Nurse – Patient

Relationship
What is interpersonal
relationship?
“ the relationships
between persons”
Components of interpersonal
relationship
 Scientific principles

 Specific communication skills

and strategies

 Creative application of self

(Boggs, 1989)
Requisites for nurse-patient
relationship
 Careful thinking

 Sensitiveness

 Energy

 time
Nurses’ roles in nurse-patient
relationship
 Care giver

 Counselor

 Educator

 Consultant

 researcher
Characteristics of good nurse-
patient relationship
 Relationship is therapeutic
 Exist until patent have fulfilled the health care needs
 Nurses’ work is to attain, maintain, and restore the
patients’ health
 Patients are satisfied
 Based on nurses’ competent care derived from skills
and knowledge
Characteristics of good nurse-
patient relationship Cont….
 Provide holistic care

 Patient/client is an active participant

 Nurse uses patients’ knowledge, attitudes, values, and

thoughts to plan interventions

 Reciprocal relationship influenced by professional

and personal characteristics of both parties
Phases of the nurse-patient
relationship
 Pre-interaction phase

 Engagement phase

 Active intervention phase

 Termination phase
 Pre-interaction phase
During this phase
• Nurse assess the environment in which the nurse
meet with patient
• Explain the professional goals and set priorities
• Both parties enter to the relationship with
expectations
• Patients develop uncertainties and hesitate to
comply with care and treatments
• Patient and nurse become oriented to overall needs
and expectations from the relationship
Engagement phase
 Begin to develop the relationship
 Nurse create a supportive environment
 Establish a therapeutic contact with patients
 Nurse introduce herself and the role functions
 Trust and empathy are basic qualities here
 Develop strong bond and feel less anxiety
 Nurse plays the key role with expertise on illness
 Nurse act as a coordinator
Engagement phase Cont….
 Nurse observe and assess patients
 Develop an impression and validate with patients
 Patients come to know their health issues and feel
fear, discomfort, or insecure feelings and expect
help
 Nurses realize patients through their body
languages and help them
 Therapeutic relationship is well established
Active intervention phase
 The sense of mutuality is developed
between nurse and patient
 Discuss conflicting situations deeply
 Nurse and patient work with
commitment
 Nurse sort out problems and solve
them
 Aware of the differences of rights,
roles, and responsibilities
Active intervention phase Cont….

 Nurse acknowledge the patients’ feelings, show the

genuine interest, and honesty
 Nurse should be congruent
 Nurse convince the patient of equal right to make
decision
 Nobody will play dominant or submissive role
 No violation of patients’ rights
 Patients become independent decision makers
Termination phase
 Start at the time of explaining plans
& goals
 Patient should be informed of this
phase at the beginning
 Otherwise patients develop strong
feeling of separation at this phase
 Nurse work on education, health
advices preparing discharge plan
Nurse-professional relationship
 To get advice

 To educational support

 To work related achievements

 To self support
Nurse-professional relationship
Co…
How?

 Collaboratively

 Cooperatively

 With acceptance and self worth

 With appreciation

 With respect
Barriers for effective professional
relationship
 Role stress

 Lack of inter
professional
understanding

 Autonomy struggle

(Northouse
& Northouse, 1992)
Role stress
 The stress arises from role conflict or
role confusion
 Role conflict is a situation that you
happen to play a role different from
what you expected to play
 Role stress occur when you are
expected to do than what you can do
 Result in stress and communication
is disturbed
Prevention of role stress
 Experienced persons are responsible

 Understand individual capabilities

 Identify the individual weaknesses

 Assign tasks accordingly

 Kindly and duly respond against inexperienced

behaviors or faults
Autonomy struggles
 What is autonomy?
autonomy is one’s ability to be one’s own person
directed by own desires, not imposed by others.

 When this ability is threatened by others

autonomy struggles are arose.

