Relationship Between Nurse and Patient

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High Acuity Nursing Practice

In this case, the nurse entered quietly into the ICU because she did not want to wake the sleeping patient. When the patient suddenly woke up and asked the nurse what she was doing, she was apologetic and she explained clearly. Then she informed him that she had attended to him on the previous day. The patient was angry but the nurse knew that he was not angry at her; it was because of his illness and regret.

She tried to solve his problem by suggesting that she give him a nicotine patch since he had been dependent on nicotine when he was smoking before he came to ICU where he could not smoke anymore. The nurse even placed her hand on the patient and listened to him and she showed interest in understanding the patient’s trouble. Before she went off, she offered to bring the patient water and juice after the assessment (Case study, n.d.).

Knowledge Used by the Nurse

The nurse used ethical knowledge when she understood the situation of the patient. She knew that the patient was not angry with her despite his complaints. She made informed decisions to handle the situation better. In the case being studied, the nurse can be said to have used ethical knowledge when she decided that Mr. Nelson’s oxygen supply and demand were in balance by then and that his assessment could wait for a few moments. She did this so that she could have more time to interact with the patient.

Personal knowledge was depicted by the nurse when she compared her patient with her father who had the same problem. Her father had passed away several years previously due to complications due to smoking and he had never been able to quit for long. She also uses the experience that she had gained from other patients. In this case, Allison remembered the first time she had an angry patient. She was frightened, but the experience in the ICU made her learn that that was not an uncommon experience.

She worked with experienced colleagues and she came to understand that the patients were not angry with her but because they were frightened or worried about families or jobs. She learned to put herself in the patients’ place in mind and that’s why she knew that MR. Nelson had something else going on in his mind and that is why he was acting like that (Ways of Knowing, n.d.).

The nurse used esthetic knowledge in making decisions in this scenario. Esthetic knowledge, which is the imaginative and creative aspect of care that is provided to a patient, is seen in the case when Allison decided to give Mr. Nelson a nicotine patch to cut his craving for a cigarette. It is also seen when Allison placed her hand gently on the patient because she had a feeling that he had more to say (Ways of Knowing, n.d.).

Allison also used sociopolitical knowledge in her practice. Sociopolitical knowledge which looks at the broader context of the nurse and the patient, their relationship, economic, political, and sociocultural aspects was seen in the nurse when she did not go and get the nicotine patch by herself but first had to contact the doctor. She also used polite language when conversing with the patient. She also offered to bring the patient juice which shows the social aspect of the knowledge (Ways of Knowing, n.d.).

My Perception of the Nurse

I see the nurse as a person with good communication skills. She was able to enhance rapport with the patient and indirectly gave him hope. She was not dominating at the scene as she gave the patient a chance to make suggestions. She understood; she did not get angry with the patient. She was able to take her time talking with the patient despite the heavy workload she had.

Allison was confident as seen when she talked to the patient and even held his hand. Allison had a lot of commitment; she was determined to see that her patient was comfortable.

My Perception of the Role of the Nurse

Allison is a morale booster. She told the patient that being in ICU was not the end and that he could regain his health. She was also a good companion since she was able to talk to her patient about his illness and advise him on what they should do to make it better.

The nurse is a professional. She assessed the patient despite his low attitude. She was not surprised as a layman when the patient talked to her even on serious issues. Her professionalism was also seen when she noted that Mr. Nelson’s heart rate was 90 and regular, blood pressure reasonable, his oxygen saturation probe 98% while he was on 3 liters of oxygen and he was breathing effortlessly, and interpreted this to mean that his oxygen supply and demand were in balance and that assessing the patient could wait a few minutes. She also used professional knowledge when she told the patient that the cardiac event didn’t necessarily mean that he was not going to be healthy again.

Effects of the Nurse on the Patient

The nurse was looking at the cardiac monitor when the patient woke up. This is part of her practice to ensure that the patient’s heart was in the right condition. By suggesting getting a nicotine patch, she improves the patient’s health by suppressing the withdrawal symptoms that the patient has. She assessed the patient and recorded the findings so that the results could be used to plan for his management.

The nurse gave the patient psychological support. She told him that he was never alone and that whenever he needed something he could call her. She also talked to him in a friendly manner. These actions have a relaxing effect on the patient and they minimize the risk of depression as in this patient who had tried to imply that there is no reason for living.

The Acutely Ill Patient

Patients Profile

Mr. Nelson is a 50-year-old male who had recently been admitted for NSTEMI. He is a type two diabetic and smokes one pack and a half of cigarettes. These two factors predisposed him to get myocardial infarction which caused his dysrhythmias which were being monitored for. He had been having trouble with electrolyte imbalances and on this day, he had had two episodes of SVT and tachycardia. His vital signs were within the normal range. He is very frustrated staying at the hospital thinking about his profession and he has many regrets as he held that all that was his fault (Case study, n.d.).

