usually the person who must try to resolve the issue.Concept of Nurse-Patient Relationship Essay

The next reason is due to shortage of nurses. Every year there are more sick patients that require much of the nurses’ time. This leaves them with very limited time with other patients. The nurses may be doing their job but they fail to form a relationship with the patients. We take for example, a nurse approaching the bedside to empty a patient’s indwelling urinary catheter. As she approached she didn’t make any eye contact and duly went about emptying the catheter, recorded the details on his fluid balance chart and walked away. At no time during the procedure did she speak. This example shows how essential communication skills are when caring for patients. Had he wanted to ask a question, the opportunity was lost. At this time, it would have been a good opportunity to take a look at the patient and perhaps ask how he was feeling. Poor non verbal communication also leads to poor nurse-patient communication.Concept of Nurse-Patient Relationship Essay

Poor communication also occurs when the nurse and patient speak different first languages. Idioms and frames of reference can carry shades of meaning in one language that may not exist in another. Mispronunciation or incorrect signing can mislead the provider or patient, causing the patient to lose his trust on the nurse. This problem usually occurs among the elderly patients and also the foreign patients. Due to the difference in language, both the nurses and the patients fail to convey each message to another. Â Especially in Malaysia, a country full of different races and languages, it is impossible for the nurses to be able to understand and speak all these different languages. There are also some patients, especially those who live in the interiors; they are not able to speak the national language but only their one native language. This phenomenon also leads to poor communication skills.Concept of Nurse-Patient Relationship Essay

Poor communication also tends to evolve out of the level of power within hospitals. The presence of hierarchies in hospitals tends to increase the likelihood of poor communication developing at some level or another within the vertical power structure. The main cause of this communication failure is due to fear but this does not to mean that the hierarchical organization of power in hospitals is a bad thing-it only means that it can lead to poor communication to develop multiple places within the medical hierarchy. One of these places is between physicians and nurses. Nurses frequently hesitate from asking physicians potentially “obvious” or unimportant questions. As both physicians and nurses are very much involved in the care and support of patients, major communication breakdown between them could lead into serious medical difficulties for their patients. For example when a physician instructs a nurse to convey important medical information to patients but the nurse does not fully understand the information and due to fear, she does not ask for further explanation from the doctor and gives the wrong information to the patient. Poor communication between physicians and nurses also often develop when physicians fully rely on written orders to convey instructions to nurses.Concept of Nurse-Patient Relationship Essay  They will write important details into patients’ medical files-often including crucial instructions for nurses, such as when to administer particular treatments to patients. If nurses missed checking patients’ medical files, they consequently also missed the important instructions that were written in them. This raises the crucial question of why physicians continue to employ indirect modes of communication to the extent they do, and why nurses don’t object to it. This is not to suggest that written communication should be prohibited, but that written communication is a poor substitute for direct verbal communication. Perhaps one reason why written communication remains prevalent is that nurses fear questioning what they might consider to be a standard practice among all physicians. Here again it can be seen that the reluctance to question the practices of superiors may lead to a communication breakdown-or, more seriously, to a complete communication failure.Concept of Nurse-Patient Relationship Essay

As nurses usually feel inferior to the physician in charge, so do junior nurses feel inferior to the senior or more experienced nurses. The younger nurses hesitate to ask questions to the senior nurses in fear of being labelled as not well educated. Sometimes, the senior nurses explains a certain procedure or information to the junior nurses, but due to lack of experience, she may not fully understand it and hesitate to ask any questions after that. The senior nurses also take for granted that the junior nurses understand all that has been explained. Miscommunication as such is very dangerous as it will affect the patient.Concept of Nurse-Patient Relationship Essay

Nurses are the backbone of any healthcare unit. The pressures of overtime and long working hours create a work-personal life imbalance, which begins to affect the health of the nurses. All nurses have to do shift work or attend emergencies at night. The stress of shift work can also worsen the nurse’s health conditions leading to depression, low morale, and low motivation. Other factors such as long commuting hours and chaotic traffic conditions adding to their stress affect the employee’s efficiency and effectiveness. All these can affect the nurse’s relationship at home as well as on the job. Home stress contributes significantly to the stress faced by nurses. Their home life is disturbed due to night shifts, overtime, transport delays, and difficulty in getting leave. They constantly worry about their children and their studies not being properly supervised. Nurses have to look after the home, cooking and cleaning as they cannot afford domestic help. This can have a negative influence on their physical and emotional health and lead to psychosomatic disorders. Psychosomatic illness is a disorder that affects the body and the mind. These illnesses have emotional origins causing physical symptoms. Some examples are acidity, anaemia, backache, and stiffness in the neck and shoulders. Sometimes, in the absence of doctors, nurses are on the front line and have to face verbal abuse from patients and relatives for issues that may not be directly connected to their work. Physical violence and aggressiveness is also on the rise in patients and their relations. Demanding patients and their relatives can cause conflict and lead to more stress. Another cause of stress is economic loss to the organization due to errors, wrong decisions, wrong choice, lack of attention, and injury. All these stress factors demotivate the nurses causing them to slack in their communication skills.Concept of Nurse-Patient Relationship Essay

Conclusion
Communication in nursing is specifically used to identify the nurse-patient relationship amongst other things; some of the ways include translating, getting to know you and establishing trust to ensure the patient receives the best treatment (Fosbinder, 1994).

In a place where an individual’s health and well-being is largely determined by the level of cooperation amongst nurses and other medical professionals who are assisting them, there are things that are more important than education, training and open communication.

Poor communication often leads to big mistakes such as prescribing the wrong medication, improper diagnosis of a patient ailment or medical condition, administering the wrong treatment plans and in some cases even death of a patient due to misdiagnosis due to lack of communication.Concept of Nurse-Patient Relationship Essay

We also know that nurses and physicians are trained to communicate differently. Nurses learn to communicate by being descriptive, detailed, and narrative while physicians learn to summarize, diagnose, mend, and repair. This makes nurses the best mediator between the physician and the patient as nurses are taught to explain and give information in the most understandable manner to the patient.Concept of Nurse-Patient Relationship Essay

Communication is at the heart of these goals and patients are being encouraged to be more involved in their care. This can only be achieved if patients truly understand what is available and feel empowered to make those choices.

Therefore, when talking to a patient next time, take time to reflect on how you think the consultation went and how it could be improved. Determine whether you use jargon or abbreviations that the patient might not understand, and more importantly did you find out if the patient understood what had been said. Concept of Nurse-Patient Relationship Essay