Effective communication and the nurse-patient relationship are known to be important in the provision of person-centred care. Select two (2) of the following communication and nurse-patient relationship concepts listed below, and discuss how they are important to person-centred care:
a) professional boundaries
b) inclusive nursing practice
c) assertive communication
d) therapeutic communication
Both professional boundaries and therapeutic communication are crucial in effective person-centred care. To understand why professional boundaries and therapeutic communication is essential in catering to person centred care, we need to understand what professional boundaries and therapeutic communication mean and how they work together to catering to person centred care.
Therapeutic communication is a central factor in nursing, therapeutic communication is defined as the process of interaction that focuses on furthering the well-being of a patient. “Based on Hippocrates’ medical principles, more than any other professionals. Nurses, who are the largest group of healthcare providers, have to communicate with co-workers, physicians, paramedics, and patients in order to effectively fulfil their complex roles.” Nurses not only have to communicate with patients, nurses must effectively communicate with other professionals, when facilitating for a patient’s needs, there are more professionals involved such as Social worker, speech pathologist, occupational therapists, physiotherapists and many more. Because of the range of professional’s that nurses need to report back to, to ensure that other professionals understand what each patient’s needs are, nurses must develop a high level of therapeutic communication, otherwise it is difficult to provide person centred care. Therefore, nurses must develop therapeutic communication techniques such as active listening, silence, and acknowledgement of what patients have said. Therapeutic communication is essential in patient centred care, as listening to patients will help identify patient needs, help nurses develop awareness as a health professional, and increase empathy towards patients. When there is a lack of empathy, the quality of care goes down significantly, therapeutic communication involves more than listening, being empathetic towards patients is also a big part in making sure that patient centred care is delivered. Furthermore, therapeutic communication includes body language, a nurse’s role is to not only provide care for a patient but also provide patients with positive and engaging body language, when patients receive this type of therapeutic communication, it is easy for nurses to establish a good rapport, thus leading to patients feeling more comfortable. Therapeutic communication can also mean being comfortable in silence and providing comfort without having to say anything. According to the Australian Health Practitioner Regulation Agency nurses registered under the Nurses and midwives board of Australia, the standards of practice for registered nurses, include therapeutic communication, therapeutic communication helps in trust and respect in professional relationships, when therapeutic communication is used effectively, the nurse is able to communicate effectively with patients, respect patients cultures, beliefs, values and rights. Furthermore, nurses are able to establish relationships that have professional boundaries. A nurse’s ultimate goal is to help patients, and by providing theses different types of therapeutic communication skills and applying it ensures that each individual is receiving person centred care.
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When nurses understand therapeutic communication, not only does it involve actions, but it also involves a nurse’s ability to maintain professional boundaries between patient and professional. Nurses are a disciplined group of individuals that also have a high level of education and training. and these individuals must adhere to ethical standards, these ethical standards help nurses provide patient centred care. Professionalism and professional trust merge together, think of it as ability, competence, and therefore the patient will regard you with a high level of knowledge and trust. Your patients hold you in a high regard, they believe you have the ability to do what you can to help your patients. Professional boundaries are used in protecting both the patient and also the professional, these boundaries allow for a safe way to provide patient centred care. Due to the fact that patients are at their most vulnerable and nurses are given intimate entry into patient’s life, to ensure that the care provided is patient-centred, nurses follow these guidelines to ensure that no boundaries are crossed, and no violations are made. The continuum of professional behaviour states that, nurses cannot be under involved which includes distancing, disinterest or neglect, these actions can be extremely harmful to the patient, by distancing from patient’s nurses are no longer able to provide the care needed and can be detrimental to a patient’s health. However, nurses cannot be over-involved, over-involvement includes boundary crossing, boundary violations, and sexual misconduct. Boundary crossing may be brief digression across professional boundaries may be inadvertent. However, boundary violation is more serious, this is when a nurse confuses their own needs with the needs of the patient, furthermore boundary violation can include misuse of power, betrayal of trust, respect or intimacy, this is characterised by excessive personal disclosure by the nurse, secrecy of even reversal of roles. Moreover, sexual misconduct is an extreme form of boundary violation, behaviour that is seductive, sexually demeaning, harassing or reasonably interpreted as sexual by the patient. All these factors contribute to boundary crossing. To focus on patient centred-care, nurses must be in the zone of helpfulness, Where the majority of patient interactions should occur for effectiveness and patient safety, focus on the patient and their needs, these are characterized by trust, respect, mutuality, goal setting, and negotiation. For example, receiving gifts, token gifts such as a piece of chocolate is acceptable, however significant gifts must be returned. Gifts have potential to change the nature of relationships between patient and health professional. Furthermore, when accepting gifts, it must be openly declared to ensure transparency. Nurses must ensure that they are following guidelines as health professionals to provide quality care for patients. As a breach in any of these ethics can cause harm to the patient.
