Many theorists have written about the nature of the nurse-patient relationship, with several writing about caring as the central concept in nursing, through which effective nursing practice occurs. • Identify and describe the phases of the traditional nurse-patient relationship. Collaboration done right has tight parameters around scope, what resources are ready to be deployed and a clear understanding of who will drive the work forward after a solution is reached. The American Nurses Association’s (ANA”s). The way in which they relate to patients, families, colleagues, and other professionals and nonprofessionals determines the level of comfort and trust others feel and, ultimately, the success of their interactions. The traditional nurse-patient relationship Collaboration is team oriented. • Identify strategies in providing care to patients who do not speak English. Each nurse-patient contact holds the potential for connection and goal achievement, as opposed to one step in a lengthy relationship-building process. Explore the role self-awareness plays in the ability to use nonjudgmental acceptance as a helping technique. This is a particular risk in some settings where the nurse takes care of a patient and family over a long period of time, such as in home health or hospice/palliative care settings, or in long-term care facilities. Few people, however, recognize their own emotions, prejudices, and biases and how they are perceived by others. Furthermore, the process of therapeutic engagement is the key process in alleviating vulnerabilities, and one of the mechanisms by which this occurs is by the nurse’s caring presence (p. 55). Nurses are prone to stereotyping just like anyone else; however, the nature of the nurse-patient relationship requires that nurses become aware of how their stereotypical views of certain patients negatively affect the delivery of care. Congruence between verbal and nonverbal communication is a key factor in the development of trust. Nonverbal communication consists of grooming, clothing, gestures, posture, facial expressions, tone and volume of voice, and actions. Consider this example: A nurse who is preparing a patient for a breast biopsy notices that the patient keeps her head turned away, has tears in her eyes, and will not look at the nurse. Collaboration refers to joint efforts between various independent teams or groups. 7. Ongoing examination of attitudes toward others is both a lifelong process and an essential part of self-awareness, maturation, and personal growth. Being self-aware means recognizing one’s feelings and understanding that, although feelings cannot be controlled, behaviors can. This is an issue of professional boundaries that has been discussed earlier in this text. Being self-aware means recognizing one’s feelings and understanding that, although feelings cannot be controlled, behaviors can. What knowledge did or might have informed me? The patient may show progress one week but not be able to sustain improved diet the following week. the relationship on a more equitable basis than the traditional nurse-patient relationship, which gives much of the power to the nurse. The second phase of the nurse-patient relationship is called the working phase, during which the nurse and patient address tasks outlined in the previous phase. Fourth, the approximate length of the relationship will have been estimated, and the nurse and patient will have agreed to work together on some aspect of the identified problems. During the orientation phase, the patient has a right to expect to learn the nurse’s name, credentials, and extent of responsibility. Only gold members can continue reading. Discuss factors creating successful or unsuccessful communication. • Am I now more able to support myself and others as a consequence? If nurses can view each new relationship both as an opportunity to assist another human being to grow and change in a positive, healthful way and as a challenge to grow and change themselves, the rewards of nursing will be rich in and of themselves, allowing the nurse to separate from patients gracefully at the natural end of the therapeutic relationship. Even as a novice in nursing, you recognize the potential harm that this dismissive response will have for the frightened patient awaiting surgery. Another example would be written communication: the writer, the written piece, and the reader. • Did I respond effectively and in tune with my values? In addition to the five elements of communication, three major operations occur in communication: perception, evaluation, and transmission (Ruesch, 1972). • How was I feeling and what made me feel that way? Relationships between nurses and their patients have some commonalities with other types of relationships. This raises the question of how we can rethink the nurse-patient relationship and find ways to modify it to suit today’s contexts of health care delivery. Prejudices are strong and are often outside our awareness, which in turn makes, Thinking differently about nurses and patients: Caring and human relatedness, Theories of caring and human relatedness provide a powerful basis for practice. The process starts with opening of client email and ends with sending and verifying mail to recipients. Johns C: Guided Reflection: Advancing Practice, Oxford, 2002, Blackwell Science, p. 10. Communication occurs when one is in the presence of another person, even if no words