 People with higher level of autonomy

underestimate others bringing struggles.
NURSING : AN ART AND A SCIENCE
Nursing is a caring profession
- unique profession (it is practiced with an earnest
concern for the art of care and the science of
health)
- the profession involves a humanistic blend of
scientific knowledge, and holistic nursing practice

Nursing - what it is today is the result of changes in the

scientific , technological, political, social and economic
climate
 CONCEPTS OF NURSING AND
CARING
 The four major concepts in nursing theories are the
person, environment, health and nursing
 “Caring creates possibility” - as an inherent feature of
nursing practice, caring enables nurses help clients to
recover in the face of illness, to give meaning to the that
illness and to maintain or reestablish connection
 Care is an essential human need, necessary for the health
and survival of all individuals
 Acts of caring refer to the direct and indirect nurturant and
skillful activities, processes and decisions that assist people
in ways that are emphatic, compassionate, and supportive
 and that are dependent on the needs, problems and values
of the individual being assisted
 Caring involves five processes:
1. KNOWING- is striving to understand an event as it has
meaning in the life of the other
2. BEING WITH – is being emotionally present to the
other
3. DOING FOR – is doing for the other as he/she would do
for the self if it were at all possible
4. ENABLING – is facilitating other’s passage through life
transitions and unfamiliar events
5. MAINTAINING BELIEF – is sustaining faith in the
other’s capacity to get through an event or transition and
face a future with meaning
 Caring in nursing practice involves
1. PROVIDING PRESENCE – is when a nurse establishes
reassuring presence, eye contact, body language, voice
tone, listening and having a positive and encouraging
attitude, act together to create openness and
understanding
2. COMFORTING – involves the use of touch and the
skilful and gentle performance of nursing care procedures
3. LISTENING – involves paying attention to an
individual’s words and tone of voice, and entering into
his/her frame of reference
4. KNOWING THE CLIENT – is at the core of the process by
which nurses make clinical decisions (to know the client
means that the nurse considers the client as a unique
individual)
5. SPIRITUAL CARING – offers a sense of
interconnectedness intrapersonally (with oneself),
interpersonally (with others and the environment), and
transpersonally (with the unseen God, or a higher
porwer)
6. FAMILY CARE – involves knowing of the family as
thoroughly as one knows the client (a nurse demonstrates
caring by helping family members become active
participants in the client care)
 CONCEPTS OF PROFESSION
 A profession is an organization of an occupational group
based on the application of special knowledge which
establishes its own rules and standards for the protection
of the public and the professionals
 A profession implies that the quality of work done by its
members is of greater importance in its own eyes and the
society than the economic rewards they earn
 A profession serves all of society and not the specific
interest of a group
 The aims of a profession are altruistic rather than
materialistic
 CHARACTERISTICS AND ATTRIBUTES OF A
PROFESSIONAL PERSON
1. Is concerned with quality (he/she possess competence to
practice the profession in terms of scientific knowledge,
technological skills and desirable attitudes and values)
2. Is self-directed, responsible and accountable for his/her
actions
3. Is able to make independent and sound judgment
including high moral judgment
4. Is dedicated to the improvement of human life
5. Is committed to the spirit of inquiry (he/she demonstrates
zest for continued studies including research, which will
steadily increase and improve knowledge , skills and
attitudes needed by the profession)
 NURSING AS A PROFESSION
 A profession possesses the following primary
characteristics
1. EDUCATION – a profession requires an extended
education of its members as well as basic liberal
foundation
2. THEORY – a profession has a theoretical body of
knowledge leading to defined skills, abilities and norms
3. SERVICE – a profession provides basic service
4. AUTONMY –members of a profession have autonomy in
decision making and in practice
5. CODE OF ETHICS – the profession a whole has a code of
ethics for practice
6. CARING – the most unique characteristic of nursing as a
profession (CARING PROFESSION)
PROFESSIONAL NURSING – is an art and science,
dominated by an ideal of service in which certain
principles are applied in the skillful care of the well and
the ill, and through relationship with the client/patient,
significant others, and other members of the health
team
PROFESSIONAL NURSE – is one who has acquired the art
and science of nursing through her basic education, who
interprets her role in nursing in terms of the social ends
for which it exists - the health and welfare of society and
who continues to add to her knowledge, skills and
attitudes through continuing education and scientific
inquiry (research) or the use of the results of such
inquiry