The Nurse–Patient Relationship

1 Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. S ec tion Two The Nurse Patient Relationship 57 22/05/13 7:10 PM. Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 58 22/05/13 7:10 PM. Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. Chapte r F i ve Establishing a Therapeutic Relationship Lisa Kennedy Sheldon Rob Marmion/ShutterStock, Inc. 59. 59 22/05/13 7:10 PM. Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 60. Chapter Five Establishing a Therapeutic Relationship Case Study Susan R. is a 38-year-old woman coming into the outpatient surgery center for a breast biopsy. She sits in the waiting room with her husband and is obviously nervous staring unblinking at the wall, tapping her feet, and wringing a tissue in her hand.

2 The perioperative nurse approaches Susan to introduce herself and bring her into the operation suite to prepare for surgery. Nurse: Mrs. R., I am Laurie Snow, and I will be the nurse working with you today. What do you like to be called? . Patient: Hello. Call me Sue; that's what everyone else calls me. This is my husband, Andrew.. Nurse: (She shakes hands with the patient and her husband.) It's nice to meet both of you. Sue, I would like to explain what's going to happen today, get a little more information from you, and answer any questions that you may have about the surgery.. Patient: Oh, thank you. I am so scared. I don't know how I am going to get through this.

3 Nurse: It's common to feel nervous about surgery. My goal is to help you through today. I will explain everything as we go along and answer any questions you and Andrew may have.. Patient: I am glad that you will be there. May my husband come with me? . Nurse: Of course.. Introduction In a few moments, the perioperative nurse in the case study has accomplished a great deal toward creating a solid nurse patient Relationship . What did she do? 1. Identified herself by name. 2. Established her credentials and her role. 3. Greeted the patient by her preferred name. 4. Addressed both the patient and her husband by their preferred names. 5. Reflected and normalized the patient's response to the surgery.

4 6. Offered her assistance in relieving the patient's anxiety by explaining her role. 7. Acknowledged that the patient might have questions and she was there to help. Good communication skills make the difference between average and excel- lent nursing care. The therapeutic Relationship between the patient and the nurse 60 22/05/13 7:10 PM. Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. Respect: Unconditional Positive Regard 61. forms the foundation of nursing care throughout the spectrum of health, illness, healing, and recovery. Some nurse patient relationships, such as the one in this example, last only a few hours; others, however, may last days, months, or even years.

5 What is exciting about each Relationship is how unique and enriching it can be for both the patient and the nurse. The underlying principles of the therapeutic Relationship are the same regardless of the length of the contact: respect, genuineness, empathy, active listening, trust, and confidentiality. The purpose of the therapeutic relation- ship is to support the patient, to promote healing, and to support or enhance functioning. A therapeutic Relationship differs from a social Relationship in that it is health focused and patient centered with defined boundaries. Peplau (1991) described the nurse's focused interest in the patient as professional closeness.

6 Communication is the cornerstone of the nurse patient Relationship . The focus of communication in the nurse patient Relationship is the patient's needs . that is, patient-centered care. To meet these needs, the nurse must take into con- sideration multiple factors, including the patient's physical condition, emotional state, cultural preferences, values, needs, readiness to communicate, and ways of relating to others. The timing of communication is also important when work- ing with patients. For example, teaching about a low-cholesterol diet and aerobic exercise is not appropriate during the acute phase of a myocardial infarction. The patient is not in the appropriate physical or emotional state to absorb this informa- tion regardless of its importance for overall cardiovascular health.

7 Later, when the patient is preparing for discharge, the nurse may begin teaching about health- promoting behaviors, such as diet and exercise. Respect: Unconditional Positive Regard Carl Rogers, in his seminal book published in 1961, defined respect or uncon- ditional positive regard as the ability to accept another person's beliefs despite your own personal feelings. Each patient's response to health or illness is a per- sonal way of adapting to challenges. Each patient brings a lifetime of respond- ing and coping with changes, requiring the nurse to be nonjudgmental. Each patient requires respect and acceptance as a unique human being. Acceptance does not mean approval or agreement; rather, it is a nonjudgmental attitude about the patient as a whole person.

8 The goal is to make the patient feel com- fortable and legitimize his or her feelings. For example, the nurse might not 61 22/05/13 7:10 PM. Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 62. Chapter Five Establishing a Therapeutic Relationship Box 5-1 Ways to Show Respect Introduce yourself by name and professional status and wear a name tag. Ask patients what they like to be called. Always begin with the formal ( , Mr., Ms., Mrs.), and then use the preferred name. Arrange for patient comfort, modesty, and privacy at all times. Prepare patients before doing any procedures, particularly those that involve p ersonal space or discomfort. Communicate with patients in ways that demonstrate a desire to listen, understand, and help.

9 Always understand why patients become angry but acknowledges that they usually have reasons, based on their beliefs and backgrounds, for these emo- tional responses. Some patients might have unhealthy habits, such as smoking or excessive drinking, that they will not change despite the nurse's best efforts at teaching health-promoting behaviors. Some patients might have difficulty maintaining their personal hygiene. The nurse's goal is to respectfully take into account the patient's symptoms, feelings, values, and beliefs, and to work with the patient to develop the goals of care (Box 5-1). Nurses demonstrate uncon- ditional positive regard by accepting people without negatively judging their basic worth.

10 Genuineness The ability to be oneself within the context of a professional role is called genuineness. Rogers described genuineness as congruence, the willingness to be open and genuine and not hide behind a professional fa ade. For example, as nurses develop into experts over many clinical experiences, their professional selves come into agreement with their personal selves. As a new nurse, this evolution may not be easy, especially when first starting in the clinical setting. In addition, the nurse will encounter many new patients, some with values and behaviors that the nurse does not accept or even understand. Holding back these judgments may seem less than genuine, yet there are many parts of the personal self that can be shared during nurse patient interactions that demonstrate true concern for the patient.