Heath Care and Nurse Patient Relationship
Nurse Patient Relationship
become an important subject of discussion, theorizing, and research since
Peplau and Orlando introduced the concept of the nurse-patient relationship as
an essential component of nursing practice.
Recognition of the need for
individualized nursing care, the introduction of new approaches to care
delivery (eg, primary nursing), increasing concerns about dehumanization
related to advances in technology, and the emergence of theories delineating caring
as a pivotal concept in nursing have reinforced the centrality of the
nurse-patient relationship in contemporary practice.
The nurse patient
relationship is now viewed as essential content in nursing curricula, and
clinicians value the development of therapeutic relationships with patients as
a significant part of their work.
Yet despite the overwhelming endorsement of
the importance of the nurse patient relationship, the practical difficulties
associated with developing relationships remain unresolved. Of importance are
issues related to balancing personal involvement and professional detachment.
Other important issues concern building relationships in contexts where the
organization of nurses’ work limits involvement or where reporting practices undermine
the development of trust.
Challenges in Relationships
Issues also arise from challenges related to
renegotiating relationships in response to changes in patient dependency and
vulnerability. Nurses have attempted to identify the unique characteristics of
the nurse patient relationship through their conceptualizations, although to
date there is little evidence to support this assumption.
The nurse-patient
relationship has been described as a therapeutic instrument with levels or
types of involvement and as an interactive process requiring the active
participation of both patients and nurses.
Important components of the
nurse patient relationship include concepts such as empathy, trust, respect,
knowing the patient, commitment, advocacy, and social control. Nursing writers
critiquing current conceptualizations of the nurse-patient relationship have
pointed out the failure to consider the collective nature of nursing work and
other realities of everyday practice such as the provision of bodily comforts.
Theorists such as Sally Gadow and Jean Watson have attempted to explain the
nature of the links between nurse patient relationships and positive health
care outcomes, and there is some empirical evidence that supports these
assertions.
Factor Affecting Nurse Patient Relationship
Although researchers have begun to explore the complex dynamics
involved in nurse-patient interactions and their therapeutic potential, there
is relatively little empirical data related to what takes place in everyday
clinical settings to support current conceptualizations of the nurse-patient
relationship.
Early investigations of nurse-patient relationships were
influenced by definitions from the social sciences and the traditions of
logical positivism. However, explanations of the relationship proved difficult
to quantify.
With increasing acceptance of qualitative research methods in
nursing, researchers have turned to a variety of new approaches to examine
patterns of relationships in nursing, including grounded theory and narrative
analysis.
These studies have revealed important new information about nurse-patient
relationships, some of which has contradicted professional rhetoric surrounding
the development of these relationships.
Complexities of Nurse Patient Relationship
The complexities inherent in the nurse patient relationship demand
that the research agenda be augmented by micro-level approaches (such as
sociolinguistics, ethno methodology, and in depth videotape analysis).
Advances
in interpretive methodology (eg, using a feminist perspective), and
triangulation (eg, triangulating conversational analysis with data from
ethnographic research), as well as by taking advantage of constructionist,
critical, and postmodern theory to understand the dynamics of nurse patient
relationships.
For example, observational studies of the development of
nurse-patient relationships as they occur in everyday clinical settings would
augment nurses’ narratives of memorable relationships.
Some researchers are
exploring the potential value of using video recorders to capture the
development of relationships over time. Detailed analysis of videotaped patient
and nurse behaviors at the interaction level have produced some encouraging
results.
For the most part, researchers have focused on the affective
dimensions of nurse-patient relationships by interviewing nurses, particularly
those who were able to provide exemplary cases.
Other dimensions of the nurse
patient relationship should be examined, as well as outcomes, as they relate to
different phases and types of relationships. Attention must be given to the
patient’s perspective and role in shaping relationships.