PRIMARY NURSINGTherapeutic Relationships

Zrinko VranjesLisa NurmilaukasChris Kokkola

Interactions

Zrinko Vranjes

Nurse-patient communication is a crucial issue in nursing elderly people because it servesas a pointer to the quality of nurse-patient relationships (Wells, 1980; Bond and Bond,1990). While the concept of a meaningful nurse-patient relationship is important in everynursing speciality, it takes on added relevance in elderly care for several reasons. Firstly,for many elderly patients nurses form the most regular, if not the sole, human contact.Therefore if patients’ need for love and reassurance are not met by nursing staff, they mayremain unmet (Fielding, 1979).

Secondly, without the development of therapeutic nurse-patient relationships through themedium of communication, effective nursing care is impossible, as “effective and meaningfulnursing care of the elderly rests on effective and meaningful nurse-patient relationships”(Wells, 1980 p. 123). Wells illustrates this through the example of patient incontinence. Sheargues that solving this problem can only be achieved within a nurse-patient relationshipwhich facilitates gaining the patient’s views on the subjective meaning of the problem andwhat will be helpful in treatment. Castledine (1987) similarly views meaningful nursepatientcommunication to be an essential component of the nurse-patient relationship, butbelieves that only qualified staff are capable of forming this relationship.

Thirdly, effective communication with elderly patients is an essential precursor to theprovision of care tailored to individual needs. Communication skills are necessary to enablenurses to gather relevant information about patients, for example in taking a nursinghistory, to plan and administer appropriate care and to evaluate the effectiveness of carewith patients. Wells puts this succinctly:“nurse-patient communication is important because it is a measure of the effectiveness of nursingcare, i.e., the patient’s need is defined, appropriate help provided, and the effectiveness of careevaluated.” (1980 p. 123)

Again, while the need to gain detailed patient knowledge in order to plan, give and evaluatecare is not confined to nursing elderly patients, they frequently have multiple nursing andA COMPARISON OF THE VERBAL INTERACTIONS OF QUALIFIED NURSES 233medical problems as well as an increased need for social and domestic support and,frequently, health education (Syred, 198 1).Finally, elderly patients often have special communication needs as a result of, forexample, memory (Armstrong-Esther and Browne, 1986) or speech and sensory problems(Walton and MacLeod-Clark, 1986).

Interactions

Interactions

References

LOIS H. THOMAS, Ph.D., B.A.(Hons.), R.G.N.Research Associate, Centre for Health Seruices Research, University of Newcastle upon Tyne, 21 Claremont Place

SUPPORT IN PRIMARY NURSING

Lisa’s part of the primary nursing group work

Definitions

Support= maintainance, bearing, sustaining

Primary= the highest in rank Nursing= well everyone should know this

which is a profession specialized in taking care of the sick or infirm

Relations of the concepts

Own Patient System

• Enables individualized care

Therapeutic relationship

• Promotes a patient’s feeling of safety and a nurse’s knowledge about the patient

Multiprofessional teamwork

• Facilitates practitioners’ decision making for the good of the client

Support in own patient system

Feeling of support created: Understanding the client Providing care according to the patient’s

needs By using a nursing care planing more

efficiently By making nursing more visible

-> higher quality of nursing care

Support in therapeutic relationship

www.nursinggrip.com

Factors indicating the feeling of being supportive: Genuiness Empathy Respect Self-exploration Immediacy

http://www.ncbi.nlm.nih.gov/pubmed/11882129

Support in multiprofessional teamwork

Sharing experiences and knowledge about the client among nurses and other professionals Nurse to nurse Nurse to doctor Nurse to Practical Nurse

Supervision

Confrontation

Chris Kokkola

Knight and Field (1981) present a study showing how a task-orientated and routinized form of nursing organization led to routinized verbal communication with cancer patients. A further consequence was the division of labour whereby qualified staff occupied them-selves with administrative and ward management tasks while unqualified and junior nursing staff performed the majority of direct patient care (cf. Seers, 1986), and thus found them-selves on the receiving end of patient anxiety about their condition. (Thomas)

While maintaining friendly relationships with these patients, ward organization facilitated evasion tactics by junior nurses in order to avoid patients’ questions. It was possible for nurses to work elsewhere, thus avoiding contact with a particular patient, and/or the nurse could indicate by her actions that she had no time to talk. Wells (1980) and Armstrong-Esther and Browne (1986) similarly cite task allocation as militating against nurse-patient interaction. (Thomas)

Anger is an inevitable part of primary care nursing. The demand that patient’s and their family demand of care takers escalate during times of crisis.

Patients and family are fond of their nurse and have little tolerance when the nurse takes a day off, cares for another patient of takes a meal break.

This is because the patients sees the nurse as the only one that understands.

This pressure adds up and is added to the nurse.

(Jellinek)

Denying Anger

Common feeling during demanding periods of nursing

May place primary nurse in a dilema Anger may be inevitable (Jellinek)

Understanding expectable anger

Reduces stress and guilt Signals a problematic patient or rising

unit tension. (Jellinek)

Consultations

Psychiatrist and/or Psychiatric Nurse may be of assistance.

Careful interview assessment Understanding long-term therapeutic care

relationships Appreciating the stresses of caring for ill

patients

May help their encounter. (Jellinek)

References

LOIS H. THOMAS, Ph.D., B.A.(Hons.), R.G.N.Research Associate, Centre for Health Seruices Research, University of Newcastle upon Tyne, 21 Claremont Place

Primary nursing: Psychological implications Jellinek, Michael S;Herzog, David B;Stoddard, Frederick J Nursing Management; May 1994; 25, 5; ABI/INFORM Complete pg. 40