06.01 Nurse-Patient Relationship

Overview

  1. Nurse-Patient Relationship
    1. Humanization
    2. Empathy
    3. Rapport
    4. Interaction

Nursing Points

General

  1. Humanization
    1. Identity through disease
    2. Bias & attitude
      1. Remove bias
      2. Check attitude
    3. Build trust
      1. Communication
      2. Fidelity
      3. Veracity
  2. Empathy
    1. Sympathy
      1. “I feel for you”
    2. Empathy
      1. “I feel with you”
  3. Rapport
    1. Trust
    2. Compliance
    3. Respect
    4. Boundaries
  4. Interaction
    1. Pre-interaction
      1. Patient history
      2. Diagnosis
    2. Orientation
      1. Establish boundaries
      2. Goals of care
      3. Plan of care
      4. Gameplan
    3. Working
      1. Work toward goal
      2. Overcome barriers
    4. Termination
      1. Appreciation of patient
      2. Time frame of care
      3. Anticipating termination
      4. Bedside report

Nursing Concepts

  1. Professionalism
  2. Interpersonal Relationships
  3. Communication

Patient Education

  1. Focus on patient needs via education pathways
    1. encouraged through positive communication and rapport building

Reference Links

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Video Transcript

In this lesson, we’re going to focus on the nurse-patient relationship.

First off, I want to remind you guys of something. You’re working so hard on your career right now, and you’re learning all of these crazy new concepts. And part of that is focusing on tasks skills, and we can sometimes forget why we’ve become nurses, and I’m hoping that this lesson will be a good reminder of that.

Your patients aren’t manikins in a hospital bed – they’re humans. They’re someone’s daughter or brother or mother or wife, a spouse…an aunt. They’re people. And we want to really hone in on that idea.

One way to do this is to eliminating the idea that disease defines someone. You should never say that a patient is a “schizophrenic patient”…because that means that their schizophrenia defines who they are. They are a patient with schizophrenia.

Be sure to remove any biases you have. Just because the last nurse complained about the patient overnight doesn’t mean that you have to have the same kind of shift. Start fresh and everybody gets a clean slate.

Also, be honest and be faithful. Tell your patient that you’ll be back in 5 minutes with their pain medications, and do it. Be back in 5 minutes. If you show them that you do what you say you’ll do, then bam, you’re winning them over already.

Another way we foster the nurse patient relationship is through sympathy and empathy. Now sympathy and empathy may seem trivial, but they’re really important when you’re communicating with your patient.

There’s a difference, and I had my communications professor in school tell me in such a way that I’ve never forgot, and I’m going to share it with you.

Sympathy is saying “I feel for you.” Empathy is saying “I feel with you” and there’s a big difference and you’ll learn to use both but it’s important to understand the difference so that you can connect better to your patient.

One of the coolest things I was a part of was working on patients that were going to donate their organs. When you are a part of the transplant team for an organ donor…keeping the patient alive, and doing labs and meds and hanging drips and talking the family and reflecting on the patient’s life…that’s a totally unique situation. Working with the family and the patient to help save several lives…that’s feeling WITH someone. When you are so moved by what they’re doing that you feel what they’re feeling.

We won’t always feel what our patients do, but sometimes we can relate because we have been in similar situations. Try to remember that these experiences can be painful, stressful and generally uncomfortable, for not only the patient but the family. So be sure to try to sympathize or empathize with them.

Now all of the things I’ve talked about so far help to focus us on this. The idea of rapport. The building of the relationship.

The end goal here is to build trust with the patient. If they trust you, they tend to be more compliant. Liquid potassium tastes gross..but your patient that’s resistant to taking it will take it because you worked to earn their trust and respect. You’ve shown them why they need it and you’ve shown them that you won’t steer them wrong. Your patient will do better because of it. They’ll also respect you because you’ve focused so much of your energy on being there for them, caring for them.

I think it’s also important to love your job and love your patients, but don’t disregard general safety by establishing safe boundaries. Don’t give out your phone number or social media. It could violate hospital policy and HIPAA and also could potentially put you at risk. I never had my last name on my badges and I never told them my last name. My job was on the unit caring for them. When I was there, they got my 100% effort and care; but at the end of the day, I made sure I had safe boundaries.

Since we’ve talked about what we do to foster our relationship with our patients, let’s look at how it works in practice.

There’s this phase called the pre-interaction stage. This is when you’re getting your patient history. You focus on familiarizing yourself with the patients issues and needs. Remember that their disease is not their identity.

The next step is orientation. This is where you introduce yourself to the patient. Be genuine – be yourself. Don’t fake this part. Some people can smell that from a mile away. Some people I was generally casual with and others I walked right in, grabbed a chair and sat and talked to them for a minute.

These were my patients that I was really concerned about what was going on. And I worked to start out that day showing them that I gave a damn and that we were going to be on a journey for the next 12 hours to kick ass. Plan your goals for your patient. “Hey, we’re going to get you out of bed, we’ll talk to PT, we’ll talk to your doctors, this is what the plan is…” I set up their expectations for the day.

The working phase of the relationship is really about putting into place what you’re doing. Sometimes your patients need reminders throughout the day. “You can’t go home on a injectable pain medicine, so let’s try some oral pain meds instead.” You’re continuing to focus on the patient and continuing to work with them.

Then we do something called “termination,” which is basically the end of your shift. Set your patient up for the idea that you’re not going to be there forever. “Hey, it’s 3 p.m. and your new nurse will be here in a few hours to take over. We’re going to do x, y and z before then.” This helps to reinforce boundaries and also helps to keep your patient oriented to reality.

And when your shift is over, thank your patient. The patient has no requirement to have you as a nurse, and you should feel like it’s a privilege to take care of them – so let them know that.

Today for our nursing concepts, we really want to drive home professionalism and interpersonal relationships. Additionally, we focus on communicating with our patients.

Ok, so let’s recap.

Don’t forget that your patients are human beings. They’re not a task, so be sure to be yourself.

Continue to work on building trust with the patient. You can do this by being truthful and faithful.

Be empathetic. Feel WITH your patient.

When you build rapport, you in turn get your patient to become more compliant.

Remember to establish boundaries and stick to them. You don’t want to give your patients false pretenses or do anything that’s unsafe or violate policy.

That’s our lesson on the nurse-patient relationship. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

Read more

  • Question 1 of 2

A nurse is caring for a client who has been sexually abused. Which of the following interventions should the nurse implement to establish rapport and to demonstrate safety?

  • Question 2 of 2

A nurse is caring for a client who is experiencing significant anxiety and is fearful because of his diagnosis of cancer. The nurse responds by reducing distractions and loud noises in the environment and providing calm and empathic care. Which outcome would the nurse most likely expect to see from the client as a response to this intervention?

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