nurse-patient relationship

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    I'm doing a research project on the nurse-patient relationship, and I have a few questions. First of all, what do you feel are the most important components to develop a healthy relationship with a patient? How close can a nurse become to her patient before it is considered too close? Are there certain guidelines that a nurse should follow in order for them to maintain a stable relationship with the patient without getting too close? Are there any guidelines that are especially important to follow? What behaviors do you consider as crossing the line in the nurse-patient relationship? Have you ever witnessed a case in which there was too much involvement with a patient? In the training you received during your nursing education, do you feel you were prepared on how to effectively develop the relationship needed for quality care?
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    I think the focus should be on helping the patient and family. A discussion of the latest ball game could let a patient relax, help them become comfortable enough to open up to you, or annoy the patient if he thinks you care about the game more than helping him.
    The purpose for the nurse should always be to provide nursing care. Not just socializing.

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    Originally posted by Roni254:
    I'm doing a research project on the nurse-patient relationship, and I have a few questions. First of all, what do you feel are the most important components to develop a healthy relationship with a patient? How close can a nurse become to her patient before it is considered too close? Are there certain guidelines that a nurse should follow in order for them to maintain a stable relationship with the patient without getting too close? Are there any guidelines that are especially important to follow? What behaviors do you consider as crossing the line in the nurse-patient relationship? Have you ever witnessed a case in which there was too much involvement with a patient? In the training you received during your nursing education, do you feel you were prepared on how to effectively develop the relationship needed for quality care?
    Hi Roni254. I feel that nurse-patient relationships are experiencing similar strains as physician-patient relationships. There is absolutely not enough time to build a quality relationship. Qualities such as trust and confidence take time to build and maintain. The "system" does not allow for that. Most nurses demonstrate care and concern at the outset, but do not have time to clarify the meaning of care and concern with the patient/family. This is where miscommunication and misunderstanding comes in. Miscommunication and misunderstanding typically lead to complaints or legal action and lawsuits.

    I think the most important quality in care today is collaboration. The nurse needs to encompass the qualities of compassion, expertise, good work ethic, etc. when collaborating with the patient/family. Collaboration is important because it acknowledges the fact that both nurses and patients/families need to be active and proactive in care for the short and longterm benefit of the patient/family.

    I went to nursing school at a time when models and processes were evolving. What I learned years ago in my diploma and BSN training is still applicable in some cases and antiquated in others. My experiences in different work settings have had a more pervasive effect. As I wrote in another post, patient care is very subjective. Nevertheless, you have probably crossed the line when your relationship with your patient/family goes beyond prudent professional. Nurses need to distinguish between being friendly and acting in friendship. Best wishes on your research.
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    I think the most important part of the nurse-patient relationship is open, honest communication. Education is a close second. Our job is to give them the tools to help them manage their conditions. If they are dying, it is our job to let them discuss their feelings, have adequate pain control, etc. Patients may not always like that you have to say, but they respect the honesty nonetheless. I have never seen a nurse-patient relationship get too close. Like others have said, our job is too busy. We focus on the important tasks, then get on with it.
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    I agree that open and honest communication is the best way to develop a relationship with a patient, but what happens when you can't communicate with a patient because they can't speak your language and they come from a totally different culture?
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    Beckyjo,
    You ask an important question. There is an A T and T language line (I've never used it, since the maj of my patients speak engliah or Spanish and I speak both, (thank goodness) but using an interpreter does not always make people feel like they are in a trusting relationship. If they speak english and the culture is foreign to you, maybe you can ask some simple questions about the culture. I have found that most people do not expect that you will "know" their culture, and showing a genuine interest in it goes a long way- it shows respect etc etc etc. But if there is no english and no translator, it does get difficult. Remember for the pt this is an entirely terrifying experience, I get called all over our hospital when the Spa interpreter is tied up elsewhere. Sometimes just your actions- getting a blanket, repositioning gently etc, can make a big difference.
    I also have never seen a nurse/pt relationship get too close. It depends on who you are. It really is a learning process as well, to not take all your pts mentally home with you. Yes, I was very well prepared to develop appropriate pt relationships: it was focused on in every clinical and before we even started clinicals.
    Crossing the line is a very individual thing: It depends ont he relationship you had with the pt. I was a Home health CNA and took care of hospice pts. I occasionally attended funerals, as I had been in the home every day for sometimes months. The family seemed to find it supportive, and it did give me some closure. Now, as an ICU nurse, I do not attend funerals (Thats all I would be doing on my days off), but I haev a very different relationship with these patients, I don't often get to know them as closely. I think it is very individual.
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    hollykate,
    Thanks for the advise. I am currently working in home health in the middle east. One of the most frustrating things for me is I cant' seem to get close enough to my patients to develop a therapeutic relationship. I do know some of the language but not enough yet. I am use to working in the hospital (Med/Surg) and the most rewarding part for me was getting to know my patients well enough to understand why they are not taking their medications or following their diet or why they don't want to get off insulin. I use an interpeter for things like getting a detailed history or education. BUt your right it really puts alot of distance between you and your patient. I am always looking for ways to get around this communication gap, but I don't feel that I have really succeeded. YET!
    Emergent likes this.
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    Although I am just a nursing student, I may have some helpful input. I feel the most important component of developing a healthy relationship with the patient is to treat the patient with kindness and respect. I think a nurse should offer some appropriate personal information to the patient if and only if it stimulates needed conversation or helps to relax the patient. To maintain a stable relationship with patient without getting too close, the nurse must always be dependable and check on patient frequently, yet still maintain a professional image. The nurse should prohibit patient-nurse discussions from getting too deep and involved if not necessary. I believe crossing the line would be offering or requesting information that is inappropriate or is not beneficial to the patient's well-being. Although I have never witnessed a case in which there was too much involvement with the patient, I feel my training has adequately prepared me to handle this situation if it ever presents itself. As far as I can tell, I feel that I am prepared to effectively develop the relationship needed for quality patient care.
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    I work in hospice care and a good nurse-patient relationship is mandatory. In hospice we address the family/significant others as the unit of care, and they become my patients. Its necessary that I MAKE the time to develop therapeutic relationships w/ them, as when I've established them, my teaching effectiveness increases.
    Someone mentioned the ATT language line. It has been really helpful at some times, but there are certain phrases, nuances that DON'T translate. Other emotions are international, and patients can tell if you have a vested interest in their care, or are 'just going through the motions'. Please use any and all means of communicationg at your disposal, but never forget the power of human touch. I don't remember nursing school spending adequate time on communication, but it seems to be an innate quality/skill that is found in caregivers, and it can be honed.



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    Beckyjo,
    Wow!!!! [img]/bb/eek.gif[/img] home health in the Middle East- you couldn't have a more difficult job (in my opinion). I almost married a man from Jordan. My understanding of his culture in general, nurses were not respected, and women, in general were also not respected (He came from a very traditional background). His family had a very difficult time with me. I found one of the things that helped me to "fit in" with his relatives that lived here was to ask a lot of advice when cooking, and ask for advice on clothing- they loved to show me how to get all decked out in the traditional garb. I am not suggesting that you wear those clothes! Perhaps if you can ask for some advise on how to cook some of the traditional foods, that can lead into a conversation about why the diabetic diet isn't being followed. Still, it is a very closed off society. I really admire you- I know I could never succeed in that. Email me any time if you need support or want to talk more. You are one courageous nurse!


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