primary nursing
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Nurse-patient communication is a crucial issue in nursing elderly people because it servesas a pointer to the quality of nurse-patient relationships (Wells, 1980; Bond and Bond,1990). While the concept of a meaningful nurse-patient relationship is important in everynursing speciality, it takes on added relevance in elderly care for several reasons. Firstly,for many elderly patients nurses form the most regular, if not the sole, human contact.Therefore if patients’ need for love and reassurance are not met by nursing staff, they mayremain unmet (Fielding, 1979).
Secondly, without the development of therapeutic nurse-patient relationships through themedium of communication, effective nursing care is impossible, as “effective and meaningfulnursing care of the elderly rests on effective and meaningful nurse-patient relationships”(Wells, 1980 p. 123). Wells illustrates this through the example of patient incontinence. Sheargues that solving this problem can only be achieved within a nurse-patient relationshipwhich facilitates gaining the patient’s views on the subjective meaning of the problem andwhat will be helpful in treatment. Castledine (1987) similarly views meaningful nursepatientcommunication to be an essential component of the nurse-patient relationship, butbelieves that only qualified staff are capable of forming this relationship.
Thirdly, effective communication with elderly patients is an essential precursor to theprovision of care tailored to individual needs. Communication skills are necessary to enablenurses to gather relevant information about patients, for example in taking a nursinghistory, to plan and administer appropriate care and to evaluate the effectiveness of carewith patients. Wells puts this succinctly:“nurse-patient communication is important because it is a measure of the effectiveness of nursingcare, i.e., the patient’s need is defined, appropriate help provided, and the effectiveness of careevaluated.” (1980 p. 123)
Again, while the need to gain detailed patient knowledge in order to plan, give and evaluatecare is not confined to nursing elderly patients, they frequently have multiple nursing andA COMPARISON OF THE VERBAL INTERACTIONS OF QUALIFIED NURSES 233medical problems as well as an increased need for social and domestic support and,frequently, health education (Syred, 198 1).Finally, elderly patients often have special communication needs as a result of, forexample, memory (Armstrong-Esther and Browne, 1986) or speech and sensory problems(Walton and MacLeod-Clark, 1986).
References
LOIS H. THOMAS, Ph.D., B.A.(Hons.), R.G.N.Research Associate, Centre for Health Seruices Research, University of Newcastle upon Tyne, 21 Claremont Place
Definitions
Support= maintainance, bearing, sustaining
Primary= the highest in rank Nursing= well everyone should know this
which is a profession specialized in taking care of the sick or infirm
Relations of the concepts
Own Patient System
• Enables individualized care
Therapeutic relationship
• Promotes a patient’s feeling of safety and a nurse’s knowledge about the patient
Multiprofessional teamwork
• Facilitates practitioners’ decision making for the good of the client
Support in own patient system
Feeling of support created: Understanding the client Providing care according to the patient’s
needs By using a nursing care planing more
efficiently By making nursing more visible
-> higher quality of nursing care
Support in therapeutic relationship
www.nursinggrip.com
Factors indicating the feeling of being supportive: Genuiness Empathy Respect Self-exploration Immediacy
http://www.ncbi.nlm.nih.gov/pubmed/11882129
Support in multiprofessional teamwork
Sharing experiences and knowledge about the client among nurses and other professionals Nurse to nurse Nurse to doctor Nurse to Practical Nurse
Supervision
Knight and Field (1981) present a study showing how a task-orientated and routinized form of nursing organization led to routinized verbal communication with cancer patients. A further consequence was the division of labour whereby qualified staff occupied them-selves with administrative and ward management tasks while unqualified and junior nursing staff performed the majority of direct patient care (cf. Seers, 1986), and thus found them-selves on the receiving end of patient anxiety about their condition. (Thomas)
While maintaining friendly relationships with these patients, ward organization facilitated evasion tactics by junior nurses in order to avoid patients’ questions. It was possible for nurses to work elsewhere, thus avoiding contact with a particular patient, and/or the nurse could indicate by her actions that she had no time to talk. Wells (1980) and Armstrong-Esther and Browne (1986) similarly cite task allocation as militating against nurse-patient interaction. (Thomas)
Anger is an inevitable part of primary care nursing. The demand that patient’s and their family demand of care takers escalate during times of crisis.
Patients and family are fond of their nurse and have little tolerance when the nurse takes a day off, cares for another patient of takes a meal break.
This is because the patients sees the nurse as the only one that understands.
This pressure adds up and is added to the nurse.
(Jellinek)
Denying Anger
Common feeling during demanding periods of nursing
May place primary nurse in a dilema Anger may be inevitable (Jellinek)
Understanding expectable anger
Reduces stress and guilt Signals a problematic patient or rising
unit tension. (Jellinek)
Consultations
Psychiatrist and/or Psychiatric Nurse may be of assistance.
Careful interview assessment Understanding long-term therapeutic care
relationships Appreciating the stresses of caring for ill
patients
May help their encounter. (Jellinek)
References
LOIS H. THOMAS, Ph.D., B.A.(Hons.), R.G.N.Research Associate, Centre for Health Seruices Research, University of Newcastle upon Tyne, 21 Claremont Place
Primary nursing: Psychological implications Jellinek, Michael S;Herzog, David B;Stoddard, Frederick J Nursing Management; May 1994; 25, 5; ABI/INFORM Complete pg. 40
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