Once I got the opportunity of caring for an old woman named Sarah who was 78 years old. She was suffering from a very poor quality life due to multiple unmanaged chronic health conditions like obesity, diabetes, foot ulcer, weakened vision, osteoarthritis as well as sleep apnea. She had recently had a fall which had left her with skin tears and many bruises. Her family had admitted her to centers centers so that she can recover from these ill health conditions. Immediately after her admission, diagnostic tests were done and various interventions were applied to her. However, I noticed closely that Sarah was not all participatory in the care interventions and was completely withdrawn. She neither responded to any healthcare professional nor had any queries about her health. I tried to apply the best evidence based care services that could be provided for her well-being and recovery of her health but not much improvement was noticed. I realized that it is important for me to understand the main reason for her behavior so that I can include her in the treatment process. Gradually, I started to communicate with her extensively about various formal as well as non-formal topics. The topics ranged from her favorite dishes to her favorite films and even about her favorite destinations and others. She gradually started opening up and in course of time we developed a close rapport with her. She started trusting me and revealed much important information that helped us in modifying the care plans and aligning them to her needs. I showed her empathy and compassion that made her believe that I am genuinely trying to help her to overcome her health concerns. It was after the development of therapeutic relationship with the patient, she told me that she was frustrated with her help and had lost hope that she would ever get better. Therefore, she was not coordinating with the professionals. I made her achieve that she can live better quality life through proper lifestyle modification and adherence to medications and maintained lifestyle. She was happy and started adhering with the treatment. Gradually she was seen to show progress in her health.
Jean Watson theory of nursing and caring had defined nursing as the human science of persons as well as human health-illness experiences that can be mediated by personal, professional, scientific as well as esthetic and ethical human acre transactions. Her theory has been based in the importance of values of kindness, concern, and love for self as well as that of the others and even respect for spiritual dimensions of the patients (Jones, 2018). Nurses need to accept the patients as they are develop an emotional connection with them and be in the moment when they interact and care for the patients. The nursing process should be committed in protecting and enhancing the human dignity at the same time respecting the needs, wishes, rituals and routines of the patients (Sitzman, 2018). Nurses need to be establishing harmony with the patient through effective rapport development where the patient feels cared and loved. While caring for Sarah, I also ensured that I could establish a strong emotional connection with her and helped her feeling homely in the healthcare environment. I showed her empathy and compassion making her believe that I understand her suffering and this made her feel pleased and satisfied. She started trusting me and revealed why she was upset initially. All these helped in development of the treatment care plans and her health outcomes as well.
Person centered care theory mainly advises the nursing professionals to encourage patients in actively participating in their own care process and take decisions regarding the care services that needs to be provided to the patient (Kogan et al., 2016). It mainly includes providing the patient with the full authority to work along with the healthcare teams being in the centre of every decision making procedures regarding their own health. The various interventions that would be developed should be such that it aligns with their needs and requirements after being confirmed by the patients. While providing care to Sarah, I ensured that she is consulted every time about the decisions of the treatment procedures taken about her health issues and that she felt included in the decision making procedures. I realized that her participating increased over time and her health was showing progress towards betterment. Evidence based studies are of the opinion that when nurses include patients in their own care and try to develop strong rapport with the patient through effective communication skills and exhibition of lobe, kindness and empathy, the patients feel empowered (Clark, 2016). This increases their adherence with the treatment. When the nurses provide importance to her decisions and likes and dislikes, they feel that their autonomy and dignity are respected. This helps in reducing their anxiety and stress and also helps in overcoming misconceptions, if harbored any. They also start trusting the nurses and this helps in developing emotional attachments with nurses. These have positive outcomes on their health outcomes.
