Nursing in Partnership with Patients and Carers

Audrey Reed

• Publisher: Learning Matters
• Year: 2011
• ISBN:
  9780857253088
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Future healthcare services are changing to give patients more rights over their own healthcare. The NMC requires that nurses work in partnership with those in their care. This book provides a timely guide to enabling patient and carer participation in nursing care. It challenges the reader to see the person in the patient and explores the nature of the nurse-patient relationship. It gives practical advice on how students can promote participation on placements and in practice. The book also offers an insight into the realities of being a carer, and discusses how quality of patient experiences can be assessed.

Chapter 1
The nurse–patient relationship

NMC Standards for Pre-registration Nursing Education

This chapter will address the following competencies:

Domain 1: Professional values

2. All nurses must practise in a holistic, non-judgmental, caring and sensitive manner that avoids assumptions, supports social inclusion; recognises and respects individual choice; and acknowledges diversity.

3. All nurses must support and promote the health, wellbeing, rights and dignity of people, groups, communities and populations. These include people whose lives are affected by ill health, disability, ageing, death and dying.

Domain 2: Communication and interpersonal skills

1. All nurses must build partnerships and therapeutic relationships through safe, effective and non-discriminatory communication. They must take account of individual differences, capabilities and needs.

5. All nurses must use therapeutic principles to engage, maintain and, where appropriate, disengage from professional caring relationships, and must respect professional boundaries.

NMC Essential Skills Clusters

This chapter will address the following ESCs:

Cluster: Care, compassion and communication

1. As partners in the care process, people can trust a newly registered graduate nurse to provide collaborative care based on the highest standards, knowledge and competence.

By the first progression point:

4. Shows respect for others.

5. Is able to engage with people and build caring relationships.

By the second progression point:

6. Forms appropriate and constructive professional relationships with families and other carers.

By entry to the register:

12. Recognises and acts to overcome barriers in developing effective relationships with service users and carers.

13. Initiates, maintains and closes professional relationships with service users and carers.

2. People can trust the newly registered graduate nurse to engage in person centred care empowering people to make choices about how their needs are met when they are unable to meet them for themselves.

By the second progression point:

3. Determines people’s preferences to maximise comfort and dignity.

By entry to the register:

8. Is sensitive and empowers people to meet their own needs and make choices and considers with the person and their carer(s) their capability to care.

3. People can trust the newly registered graduate nurse to respect them as individuals and strive to help them preserve their dignity at all times.

By the first progression point:

2. Engages with people in a way that ensures dignity is maintained through making appropriate use of the environment, self and skills and adopting an appropriate attitude.

By entry to the register:

5. Is proactive in promoting and maintaining dignity.

Chapter aims

By the end of this chapter, you should be able to:

• discuss the implications of using a biomedical model for nursing care delivery;
• identify the importance of respecting patient individuality and promoting dignity;
• discuss the values that underpin patient participation in their care;
• debate issues of power and control within the nurse–patient relationship;
• appreciate the centrality of the nurse–patient relationship in promoting participation.

Introduction

The power to heal lies within the patient and not the nurse.

(Pearson, 1989, p141)

In this quotation, Pearson points to the natural ability of human beings to heal, given the right care. Nursing these days is very much about giving people in need of care the power to control their own care. In fact, encouraging patients to participate in care is now at the forefront of the health agenda in this country. People are no longer expecting to be passive recipients of care, but are being encouraged to actively participate. There is even a new word, ‘expertience’, which acknowledges patients’ expertise and their lived experience (Warne and McAndrew, 2007).

Case study

Marie is a 36-year-old secretary who was diagnosed with multiple sclerosis six years ago. On a recent clinic visit, she mentioned to the nurse that she was experiencing increased urinary symptoms, which were seriously impacting on her quality of life. She was finding the incontinence made her working life difficult and embarrassing. The nurse listened to her problems and suggested that she might like to learn to self-catheterise. Marie was hesitant at first because she did not think that she could manage this. However, having discussed it with the nurse and taken the literature she was offered, she said that she would think about it. Marie decided to ‘give it a go’ and, with the guidance and support of the nurse, successfully learnt this procedure, which transformed the quality of her life.

