The should address the patient and his relatives

The
nurse-patient relationship, otherwise known as therapeutic relationship, is the
foot on which the entire spectrum of nursing care is built on. As opposed to a
social relationship, this kind of correlation is focused on the health of the patient
by promoting the patients’ wellbeing and further improving the quality of life.
This is done by multiple underlying constants irrespective of the duration of
the relationship.

Without
a doubt, communication is the basis of this relationship from the very start
when the nurse first encounters the patient. No matter the different setting of
the hospital, the nurse must first introduce herself and establish her role.
She should address the patient and his relatives in a manner which they most
prefer so as to make them feel more comfortable and at ease. When explaining a
procedure or a diagnosis to the patient, it is crucial to speak in terms which
are understandable by the patient.  In my
opinion I believe that although all this may seem as an easy task, senior
nurses may take this for granted and fail to realise that this is what makes a
distinction between an average nurse and an outstanding one. An old Turkish
proverb says that “if speaking is silver, then listening is gold.” This is why
active listening goes hand in hand with communication. By keeping eye contact
for the right amount of time – so as not to intimidate the patient, smiling
occasionally when the patient is talking and making periodical gestures with
your head to show that you are understanding what he is saying, the patient relaxed
and is shown that you care about him. Whilst doing this, the above average
nurse would be observing the patient’s nonverbal behaviour by detecting any
facial expressions and posture which show pain and lack of comfort. Sometimes
it helps to paraphrase what the patient has just said to make sure that the right
concerns are understood.  

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Being
a nurse means that you get to meet people having different backgrounds – having
different cultures, values, norms and sometimes even unfortunate backgrounds
which they are not proud of. Hence, this results in all different patients
having unique ways of coping with their challenges, in this case, regarding
their health. This requires the nurses to put their own personal beliefs aside
and accept the patient as the human being he is without being judgemental. This
capability to accept the patient with his own principles and coping methods, in
spite of having personal opinions, is called unconditional positive regard
(Rogers, 1961).  The goal is not to
approve a patient’s past adverse behaviour or to give consent to unhealthy
habits such as smoking or drinking, but to recognise that every patient has his
own dignity and is worthy of being taken care of in the best possible way,
regardless of his past, place in society and severity of his health issue. In
this respect, being accepting will result in the patient feeling more secure
and safe and in return he will come more in terms with his health status and
will open up more about his feelings and symptoms which in turn will help
minimise the length of the patient’s stay in the hospital setting whilst promoting
a faster recovery. If the patient is not shown the respect he deserves and is
treated in a judgemental manner or is looked down upon, he will most likely
find it harder to regain his strength and this also goes against his human
rights.

When
it comes to interpersonal relationships such as the therapeutic relationship,
trust is the basis of all, regardless of the clinical speciality in a
healthcare setting. It is a vital requirement which all human beings seek from
the very start of their lives (Freud, ) as described in various psychoanalytic
theories. It is in fact the first stage in Erik Erikson’s (1959) psychosocial
stages of development where he describes it as “the reliance on consistency,
sameness, and continuity of experiences provided by familiar and predictable
things and people.” (Erikson, 1963). In a clinical setting, patients are most
likely to feel vulnerable and exposed both in a physical and emotional way, not
to mention that some may also feel unguarded on a spiritual level. For this
reason, it is imperative that nurses show their patients that they can be
relied on throughout and maintain a knowledgeable appearance when at work, so
that the patients will be able to feel in safe hands and will be conscious that
they have well-informed nurses who know what they are doing. This trust is also
gained by being honest and direct – in a sensitive manner, and by acting
orderly and consistent with all the patients. If this trust is violated, it is
very hard to be gained again. This is why nurses should never lie to patients
especially when it comes to their health status. Whenever questions on this
arise and there are uncertainties, the consultant in charge should be contacted
to handle the case as required. Apart from this, it is also significant that
this trust is not lost in little things such as breaking promises. If a nurse
promises a patient that she will call to check up on him or to visit him later
on during shift hours, sticking to what was promised does not only make the
patient feel important and cared for, but also maintains trustworthiness and
credibility. It is also important to mention that the patients know for a fact
that any personal information that is shared with a healthcare worker such as
the nurse, will be confidential and not shared with anyone, unless it involves
something which requires the nurse to step forward and take the appropriate
measures, as dictated by the legal constitution of the country. This may
include danger of potential harm to oneself or others, committing a crime or
signs of abuse. Here, although trust is breached, I feel that it is for the
better of the patient and/or others around him.

