WEST AFRICAN COLLEGE OF NURSING IN
PARTIAL FULFILLMENT FOR THE AWARD OF FELLOWSHIP OF THE WEST AFRICAN COLLEGE OF
NURSING
THE PURPOSE OF THIS STUDY
THE OBJECTIVES OF THE STUDY
1. To improve on the image of the nursing
profession.
2. To
highlight the strategies for improving the nurse/patient relationship
3. To improve the quality of patient care.
4. To promote nursing as a caring
profession.
INTRODUCTION
Good nurse/patient relationship is a
vital tool in the quick recovery of the patient in the hospital. Apart from
medication, many factors are needed for the quick recovery of the patient.
In the entire health sector, the
nurse stays with the patient 24hrs a day and seven days of the week. Whether
rain or sunshine the nurse is with the patient. The attitude and contributions
from the nurse to the patient has a great effect on the degree of recovery of
the patient.
One of the theorists/leaders in
nursing virginal Herndason described the unique function of a nurse
1is to assist the individual, sick or well in the
performance of those activities contributing to health or its recovery (or to
peaceful death) that he would perform unaided if he had the necessary strength,
will or knowledge. And to do this in such a way as to help him gain
independence as rapidly as possible. In addition, she helps the patient to
carry at the therapeutic plan initiated by the physician. She also as a member
of the medical team, helps other members, as they in term help her, to carry
out the total programme whether it be for the improvement of health, or the
recovery from illness or support in death”
In other words nursing is more or
less a caring profession. Apart from making sure that the patient take his/her
medication as and when due, the nurse ensures that there is a friendly/therapeutic
environment, uses and apply her psychological techniques in handling the
patient. A healthful clean environment also aids healing.
The image of the nurse before the
public has been found wanting. There is need for the nurse to improve on her
relationship with the patient for the betterment of the patient.
The patient is said to be always
right, in other wards the nurse must not degenerate to the level of fighting
with the patient or abusing the patient. There is need in this present time for
the nurse to improve on her/his relationship with the patient. This will help to boost the image of the
nursing profession in the eyes of the public. This write up will examine the
various ways of boosting the nurse/patients relationship in recent times, the
nurse patient relationship has deteriorated to the lowest ebb, so that most
patients view the nurse as an enemy. There are cases were the nurse carry out
unethical practices against the patients. In view of all these, this paper seek
to highlight the various strategies for enhancing the relationship between the
nurse and the patient.
The nurse therefore could use the
following strategy in enhancing her relationship with the patient- ethnical
practices, advocacy role, confidentially, avoidance of stigmatization, care
giving, collaboration, counseling, communications skills, and Nursing process.
- Ethical
practices
Nursing code of ethics “is a formal
statement of the ideals and values of nursing and ethical principles that serve
as standard for nurses actions”. It concerns the behaviour that is normally
right for a nurse in professional situations. Nwonu (2009)2
Every profession has ethnical code guiding it and nursing is not different. The
International Council of Nursing ICN code of ethics has four fundamental
responsibilities which includes - to promote health, to prevent illness, to
restore health and to alleviate suffering. The first element of the code which
says that the nurse‘s primary responsibility is to people requiring nursing
care. In the course of providing nursing care, the nurse promotes a conducive
environment, upholds the patients values, human rights, customs and spiritual
beliefs.
The nursing ethics requires the
nurse to treat the patient with dignity and respect. Every patient is special
and autonomous. The patient has a right to accept or refuse care. The nurse
applies Beneficence i.e doing good and non-male-ficence i.e avoiding evil in
handling the patient. There is also need for justice so that there is equal
treatment irrespective of age, gender, colour race and status,
Both the ethical and moral
principles should be applied in handling the patient. All should be treated
equally. A Christian nurse should not neglect a patient because he/she is a
Moslem and vice visa. Ethnicity should be suppressed while handing the patient,
3The
nurse must therefore be studious, observant, and professional in handling the
patient Ufere (2008).
Ethical decision is said to be a
rational choice made based on universal moral principles and frame work. It is
based on ethical codes and principles rather than on emotions.
The four primary principles of
autonomy, beneficence, justice and veracity should always be applied. The
principle of autonomy holds that people have a right to determine their own
actions and in actions based on their values and beliefs.
On the other hand beneficence which
is doing greed has four components which the nurse should apply – the nurse
should not inflict harm or do evil to the patient. The nurse should prevent harm and evil from the
patient; the nurse should remove harm and evil from the patient and the nurse
should promote good to the patient;
promote health, prevent illness, restore health and alleviate suffering.
The nurse is under obligation to
carry out the physicians orders intelligently but should refuse to participate
in unethical procedures in the interest of her patient.
