Importance of Interpersonal Relationships
A nurse interacts daily with medical staff, patients, and their families as a part of the professional activities. The nurse must have interpersonal communication skills to ensure an adequate level of these contacts. The importance of interpersonal relationships lies in the fact that communication with the patient depends on implementing these skills and, in the long term, the treatment outcome. A critical interpersonal skill is active listening; it allows the nurse to communicate with patients far from understanding medical terminology. As a result of the implementation of this skill, an essential aspect of communication with the patient is achieved: deciphering symptoms by verbal signs. An essential skill for establishing interpersonal communication with the patient is patience.
The nurse’s professionalism is vital in helping reassure patients and their families and establish a trusting relationship with them. Interpersonal relationships are also part of teamwork, in which the entire staff becomes a team whose goal is to provide high-level medical services (O’Donovan & McAuliffe, 2020). Communication skills are necessary for the nurse to establish these interprofessional relationships. Interpersonal communication is essential because it is consistent with the goals of an ethical relationship with patients. The nurse, in this vein, implements critical thinking, ensuring the accuracy of the information for the patient and establishing positive relationships (Hollen & Stein, 2020). Interpersonal communication within the framework of patient care maintains morale and helps to achieve the most effective results in treatment.
The Four Phases of Establishing Interpersonal Therapeutic Relationships
All interactions between a nurse and a patient can be divided into phases, each meeting its own goals and objectives. The phases of the therapeutic relationship are divided into the preliminary interaction phase, the orientation phase, the direct working phase, and the completion phase (Forchuk, 2021). In the case of Alicia MacArthur, who is starting as a nurse, the instructions for each phase must be followed closely.
In the current setting, nurses Alicia MacArthur and her colleague Chloe must demonstrate their theoretical knowledge in practice. Nurses must understand the importance of establishing a trusting relationship with the patient and maintaining it throughout treatment. Nurses’ respect for patients is demonstrated through small details such as hand hygiene. In addition, nurses must distinguish personal and social relationships from therapeutic ones. Finally, nurses must be aware of their boundaries when interacting with patients.
Relationship with the Patient before the Interaction
The first stage of communication begins when the nurse is responsible for initiating the relationship with the patient. This phase is critical for establishing and further maintaining nurse-patient contact. This stage may include a preliminary study of information about the patient and the nurse’s planning and thought process (Malini & Kusumawaty, 2019). Since Alisha does not have enough experience in communicating with patients, she first needs to prepare for the meeting. She demonstrates the skill of primary communication because she knows how to introduce herself to the patient. In addition, before a direct meeting, it is necessary to recognize and work out internal emotions and identify data on the patient’s health, social and professional status.
Introductory Phase
At this stage, the first meeting of the nurse with the patient takes place. Alisha and Mr. Baird already had it; Alisha competently initiated the relationship, introducing herself and explaining the nature and duration of the interaction. In further relationships, it is necessary to win the patient’s trust and create comfortable conditions. The nurse must effectively capture and record the patient’s feelings and emotions and develop goals they have to achieve together (McGonigle & Mastrian, 2021). This stage can be characterized as the phase of identifying problems and outlining ways to solve them. One of the problematic points that can arise is the emotional attachment to the client. In this situation, Alisha will need to reflect emotions by seeking help from a mentor. Problems can also arise when setting goals or finding an approach to the patient. All emerging difficulties must be resolved at the orientation stage; otherwise, the interaction will be ineffective in the future.
Working Phase
Most therapeutic interventions take place during the working phase of nurse-patient relations. The nurse and the patient must become a team to achieve joint results (Arnold, 2020). Mutual understanding at this stage is critical to achieving effective treatment. Alisha, at this stage, must gather as much data as possible about Mr. Baird in order to understand the patient’s stressors. It is essential to set realistic goals that will not disappoint either the patient or the nurse (Arnold, 2020). The team of the nurse and the rest of the medical staff is needed to implement an interprofessional approach at this stage.
Termination Phase
The end of the therapeutic phase should be the most critical milestone in the relationship between nurse and patient. It is essential to be aware of the nurse’s and the patient’s feelings for the successful completion of the relationship (Sibiya, 2018). Alisha must review the progress and report it to Mr. Baird. A joint discussion of the achieved goals will help pave the way for further consultations, if necessary (Arnold, 2020). Problems that a nurse may face may include patient dissatisfaction. To effectively manage the situation, the nurse needs to understand the patient’s feelings clearly.