My perception of the Patient’s experience the Illness

The reasonable conversation that the patient had with the nurse shows that he is fully oriented. He knew the cause of his illness and was blaming himself for it. He knew that he was in the hospital and needed to get out of there to do his job. The patient was angry for being held up in the hospital. The patient was stable in this conversation as he did not contradict his earlier statements and the conversation flow smoothly as the nurse advised him on what to do.

Allison’s experience with patients had taught her that patients were not angry at her but they were angry because of other factors like worries about their jobs or feeling that they don’t deserve to get sick (Case study, n.d.).

What I Learn about the Patient

Mr. Nelson was a responsible person. He used to smoke many cigarettes but he knew it was wrong, and this is confirmed when he said that he had tried several times to quit but failed. His sense of responsibility was also depicted when he said that he is held up in the hospital instead of doing his job. The patient is honest and straightforward as he said things about himself that one could be embarrassed to say and answered questions directly without hiding anything.

When Allison asked him if he was frustrated, he said “Damn right, I’m frustrated.” Another example is when he thought that it was his fault and went ahead to say that it was his smoking, the job, the crappy eating, and his lack of exercise that made him sick (Case study, n.d.).

Factors Supporting or Hindering the Nurse’s Ability to Learn about the Patient’s Experience

In this context, most of the factors are seen to support learning. The nurse has a personal experience gained by the interactions she had with her father, who died from complications related to smoking. She also has professional experience as shown when she thought about angry patients and knew, through experience, that they were not angry at her.

The nurse had good communication skills and she was able to enhance rapport. She had patience and time to converse with the patient. She had respect for her patients. She is depicted as a trustworthy person. She is compassionate and confident as seen when she talked to both the patients easily and freely. She was committed to her work, and she showed value for health and life in general (Case study, n.d.).

The patient was also honest and straightforward. He was a well-oriented person who could make reasonable decisions. Despite his anger, he showed respect to the nurse. He was in a normal physiological state. These factors increased the nurse’s ability to know him better.

The Nurse-Patient Relationship

Nature of the relationship

The relationship between Allison and Mr. Nelson can be described as ideal. The patient could communicate with the nurse and share his sorrows and opinions with her. He was a responsible person who was not too rebellious for the nurse to handle. The nurse on the other hand was somebody who was committed to her work. She had good communication skills, good experience, and was professionally equipped to handle the situation (Case study, n.d.).

Attributes, Personal Characteristics, and Capacities of the Nurse that Influence the Nurse-Patient Relationship

These aspects of the nurse can be described best using the attributes of caring commonly referred to as the five “Cs”. They are practiced in the context of high acuity nursing. The first C stands for Competence. Competence, which can be defined as “the state of having the knowledge, judgment, skills, energy, experience, and motivation required to respond accurately to the demands of one’s profession” (Attributes, n.d.) is seen when Allison assessed the patient. She had practical knowledge in operating and interpreting the results. She has theoretical knowledge about cigarettes and myocardial infarction and the nicotine patch.

The second C stands for Compassion. Allison showed compassion when she treated the patient as a unique person, she was there for him and she showed empathy. She could wait a few moments before she assessed him so that she could talk to him. Confidence is the third C as seen when the nurse and the patient had a mutual understanding, with no one party dominating over the other. Allison did not dominate over the patient as seen when he told her to assess him and she agreed. She also demonstrated confidence earlier when she decided that his assessment could wait a few moments.

The fourth C is Conscience and is depicted when Allison acted according to the nursing ethics. She learned conscience from her professional experience at the hospital and her father. Commitment is the fifth C and it is said to comprise all the actions that the nurse took in caring for the patient. She could afford to talk to the patient through busy; she offered to bring him the nicotine patch and juice, and when she was done with him, she started on the charting, knowing that in the ICU she could attend to anything any time (Attributes, n.d.).

Effects of the Context on the Nurse-Patient Relationship

The patient’s wife had been telling him to stop smoking and this caused more regret on the patient, but it also created a sense of responsibility in the patient to think through his actions. The ICU is described as being busy in this scenario and it caused more frustration on the nurse and more on the patient and this hurt the nurse-patient relationship. A busy environment can cause stress in people. Stress in the patient could be caused by this environment and this could cause anger in the patient which could make it hard for the nurse to communicate with the patient.

The chief nurse was also very helpful in this relationship since he was determined to see that the nurses were not overworked. This could encourage the nurse and give her the morale to do good work, which involves better health care delivery and this enhances the nurse-patient relationship.

References

Attributes. (n.d.). 5 attributes of caring.

Case study. (n.d.). Case Study #1.

Influencing factors. (n.d.). Influencing factors in knowing a patient.

Ways of knowing. (n.d.). Ways of knowing.

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