Assessment of Nurse-Patient Relationship in Australia

This paper assesses a case study of nurse-patient relationship in Australia, discussing the components of a therapeutic nurse-client relationship, the impact of NMBA's professional codes, and the concepts of paternalism and cultural safety. It highlights the importance of patient's consent, cultural sensitivity, and collaborative decision-making process in healthcare services.

NUR1202 Professional Identity Semester 2, 2018
Nurse-Patient Relationship in Australia
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NUR1202 Professional Identity Semester 2, 2018
Introduction
The paper seeks to provide an assessment of a case study of nurse (Michael) who was
a registered nurse by the time a case of doing an assessment to a female patient happened.
The article goes on to give the components of the therapeutic nurse-client relationship
between a therapist and a patient and how it could have been of good use in the case.
It also gives an in-depth analysis on how Code of Conduct for Nurses and the
Registered Nurse Standards for Practice from the NMBA impact the formation of a
therapeutic relationship between Michael's case and the patient. The paper finally explains
the concepts of paternalism and cultural safety and then provides a clear description on how
its principles are applicable to this study. Nevertheless, the essay will also illuminate on the
general professional standards of nurses as pinpointed by the NMBA and the national law
governing the practices of the nurses in close look of the case study provided.
Section A
The Components of a Therapeutic, Person-Centered Relationship
The main components of a therapeutic nurse-client relationship are five in number and they
include, respect, trust, power, empathy and professional intimacy. These components are
always present to nurse irrespective of that the nurse is a primary or a secondary care
provider (Johnstone et al, 2009). As per the case of Michael, the components of the
relationship are relatively applicable though not all of them are professionally adjudicated.
This essay discusses the components.
Trust
It is vital in the nurse-client relationship due to the vulnerability nature of the client.
In any relationship of a nurse and a patient, the nurse owes the patient negligence. The nurse

NUR1202 Professional Identity Semester 2, 2018
should keep the promises in the relationship in order to build trust. If in any case trust
happens to be breached, it is very hard to rebuild it again. The component of trust lacked
between the nurse Michael and the woman who was done the assessment. The reason is that
the patient felt uncomfortable to explain her cultural background to Michael due to lack of
trust. In general, nurse-client trust is very pivotal in healthcare services.
It fosters the relationship and thus is a component that should be highly considered by
the NMBA. Additionally, if by any case either of the two parties does not believe each other,
inconveniences might arise. In this case, the woman's family did not trust the practices of the
nurse that is why they petitioned a complaint to the top management.
Respect
It involves how a nurse recognizes a patient with dignity, uniqueness, and values
notwithstanding the social and economic standards, personal traits as well as the health
problem. Michael did not respect the patient and went against the ethical requirements of the
nursing profession. In addition, respect is a two-way process, that is the patient should exhibit
a sense of respectability as same as the nurse. Respect encompasses all aspect of professional
standards of nurses.
Professional Intimacy
The professional intimacy or rapport is attributed to any type of care as well as
services that nurses provide. Examples include physical activities and services that the nurse
offers to the patient that brings closeness. It may also constitute of spiritual, psychological
and social characters identified in the care plan. The nurses access to the personal information
of the client, allowing the limits of freedom of expression as well as the protection of Privacy
Act. All these factors contribute to the professional intimacy.
Empathy

NUR1202 Professional Identity Semester 2, 2018
It is the show of understanding and reasoning as well as validating the way healthcare
perceives for the client. In the nursing field, empathy involves a significant distance
emotionally from thus ensuring being objective and responding professionally to the patient.
It also involves responsiveness and general understanding of the patient's needs. In the case
provided, Michael did not exhibit this component to the latter as the woman later complained
about the service, a concern presented to his manager.
Benefits of Forming a Therapeutic, Person-Centered Relationship with This Client
The therapeutic nurse-client relationship has a couple of benefits to all the parties
involved. The case between Nurse Michael and the woman patient, when it is applied many
benefits could be accrued. Firstly, it improves the ability of the patient to express herself to
the nurse openly without any fear. People who are in any genuine relationship guided by trust
amongst the party's often discuss issues openly with each other. It increases the sense of trust
amongst the nurse and the patient (Johnstone et al, 2009).
Secondly, a good forming a Therapeutic, Person-Centered Relationship with This
Client is that it promotes a much-reduced discrepancy between the client's real self and ideal
itself. Thirdly, the establishment of a therapeutic client-nurse relationship between Michael
and the patient leads to improved mood and as well as fewer or totally reduced symptoms of
depression on the client. If the nurse could have been in a good relationship with the client,
the client would have explained to him about being not comfortable with the assessment. The
other benefit accrued would be decreased in guilt with past mistakes.
Section B
All the nurses and midwives must register with the Nursing and Midwifery Board of
Australia (NMBA) and by registering they agree to be confined by the NMBA's professional
codes. The professional standards outline the behavior and practices of both the midwives