are spoken. The patient and nurse feel good about the gains the patient has made in accomplishing goals. The second phase of the nurse-patient relationship is called the working phase, during which the nurse and patient address tasks outlined in the previous phase. Nonjudgmental acceptance means that nurses acknowledge all patients’ rights to be who they are and to express their uniqueness. The termination phase includes those activities that enable the patient and the nurse to end the relationship in a therapeutic manner. The sender is the person sending the message; the message is what is actually said plus accompanying nonverbal communication; the receiver is the person acquiring the message. Not only was this nurse’s behavior with this patient during her hospitalization “highly improper, but his socialization with the patient after her discharge from the hospital, not to mention the fact that he provided the patient with a controlled substance, was ample reason to impose strict disciplinary action” (p. 5). Feelings of anger and fear may surface, in addition to sadness. Teamwork is major key that thrives to success. During a lecture, the professor is the sender, the lecture is the message, and students are the receivers. First, the patient will have developed enough trust in the nurse to continue to participate in the relationship. In fact, a 2017 market research report valued the collaboration software market at over 8 billion USD in 2017, with a projected CAGR of over 9% from 2018 to 2025.. • How was I feeling and what made me feel that way? • Understand the roles of professional interpreters and translators. • Identify key aspects of collaboration. • Identify and describe the phases of the traditional nurse-patient relationship. Even if you are not allowed to accept a gift, you can acknowledge that you wish you could accept their gift and express your gratitude for their thoughtfulness. The person who creates the communication, the communication itself, and the person who receives the communication. Some people have difficulty accepting help of any kind, including nursing care. Box 9-2 describes a case in which a nurse was disciplined by his state board of nursing for failing to honor the professional boundaries between a nurse and patient. Use active listening, and accept the patient’s thoughts and feelings without passing judgment on what he or she is telling you. They were first addressed by Florence Nightingale in the Nightingale Pledge (refer to Box 3-1 on p. 58 to review this statement). Words can be used to mask feelings, but individuals are less able to exercise conscious control over nonverbal communication than verbal communication, therefore the nonverbal component may be a more reliable expression of feeling. Shortly after the relationship ended, the patient was readmitted, “suffering adverse effects from the affair” (p. 4). Communication is the exchange of thoughts, ideas, or information and is at the heart of all relationships. In this topic, we are going to discuss in detail about basics of email, email addressing, configuring email client, using emails, opening email client, mailbox, creating and sending a new email, replying to an email message, forwarding an email message, sorting and searching emails, advance email features, sending documents by email, activating spell check, using address book, sending softcopy as attachment, handling spam, instant messaging and collaboration, using emoticons and some of the internet etiquettes. • What would be the consequences of alternative actions for the patient, others, and myself? Even as a novice in nursing, you recognize the potential harm that this dismissive response will have for the frightened patient awaiting surgery. They may feel sadness about ending a relationship that has been open and trusting. In a detailed analysis, Hobbs found that alleviating vulnerabilities (e.g., feeling alienated, lack of control) experienced by the patient is central to patient-centered care in acute care settings. The traditional nurse-patient relationship has been taught and practiced since the middle of the twentieth century; however, several assumptions on which it is based no longer hold true in many of today’s practice settings. As in any relationship, positive and negative feelings often accompany termination. Therapeutic use of self can be helpful to you in relating effectively to patients, patients’ families, and other health care professionals. Developing excellent communication skills is important in your education as a nurse, because much of what you do as a professional nurse requires the ability to express yourself clearly and to understand another person. If you aren't sure how to show your interpersonal skills on a resume, you can get professional help with our resume feedback questionnaire. There’s no shortage of communication tools on the market. Communicating in a congruent manner requires that nurses be aware of their own thoughts and feelings and be able to share those with others in a nonthreatening manner. However, even in the most abbreviated contacts, nurses must orient patients and help them feel comfortable and as trusting as possible. The professor (sender) receives feedback from the students (receivers) through their facial expressions, alertness, posture, attentiveness, and comments. The nurse should examine any boundary crossing, be aware of its potential implications, and avoid repeated crossings. 