PROFESSIONAL DEVELOPMENT
Written communication: Relationships: from staff nurse to nurse consultant
Part 2: nurse–patient relationships John Fowler
350
their coffee strong, medium or weak, and how they liked their tea. They don’t normally get a choice, they joked. I thought about it and said to them that I thought it stemmed from my student nurse days in the 1970s when I probably spent most of my first year taking the tea trolley around the ward and serving drinks to the patients. Asking them how strong they liked their tea or coffee gave the patients a choice and acknowledged their individuality. Additionally, this simple interaction often formed the beginning of the nurse–patient relationship: the way the patient responded gave me clues as to how they were feeling, as it did with the responses I got from the parents of the toddler group. In a very simple way, it shows that you care; and if you care about the little things, then the patient will quite probably believe that you will care about the more important things as well. This leads to the next important foundation of a nurse–patient relationship and that is forming a bond of trust. If I go to a dentist, surgeon or anyone waving a sharp needle at me, I need to trust that they know what they’re doing; that they are only going to do it to me because it is absolutely essential; and that whatever it is they are going to do to me, they will cause me as little pain or discomfort as possible. If I begin to think that the professional looking after me is lacking in any of those areas of knowledge, ability and analgesia, then I will not trust them and will probably begin to panic. Take a few minutes to think about how trust is developed in the professional caring relationship. If you are sitting in a coffee room or with someone, ask them how they think that trust is established and developed. When I pose this question to patients and nurses, the following things are normally mentioned: ■■ The status of nursing as a profession. As a general rule, the public trusts the nursing profession ■■ A uniform or code of dress that is clean
and tidy conveys the professional image of trustworthiness ■■ Body cleanliness, makeup and piercings can all convey messages of trustworthiness or lack of it. As a general rule, patients have more trust in clean and tidy nurses, with minimal makeup and no piercings ■■ Eye-contact, body language and tone of voice all contribute to the picture that the patient is making of the nurse ■■ Does the nurse stand up or sit down at the eye level of the patient? ■■ Does the nurse introduce themselves and do they refer to the patient by name? ■■ Does the nurse look tired, rushed and give the impression that they have more important things to do? ■■ Do they seem to know what they are doing? ■■ Can they explain what is happening in language that patients understand without seeming patronising? This is by no means a complete list; the factors that convey trust are complex and multivariable, but some of the essentials are covered above. How does your list compare? I hope you have identified some qualities in yourself and your own practice that are important and specific for you and the building of trust in your nurse–patient relationship. BJN Fowler J (2015) From staff nurse to nurse consultant. Part 1: good relationships. Br J Nurs 24(4): 293 Schon D (1983) The Reflective Practitioner. Jossey-Bass, San Francisco. Dr John Fowler is a general and mental health nurse. He has worked as an Educational Consultant to primary care trusts and as a Principal Lecturer in Nursing for many years. He has published widely on educational and professional topics and is series editor of the Fundamental Aspects of Nursing Series and the Nurse Survival Guide Series for Quay Books
© 2015 MA Healthcare Ltd
T
his second article in this new series will be exploring ‘relationships’. Over the next 11 issues, the series will be examining team working and relationships with junior staff, medical and allied health team members. It will look at relationships with terminally ill patients, people with mental health problems and relatives, and give some tips on how to handle personality clashes. At the end of the first article in the previous issue of BJN (Fowler, 2015), I asked you to take some time and energy to focus and reflect on your relationships with patients, relatives, colleagues and friends—initially reflecting ‘on action’ (that is, after it has occurred) but then trying to develop your ability to reflect ‘in action’, that is, during the actual interaction (Schon, 1983). I challenged you to think about what you are saying verbally and non-verbally, while you are saying it, and how the person is responding. The foundations of a good nurse–patient relationship are essentially built around this ability to listen to (using all our senses, not just our ears) and respond to the patient as an individual. I’ve lost count of the number of times an experienced nurse has said to me how much they have learnt about nurse– patient relationships from being a patient themselves. I’m a little saddened that these nurses needed to become patients themselves before they fully appreciated the importance and nuances of the nurse–patient relationship. When you sit down as a patient you realise how important it is for the nurse to make eyecontact with you when they talk to you; how important it is for them to remember your name; and how important it is that they take a little time to treat you as an individual. All of these are so simple to do yet so easily forgotten when we become stressed and busy. I’ve just spent the morning serving tea and coffee to the parents at a local toddlers’ club, where I help out every couple of months. The regular helpers in the kitchen were amused that I kept asking the parents if they liked
British Journal of Nursing, 2015, Vol 24, No 6
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 12, 2015. For personal use only. No other uses without permission. . All rights reserved.