The principle of veracity expresses
the concept that nurses have a duty to be honest and trustworthy in their
dealings with the patient. The nurse should respect the inherent trust that
exist between her and the patient. The nurse should communicate truthfully with
the patient, avoid deception and maintain intellectual integrity. Veracity or
truthfulness in other words requires that nurses do not intentionally deceive
or mislead the patient. If there is no trust and honesty, meaningful
relationship would breakdown. There are though some limitations to this
principle, where telling the truth to the patient would seriously harm the
patient; when therefore ethical dilemma presents, the nurse should use her
initiative and wisdom to handle it. The nurse should equally respect the
patient’s values. Value means the worth or estimate of something. A value is a
personal belief about the worth of a given idea, object or behaviour, they are
the internal control for behaviour as a person’s real values are shown by
consistent patterns of behaviour “Anarod4
(2002) the patient should not be forced against
his/her values.
ADVOCACY
The nurse assumes the position of the patient’s
advocate. She speaks for the patient’s interest. She has the patients interest
at heart and guards against all forms of traumatization by other health care
workers and the environment. The nurse ensures that the patient’s rights are
respected. The patient has right to privacy, accept or reject treatment,
information on the nature of care being given.
All the nurse’s attention must be
patient oriented. She relates information about the patient to other health
workers for the interest of the patient. The nurse must be knowledgeable posses
the professional skill and tact. She has to refuse orders that are not in the
interest of the patient courageously using tact and diplomacy.
If nurses in the actual sense know
the type of relationship they have with the patients and try to relate
accordingly applying their technical know how the erroneous believe about nurse
will change and the negative image on nurses would improve for the better. The
nurse also solicited for the patient making sure that he/she get all the health
care required as and when due. The nurse prevents unnecessary delays and
omissions that might affect the patient relatively. She also protects the
patients from unnecessary expenditures or discomforts.
CONFIDENTIALITY
It is the nurse’s duty to protect the interest of the
patient. All information about the patients, medical records should be handled
with utmost confidence. The nurse should only discuss the patient’s information
with various groups handling the patient treatment. The information should not
be revealed to any relation without the patient’s informed consent. Information
on the patient should not be given to un-authorised persons. Patients charts,
results, x-rays, folders may be the property of the hospital, but the
information therein belong to the patient.
Apart from the patients documents,
oral information about the patient should not be given to un-authorized
persons. Confidentiality is an important goal that should be vigorously
pursued. Though institutional confidentiality may not be easily guaranteed, the
nurse should strive to discourage the violation of the patient’s
confidentiality.
In the case of HIV positive
patients, the nurse must uphold her professional code of conduct in the
discharge of her duty and disclose
result to only those that should know for the better management of the patient.
The nurse should avoid gossip in every ramification and resist giving
privileged information to friends, family members and colleagues not involved
in the management of the patient. During voluntary counseling and testing, the
nurse should ensure “anonymous testing whereby the person being tested is
identified by a code so that no other person can easily understand” USAID5 (2003). They in these ways ensure
proper confidentiality for her patient.
STIGMATIZATION
Oxford6
dictionary describe stigmatization as being treated by society as if you should
be ashamed of your situation or actions. The nurse should as much as possible
avoid any form of stigmatization or discrimination over the patients.
Patients should be treated equally
with respect and dignity. In other not to discriminate the patient, the nurse
should in the management of the patients apply universal precaution.
The universal precaution measures
involves treating every pecan/patient as being infested especially in the case
of HIV Aids patient, e.g if the nurse is wearing glows to make the beds, she
should wear it while making all the beds. This will remove any atom of
stigmatization from the patient. In other words universal or standard
precautions are designed to reduce the risk of transmission of micro-organism
from both recognized and unrecognized sources of infection in the healthcare
settings and apply to all patients regardless of diagnosis or presumed
infections status.
CARE GIVING
Nursing is said to be a caring
profession. The nurses dictionary defined care as 7“The
provision of welfare and protection to children, the elderly, the sick, those
in need etc,”. It is also said that care giving is an important component of
nursing practice. The care rendered include both physical care and psychosocial
interventions. The care given is documented to facilitate the evaluation of
outcomes. The care is planned and individualized.
Medical care may talk about disease
entity but nursing care has to deal with the individual patient reactions. The
care given to the patient is holistic. The commitment of a nurse to the
patients care is total (physical, mental and social).
Virginia Henderson said that the
nurse helps the client regain health through the healing process, addresses the
needs of client, restore emotion and social wellbeing. Florence Nightingale the
founder of professional nursing was famous for her actions in nursing solders
during the Crimean war. Her unique actions nicknamed her “the lady with the
lamp”. She used to carry lamp in the dead of the right to check on her patients.