1. What were the consequences of my actions on the patient, others, and myself? The nurse, not the patient, is responsible for delineating and maintaining boundaries. A fact of contemporary nursing practice is that patient interactions may be brief, sometimes lasting only minutes. A response to a message is termed feedback. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) The interactions are simply units of the behavior of a classifier. Communication exists simultaneously on at least two levels: verbal and nonverbal. Becoming nonjudgmental • Centered on meeting patient’s needs; do not address nurse’s needs Reprinted with permission of Wiley-Blackwell. Others have written about caring in nursing, including Watson (1988), whose theory is discussed in Chapter 13, and Roach and Maykut (2010), who described the essential elements of comportment central to professional caring. Hagerty and Patusky (2003) proposed a theory of human relatedness through which to conceptualize the nurse-patient relationship. According to the NCSBN, nurse-patient relationships can be plotted on a continuum of professional behavior that ranges from underinvolvement (such as distancing, disinterest, neglect) through a zone of helpfulness (the ideal space) to overinvolvement (such as excessive personal disclosure by the nurse, secrecy, role reversal, touching, gestures, money or gifts, special attention, social contact, getting involved in a patient’s personal affairs, and/or sexual misconduct). Such is the importance of communication … Usually text messages are transmitted through email. Concepts and theories investigate and attempt to explain the subtle complexity of interpersonal communication. Stereotypes are simplistic, distorted images used to describe or characterize groups. The atmosphere in the classroom is the context. “What we have here . . . is a failure to communicate.” From the 1967 movie Cool Hand Luke, this is one of the most famous quotes in American movie history. Both the agency’s policy on gifts and your instructor should also be consulted. Patients come to know their nurses well, and details of nurses’ lives are sometimes shared as part of conversation over time. • To what extent did I act for the best? Stereotypes result in prejudices and negative attitudes developed through social and cultural interactions. The nurse should avoid dual relationships in which the nurse has a personal or business relationship with a patient, as well as the professional one. Nurses must realize that there can be no socialization between themselves and patients, particularly sexual in nature. This in turn causes problems relating to patients who are stereotyped. Verbal communication consists of all speech and represents the most obvious aspect of communication. The termination phase Nurses must get their own emotional needs met outside of the nurse-patient relationship. Variables such as the care setting, community influences, client needs, and the nature of therapy affect the delineation of boundaries. This flexibility alone adds to increased communication and collaboration within the workplace. Baca (2011) listed five ways in which self-disclosure becomes problematic: (1) if the nurse’s problems or needs are disclosed; (2) if disclosure by the nurse becomes a common, rather than rare, event during interactions with a patient; (3) when the disclosure is unrelated to the patient’s problems or experiences; (4) if it takes more than a very short time during an interaction; and (5) the nurse discloses personal information even if it is clear that the patient is confused by the interaction. Communication skills useful in nurse-patient interactions are discussed later in this chapter. (Photo used with permission from iStockPhoto. Nurses should recognize that in the working phase patients may exhibit alternating periods of intense effort and of resistance to change. Patients accept a simple explanation, “I don’t know the answer to your question, but I will find out for you” more readily than a thinly veiled, evasive response. Collaboration, contribution and communication is a matter of sharing ideas together. When congruent communication occurs, the verbal and nonverbal aspects match and reinforce each other. Understand the roles of professional interpreters and translators. Consider the classroom situation. Nurses and nursing students may find that their personal values are challenged by the realities of practice. Incongruent communication creates confusion in receivers, who are unsure which level of communication they should respond to. This case involved a California registered nurse at a psychiatric facility in Fresno who was accused of having sexual relations with his former patient after her discharge. • Differentiate between social and professional relationships. Becoming a nurse: Defining nursing and socialization into professional practice, Ethics: Basic concepts for nursing practice, Conceptual and philosophical bases of nursing, Nursing theory: The basis for professional nursing, Illness, culture, and caring: Impact on patients, families, and nurses. ), Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Communication and collaboration in nursing. Words can be used to mask feelings, but individuals are less able to exercise conscious control over nonverbal communication than verbal communication, therefore the nonverbal component may be a more reliable expression of feeling. The