NUR1202 Professional Identity Semester 2, 2018
and nurses separately. They include codes of conduct, codes of ethics and standard for
practice. The NMBA protects the public interest by undertaking the functions stipulated by
the Health Practitioner Regulation National Law and developing professional standards,
codes, guidelines, and framework. In general, it regulates the professionalism of nurses and
midwives. This essay will shade light on the code of nurses and how it influences the nurse-
patient relationship drawing provisions from NMBA and the National Law on a case study
((Nursing & Council, 2008).
Registering to NMBA as a nurse is a mandatory requirement to meet all the
compulsory practices and standards. Comprehending the culture of patients is a frame
stipulated in the NMBA professional standards as not to compromise with the patient's
interest. In addition, the board has also provided exemptions within which the culture is not
considered when administering treatment to a patient for instance when the life of the patient
is in a critical stage. The board requires the nurses to diligently exercise their professionalism
to save the lives of patients and thus serving the public interest (Nursing & Council, 2008).
In this case, Michael did not diligently acknowledge the role of culture in nursing as
prescribed in the NMBA and therefore he compromised with the will of the patient. Cultural
safety is a pillar for nurses and wives to culminate in delivering quality healthcare outcomes
(Sammer, 2010). It is also acknowledging the role of structural, social and historical factors
that influence the health of people. Moreover, when nurses pay attention to the cultural
beliefs they administer more quality services to the patients hence avoiding clashes between
the patient's relatives and the nurse through the board and also it fosters the relationship
hence better health care. The NMBA new standards guide all the nurses on cultural safety.
Most prominently, the standards give the guidance in key principles of culturally
respectful and safe practices (Wagner & Bear, 2009). These codes are about honoring and

NUR1202 Professional Identity Semester 2, 2018
acknowledging various cultures, identities, and customs and practicing in a manner that takes
these considerations into account. In the case presented, Michael undermined the
aforementioned aspects thus why the nurse-patient relationship was in question and the
relatives raised concern to the board.
Making informed decisions is a shared responsibility between the woman and the
nurse. The patient is protected by the cultural safety to involve the family members, friends
and partners for them to be cognizant of their patient as they may provide pivotal information
but not only improving the relationship. It is also important to take into account the woman-
care approach to managing woman's welfare and concerns consistently with the woman's
preferences and values (Nursing & Council, 2008). In addition, the NMBA supports the
freedom of a woman to seek consultation and subsequent opinions and also the right to accept
or refuse the treatment. In general, collaborative decision making is a very crucial framework
for improving the relationship and fostering the health services. Also, the nurse ought to
understand that the same care might have been provided to the same woman by another
female nurse. Informed consent is the patient's willing agreement to healthcare which should
be made with the consent of any risks or potential benefits which may arise.
Section C
Paternalism concepts
Paternalism means that the interests of a person have been interfered with. It is where
those in authority restrict the responsibilities and freedom of the subordinates. In this facet,
paternalism is a situation where the physician interferes with the freedom of action of the
patient against the best interests of her (Madoc‐Sutton et al, 2011). In this case, paternalism is
exhibited where the nurse code is against the will and sovereignty of the patient. Similarly,
the behavior has expressed the will, attitude, and superiority of the nurse. The freedom of the

NUR1202 Professional Identity Semester 2, 2018
patient was to some extent compromised by the nurse. Michael did not pay into consideration
the choice of the woman regardless he administered healthcare service to the patient. This
principle is also stipulated in the current professional standards governing the performance of
nurses under NMBA. Finally, personal consideration is crucial in this case since the dignity
of the patient was belittled according to the national law governing the professional
standards.
Conflict of interest may aggravate to paternalism. It may arise when the nurse has a
personal interest or a relationship or even personal beliefs which may negatively affect the
service to the patient and alternatively for personal gain to the nurse (Madoc‐Sutton et al,
2011). This means that the nurse did not prioritize the interests of the patient as they should
thus be regarded as paternalism or unprofessional conduct. To curb paternalism, nurses
should involve the patient in decision making, and if possible involve the patient's relatives to
avoid this undesirable conduct.
Also, this concept can be resolved through nurses acting with a lot of integrity and
above all the top-notch interest of the woman when arranging, making referrals, providing
and administering treatment or diagnosis. In addition, the medical practitioner has the
obligation to report to the senior or her family relatives in the case where the patient objects
the care for further direction with the aim of ensuring that the woman receives alternative
treatment options. In my opinion, Michael to some extent neglected the woman's opinion
though she did not verbally express her consent. However, Michael ought to have diligently
exercised his professionalism to understand the mind of his client and consider the
aforementioned provisions of paternalism.
Cultural Safety

