Introduction
The latest research evidence (for example, Tzelepis et al., 2015; Zucca et al., 2017) advocates for patient-centred care. In the wake of this new approach to care, healthcare practitioners, including nurses, must involve patients in their care (Tzelepis et al., 2015). In light of this, nurses and other care providers need to collaborate with patients to deliver quality care. However, forging a partnership with the client is not a one-time task. Still, it is an ongoing process that entails implementation of various principles of nursing practice, such as treating people with dignity, respect, and being accountable for the care provided (RCN, 2010). Besides, an effective partnership with other professionals is essential to ensuring the care continuum, as care provision involves more than one provider. Therefore, partnership describes efforts to engage a patient in all aspects of his or her care, including in decision-making about different approaches to their care (Brown 2013). This paper seeks to discuss three aspects of partnering with the patient, including professional skills and values that a nurse must demonstrate to ensure a successful partnership with the patient, areas of conflict that may arise, and the legal and ethical principles.
Professional Skills and Values
Professionalism
Different professional nursing associations prescribe specific skills and values that nurses need to facilitate partnership with colleagues and other practitioners, and service users or patients (NMC, 2015; RCN, 2010). These skills and values are necessary to forge and maintain a positive partnership with both the patient and other professionals in the health care setting. They include professionalism, NHS values, caring values, communication skills, and therapeutic relationship (NMC, 2015).
The NMC code of ethics prioritises the interests of the patient and their families or carers. These codes represent the values that nurses must uphold as professionals (NMC, 2015). The first NMC code is to treat people as persons and regard them with dignity. To achieve this code, nurses must respect, be kind,d and compassionate to others (NMC, 2015). They must also ensure that they deliver the essentials of care successfully. The nurse should also desist from making assumptions and appreciate cultural diversity and preferences (NMC, 2015). Moreover, nurses are required to respect and support the rights of patients and other service users. To forge a working partnership with patients and their families, nurses need to recognise and value the contributions of patients in advancing their health and wellbeing; moreover, they should understand their preferences and concerns to respond. As a nurse, the NMC recommends that I persuade and empower others to share their positions regarding treatment for and care of their conditions. A nurse must also respect the extent to which care users want to be involved in decision-making about their health, care, and wellbeing (NMC, 2015).
Nurses should be ready to respect, facilitate, and record the right of a patient to accept or decline a specific approach to care and treatment. The nurse should demonstrate the ability to recognise when the patient is anxious or distressed and respond with compassion and politeness (NMC, 2015). As patient advocates, nurses must collaborate with the patient to further the wishes of the patient regarding treatment and care, and further their autonomy about making known their preferred treatment and approach to care (NMC, 2015). In light of this, a nurse should respect the right of a patient to question and reject a treatment.
The values of the NHS and healthcare policy
Thomas (2013) defines compassion as an intrinsic ability of humans to understand other people’s plight and to empathize with them. Compassion is essential to establishing a successful partnership with care consumers (Thomas, 2013). This principle is particularly true because people naturally respond positively to others who express an understanding of their position and circumstances, as well as their feelings and emotions (Thomas, 2013). Therefore, a nurse must be sensitive to the emotions, feelings, and moods of patients and their family members. Communication skills
Brooks and Heath (1985) define communication asthe process by which two or more people share information via verbal and non-verbal means. For example, a nurse communicates compassion and kindness by wearing a smile while attending to a patient. For this process to contribute positively to partnership, a nurse and the care users must observe mutual respect (Thomas et al., 2014). A nurse with good communication skills should be able to combine verbal and non-verbal communication skills effectively to share a specific message to their audience.
Therapeutic Relationships
Wright (2011) asserts that initiating a therapeutic relationship has been acknowledged widely as a central component of patient treatment and care. Further, Wrights (2011) argues that a positive therapeutic relationship is the best determinant of the outcome of care and therapy, and thus, may be more decisive than the treatment itself despite the difficulty in quantifying and defining it.
