Developing a Therapeutic Nurse-Patient Relationship: A Case Study of Raymond Nguyen

This essay explores the strategies for developing an ideal nurse-patient relationship within the therapeutic guidelines, using the case of Raymond Nguyen, a 63-year-old male patient with a chesty cough and a history of chronic smoking and alcoholism. It examines the importance of communication, both verbal and non-verbal, in building trust and understanding. The essay also delves into the principles of patient-centered care and the role of effective documentation in maintaining a therapeutic relationship. By analyzing Raymond's case, the essay highlights the crucial elements of a successful nurse-patient interaction, emphasizing the need for empathy, respect, and collaborative decision-making.

ASSESSMENT 2
Introduction
The healthcare is about different health-care professionals from various
fields trying to help individuals with ill health. In healthcare, the most
important aspect is the formation of relationship between the service user
and the service provider. This relationship is known as the therapeutic
relationship between patient and the nurse. Communication is essential
for better planning and outcomes so it is essential to develop a good
interaction between the healthcare provider and the patient to ensure
proper care and environment to achieve expected results for the patient.
In this essay, we will discuss the strategies for development of an ideal
nurse-patient relationship under the therapeutic guidelines. This
discussion will also include the importance of interaction and how nurses
interact as this can be an important feature for transfer of information,
support and treatment benefits.
The given case scenario is a 63 years old male patient named Raymond
who is presented with the problem of a chesty cough since 5 weeks with a
history of chronic smoking and alcoholism since 42 years.
Communication is a process of exchange of information in various forms
and by various methods. This exchange of messages or information is
usually done between nurses and patients in healthcare and is beneficial
for proper care plan (McQueen, 2004). Various forms used for interacting
with patient s in nursing involve verbal, non-verbal, written and silent
approaches. Stein-Parbury, 2013 described verbal communication as the
exchange of information or a source of interaction by means of words that
can be written or spoken. Language and use of appropriate words are
important in communication with patients as casual and slang language is
not to be preferred with patients in healthcare (Stickley & Freshwater,
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2002). The nurse needs to improve his efficiency of speaking and choice
of proper words to interact with a patient that will maintain their dignity
and address respectfully with a friendly gesture towards them. Another
way of interaction widely accepted in healthcare is non-verbal
communication that does not involve the use of words and spoken or
written messages. This way of interaction is important as it helps to bond
the nurse and patient into a therapeutic relationship under the thread of
trust and openness. The body language of the nurse while communicating
with the patient as in given scenario should be appropriate and full of
empathy. The non-verbal communication includes gestures, expressions,
touch and reading of patient's expressions that whether it matches to the
answer the patient is providing the nurse with or not (Levett-Jones, 2014).
Non-verbal communication is a very effective tool but it is sensitive
enough if not administered properly, abusive expressions or non-verbal
messages from the nurse to a patient can promote misunderstandings
and uncooperative behaviour. The nurse working in healthcare should be
trained effectively and acknowledged about these ways of communication
and do’s and don’ts of the non-verbal method. Nurses should reflect
effectively the use of these communication methods in their practice to
improve and enhance the efficiency of the service provided (Röndahl,
Innala & Carlsson, 2006).
The common term emerging in modern healthcare these days is patient
centred care. this phenomenon is about the care style and changes in
healthcare delivery according to the model of patient centred theory
where the patient is considered to be the centre and the peak priority of
healthcare plan (Hill, R Hall &Glew, 2017). Roger, 1940s introduced a
model of patient centred care that includes the aspects of the humanistic
theory of psychology. Researchers show that this method is widely
discussed by the healthcare industry and professionals but is very lowly
understood and practised properly (Gerteis, (1993.) Fulfilling the needs of
the patient is a core element of healthcare but fulfilling the requirements
of patients according to their care planning and decision making is the
core element of patient centred care. This model helps the nurse to make
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combined decisions of care with keeping in mind all the requirements and
opinion of the patient himself this will produce better outcomes and
satisfactory service approach. It is very important for the nurse to
understand that this approach follows the rule of no imposition of decision
making on patient regarding their treatment but only the nurse has to
guide the patient towards right direction to activate the ability of patient
to make reformed and effective decision for own self (Morgan &Yoder,
2012). This will induce the therapeutic relationship between nurse and
patient and help the patient to have greater communication and trusted
environment. The basic elements of this approach are empathy,
communication, transparency and respect. These elements if addressed
properly will hit the exact target of patient-centeredness. In given
scenario nurse should communicate with Raymond with various methods
described above and should inculcate her communication on basis of this
theory. Keeping patient as a judge for the care planning is an important
feature and in this case use of this approach will be beneficial. Raymond is
a happy individual who has a family and a daughter with 3 kids, he is
outgoing and chirpy as per his explanation given to the nurse. Yet, his
alcoholism and chronic smoking habits indicate various subtle issues in his
life which a nurse should investigate further to reach a proper plan. By
using this patient centred approach nurse will be able to enhance the
transparency and openness with Raymond and can build a fine
relationship under therapeutic guidance.
Another aspect of the formation of this therapeutic patient-nurse relation
is effective documentation. Communication, making the patient a centre
of care, taking collaborative decisions and every other aspect is crucial for
healthcare but the progress of any healthcare programme is ensured by
proper documentation and referral made by the nurse. Documenting
patient care is important criteria to ensure proper delivery of services and
continuity of healthcare to the patient. Documentation also provides a
standard platform for communication between different healthcare
professionals and nurses. According to government guideline, nurses
should compile the records of every patient precisely for evidence and
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legal aspect as well (Iyer & Camp, 1999). MIS management information
system is recently used modality to provide better record keeping and
documentation of patient’s data. Every nurse is trained efficiently to be
able to record the data provided by the patient and the data included in
patient care throughout the patient care programme. This will ensure
evidence-based practice with respectful confidentiality rules to be
followed and monitored inpatient record maintenance (Nursing and
Midwifery Board of Australia, 2008).
