In the field of nursing, nurses have a responsibility of providing treatment and care to their patients; this provision ensures easy coping with ailments and wellbeing. In order to carry out their responsibilities effectively, nurses must interact with their patients in an appropriate manner. The nurse-client relationship is an interactive process in terms of feelings, thoughts, and actions. According to Peplau’s outline of Interpersonal Relations theory, such relationships are crucial in nursing practice. Whether the client is an individual, group, family or community, this relationship benefits them in a variety of aspects (College of Registered Nurses of British Columbia, 4).
Effective relationships require the use of standards and regulations; they limit the extent of interaction between the patient and nurse. Nursing organizations employ a variety of ways in controlling this interaction. Some of the structures include; Practice Standard Nurse Client Relationships, Code of Ethics for Registered Nurses, and Professional Standards for Registered Nurses. These documents ensure the maintenance of boundaries and describe the nurse’s roles in sustaining professional relationships with their clients; this is irrespective of the scenario or situations that may present themselves. This applies to all nurses including; nurse practitioners, registered nurses, student nurses, and licensed graduate nurses (CRNBC, 5).
Description of Nurse-Patient Relationships
A nurse-patient interaction is a therapeutic and professional process. The relationship gives importance to the needs of clients; it ensures these needs, and not the nurses’, are met first. The relationship is in line with the provision of better health and enhancement of the client’s wellbeing. The nurse has the responsibility of establishing and sustaining boundaries with their patients. The nurse achieves this by focusing on the components of nurse-patient relationships. The components include; respect, trust, professional intimacy, power and empathy.
Respect refers to the nurse’s ability to view the patient as a valuable and important individual. The treatment of patients in a dignified manner improves their feelings of self-worth and uniqueness. Nurses should treat all patients in a respectful manner; this is regardless of the differences in socio-economic status, nature of health conditions, and personal attributes.
Trust is an important component of the relationship. In most cases, the patient is in a vulnerable position physically, psychologically and otherwise. The problems a patient faces often contribute to health challenges and slow recovery. Finding someone to share with and help in finding solutions facilitates quick recovery. The development of trust is a difficult task; it may take a long time. It is crucial for a nurse to make a patient comfortable and open up; this builds trust. Once formed, trust should continue; the re-establishment of trust is difficult once broken.
Professional intimacy is a concept relating to the care nurses provide patients with; these services are close and relate to physical activities such as bathing and dressing. The activities performed with or for patients create closeness between him/her and the nurse. The plan of care creates spiritual, psychological, and social bonds; these bonds make boundaries hard to maintain. Professional intimacy provides the nurse with crucial information about the patient’s condition; this makes the treatment process easier.
Empathy involves the nurse’s ability to feel and understand the patient’s condition and challenges. Empathy towards the patient makes the provision of appropriate treatment and care an easy task. Empathy in nursing also includes maintaining appropriate emotional distance from the patient; this ensures professional response and objectivity. It also promotes a validation of the meaning of treatment experiences for the patient.
In a patient-nurse relationship, power lies with the nurse. Though the relationship focuses on the needs of the patient, it is up to the nurse to make decisions regarding the interaction. The nurse has influence in the medical system and authority, specialized knowledge and ability to provide for the patient’s needs. The power helps in setting up boundaries and maintaining them. The use of power combined with a caring nature is crucial; this helps the nurse in meeting his/her patient’s needs. There is a risk of misuse of this power; this results in the abuse of patient needs. These components apply depending on the context, whether a nurse is a secondary or primary provider, and length of interaction.
Nurse-patient relationships have distinct elements including; contact, boundaries, confidentiality and therapeutic nursing behavior. Contact refers to the condition of interactions between the parties. Contact incorporates; time, purpose of meeting and place. These conditions involve; the duration patients interact with nurses, and reasons for the interaction. The conditions for termination of the contract also fall under this category; this outlines situations where the relationship becomes unnecessary.
Boundaries are rules and regulations controlling the extent and nature of the relationship between the parties. Boundary provisions outline the roles of participants. In this situation, the nurse has the role of providing professional help; this caters for the client’s needs and problems. The client’s needs should be the focus of the interaction.
Confidentiality refers to the nurse’s ability to uphold the patient’s trust; he/she keeps the information provided in confidence. However, confidentiality has limits; in cases where information is vital for the patient’s wellbeing, the nurse must share it with relevant staff members. It is crucial to acquire the patient’s written permission before divulging confidential information.
