Dimensions of Nursing Care

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. Nurse-patient relationship is a therapeutic relationship between a nurse and a client built on a series of interactions and developing over time. All interactions do not develop into relationships but may nonetheless be therapeutic. The relationship differs from a social relationship in that it is designed to meet the needs only of the client. Its structure varies with the context, the client’s needs, and the goals of the nurse and the client. Its nature varies with the context, including the setting, the kind of nursing, and the needs of the client. The relationship is dynamic and uses cognitive and affective levels of interaction. It is time-limited and goal-oriented and has three phases. During the first phase, the phase of establishment, the nurse establishes the structure, purpose, timing, and context of the relationship and expresses an interest in discussing this initial structure with the client. Data collection for the nursing care plan continues, and basic goals for the relationship are stated. During the middle, developmental, phase of the relationship, the nurse and the client get to know each other better and test the structure of the relationship to be able to trust one another. The nurse is careful to assess correctly the degree of dependency that is necessary for the particular client. Plans may be devised for improved ways of coping with problems and achieving goals. The nurse is alert to the danger of losing objectivity during this phase. The last phase, termination, ideally occurs when the goals of the relationship have been accomplished, when both the client and the nurse feel a sense of resolution and satisfaction.

The Nursing and Midwifery Council exist to safeguard the health and wellbeing of the public. Following the Standards set by the NMC are essential in the patient care experience.

Trust – The patient and their family need to be able to rely on you and have confidence in the work your doing. A nurse has a very powerful position and most patients place trust in a nurse because there depending on the nurse to help 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.

Respect -discretion in keeping secret information- A nurse must always treat patients with respect at all time, ensuring to ask how the patient wishes to be addressed

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.

Collaborate a nurse and patients work together for the common welfare of the patient this involves cooperation and good communication to be successful.

Consent-give permission a nurse must always gain consent for any procedure or information sharing from the patient involved, depending on the condition of the patient.

Boundaries-limitations a nurse must always be open and honest with the patient. Be aware of 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 unfortunately. 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 evective communication such as the patient being hungry, tired or in pain. Emotional factors have to b 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 perceivement 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 are 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.

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, 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, take your time to listen and explain and remember to use open body posture.

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 had 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. On admission i would take the patient to their room, which were all single cubicles with on-suite 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 to make 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 effects 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 well being 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 discreetly 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.

If i am unaware of my of my strengths and weaknesses, it is more likely that i will be unable to to help others (Burnard 1992).