Professionalism Connected with Hand Hygiene Practice Prior to Developing a Therapeutic Relationship
Alisha knows the five rules of hand hygiene and is ready to demonstrate her skills. The aspiring nurse rightly emphasizes the importance of hygiene to professional conformity. The most obvious argument for the importance of hand hygiene is the prevention of nosocomial infections (Dunne et al., 2018). However, Alisha and Chloe comply with the rules of hygiene to demonstrate professionalism. Compliance with important rules of hygiene is necessary to establish a relationship between nurse and patient. While there is a positive attitude among healthcare professionals towards hand hygiene, actual compliance with this practice is less than 30% (Le et al., 2019). Medical personnel must practice good hygiene to reduce the spread of germs and infections from person to person. Hygiene also reduces the spread of infectious diseases of the upper respiratory tract. Alisha and Chloe are aware of these dangers and demonstrate their professionalism by showing compliance with the rules and regulations.
Hand hygiene is a manifestation of respect for the patient. Hand hygiene is well known to be the most effective method of disease prevention (Hillier, 2020). The patient will establish a more trusting relationship with the nurse, realizing that the medical staff is trying to reduce all risks. Hand hygiene is paramount when dealing with the elderly, children, and immunocompromised patients (Stoeva & Kwan-Hoong, 2021). Moreover, poor hygiene can pose a risk to the patient’s family, which is not good for establishing a good relationship between the nurse and the patient. Alisha and Chloe seek to establish a trusting relationship with the simulated patient, so hand hygiene becomes one way for them to demonstrate that they care about the health consumer.
Implementing Nursing Council of New Zealand Competencies for Registered Nurse Practice
Registered nurses should use the knowledge gained during their studies to support people in the field of health management. Nurses are responsible for developing, implementing, and evaluating the care plan (NCNZ, 2016). In addition, the nurse must build partnerships with patients, their families, and communities. The responsibility of nurses occurs in the area of ensuring the correspondence between the services provided, their education, and competencies (NCNZ, 2016). The nurse must understand the responsibility and provide quality and competent patient care.
Professional Responsibility
The first domain of Competencies for Registered Nurse Practice deals with the most critical part of being a nurse: professional responsibility. Competence 1.1. states accepting responsibility for ensuring that nursing practice meets professional, ethical, and legal requirements (NCNZ, 2016). It is especially important for Alisha and Chloe to act in accordance with the competencies as they are starting their journey in the field of medicine. To meet Competency 1.1, Alisha and Chloe must understand and act strictly with applicable law. One of the most critical points is that nurses must take responsibility for making decisions and every action concerning the patient and the team (NCNZ, 2016). For example, an indicator of professionalism will be the observation and detection of law violations and immediate response to them. Alisha and Chloe must be guided by professional standards during their nursing activities.
Interpersonal Relationships
The third domain of Competencies for Registered Nurse Practice concerns the establishment of interpersonal relationships during nursing practice. Competence 3.1 concerns establishing, maintaining, and completing therapeutic interpersonal relationships between nurses and health consumers (NCNZ, 2016). Alisha and Chloe can demonstrate this competency by initiating and effectively maintaining a relationship with a simulated patient. This competency includes demonstrating competent interviewing and psychotherapeutic knowledge to establish trust (NCNZ, 2016). Finally, Alisha and Chloe can show knowledge of competencies by demonstrating respect, empathy, and interest in the health consumer.
The Differences between Personal, Social, and Interpersonal Therapeutic Relationships
Depending on the conditions of communication, different types of relationships can arise between people: personal, social, or professional. A therapeutic relationship refers to the kind of relationship that occurs in a professional setting (Molina-Mula & Gallo-Estrada, 2020). In particular, a nurse and a patient enter into such a relationship during the provision of medical care. Ethical and moral boundaries should guide the activities of the nurse in order to ensure the most effective communication. The therapeutic relationship is a means to achieve the goals of treatment.
Personal Relationships
Personal relationships represent the narrowest aspect of social communication. The most valuable in personal communication is the quality of communication with another person. Personal relationships are characterized by particular forms of interaction between a narrow circle of people. Personal communication is governed by rules established between several people. Usually, personal relationships are established with a narrow circle of people and are characterized by special trust and strong attachments.