Therapeutic nursing behavior refers to the characteristics and personal traits a nurse should have; this helps in ensuring effective interaction between the nurse and his/her patients. Through self-awareness, the nurse knows his/her purpose and how to accomplish it. A nurse’s genuine attitude, warmth and respectfulness provides patients with a feeling of importance and self-worth. Empathy helps the nurse understand the patient’s challenges thus help in coping with them. Through cultural sensitivity, the nurse provides equal treatment to patients of diverse characteristics; this is in terms of tribe, race, gender, age, and many others. Collaborative goal setting helps patients and nurses work together in ensuring the patient’s wellbeing; this involves the exploration of possible treatment strategies.
There is theoretical support for the importance of nurse-patient relationships. According to Finch (1), nursing care interaction and behavior determines the health outcomes. Care is important in promoting the wellbeing of patients, however, if not monitored; the care may interfere with boundaries. The boundaries set by standards of practice regulate the extent to which a nurse interacts with patients. Peplau’s theory focuses on the importance of patient-nurse communication. She views nursing as a human relationship between the sick and nurses; the nurse recognizes and reacts appropriately to patients’ needs. This theory focuses on catering for patients’ needs and helping the nurse understand his/her own behavior. Watson’s theory of caring banks on the need of respect, trust, and empathy; these facilitate understanding and acceptance. Though the relationship between the patient and nurse is the foundation of nursing practice, the caring aspect is of greater importance.
Boundaries in the Nurse-Patient Relationship
Professional boundaries are factors that separate a registered nurse’s therapeutic behavior from other behaviors; this increases the benefit of nursing care to clients, families and community (CRNNS b, 4). These boundaries are important; nurses must realize when professional relationships start slipping to the non-professional realm; nurses should be cautious and take immediate action when this happens. According to CLPNBC (1), there are practice standards providing for various aspects of nursing practice. These standards work alongside policies and bylaws relevant to nursing.
The nurse-patient relationship is the foundation of practice based on; respect, trust and professional intimacy. The boundaries ensure the patient’s autonomy, dignity and privacy remain safe. A violation of boundaries harm the relationship and patients. The violation occurs in relation to behaviors related to; physical contact, favoritism, friendship, gifts, socializing, intimacy, dating, chastising, disclosure, and coercion. Though some boundaries are clear, others require professional judgment. The employers in medical organizations provide supervision, education, and support in relation to boundary issues; this helps nurses in realizing and resolving problems in the early stages (CRNNS, 4).
The boundaries rely on certain principles.
- First and foremost, the nurses use professional judgment; this determines boundaries of the therapeutic relationship with patients. Establishing and maintaining boundaries is the nurse’s role.
- Nurses have the responsibility of starting, maintaining, and terminating patient relationships; this ensures the patient’s needs come first.
- Nurses should not engage in friendships or romantic relations with clients; this also applies to sexual relations.
- Nurses should practice care when socializing with patients or former patients; this is crucial when patients are vulnerable and require continuous care. The boundaries also apply to the patient’s family and friends.
- Nurses support each other in maintaining professional boundaries; they report cases of boundary violations so they can be addressed early. In cases where the nurse wants to provide care for family and friends, discussion of boundaries, dual roles, and caution occur.
- Despite the access to confidential and privileged information about patients, nurses must use it only for the patient’s benefit and not personal interest.
- Nurses should not disclose information about themselves unless deemed necessary. They may provide information about themselves only when the information may help in meeting the patient’s needs. The communication with or about patients should be appropriate; it should not be inappropriate such as in the case of; demeaning, insulting, seductive, humiliating, or disrespectful interaction.
- Nurses do not carry out activities of inappropriate personal or financial gain; they should not solicit or receive gifts from patients.
Personal relationships affecting Nurse-Client Relationships
There are other forms of interpersonal relationships presenting challenges to the maintenance of patient-nurse professional relationships. Casual relationships, for instance, occur when nurses become acquainted with other people. Nurses, just like other people, are members of the community who constantly interact. The interactions during normal life activities result in casual relations.
Friendships are platonic relationships; they may exist between nurses and patients or other people outside the nurse-patient relationship. This is closer than casual relationships and may have an important meaning. Though nurses do not enter platonic relationships, they may have pre-existing ones with individuals; these individuals then become their patients.