Written communication: Relationships: from staff nurse to nurse consultant
Part 2: nurse–patient relationships John Fowler
350
their coffee strong, medium or weak, and how they liked their tea. They don’t normally get a choice, they joked. I thought about it and said to them that I thought it stemmed from my student nurse days in the 1970s when I probably spent most of my first year taking the tea trolley around the ward and serving drinks to the patients. Asking them how strong they liked their tea or coffee gave the patients a choice and acknowledged their individuality. Additionally, this simple interaction often formed the beginning of the nurse–patient relationship: the way the patient responded gave me clues as to how they were feeling, as it did with the responses I got from the parents of the toddler group. In a very simple way, it shows that you care; and if you care about the little things, then the patient will quite probably believe that you will care about the more important things as well. This leads to the next important foundation of a nurse–patient relationship and that is forming a bond of trust. If I go to a dentist, surgeon or anyone waving a sharp needle at me, I need to trust that they know what they’re doing; that they are only going to do it to me because it is absolutely essential; and that whatever it is they are going to do to me, they will cause me as little pain or discomfort as possible. If I begin to think that the professional looking after me is lacking in any of those areas of knowledge, ability and analgesia, then I will not trust them and will probably begin to panic. Take a few minutes to think about how trust is developed in the professional caring relationship. If you are sitting in a coffee room or with someone, ask them how they think that trust is established and developed. When I pose this question to patients and nurses, the following things are normally mentioned: ■■ The status of nursing as a profession. As a general rule, the public trusts the nursing profession ■■ A uniform or code of dress that is clean
and tidy conveys the professional image of trustworthiness ■■ Body cleanliness, makeup and piercings can all convey messages of trustworthiness or lack of it. As a general rule, patients have more trust in clean and tidy nurses, with minimal makeup and no piercings ■■ Eye-contact, body language and tone of voice all contribute to the picture that the patient is making of the nurse ■■ Does the nurse stand up or sit down at the eye level of the patient? ■■ Does the nurse introduce themselves and do they refer to the patient by name? ■■ Does the nurse look tired, rushed and give the impression that they have more important things to do? ■■ Do they seem to know what they are doing? ■■ Can they explain what is happening in language that patients understand without seeming patronising? This is by no means a complete list; the factors that convey trust are complex and multivariable, but some of the essentials are covered above. How does your list compare? I hope you have identified some qualities in yourself and your own practice that are important and specific for you and the building of trust in your nurse–patient relationship. BJN Fowler J (2015) From staff nurse to nurse consultant. Part 1: good relationships. Br J Nurs 24(4): 293 Schon D (1983) The Reflective Practitioner. Jossey-Bass, San Francisco. Dr John Fowler is a general and mental health nurse. He has worked as an Educational Consultant to primary care trusts and as a Principal Lecturer in Nursing for many years. He has published widely on educational and professional topics and is series editor of the Fundamental Aspects of Nursing Series and the Nurse Survival Guide Series for Quay Books
© 2015 MA Healthcare Ltd
T
his second article in this new series will be exploring ‘relationships’. Over the next 11 issues, the series will be examining team working and relationships with junior staff, medical and allied health team members. It will look at relationships with terminally ill patients, people with mental health problems and relatives, and give some tips on how to handle personality clashes. At the end of the first article in the previous issue of BJN (Fowler, 2015), I asked you to take some time and energy to focus and reflect on your relationships with patients, relatives, colleagues and friends—initially reflecting ‘on action’ (that is, after it has occurred) but then trying to develop your ability to reflect ‘in action’, that is, during the actual interaction (Schon, 1983). I challenged you to think about what you are saying verbally and non-verbally, while you are saying it, and how the person is responding. The foundations of a good nurse–patient relationship are essentially built around this ability to listen to (using all our senses, not just our ears) and respond to the patient as an individual. I’ve lost count of the number of times an experienced nurse has said to me how much they have learnt about nurse– patient relationships from being a patient themselves. I’m a little saddened that these nurses needed to become patients themselves before they fully appreciated the importance and nuances of the nurse–patient relationship. When you sit down as a patient you realise how important it is for the nurse to make eyecontact with you when they talk to you; how important it is for them to remember your name; and how important it is that they take a little time to treat you as an individual. All of these are so simple to do yet so easily forgotten when we become stressed and busy. I’ve just spent the morning serving tea and coffee to the parents at a local toddlers’ club, where I help out every couple of months. The regular helpers in the kitchen were amused that I kept asking the parents if they liked
British Journal of Nursing, 2015, Vol 24, No 6
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 12, 2015. For personal use only. No other uses without permission. . All rights reserved.