Social Relationships
Social relationships refer to the bonds that exist between people that have repetitive interactions that the participants perceive as having personal meaning. At their core, social relationships are extended personal relationships. According to the level of interaction between people, two types of relationships can be differentiated by the number of repetitions and the depth of relationships. In social relations, the needs of all communicating parties must be satisfied.
Therapeutic Relationships
The therapeutic relationship is an interactive relationship established during the treatment between the nurse, the patient, and their family, which should be caring, positive, and professional. The therapeutic relationship has a crucial difference from social and personal relationships. The critical difference is that during the therapeutic relationship, only the needs of one party, the patient, are met (Bugatti, 2020). While social relationships are established for the purpose of exploring the feelings of the participant, therapeutic relationships are intended to establish an effective partnership.
Social and personal relationships imply equal responsibility between the participants. For the therapeutic relationship, the responsibility for establishing, maintaining, and terminating communication is solely the nurse’s responsibility (Kaur, 2020). A common feature of therapeutic and social relationships is the based on kindness and mutual respect. However, the therapeutic relationship is a team effort to achieve treatment goals (Kaur, 2020). The medical professional has formal, legal, and ethical responsibilities to the consumer. Medical personnel should not use the therapeutic relationship with the patient for any benefit and should not enter into a personal relationship with a consumer of health services. (Kaur, 2020). Social communication can be seen as a service to another person; therapeutic as a professional duty.
Professional Boundaries, Governing Nurses’ Professional Communication Interactions
The basis of the relationship between the nurse, the patient, and their family, for the most part, is the observance of the necessary ethical boundaries. Nurses must be held accountable by maintaining personal and financial boundaries with health consumers (NCNZ, 2012). The boundaries of the relationship between patient and nurse must be maintained to some extent, not only in professional activities but in personal life (NCNZ, 2012). In addition, it is important that medical professionals must personally contribute to the creation of boundaries since each patient and each case is strictly individual.
Ethical patient care involves a balance between leadership and personal relationships to achieve patient satisfaction and treatment goals. Nurses must understand that they have more power and authority in all types of relationships with the patient (NCNZ, 2012). This happens because the medical worker has exceptional knowledge and access to classified medical information. The imbalance must be avoided, the authority must not be abused, and the healthcare consumer must not be given too much freedom.
A nurse may have a professional relationship with the family of a healthcare consumer. These relationships may expose the patient to vulnerabilities in terms of psychological comfort and confidentiality (NCNZ, 2012). The imbalance can be increased if the consumer has limited knowledge about their health status. Such vulnerable consumers may include children, the elderly, or persons with mental illness (NCNZ, 2012). In this case, an exceptional level of responsibility is imposed on the patient’s family and medical personnel. The nurse must establish a relationship in which the patient will be able to trust the staff to protect them from vested interests.
Health consumers may have different ideas about what a nurse-patient relationship should be like and may seek personal satisfaction from this contact. It is the responsibility of the nurse to maintain appropriate professional boundaries (NCNZ, 2012). The health consumer is in an unfamiliar situation and may not be aware of the necessary boundaries. The professional relationship between the nurse and the patient should remain the nurse’s responsibility as long as she has the necessary knowledge and skills.
There are several criteria that a nurse can use to assess whether the relationship with the patient is consistent with the understanding of boundaries. It is necessary to understand the nature of the relationship and be aware of whether there is an imbalance of power and whether the nurse has an authoritative position. In addition, it is important to know how vulnerable the state of health of the patient is. It is imperative to understand the confidentiality of information held by the nurse, which can compromise the health of the patient. The same considerations apply to relationships with relatives of former patients. There may be the possibility of harming the health consumer or other family members. In unclear situations, the nurse should seek advice from their professional body.
Summary
It is impossible to overestimate the importance of interpersonal relationships during the contact between a nurse and a patient. Active listening, critical thinking, and patience are essential for a nurse to develop effective relationships. It is interpersonal relationships that can achieve the goals of treatment. The patient’s trust in the healthcare professional develops during a professional relationship. Trust is essential for patient compliance with medical recommendations and confidence in a positive outcome. During the relationship with the patient, it is necessary to strictly follow the steps to establish communication and effectively resolve possible conflicts. It is important to clearly separate the therapeutic relationship from other types in order to meet moral and ethical standards. For effective relationships, it is vital to establish boundaries, which is the nurse’s responsibility. A nurse must have special knowledge and competencies to build a relationship with a patient. The criterion for meeting the standards of nursing is a sensitive, empathic, and respectful attitude toward the user of medical services.
References
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