Nursing can still imbibe such attitudes in to days nursing.
The nurse also employs her research
skills in the care of the patient. She identifies, investigates and analyses
the patient’s problems/needs. She sets out plan for care, implements and
evaluates. The findings help her to provide care on one to one basis focusing on
every patient as a unique individual requiring individualized care. She uses
holistic approach in the care of the patient and uses an interdisciplinary team
in providing comprehensive care to the patient. “In one sense, the
multi-discipline approach to health care is describable because ideally, it
ensures that the various needs of the patient will he bet”. 8Nwonu 2002.
The nurse should also apply Abraham
Maslow’s need theory in the management of the patient. “The five levels of need
in the ascending order include physiologic need, safety and security needs, love
and belonging needs, self esteem needs and self actualization needs” Okoronkwo9 (2005)
- The
physiologic needs of the patient should be taken care of which includes-needs
for good air – proper ventilation, food, water, rest, sleep, shelter
elimination and temperature control.
- The
safety and security needs include need for protection, trust, familiarity and
job security.
- Love
and belonging needs are need for affection, approval and acceptance.
- Self
esteem needs include need for independence, competence, self respect,
recognition, appreciation, freedom, prestige and status.
- There
is also need for self actualization which involves need for self-fulfilment,
need for excellence, recognition and achievement.
The nurse should in her care of the
patient strive to help the patient meet these needs from the physiology needs.
COUNSELING
The nurse does not only take care of
the physical needs of the patient. She also takes care of the patients
psychological problems. There is need for the nurse to handle the patient with
empathy putting herself in place of the patient). The nurse creates a conducive
atmosphere which will enable the patient to open up and get to the root course
of expressed problems. According to Cockerham10
(2003) a sick person passes through five different response stages which
include - symptom experience, assumption of sick role medical care contact,
Dependent patient role and Recovery and Rehabilitation.
The nurse counselor sees beyond the patient’s
expression. The nurse observes the patient’s
attitude, looks, involves relations in the care of the patients. This will establish a healthful relationship.
It
is worthy to note that in some cases, the physical and social health many he
taken care of while the psychological health is neglected. The nurse should be
sensitive to the patient’s need commend for efforts made and encourage him/her
to keep it up. The nurse gives the patient information that would enable
him/her make an informed decision that would lead to early recovery and healthy
life thereafter. To be a good counselor, the nurse must posses these skills,
she must be active listener, have effective questioning skills, be able to reflect;
paraphrase and summarize. In the course of counseling the nurse must posses
these attributes – empathy, must be non- judgmental, patient, well informed and
respectful.
COLLABORATION
The nurse is the coordinator of the patient’s
management. The nurse is around the patient 24 hours of the day. The nurse
should always see her relationship with the patient as collaboration she should
avoid using commands and high tones in dealing with the patient. The patient
should always be informed of everything and consulted. There is need for the
nurse to always carry the patient along. The patient should not be looked down
on, the nurse should not claim to know everything. Everybody is important and
has something to contribute.
There is also need for the patient
to be allowed to have a say or air his view in his/her management. Every
procedure should be explained to the patient and he/she should be handled with
dignity. The patient should be addressed properly with correct designation e.g
Mr. or Mrs. so and so not with their diagnosis. People are now enlightened, and
if the patient is not carried along it could lead to litigation.
The nurse equally collaborates all
the other team managing the patient. She makes sure that things that needs to
be done are done. Health care workers work as a tem in the management of the
patient and the nurse is the coordinator of all the activities. Health care
workers need to see themselves working not in isolation for, but in
collaboration with other workers in health disciplines to meet the health need
of the patient” Onuzulike (2005)11.
The nurse co-ordinates the activities
of nursing as well as that of the other health workers managing the patient.
She provides total nursing care to her patient using tools that include
planning, managing, organizing, directing, budgeting and reporting. The
professional nurse employs all these tools during her daily schedule, monitors,
supervises and reports at the end of the shift to ensure continued care and
comfort by the incoming shift. The nurse plans her time, resources (both human
and material), engages everyone around her in one thing or the other for the
ultimate interest of the patient.
The nurse also interprets the
patient need to the family and carry them along. The nurse also sustains
inter-sectorial collaboration by incorporating all other mechanisms in the
management and for the interest of the patient Okoronkwo (2004)12. The World Health organization
constitution defines health as a state of complete physical, mental and social
well being and not merely the absence of disease or informally. It also
stressed that the best possible state of heath should be a fundamental right of
every human being. The nurse should bear in mind that she/her has a big role to
play in sustaining or bringing the patient back to health.
