The Nurse-Client Relationships in Augmenting Patient Security

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             The Nurse-client Association in                  Augmenting Patient Security

            Maintaining and ensuring patient safety is a vital component of care delivery (Jeffs, Saragosa, Merkley, & Maione, 2016). Patient safety is a multidimensional concept that integrates correlated features such as psychosocial and physical safety (Jeffs et al., 2016). The relationship between patients and nurses is comprehension and mutual-centered communication in which discussions occur, and activities are interchanged between the patients and nurses (Jeffs et al., 2016). Each patient needs acceptance and respect as a unique human being (Jeffs et al., 2016). Acceptance does not denote agreement or approval; instead, it involves a non-judgmental outlook concerning the patient or client as a whole person (Jeffs et al., 2016). The aim of nurse-patient or client interaction is to make the patient feel at ease and legitimize their emotions (Jeffs et al., 2016). Therefore, an effective nurse-patient interaction should ensure that all the aspects mentioned above are considered when providing and planning care.

            In light of the elements stated above, this discussion below explores the significance of nurse-patient interaction by taking into consideration of a case study where a registered nurse (Michael) as he explained to a woman (patient) why a vaginal examination was required; he did not ask her if she was comfortable with him doing the inspection. The paper further examines the elements of therapeutic relationships and the application of the Code of Conduct for Nurses and the Registered Nurse Standards for Practice from the NMBA. Concepts of paternalism and cultural safety will also be discussed in the essay.

                        Therapeutic Relationship

            Therapeutic nurse-patient interaction refers to a productive relationship that involves helping with the gratification of a patient’s spiritual, emotional, and physical needs (Conroy et al., 2017). The nurse-patient relationship centers on nurturing of hope and faith, the building of respect and trust, and nurses practicing sensitivity to the patients via their skills and knowledge (Conroy et al., 2017). Discussed below are the components of the nurse-patient relationship:

                                                Boundaries

            Boundaries form an essential component of the nurse-patient interaction as they symbolize invisible structures imposed by professional, ethical, and legal principles of nursing practice that respect the rights of patients and nurses (Conroy et al., 2017). The boundaries ensure that the aim of the nurse-client relationship remains on the patient’s requirements, not exclusively by word but by law as well (Conroy et al., 2017). The Australian Nursing and Midwifery Council (ANMC) emphasizes that it is the nurse’s duty to create the limits and boundaries of the interaction between the patient and the nurse (Conroy et al., 2017). The restrictions have a specific health goal that demands that the relationship ends once the identified health goal is attained (Conroy et al., 2017).

            Any decision or action in a nurse-patient relationship that is taken at the expense of the patient’s consent can be considered a boundary violation (Conroy et al., 2017). A perfect example of boundary violation in the case study is when Michael decided to neglect to ask for the patient’s consent regarding the examination of her private parts to know if she was comfortable so that he could undertake the clinical procedure. Instead, as a registered nurse, Michael’s mandate would have been to respect dissimilarities in his patient’s personality by first asking if she was comfortable.

                                           Respectful and Genuine

            Highly experienced nurses must be equipped with specific traits to successfully create an effective nurse-patient relationship (Conroy et al., 2017). Qualities such as being respectful and genuine are among the vital components of the therapeutic nurse-patient relationship (Conroy et al., 2017). A component such as respect needs the identification and keen observance of the patient’s culture and ensuring the incorporation of open-mindedness during the period of the nurse-patient relationship (Conroy et al., 2017). The nurse should work towards the empowerment of the patient together with their family to become more involved in understanding their health and the manner in which it can be enhanced (Conroy et al., 2017). The observation of the patient’s respect in combination with being genuine with patients is likely to establish the desired nurse-patient relationship (Conroy et al., 2017).

                                          Confidentiality

            The confidentiality aspect makes the nurse-patient relationship safe and creates trust (Conroy et al., 2017). For instance, it creates an environment where the patient becomes comfortable to ask questions and disclose personal information to the nurse that can help facilitate the patient’s recovery (Conroy et al., 2017). Nurses are obliged to only share with other clinical staff who require to know and must obtain the patient’s written consent to share the information with other persons outside the therapeutic team (Conroy et al., 2017).