In the healthcare setting, an understanding of the need for a mutual responsibility for the outcome of care is essential, as expressed in Bordin’s working alliance model. Often, clients assume that health practitioners will provide care unconditionally, driving many to decline treatment and care, and/or engage advocates to help them obtain what they perceive to be appropriate care and therapy (Wright, 2011). Therefore, power and control imbalance in such a patient-nurse relationship is obvious. Staff may consider more complex clients as difficult or manipulative, an observation that is informed by the behaviours and interpersonal skills of the client (Wright, 2011).
Self-understanding is critical in helping others work towards achieving a mutual goal (Short, Grant, & Clark, 2007). Workers can benefit from certain elements of their personality, such as a sense of humour and a duty to obtain acceptance by both the client and colleagues (Wright, 2011). These elements of personality may serve as instruments in initiating a therapeutic alliance (Scanlon, 2006). This perspective reinforces the perception that the relationship itself is what is therapeutic (Welch, 2005).. Therapeutic relationship entails a setting where the patient and the staff listen and respect each other. In a therapeutic relationship, a nurse must rely on their skills, personality, and professionalism to encourage a desired behaviour from the client (Wright, 2011).
Sources of Conflict in Establishing Partnership with Patients and Their Families
Various factors can jeopardise the establishment of effective partnerships between professional nurses and care consumers. Factors that affect partnership include communication and cultural differences, among others. These are the major barriers to partnership.
Cultural Difference
Keer et al. (2015) are of the view that conflicts between healthcare professionals and patients’ family members are attributed to cultural diversity. Keer et al. (2015) found that care practices informed by cultural expectations hindered healthcare professionals in their work of providing quality care to patients and controlling the care environment. Of note, most conflicts relate to different expectations of patients and health practitioners about practices, emotional involvement, information exchange, and decision-making (Keer et al., 2015).
Families and friends of patients perceive visits as a religious and social duty. Patients can receive many visitors during visiting hours and often disregard the rules on visiting. Keer et al. (2015) found that disregarding visiting causes stress to the staff caring for patients. Some staff feel uneasy when administering care to patients in the presence of visitors (Keer et al., 2015). However, this problem is especially associated with minority groups of migrants.
Communication Barriers
Some patients who do not understand the language of care providers request family members to care for them because of the language barrier. The family members of patients understand and respond to patients' non-verbal communication better than the health staff. Such healthcare professionals usually disapprove the bedside care practices as these bedside activities may compromise the patient’s clinical state (Keer et al., 2014).
All registered nurses must demonstrate good communication skills to enhance effective partnership with patients as well as colleagues. According to Kelly et al. (2014), using proper terminology and providing opportunities for clarification enhances the afety of the patient. However, various barriers can disrupt ideal communication. Examples of factors that can interfere with proper communication and, in turn, effective partnership include education levels, cultural barriers, and stress. Therefore, nurses must develop strategies to recognize and address such barriers. Kelly et al (2014) argue that although nonverbal communication, including facial expressions, body postures, and eye contact, may indicate a certain message to the nurse, the nurse should verify their meaning verbally for the sake of patient safety.
Legal and Ethical Principles in Forming Nurse-Patient Partnerships
The purpose and goals of the patient-nurse partnership are dictated by specific boundaries. When establishing a nurse-patient partnership, legal and ethical boundaries facilitate the definition of the roles of the two parties, besides determining the nature of the relationship. According to Sheldon and Foust (2014), objectivity is a crucial attribute in evaluating the unique demands of the patient and providing competent quality care. Sheldon and Foust (2014) argue that compassion in nursing practice means exercising empathy while limiting emotional closeness to the patient, as it tends to jeopardise objectivity and judgment in giving patient care. Sheldon et al. (2014) underpin that boundaries for relevant topics and dialogues with service users facilitate professionalism in care provision (Sheldon & Foust, 2013).