Conclusion
Relationship with a patient under therapeutic guidelines is an essential
tool for effective healthcare delivery. Use of various verbal and non-verbal
communication skills with an appropriate skilful intervention of
therapeutic relationship and basic documentation will ensure a good
therapeutic relationship between patient and nurse (Bachelor & Horvath,
1999). Without a relationship in healthcare good service delivery and
effective consumer support is not possible hence, it can be concluded that
every practice should match the ideal bond formation between the nurse-
patient relationship that will improve the nursing practice as well as
enhance the positive outcome for the patient.
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References
Bachelor, A., & Horvath, A. (1999). The therapeutic relationship.
Gerteis, M. (1993). Through the patient's eyes: understanding and
promoting patient-centred care.
Hill, R., Hall, H., &Glew P. (Eds.). (2017). Fundamentals of nursing and
midwifery: A person-centred approach to care (3rd Australian and New
Zealand ed.). Sydney, Australia: Lippincott Williams & Wilkins.
Iyer, P. W., & Camp, N. H. (1999). Nursing documentation: A nursing
process approach. Mosby Inc.
Levett-Jones, T, (Ed.). (2014). Critical Conversations for Patient Safety: An
Essential Guide for Health Professionals, Melbourne, Australia: Pearson
McQueen, A. C. (2004). Emotional intelligence in nursing work. Journal of
advanced nursing, 47(1), 101-108.
Morgan, S., & Yoder, L. H. (2012). A concept analysis of person-centered
care. Journal of Holistic Nursing, 30(1), 6-15.
Nursing and Midwifery Board of Australia.(2008). Code of ethics for nurses
in Australia. Retrieved from
http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?
record=WD10%2f1352&dbid=AP&chksum=GTNolhwLC8InBn7hiEFeag
%3d%3d
Röndahl, G., Innala, S., & Carlsson, M. (2006). Heterosexual assumptions
in verbal and non‐verbal communication in nursing. Journal of Advanced
Nursing, 56(4), 373-381.
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Stein-Parbury, J. (2013). Patient and person: Interpersonal skills in nursing.
Elsevier Health Sciences.
Stickley, T., & Freshwater, D. (2002). The art of loving and the therapeutic
relationship. Nursing Inquiry, 9(4), 250-256.
Assessment 3
ISBAR is a tool used for interviewing the patient to develop an effective
therapeutic relationship and by using this tool and addressing all the
levels a good therapeutic relationship can be formed (Finnigan, Marshall &
Flanagan, 2010). The first most step of the interviewing process is
identification as in given case the interview started with identifying the
patient and making the identity of nurse or interviewer clear to the
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patient. The patient here is Raymond Nguyen a 63 years old male who is
basically from Vietnam. He is seated comfortably in chair with back rest;
the nurse introduced herself as a nurse practitioner working at the clinic
and took Raymond’s consent to interview him (Eunson, 2016). To analyse
the situation of the patient nurse asks the patient about current problem
he is facing, his lifestyle and the chief complain which brought him to
doctor. Here, assessment of situation denoted that Raymond is not very
active and is busy with taking care of his daughter and three children; he
has got some minor health issues like chesty cough and breathlessness.
The health background is checked and inspected in the next step which
includes asking Raymond about his past medical history, allergies, health
issues and habits. The interview proceeds and reveals that the patient has
history of smoking and alcoholism since 42 years. Although he has quit
smoking some time ago but still consumes alcohol on routine basis. On
further investigation, it is revealed that Raymond hardly cooks and
consumes take away fried food. Also his daily routine comprises o waking
up early, doing his job and also to take care of his daughter’s kids that
leaves him exhausted. This is one of the causes of increased alcohol
consumption by the patient. The vitals are recorded and reveal that his
BP, RR and Pulse are increased and mark some underlying health issue.
The background check for health and medical history and personal history
all together helps in formulation of assessment (Lewis & Foley, 2014). As
per the history given by the patient and current vitals recorded by nurse,
the vitals indicate hypertension, increased heart and respiratory rate and
the patient complains of tightness in chest and chesty cough since 5
weeks. This may be due to COPD or some cardiac issue that may be
confirmed with further investigations. Thus, he has been recommended
for further tests like ECG and chest X-Ray to rule out all possible
conditions and to commence appropriate treatment. Raymond is
explained about the condition he is facing and the need for further tests
and lab procedures to reach point diagnosis of his condition. He is then
advised to get medication prescribed for relief of his symptoms and
further treatment to be followed after the test results decodes. More
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recommendation to him will be to make certain changes in his diet and to
have an active lifestyle and stoppage of habit such as alcohol. The
interview is concluded on a note that the patient should understand the
need for further investigations and requirement to eliminate the ill habits
which are deteriorating his health. Prescribed medication is to be
explained to Raymond about right dosage and duration of the treatment
to be taken. Quick consultation from a cardiologist is to be made in
Raymond’s case to give effective treatment as soon as possible.
References
Eunson, B. (2016). Communicating in the 21st century (4th ed.). Milton,
Australia: John Wiley & Sons Australia
Finnigan, M. A., Marshall, S. D., & Flanagan, B. T. (2010). ISBAR for clear
communication: one hospital’s experience spreading the message.
Australian Health Review, 34(4), 400-404.
Lewis, P., & Foley, D. (2014). Weber & Kelley’s health assessment in
nursing (1st ANZ ed.). Sydney, Australia: Lippincott Williams and Wilkins.
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