Romantic or sexual relations, on the other hand, imply erotic activities or desires; they incorporate sexual and emotional intimacy. In the nursing field, such relations are forbidden; it is against the professional and ethical provisions for nurses to have such relations with patients. The relationships result in harmful consequences for patients (CRNBC, 7).
Differences between professional and personal relationships
In professional relationships, a code of ethics and professional standards regulate the nurses’ behavior. In other relationships, the nurse’s behavior towards the patient relies on beliefs and personal values. In terms of remunerations, nurses receive payments in return for the provision of care to patients. In personal relations, no payment occurs for being in the relationship.
In professional relationships, the length of the relationship is time-limited; it occurs only during the time the patient needs nursing care. Personal ones, on the other hand, may last a lifetime. The location of professional relationships is defined and limited to the area of nursing care provision. Personal ones occur in unlimited and undefined areas.
Professional relations are goal-oriented; the purpose is the provision of care to patients. Personal relationships are for pleasure and occur in an unstructured and spontaneous manner. The power of balance is unequal in professional relations; nurses have more power due to the pre-acquired knowledge, authority, influence, and access to information about the patient. In personal relationships, the power is equal.
In professional relationships, the nurse has the responsibility of establishing and maintaining relations; in personal ones, the responsibility is equal. In order to establish a professional relationship, the nurse requires preparation, formal knowledge, training and orientation. Personal relationships, on the other hand, do not require preparation. In professional relationships, the time spent in relationships depends on contractual agreements; they outline the working hours when a nurse and patient can interact. In personal ones, time spent is a personal choice.
Indicators of breach of boundaries
- The nurse’s behavior changes and becomes inconsistent with the standards of practice.
- A conflict emerges between the patient’s needs and the nurse’s needs; the nurse may fail to prioritize the patient’s needs.
- The nurse hides aspects of his/her relationship with the patient from other practitioners.
- The nurse stops others from having a relationship with the patient; he/she becomes protective.
- The nurse uses the patient for personal gains in terms of; social support, status and financial gain.
- The nurse becomes preoccupied with the patient; he/she gives preferential care to a specific patient at the expense of other patients.
- The nurse loses perspective in terms of boundary; he/she may enter a personal relationship with the patient before ending the professional one (CRNNS b, 4).
Improving Nurse-Patient relationships
The nurse should ensure transparency, therapeutic and ethical behavior towards current and former clients. In case of complex issues and unclear boundaries, the nurse should consult trusted and knowledgeable colleagues.
Personal information, of then nurse, should only be disclosed if it has therapeutic benefit to patients. Divulging personal information creates a rapport and develops the patient’s trust. However, the nurse should focus on the patient’s needs and avoid disclosing long descriptions and intimate details.
Nurses should realize that interacting with patients on a personal level crosses professional boundaries; it breaches confidentiality and client privacy. Client information should not be discussed on social sites and public for a.
Nurses should understand that living and working in the same community as their patients poses the need for dual roles; they maintain this by differentiating the professional and personal interactions. They ensure caution in forming relationships with former patients.
They should be careful about gifts from clients; he/she should determine the reason for gifts. Refusing a gift requires sensitivity and explanation for the refusal. The patient can be provided with options on how to redirect the gift (CRNNS, 4).
The nurse-patient relationship is a central foundation in nursing practice (Muk & Pui, 1). Various theoretical views like Peplau’s and Watson’s theory of caring support the need for a healthy relationship. They outline the roles and responsibilities of parties. This relationship relies on the standards of practice for regulation; these standards outline the principles and boundaries of interaction during and after care. This research paper analyzes this relationship in details; it focuses on its definition, description elements, components, principles and boundaries. The nurse requires skills and experience in maintaining a healthy relationship with patients; this is solely his/her responsibility. Ensuring the healthy recovery and wellbeing of patients is the role of every nurse.
Finch, Linda. Development of Substantive Theory of Nursing Caring. International Journal for Human Caring, Vol. 12(1). (2013): Web. Available from < http://www.memphis.edu/nursing/pdfs/finch- development_of_a_substantive_theory_of_nurse_caring.pdf> [Accessed July 20, 2013]
Mok, Esther, and Pui, Chi. Nurse-Patient Relationships in Palliative Care. Issues and Innovations in Nursing Practice. Journal of Advanced Nursing, Vol. 48(5): Web. Available from < http://www.beathamscience.com/open/tohspj/articles/V004/15TOHSPJ.pdf> [Accessed July 20, 2013]