It is a nurse’s job to care for a patient’s medical needs. However, caring for their emotional well-being can have just as beneficial an impact on patient care. The relationship between nurse and patient requires trust, as well as understanding. For a patient to disclose private or embarrassing details about their physical or mental condition, they need to first trust that their nurse will treat them with dignity and respect. Furthermore, patients will only follow the advice of their nurse if they trust in his or her professional opinion. This careful balance of trust and professional respect is the founding principle for a healthy nurse-patient relationship.
Conceptual Framework, Community College of Rhode Island: Illustrates the important of the nurse-patient relationship in a caring practice.
USA Nursing Knowledge Consensus Conference: Discusses the human aspect of the nurse-patient relationship.
The Imbalance of Power
By its very nature, the nurse-patient relationship demonstrates an imbalance of power. The nurse has a more extensive knowledge base in terms of care and treatment options. The patient must rely on their nurse and other health care professionals to advise them of the best treatment options for their needs. As a result, there can be an unintended power struggle. The nurse, feeling he or she knows what is best for the patient, can unwittingly influence a patient’s choice or try to remain in control of medical decisions. While influencing a patient to choose the best course of care is important for patient participation, nurses must learn to walk a fine line between influence and assuming control.
Power Imbalance Study: Discussion on how the imbalance of power inhibits partnership in care.
Patient Participation: Current Knowledge and Applicability to Patient Safety: Article discusses, among other things, how the imbalance of power and nurses’ need to retain control can influence patient participation in care.
Empowering Counseling: Discusses how nurses can influence therapeutic patients by promoting the right atmosphere.
Nurse-Patient Communications
Communication with patients is a primary responsibility for a nurse. However, different patients require different approaches to communications. Depending on a patient’s age, temperament, current medical condition, and other factors, nurses often find their normal methods of communication are ineffective. In these situations, and for patients with special needs, knowing a variety of communication techniques is invaluable.
Communication with Elders: Techniques and training for communicating effectively with elderly patients.
Training Nurses in Patient Communication: Brief article with linked bibliography of resources discussing methods and techniques for nurse-patient communication.
Patient Relations – Communication Skills: Article discussing various verbal and nonverbal communication skills, as well as tips for patients with special communication needs.
Techniques of Therapeutic Communication: PDF File with an overview of various therapeutic techniques for nurse-patient communication.
Age Considerations
The age of a patient has a significant impact on the nurse-patient relationship. Children and the elderly require different treatment options and approaches to the relationship than middle-aged adults. Other family members are routinely involved to varying degrees, and heavily influence the nurse-patient relationship, depending on the age of the patient. For example, the relationship between a nurse and a pediatric patient will greatly rely on the relationship between nurse and parent, as well as parent and child. Likewise, the relationship with an elderly patient will involve influences from other contributing family members. Not only will the care of a patient vary with their age, but so does their ability to communicate and participate in decision-making, which also affects the nurse-patient relationship.
Pediatric Nursing Certification Board: Offers certifications and exams, as well as resources for nurses working with pediatric patients.
National Association of Pediatric Nurse Practitioners: Resources and guides for nurse practitioners working with infants and young children.
University of Minnesota Center for Adolescent Nursing: Includes course information and newsletter for nurses specializing in adolescent care.
Parish Nursing and the Elderly: PDF discussion of the benefits of parish nursing and the elderly, how small communities and parish nursing effect patient outcomes.
Nursing Care Improves Elderly Care: PDF document discussing the work practices and knowledge gaps that can make nursing elderly patients difficult.
Ethnic, Race, and Cultural Considerations
Cultural background, race, and ethnicity play an important role in a patient’s life. Not only do these factors play a part in medical issues and diagnoses, but also in their state of mind and emotional approach to medical care. Understanding the subtle, and at times not so subtle, differences in family life, cultural habits, physical differences, and other defining attributes helps nurses understand how best to help their patients. Sensitivity to cultural diversity can make all the difference in building a healthy nurse-patient relationship.
Transcultural Nursing: Website devoted to cultural considerations involved in treating patients of different ethnic backgrounds.
Student Notes Culture and Ethnicity in Nursing: PDF file intended for student nurses to explore the concepts of cultural and racial differences as perceived by patients.
The Basics of Race, Ethnicity, and Health Care: Resources, including governmental agencies and nonprofit foundations, that offer information on cultural and racial issues in nursing and health care.
New Mexico State University: Information for nurses and other health care providers based on ethnic groups.
Maintaining Boundaries
Given the close, personal nature involved in caring for another person, it is easy to let professional boundaries blur. Nurses today are encouraged to take a more human, holistic approach to patient care. That increased sensitivity and attention to the emotional side of a patient’s treatment can easily lead to a loss of the professional distance nurses must maintain. Learning to balance care and compassion, while maintaining a professional distance is a difficult task to master, even for experienced nurses. However, it is imperative that nurses find and maintain that balance. Government regulations, malpractice insurance, and disciplinary measures ensure that nurses who routinely cross the line and inappropriately blur professional boundaries no longer practice.
Sexual Misconduct Prohibited: Discussion of requirements, prohibited relationships, and establishing professional boundaries to avoid sexual misconduct.
Public Health Nurses Professional Boundaries: Publication from the Arkansas State Board of Nursing, including an extensive article on professional boundaries for nurses.
Nebraska Department of Health and Human Services: Resources and links on accountability in nursing conduct. Includes a section specifically about boundaries between nurse and patient.
Nursing Practice Standards
It is normal for a patient to feel gratitude towards a nurse who has helped them through a difficult medical treatment. However, there are standards nurses must follow when giving and receiving gifts, hugging and touching patients, or other instances that may blur the line between personal and professional involvement. In small communities or in cases where a nurse cares for close friends or family, it is even harder to maintain professional standards. However, there are rules and standards for every profession, including nursing. There are ethical codes of conduct and actions for which all nurses are held accountable, no matter the patient.
Therapeutic Nurse-Client Relationship: PDF from the College of Nurses of Ontario covering all aspects of standards including boundaries, working for friends and family, giving or accepting gifts, and other standards.
Elder Abuse: Standards set forth by the NJ State Nurses Association regarding elder abuse, what constitutes abuse or coercion, why it happens, and a nurse’s responsibility for reporting.
Therapeutic Boundaries: While written from a rural psychotherapy point of view, the issues of appropriate boundaries and relationships also apply to nursing and other health care providers in small communities.
Practice Alerts and Guidelines: Example of the Code of Ethics for nurses, covering a nurse’s primary commitment to the patient and maintaining the dignity of the profession.