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.

            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.

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.
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.

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.
            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.
            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.         

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 “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.
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.

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.
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