NUR1202 Professional Identity Semester 2, 2018
It gives a clear focus on the associations of power between the service providers and the
service users. Cultural safety requires that a nurse undergoes a reflection process on their
specific identity based on culture, and have experiences in learning on how to practice in a
manner that acknowledges the culture of patients as well as those of other registered nurses.
A poor cultural practice or a cultural practice that is not safe is any action is undertaken that
undermines or that which does not empower the well-being of people and their cultural
identity.
Most prominently, paying attention to the cultural factors, economic, social, and
gender sensitivity commutatively influences the quality of health care, both at the personal,
community and the society in general. Adapting to practices that respect persons' diversity,
discrimination based on social class and challenging cultural norms based on assumptions
like sexuality and ethnicity is a requirement by the NMBA. In general, creating a culturally
safe working environment by considering the above-pinpointed facts will lead to a mutually
acceptable nurse-patient relationship hence fostering the quality of services delivered
(Johnstone&Kanitsaki, 2009).
Respectful practices lie under the culturally safe codes as pinpointed by NMBA.
Respectful practices cover aspects such as effective communication, bullying and harassment,
and confidentiality and privacy. Regarding confidentiality and privacy, nurses have the legal
obligations to protect the privacy of the patients. Confidentiality involves both protecting the
patient's information and revealing them when and only an emergency arises; professional
care is needed or by law and privacy also involves practicing professionalism in a manner
that protects the confidentiality of the woman (Upton, et al 2011).
Effective communication also involves consultative action before administering
treatment, that is each party should be in consent and comfortable. Bullying involves taking

NUR1202 Professional Identity Semester 2, 2018
action that is against the will of the patient. This principle is clearly exhibited in the given
case since the nurse did not satisfactorily consider the professional standards and culturally
safety and respectful practices exhibited in the NMBA.
Conclusion
Patient's consent is a very pivotal aspect in this facet of nursing. Most prominently,
the nurse ought to diligently seek the patient's mind and if possible consult the family
relatives before attending to the patient. This is because both the patient and the relatives may
hold essential information regarding culture, (if the nurse does not understand the customs of
the patient) and other details that will aid in administering quality healthcare to the client. In
other words, being culturally sensitive, and paying due respect to the components of the
nurse-patient relationship will help mitigate the inconveniences aggravated by paternalism. In
addition, a collaborative decision-making process is needed in healthcare services.
A thorough understanding of professional intimacy and standards governing the
practices of nurses is necessary as it clearly stipulates all the performance standards.
Moreover, culture is very dynamic and therefore the NMBA should induce an elaborative
approach in dealing with patients’ diversity as to mitigate culture-professionalism conflict.
This is because a substantial number of nurses have proven not to be conversant with the
existing culture and this might aggravate to conflict.

NUR1202 Professional Identity Semester 2, 2018
References
Nursing, A., & Council, M. (2008). Codes of Professional Conduct & Ethics for Nurses &
Midwives, 2008. Australian Nursing and Midwifery Council.
Sammer, C. E., Lykens, K., Singh, K. P., Mains, D. A., &Lackan, N. A. (2010). What is
patient safety culture? A review of the literature. Journal of Nursing Scholarship,
42(2), 156-165.
Wagner, D., & Bear, M. (2009). Patient satisfaction with nursing care: a concept analysis
within a nursing framework. Journal of advanced nursing, 65(3), 692-701.
Upton, J., Fletcher, M., Madoc‐Sutton, H., Sheikh, A., Caress, A. L., & Walker, S. (2011).
Shared decision making or paternalism in nursing consultations? A qualitative study
of primary care asthma nurses' views on sharing decisions with patients regarding
inhaler device selection. Health Expectations, 14(4), 374-382.
Johnstone, M. J., &Kanitsaki, O. (2009). Ethics and advance care planning in a culturally
diverse society. Journal of transcultural nursing, 20(4), 405-416.

NUR1202 Professional Identity Semester 2, 2018