California Board of Registered Nursing initiated disciplinary proceedings for “acts of unprofessional conduct.” An administrative law judge heard testimony, made a determination of misconduct, and recommended that the nurse’s license be revoked, but stayed the revocation and recommended that the nurse be placed on probation for 5 years on multiple conditions. Finding the time and space for reflective practice can be a challenge to busy students and practicing nurses alike. Configuring email client is setting up a client which includes the various steps. This raises the question of how we can rethink the nurse-patient relationship and find ways to modify it to suit today’s contexts of health care delivery. Although it is not necessarily a boundary issue for a patient to learn certain details of nurses’ lives, it is always a problem when the nurse comes to depend on patients for his or her own emotional support. For example, if a nurse expects that elderly people are irritable and demanding, the nurse may seek to avoid caring for elderly patients or to treat their complaints as unimportant: “just another grumpy old person.” Moreover, some nurses demonstrate lack of respect to elderly patients, using names like “sweetie,” “dear,” and “honey,” among others. Each of three phases—orientation, working, and termination—is sequential and builds on previous phases. • Write a description of an experience that seems significant in some way. Much of one’s message, however, consists of nonverbal communication. Worse, patients can bear the burden of their nurses’ emotional needs. Modified from National Council of State Boards of Nursing (NCSBN): Professional Boundaries: A Nurse’s Guide to the Importance of Appropriate Professional Boundaries, Chicago, 1996, National Council of State Boards of Nursing. • How might I respond more effectively given this situation again? Imagine your patient telling you, “I am really worried about my surgery tomorrow.” Then imagine yourself saying, “That’s silly, you will be fine,” as you take her blood pressure, then leave the room. All of these elements are necessary for communication to occur. Interprofessional Collaboration: Not a New Concept Even if you are not allowed to accept a gift, you can acknowledge that you wish you could accept their gift and express your gratitude for their thoughtfulness. Log In or. This requires taking time to focus on their own thoughts, feelings, actions, and beliefs. Interpersonal communication is the process by which people exchange information and feelings both verbally and non-verbally. 2. Developing an initial understanding of the patient’s problem or needs also starts in the orientation phase. In the classroom situation just described, students select, organize, and interpret various pieces of the professor’s message or lecture. elsevier.com/Black/professional. • What factors influenced the way I was feeling, thinking, or responding? Therapeutic use of self can be helpful to you in relating effectively to patients, patients’ families, and other health care professionals. • What knowledge did or might have informed me? They also recommended that nurses approach their patients with a sense of the patient’s autonomy, choice, and participation (p. 147), putting. Each student perceives the information differently; his or her perception is based on a variety of factors such as personal experience, preparation before class, alertness, fatigue, sensitivity to subtleties of meaning, and sociocultural background. Email address is a unique address given to the user that helps to identify the user while sending and receiving messages or mails. The importance of the relationship to both patient and nurse can be shared in a caring manner. The nurse should work within the “zone of helpfulness,” which is neither aloof nor too intense/emotionally involved. Actions that overstep established boundaries to meet the needs of the nurse are boundary violations. Every professional nurse’s goal is to accept all patients as individuals of dignity and worth who deserve the best nursing care possible. Use active listening, and accept the patient’s thoughts and feelings without passing judgment on what he or she is telling you. The nurse should avoid dual relationships in which the nurse has a personal or business relationship with a patient, as well as the professional one. Relationships between nurses and their patients have some commonalities with other types of relationships. BOX 9-4   MODEL FOR STRUCTURED REFLECTION. 4. Build teams based around individuals’ strengths. • Discuss factors creating successful or unsuccessful communication. Communication exists simultaneously on at least two levels: verbal and nonverbal. If the receiver can hear the sender, he or she can also pick up cues from the sender's tone of voice, such as emphasis and emotion. I am Jennifer Carter, and I am your nurse until 7 this evening. After studying this chapter, students will be able to: Third, the patient’s perception of major problems and needs will have been identified. Professional relationships Configuring email client is setting up a client which includes the various steps. Collaboration skills include communication, emotional intelligence, and respect for the diversity of your colleagues. • Outcome is improved health status of patient Because stereotypes and prejudices tend to persist despite contrary experiences, they are irrational or illogical beliefs.