Communication Skill
Good communication skill is an
important tool in nurse/patient relationship. Interpersonal communication is a
verbal and non-verbal exchange of information between person to person or
person to a group. The nurse should be aware of her emotions and keep them
under control while communicating with the patient/client. The nurse should be
aware of the non-verbal communication where messages can be passed through
facial expression, eye contacts, gesticulation, shaking of the head, smiling,
flowing etc.
Verbal communication is said to be
about 7% while non-verbal communication is about 93%. Inefficient communication
of an organization leads to faulty cooperate chain. Communication is very
important because all the other strategies hinge on an effective communication
skill. The nurse should have established channel both formal and informal means
of transmitting information to the patient. There is also need for the nurse to
improve on her capacity so that she/he would always be well informed. She
should be up to date in changes in health care delivery. The nursing process is
communicated verbally. Effective communication enhances client care. Oral
communication is the most frequent mode for conveying one’s ideas, thoughts and
feelings to others. During the assessment process, the nurse uses oral communication
to interview the patient/client.
Apart from the oral communication,
written communication is also very important. Its Importance in nursing
services are three fold: it is used to validate services rendered to the
patient, to provide means of communicating nursing services to the public and for
record purposes. Documentation in nursing care can not be over emphasized. When
services rendered to the patient is not documented, it literally means that the
services has not been rendered. The nurse should equally not document services
not rendered through falsification. If a patient is given his medication and it
was not documented, it could lead to double dosage which could be detrimental
to the patient. There is also need for the nurse to be an active listener. It
involves listening with full attention and trying to understand what the
patient is saying, not just hearing the word and reaching a conclusion. Active
listening would enable the nurse detect emotionally tastes of the patient. It
calls for alertness and attention, and it enables the patient to verbalize
his/her feelings. The nurse must have a good working relationship for the
patient to be able to trust her/him and open up.
NURSING PROCESS
Nursing process “is a systematic and goal-directed set
of activities which are interrelated and dynamic, used by the nurse to
determine, plan and implement individualized nursing care, which is aimed at
helping the patient to achieve integration of his whole being or optimal level
of wellness” Nwonu (2002).
Nursing process is individualized
because the product of activities carried the patient is peculiar for that
individual alone. It is systematic and goal directed in the sense that it
follows a sequential process and all the activities are directed at achieving
some set of goals which is effective nursing care. The activities change as
patient condition improves or detenorates.
Nursing process is also basically a
scientific problem solving method applied to nursing in order to achieve a
maximum level of change towards an expected health outcome. It is a tool used
by the nurse in nursing situation to meet the patient’s need.
Nursing process is equally grounded
in a wholistic frame work which offers the potentials for advancing nursing
care in the interest of the patient. Nursing process are in five stages which
include Assessment, nursing diagnosis, planning, implementation and evaluation.
It is a sequential process that are interrelated in the sense that activities
carried out in each step are dependent on each other to achieve effective
patient care.
Nursing process is an indispensable
tool in archiving a quality patient care.
CONCLUSION
Nursing is no doubt a caring, noble and enviable
profession. They are around the patient twenty four hours of the day. Unlike
other members of the health team that focus on disease entity, nursing focuses
on the totality of the patient.
The nurse should apply the ethical
principles, and other strategies as a guiding tool. The autonomy and uniqueness
of the patient should be emphasized. The patient has a right to accept or
reject care. There is also need for confidentiality and avoidance of
stigmatization. Equally the nurse should be a good counselor to the patient and
team player to the other members of the health team. Finally, the nursing process
is a valuable tool in todays nursing.
REFERENCES
1. Henderson
Virginia in Ofi, B, et al., Nature of
Nursing (2004). National open University
of Nigeria.
2. Nwonu,
E.I. Nursing Ethics and jurisprudence: (2009). National Open University of
Nigeria (2009).
3. Ufere
Anthony A. the Good Nurse (2008). Sabena Books & Publishing House.
4. Anarado,
A.N (2002). Ethics and Law in Nursing practice snap press.
5. UNAIDS
(2006). “Overview of the global Aids epidemic”, 2006 Report on the global Aids
epidemic.
6. Oxford
Dictionary of current English third Edition 2006.
7. Bailliere
Nurses Dictionary for Nurses and health care workers Twenty-forth Edition.
8. Okoronkwo
Ijeoma (2005), Nursing Service Administration and management theory and practice.
Institute for Development studies University of Nigeria, Enugu Campus.
9. Nwonu,
E.I. (2002) Nursing process concept and practice. Snaap press
10. Cockerham,
W.C. (2003) Medical sociology (9th edition) NY: Prentice Hall.
11. Onuzuluike,
Nonye M. (2005) Health care delivery system megsoft publishers.
12. Okoronkwo
Ijeoma (2004) Nursing serves Administration and management theory and practice.
Institute for development studies university of Nigeria, Enugu Campus.