Standards of Practice are set of nursing principles that every nursing professionals need to follow to provide safe and quality care to patients and to ensure maintaining ethics and laws in the care service delivery. This has been proposed by the nursing professional body called the NMBA. Standard “2” promotes the importance of engaging in a therapeutic as well as professional relationship with the patient (NMBA, 2016). The nurses need to communicate effectively with the patient and respect their dignity, values, cultures and beliefs and recognize them as experts of their own lives. It also talks about the establishment of relationships with patients thereby enhancing patient satisfaction and care service effectiveness. Evidence based studies opine that therapeutic relationship development enhances trust and mutual respect between nurses and patients which have positive impacts on health outcomes of patients. Patients become more involved in their own care and develop self coping and self-management abilities as they feel empowered by the nurses (Zoffman et al., 2016). They feel respected by nurses and their adherence and cooperation also increases. Another important standard is standard 3 which mainly described the importance of maintaining capability in practice by the nurses. Nurses need to consider and respond in timely manner and provide information and education to the patients to enhance their control over their health. Evidence based studies state that developing health literacy in patients is associated positively in developing self-management and coping abilities in patient and making them feel empowered to take care of their own health (Malmberg et al., 2019). Sarah had misconceptions about her health and when she was educated about proper lifestyle interventions, her progress in health was noticed
Fig: Developing an emotional connection with patients based on empathy and compassion can act as the best means of patient satisfaction in healthcare
Initially, I used to believe that nursing profession was all about having the best clinical as well as pharmacological knowledge to treat patients. I used to believe that it is very important for nurses to have detailed ideas about every disorder and the interventions that needed to be provided. While caring for the patient named Sarah, I applied my best clinical knowledge and skills and thereby developed the best evidence based interventions that could have cured her. However, I realized that it was not resulting in positive outcomes as expected by me. The patient was withdrawn and was not showing signs of recovery. At this time I realized an important aspect. Only analyzing the biological determinants of an ill patient and providing intervention would not suffice to provide him better quality life. Holistic care needs to be provided by which their psychological and social aspects of health also needs to be analyzed (Goulding et al., 2018). Sarah was psychologically broken down because of stress, anxiety and depression and hence, it was needed to be looked after. In the future, I would not only consider the biological determinants of health but also care for their psychological and social determinants of health for best outcomes on health.
Another important aspect was developing a therapeutic relationship with the patient based on effective communication, empathy, compassion, kindness and love. Their liking for the professionals increases when patients feel respected and cared by the professionals. When patients are included in the care processes and they are allowed to take decisions about their own care, they feel empowered (Amoah et al., 2019). They feel that their autonomy and dignity are respected and cared by professionals. They develop strong bonds with patients based on emotional connection and trust with the nurses and work accordingly as per their advices. Their adherence increases and this has positive outcomes on their health (Riley, 2015). When, I was able to establish therapeutic communication with Sarah, through active listening, proper eye contact, exhibiting empathy and compassion along with marinating a harmony with her, she started opening up gradually and revealed much important information that helped in designing her care process. She overcame her stress and anxiety and participated in her own care that had positive effects on her health and on her satisfaction level with healthcare services. In the future, I would make the caring principles proposed by Jean Watson as the foundation of my care services and would provide equal importance of establishing therapeutic relationship with patient as providing interventions for their physical ailments.
References:
Amoah, V. M. K., Anokye, R., Boakye, D. S., Acheampong, E., Budu-Ainooson, A., Okyere, E., … & Afriyie, J. O. (2019). A qualitative assessment of perceived barriers to effective therapeutic communication among nurses and patients. BMC Nursing, 18(1), 4.
Clark, C. (2016). Watson’s human caring theory: Pertinent transpersonal and humanities concepts for educators. Humanities, 5(2), 21.
Goulding, A., Allerby, K., Ali, L., & Waern, M. (2018). S253. Person-centered Psychosis Care (pcpc) In An Inpatient Setting: Patient Outcomes. Schizophrenia Bulletin, 44(Suppl 1), S426.
Jones, S. N. (2018). Watson’s Theory of Human Caring: Effect on Nurse Perception of Care Environment(Doctoral dissertation, Gardner-Webb University).
Kogan, A. C., Wilber, K., & Mosqueda, L. (2016). Person?centered care for older adults with chronic conditions and functional impairment: A systematic literature review. Journal of the American Geriatrics Society, 64(1), e1-e7.
Malmberg, L., Rodrigues, V., Lännerström, L., Wetter-Edman, K., Vink, J., & Holmlid, S. (2019). Service Design as a Transformational Driver Toward Person-Centered Care in Healthcare. In Service Design and Service Thinking in Healthcare and Hospital Management (pp. 1-18). Springer, Cham.
Nursingmidwiferyboard.gov.au, 2016, Registered nurse standards of Practice, NMBA, Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx
Riley, J. B. (2015). Communication in nursing. Elsevier Health Sciences.
Sitzman, K. (2018). Caring science, mindful practice: Implementing Watson’s human caring theory. Springer Publishing Company.
Zoffmann, V., Hörnsten, Å., Storbækken, S., Graue, M., Rasmussen, B., Wahl, A., & Kirkevold, M. (2016). Translating person-centered care into practice: a comparative analysis of motivational interviewing, illness-integration support, and guided self-determination. Patient education and counseling, 99(3), 400-407
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