            One of the many reasons why the nursing profession may be
a tiresome one, especially overtime, is because of the constant need to be
empathic, compassionate, altruistic and sympathetic. These four terms best
describe the fact that this profession is not like any other, but one which
requires full dedication and show that this is a vocation that needs to be felt
from within, rather than just another occupation in a hospital setting. Empathy
is about “standing in someone else’s shoes, feeling with his or her heart,
seeing with his or her eyes.” (Pink, 2008). In other words, it is the
well-educated understanding of the emotional and psychological state that
another person is in. This permits the nurse to know exactly the patient’s
troubles and hence, these can be resolved more specifically. While empathy is knowing,
compassion is a strong wish to understand, followed by a want to help.
Patients’ problems may vary from physical symptoms, psychological and social
concerns and also problems relating to the spiritual area. Altruism is when a
person unselfishly devotes himself to others even if this requires
self-sacrifice. Unfortunately, prolonged altruism may lead the nurse to become
emotionally exhausted. (Henderson, 2001). Sympathy is the power of actually
feeling what another person is experiencing. Personally, I consider this as
being both positive and negative at the same time. This is because although the
patient gets to know such emotions are not felt by him alone, it may impair the
ability for the nurse to continue working effectively since personal emotions
may get in the way of professional judgement. This is why the nurse must ensure
to be emotionally distant appropriately from the patients and be ready to
respond professionally.

            Working with patients requires nurses to be as genuine as
possible. This is when nurses let their personal-self meet their professional
role. Although this ability takes time to be developed, when it does, it is a
freeing experience where humanity is preserved and the patients are not just
seen as a diagnosis but human beings who need to be treated with a sense of
gentleness which can only happen when nurses step out of their professional
façade. This can be done by little things such as encouraging them to do not
give up, asking about their family and place of work, and what they like to do
in their free time, whilst maintaining certain boundaries. Certain patients may
be feeling lonely due to not being visited enough by family members or by the
healthcare team itself. This is why saving some time to chat with patients and
exchanging life stories, does not only show interest, but can also be an
experience where both the nurse and the patient learn from each other. Also,
using a little humour in conversations where appropriate can be a coping
mechanism where it helps in uplifting the patients’ spirits and enhances the
nurse-patient bond during such difficult situations.

            Being an occupation which involves interactions,
especially long-term ones, nursing can result in nurses exceeding their social
parameters. This is when nurses go beyond their boundaries and in turn, this gives
rise to various ethical and legal issues. Such closeness can be both emotional
or physical. For example, it should be kept in mind that although communication
is a very basic asset in the nurse-patient relationship, neither a patient nor
a nurse should disclose personal information especially regarding private life
issues. This goes against the standards of the relationship resulting in a
great deal of consequences. Physical closeness should also be taken into
consideration. One must not forget that certain patients will need a sense of
physical touch such as a hug or hand-holding, depending on their cultural
background and norms which ought to be respected. In addition to this, it is
normal in certain cultures to give a gift to nurses as a sense of gratitude.
Unless holding back from this will put the patient at risk of disrupting the
recovery or harming the nurse-patient relationship, such gifts should be
refused as this would be an example of breaching boundaries. For these reasons,
it is important that nurses indicate exactly what their role is to the patients
so as not to confuse them. If the nurse becomes too attached to the patient and
his case, objectivity will be hindered and it will become even harder to
provide the optimum care required to all patients. In my opinion, the concept
of compassion versus over-involvement can only be settled if nurses give
importance to self-awareness. This is the ability to fully recognize which
feelings, emotions and sentiments belong to themselves and which belong to the
patients.

            As previously mentioned, self-disclosure can be a
delicate subject. While it is important for the nurse to maintain
professionalism and not reveal personal details, it is very common to be asked
questions by patients related to marital status, whether the nurse has children
and place where the nurse is from. Most often these questions are not asked
with the intention to cause harm to the nurse’s employment, but in order to
make conversation with the nurse by trying to find mutual interest in order to
feel more comfortable. The question is, how much of this information should be
shared? Personally, I believe that it depends on the duration of the
relationship. If the relationship will only last a day or is at its very
beginning, the time spent with the patient should be focussed on the patient
only and the reason why he is in the clinical setting. When the duration of the
relationship is lengthened, sharing of such information may feel more
appropriate. Regardless of this, disclosure of information concerning private matters
and intimate issues are completely inappropriate. When uncertain or in a
dilemma, one should ask senior healthcare workers for advice or explain to the
patient that such disclosure would be irrelevant to the rationale of the
therapeutic relationship.

                         Personally, I believe that as long as all the mentioned
constituents are maintained, this unique relationship will lead to an exciting
one, enriching for both the nurse and the patient, where both parties learn from
each other. This is because I feel that the nurse-patient relationship is not just
one where the nurse does her job and the patient regains health, but an opportunity
where both experience an emotional growth in the period of their encounter.