As both therapeutic communication and professional practices are necessary in patient centred care, we need to learn how these can work together to provide patients with the highest quality of care possible. The Australian Health Practitioner Regulation Agency and Nursing and Midwifery board of Australia is responsible of registering nurses and providing a code of conduct and standards of practice for nurses, these two boards work together to provide ensure patients are treated with high quality care. They provide registered nurses with standards for practice, in these standards, engaging and therapeutic and professional relationship is one of the main points in what a registered nurse should do. In order for a nurse to be able to give a patient the highest quality of care that is suitable for their needs, a nurse must be able to both communicate with the patient, family, and also other professionals of other disciplines. To be able to do this effectively nurses must possess the skills of therapeutic communication whether it is comforting a patient or talking with the patient’s family, the nurse must show empathy and comfort both patient and family, however, providing patient or family comfort can sometimes lead to a crossing of professional boundaries, thus, keeping professional boundaries plays a big role in patient centred care. It can be easy for nurses to overstep the professional boundaries causing a boundary cross, because of how closely nurses work with patient’s and their families, nurses must remain in the zone of helpfulness and abide to guidelines set by the Australian Health Practitioner Regulation Agency to avoid any violations and focus on providing the patient with their needs. Furthermore, interaction with patients is necessary for nurses to provide high quality to patients, further emphasising the need for nurses to be able to communicate to patients in a therapeutic way, in order to give patients a sense of comfort but also remain within professional boundaries. Professional boundaries and therapeutic communication work hand in hand to provide individuals with patient centred care, if nurses do not possess the skill to communicate with patients in a therapeutic way, it can often to lead to either over involvement or under-involvement, which both cause harm to not only the patient but also the nurse, thus providing nurses with professional boundaries paired with the skill to communicate to patients therapeutically is crucial in giving patient centred care.
Professional boundaries can be easily crossed because of the amount of interaction between nurses and patient, therefore, pairing the skill to communicate therapeutically to patients is crucial in providing individuals with patient centred care, without either of the two, both patient and nurse can be impacted in a negative way.
References
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Abdolrahimi. (2017). Antecedents and Consequences of Therapeutic Communication in Iranian Nursing Students: A Qualitative Research. Nursing Research and Practice.,2017, 4823723.
Ahpra.gov.au. (2019). Australian Health Practitioner Regulation Agency – Complaints and feedback. [online] Available at: https://www.ahpra.gov.au/About-AHPRA/Complaints.aspx [Accessed 4 Mar. 2019].
Ahpra.gov.au. (2019). Australian Health Practitioner Regulation Agency – What we do. [online] Available at: https://www.ahpra.gov.au/About-AHPRA/What-We-Do.aspx [Accessed 4 Mar. 2019].
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia – Guidelines: Continuing professional development. [online] Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines/Guidelines-cpd.aspx [Accessed 4 Mar. 2019].
Griffith, R. (n.d.). Professional boundaries in the nurse-patient relationship. Br J Nurs, 22(18), 1087-1088.
Powell, A., & Davies, H. (n.d.). The struggle to improve patient care in the face of professional boundaries. Social Science & Medicine., 75(5), 807-814.
Thompson, C. (2007, September). Being clear about professional boundaries: nurses must always maintain their professional boundaries and be very aware of events or situations that may threaten them. There is plenty of information to help nurses understand this critical practice issue. Kai Tiaki: Nursing New Zealand, 13(8), 29. Retrieved from http://link.galegroup.com.ez.library.latrobe.edu.au/apps/doc/A169382804/AONE?u=latrobe&sid=AONE&xid=c5a5cef5
Webster, D. (2013). Promoting therapeutic communication and patient-centered care using standardized patients. J Nurs Educ, 52(11), 645-648.
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