                                     Cultural Sensitivity

            Healthcare is a multiethnic setting; hence nurses are required to anticipate that they will care for clients from multicultural or diverse ethical environments (Conroy et al., 2017). Cultural backgrounds affect an individual’s opinion about health and life; therefore, nurses need to have a body of knowledge that enables them to deliver culturally specific care (Conroy et al., 2017). This commences with an accepting attitude and an open mind by nurses (Conroy et al., 2017). Cultural fitness is a perspective that improves awareness and respect for the patient’s cultures which might be different from those of nurses (Conroy et al., 2017). It means putting aside one’s viewpoint to comprehend another individual’s opinion (Conroy et al., 2017).

                Benefits of Therapeutic Relationship

            Generally, a therapeutic nurse-patient relationship exhibits empathy, genuine interest, friendliness, warmth, and willingness to support and facilitate proper patient care (Conroy et al., 2017). As a result, the relationship engenders an atmosphere for interactions that enable effective communication between the patient and nurse (Conroy et al., 2017). The connection is further linked to enhancement in patient’s quality of life, adherence to treatment, patient satisfaction, improved levels of depression and anxiety as well as the decreased cost of healthcare (Conroy et al., 2017). Equally, enhanced psychological agony and emotions of dehumanization are related to negative nurse-client interactions, and this is evident in the case study where the patient complained about Michael’s decision to conduct a vaginal examination at the expense of her consent. One can hence, associate the patient’s complaint to be stemming from the psychological distress that she suffered from the nurse’s misconduct (the boundary violation). 

  The Influence of the Code of Conduct for Nurses and the Registered Nurse Standards for Practice from the NMBA on the Therapeutic Relationship

            The Nursing Midwifery Board of Australia is a legitimately established entity within Australia charged with the duty to Register midwifery and nursing students and practitioners and develop guidelines, codes, and standards for midwifery and nursing professions (Fisher, 2017). The board operates in partnership with the Australian Nursing and Midwifery Council (ANMC) to maintain public safety through ensuring that all citizens have access to competent and quality midwives and nurses who can deliver midwifery and nursing care via the practice of therapeutic interaction between nurses and their patients (Fisher, 2017). For instance, both the NMBA and ANMC have developed a decision-making approach that can assist nurses in identifying their scope and considering their experience and knowledge when making patient care decisions (Fisher, 2017). The objective of the framework is to ensure that registered nurses or enrolled nurses execute their duties safely and within their scope by making consistent decisions (Fisher, 2017).

            As a registered nurse, there exists the Code of Conduct for nurses and the Registered Nurse Standards for Practice from the NMBA that Michael was obliged to follow. Michael ought to have used these guidelines and codes to inform him of what general conduct or behavior was expected of him. For this reason, it was essential that Michael first understand the professional guidelines and codes that govern his profession prior to contributing to the provision of nursing care to his patient. In applying the Code of Conduct for Nurses and the Registered Nurse Standards for Practice from the NMBA, the facility manager utilized principle 3 of the code of conduct to assess Michael’s conduct to provide him with direction on delivering appropriate and culturally safe care. The Principle 3 code of conduct gives the central standard that all registered nurses are expected to adopt during their practice (Cashin et al., 2017). The code stipulates that “nurses interact with individuals in a respectful and culturally safe manner, facilitate compassionate, honest and open relationships and follow their mandates concerning confidentiality and privacy” (Cashin et al., 2017. p. 257). In particular, the behavior and conduct that are directly associated with this conduct are:

• Principle 3.1b which states that “all nurses are obliged to act to assist access to culturally safe and quality health services for Torres Strait Islander or Aboriginal people” (Cashin et al., 2017. p. 258).
• Principe 3.5a stipulates that “all nurses must respect the privacy and confidentiality of patients through seeking informed consent prior to performing any medical test, disclosing patient information, including officially recording such consents where necessary “(Cashin et al., 2017. p. 260).

            However, even though Michael thought that he was providing respectful and safe care for his patient, his conduct did not meet the expectations within the code of conduct for nurses, especially in the sense that he assumed what was respectful and culturally secure for his patient without seeking the patient’s consent during the medical examination. It was, therefore, appropriate for the facility manager to refer to the Code of Conduct for Nurses and the Registered Nurse Standards for Practice from the NMBA, to guide Michael concerning what is considered appropriate and culturally safe care. During the discussion, it would be important to emphasize to Michael the point that providing proper and culturally safe care requires consideration of the participation of Torres Strait Islander or Aboriginal people's consent or opinions during the decision-making process. In light of the above, facts, it is evident that the Code of Conduct for Nurses and the Registered Nurse Standards for Practice from the NMBA facilitate the establishment of therapeutic care by emphasizing that all nurses need to seek the patient's consent in the decision-making process while performing the medical tests.