Legal and ethical issues often involve communication. According to Carvalho, Reeves, and Orford (201,1), communication not only has professional implications but also ethical and legal implications. Truthfulness, choice, consent, advocacy, and autonomy are the main issues related to ethics and law governing nursing practice. Written communication also presents an opportunity for observance of ethics and law governing nursing practice or their violations (Carvalho et al., 2011).
Truthfulness is an important principle for nurses. Most often, nurses find themselves in an ethical dilemma when confronted with a truth that may have serious implications for clients. Nurses may withhold the truth from the client to minimise harm, a principle called non-maleficence. Indeed, nurses have to encounter dilemmas of truth-telling that are not their making. The most common situation of truth-telling arises in discussing diagnosis or prognosis with family members or patient without the knowledge of the other (Carvalho et al., 2011).
A good example is when nurses experience challenges telling the truth, such as when a patient resists therapy. This situation has elicited significant debate on the topic, and many court cases have followed events when nurses have violated this principle by administering medications in concealed form. In light of this, the NMC 2007 (cited in Carvalho et al., 2011) provides direction regarding incompetent patients who cannot provide informed consentt and the therapy is in the best interest of the patient. The NMC (2007) prohibits the use of disguised medication on care consumers for the convenience of the healthcare team, as this constitutes a violation of the principle of truthfulness. Truth-telling is an initial step in the process of nurse-patient communication, after which the patient is free to accept or reject the options a nurse presents. The freedom to accept or reject the request of a healthcare professional is known as autonomy.
The principle of autonomy provides that healthcare professionals should allow patients to make decisions regarding care and treatment interventions. Based on Thiroux and Krasemann (2007), people have unique differences in the way they view the world and moral, ethical, and legal principles that govern humanit,; whereby they follow their intelligence and conscience. Thus, they must have the opportunity to exercise their conscience and understanding of the world. To achieve this objective, they need complete information to decide whether to accept or reject the presented alternative (Fletcher & Buka, 2007). The options presented to the patients should uphold their best interests (Thompson, Melia, & Boyd, 2006).
Discrimination
Thornicroft et al (2014) highlight discrimination in the provision of care as an important ethical and legal issue in healthcare settings. Thornicroft et al. (2014) underpin equality and diversity as an essential component of care provision. While the law requires that nurses should treat all people equally regardless of their culture and language, cases of discrimination in healthcare settingsg abound (Thornicroft et al., 2014). Over the past decade, an editorial by Jean Gray in the Nursing Standard (2008) highlighted discrimination that people with learning disabilities face in healthcare facilities. In particular, Gray (2008) asserted that healthcare services are not catering to their needs in disregard of anti-discrimination laws. Besides, patients have been discriminated against based on their ethnicity and race (Abramson, Hashemi, & Sanchez-Jankowski, 2015).
Privacy and confidentiality
Issues of privacy and confidentiality emerge about the handling of patients’ data and information (Chalmers & Muir, 2003). According to Chalmers et al. (2003), the NHS had engaged in a discourse about prohibitions on the use of patients’ data by care professionals s) such as nurses and other healthcare experts. Specifically, the question of who should access a patient’s data and for what use they intend to put the data arises. In light of this, health providers must realise the need to comply with the laws regarding pthe rotection of data, such as the Health and Social Care Act, and current professional guidance (Chalmers et al., 2003).
Confidentiality has been a central element in clinical consultation (Chalmers et al., 2003). On the other hand, privacy is rather an ambivalent right that has to be weighed against the rights of other individuals or groups (Chalmers et al., 2003). Nurses and other professionals should always seek explicit consent of the patient for any use of their data besides clinical purposes.
Conclusion
Partnership is pivotal in the delivery of quality, safe care. Nurses must initiate and establish an effective partnership to deliver effective care to patients and their family members. Various codes of ethics and professional standards have been developed to guide nurses in providing effective care. Certain skills and personalities, such as compassion and communication, are necessary to forge a successful partnership with patients. Nurses may experience various obstacles in their quest to build a working partnership with patients. Examples of such obstacles include communication barriers and cultural differences. In addition, specific ethical and legal principles help nurses establish a successful partnership.
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