This case study demonstrates what a difference involving patients in their care can make. This chapter intends to look at how nursing care has changed so as to make this kind of participation easier; it will challenge you to recognise the patient’s perspective and participation in care. We will first look at the nurse–patient relationship in the early days of nursing, and then move on to the nursing process and how care is delivered today. Then you are asked to consider the importance of the nurse–patient relationship and factors that may impact on it. The chapter ends by identifying power issues within the relationship and how you as a nurse can empower patients to participate in their care.

The nurse–patient relationship and the biomedical model

In this section, we will consider past influences on the nurse–patient relationship so that you can understand the evolution and importance of patient involvement in care today. Although Florence Nightingale suggested that the role of nursing was to nurture the patient’s inner resources and to put him [sic] in the best state for nature to work on him (Nightingale, 1859, p133), nursing in the early part of the twentieth century was viewed as a skilled adjunct of medicine, and involved carrying out medical orders. The nurse monitored the effects of these treatments and reported back on the results. It was mechanistic and reductionist, and viewed patients in terms of biological systems and their medical diagnosis. Nurses were not required to make decisions about their care as they were carrying out medical orders. This type of care became known as the ‘biomedical model’ because it focused on patient diagnosis and pathology. The body was viewed as being made up of biological systems that could be viewed independently of each other. The biomedical model was the standard model of care in the Western world from the early twentieth century right through to the 1970s. Activity 1.1 will help you think about some of the real effects on patient care of using the biomedical model.

Activity 1.1 Reflection

• What knowledge would you need to nurse according to this biomedical model?
• What would be the advantages and disadvantages of employing a medical model of nursing care?

An outline answer is given at the end of the chapter.

If you nurse according to a biomedical model of care, the content of your nurse training programme would focus on the biological sciences, pharmacy, carrying out prescribed procedures and making observations. It would not include the social sciences that are in your present curriculum and there would be no interpersonal skills teaching. The nursing component would be about procedures as defined by the hospital procedure manual. This was certainly the case in previous nursing practice (Ford and Walsh, 1994). Nurses were not seen as needing a university education as they were only following orders (Dingwall et al., 1991).

The main disadvantage of the biomedical model is that the human side of care may be neglected (Pearson et al., 2005). Patients may be labelled according to their diagnosis, with people being described as ‘schizophrenics’ or ‘diabetics’, which depersonalises them. Being treated as an object like this causes patients anxiety; this form of labelling can all too easily lead to a type of non-person treatment (Morrison, 1994, p63). The biomedical model also values high technology, which is associated with scientific development, so low-tech specialities such as care of the elderly have lower status and receive less funding. In this model, the doctor is the head of the team and the person who allows access to the patient. This model did not allow for understanding the person as a whole, which is vital, especially in caring for people with mental illness (Mason and Whitehead, 2003). Finally, because all the information and decision-making rests with the medical staff, patients are precluded from being involved in their own care management and may well be deprived of all the information they need (Pearson et al., 2005).

Case study

Mrs Smith was an 80-year-old lady who had been admitted for treatment for her leg ulcers. The nurses were always very kind and dressed her legs carefully, but Mrs Smith was sure the dressings smelled and she did not want to mix with the other patients because of this. However, as the nurses only seemed to have time for doing her dressings, she did not like to raise the subject. She became quiet and withdrawn. Also, she lost her appetite and did not eat much, which had an impact on her wound healing.

The above case study illustrates the problems that may arise with only directing nursing towards the patient’s diagnosis. This may seem a strange way of nursing to you, but think about whe...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Foreword
• About the authors
• Acknowledgements
• Introduction
• 1 The nurse–patient relationship
• 2 Health policy on patient and carer partnership
• 3 Patient participation and partnership
• 4 Nursing in partnership with carers
• 5 Family-centred care
• 6 The biographical approach and assessment
• 7 Supporting self-care
• 8 Health information and health literacy
• 9 Quality issues in patient participation
• References
• Index