  The Concepts of Paternalism and Cultural Safety

            Clinical paternalism entails a set of practices and attitudes in the nursing field where the nurses determine that the patient’s choices or wishes need not be honored (Häyry, 2002). The practice came into existence in the early 20th century to the mid-20th century and was characterized by a lack of respect for the patient’s autonomy and surrogate decision-making (Häyry, 2002). The practice is almost exceptionally undertaken with the objective of benefitting the patient, even though this is not usually the case (Häyry, 2002). Paternalism used to be considered an absolute clinical prerequisite as there existed limited public comprehension of the clinical practices and procedures (Häyry, 2002). As a result of the subjective nature concerning to what degree and when paternalism is mandated, clinicians, as well as nurses who engage in this practice, may encounter complicated legal scenarios and this may be linked to Michael’s situation in the case study (he decided not to consider his patient’s choice to know if she was either comfortable or uncomfortable about the vaginal examination; consequently, this made him face ethical problems in respect to his conduct).

            Presently, the patient possesses the right to decide their personal destiny, by actively participating in the process of treatment and making free choices (Nguyen, 2008). However ethical decision-making in exercise demands specific components. Nguyen (2008), asserts that the primary element to make an ethical decision necessitates notifying the patient, stimulating the patient to participate in the treatment process, answering the patient’s queries appropriately, and respecting their rights. Cultural safety is the new approach that creates a suitable setting for the assurance and attainment of the aforementioned patient's rights as it balances the power among the health experts and the patients (Nguyen, 2008). Through cultural safety, the cultural autonomy of patients was established (Nguyen, 2008). This denotes that patients can propose, track, actively contribute to, and assess their individual decisions within the healthcare system (Nguyen, 2008).

            As a registered nurse, most of Michael’s responsibilities were obtaining the patient’s medical history and conducting the vaginal tests, if necessary. But again, Michael was mandated to exercise cultural safety by respecting his patient as an individual who possesses the right to a personal decision. According to Choi (2015), sensitive medical practices such as vaginal inspections might have a substantial psychological impact on numerous women, hence resulting in post-traumatic stress syndrome. Therefore, prior to proceeding with this exercise, Michael needed to have asked the patient’s consent to know if she was comfortable with him conducting the vaginal screening. Conducting the practice without the patient’s consent made the situation be interpreted as an actual assault or a trespass, hence the patient’s family reporting the matter to the facility manager.

                      Conclusion

            In light of the entire reasons discussed above, it is indisputably clear that maintaining and ensuring patient safety is a vital aspect of care delivery that requires the following components of the nurse-patient relationship; observing boundaries, being genuine and respectful, respect for confidentiality and being culturally sensitive. These components are beneficial in that they facilitate a therapeutic relationship that is linked to enhancement in patient’s quality of life, adherence to treatment, patient satisfaction, improved levels of depression and anxiety as well as the decreased cost of health care.

            From the above illustrations, it is also evident that the Code of Conduct for Nurses and the Registered Nurse Standards for Practice from the NMBA facilitates the establishment of therapeutic care by emphasizing that all nurses need to seek the patient's consent in the decision-making process while performing the medical tests. Besides, the essay highlights that paternalism which was majorly practiced in the 20th century is characterized by the lack of respect for patient autonomy and surrogate decision-making. However, the current implementation of cultural safety is the new approach that creates a suitable setting for the assurance and attainment of patient rights as discussed in the paper above since it balances the power among the health experts and the patients.

                                                      References

Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., & Fisher, M. (2017). Standards for practice for registered nurses in Australia. Collegian, 24(3), 255-266.

Choi, P. P. (2015). Patient advocacy: the role of the nurse. Nursing Standard (2014+), 29(41), 52.

Conroy, T., Feo, R., Boucaut, R., Alderman, J., & Kitson, A. (2017). Role of effective nurse-patient relationships in enhancing patient safety. Nursing Standard (2014+), 31(49), 53.

Fisher, M. (2017). Professional standards for nursing practice: How do they shape contemporary rehabilitation nursing practice? Journal of the Australasian Rehabilitation Nurses Association, 20(1), 4.

Häyry, H. (2002). The limits of medical paternalism. Routledge.

Jeffs, L., Saragosa, M., Merkley, J., & Maione, M. (2016). Engaging Patients to Meet Their Fundamental Needs: Key to Safe and Quality Care. Nursing leadership (Toronto, Ont.), 29(1), 59-66.

Nguyen, H. T. (2008). Patient-centered care: cultural safety in Indigenous health. Australian Family Physician, 37(12), 990.