Nursing Patients with Collaborative Nurse Client Relationship

Reflection Paper on the Collaborative Nurse-Client Relationship
Introduction
The collaborative nurse-client relationship (CNCR) is vitally important in achieving high quality of care in the field of nursing. However, as Feo, Rasmussen, Wiechula, Conroy and Kitson (2017) point out, developing these type of therapeutic relationship is not without its challenges. Putting the patient at the center of the care process and working with the patient so that the client takes ownership of his or her own care process and is involved in the decision-making process is the best way to ensure optimal care. Collaboration is a crucial concept in nursing (Trautman, 2017), and when it comes to developing the nurse-client relationship it is no less vital than it is when it comes to collaborating with other health care professionals. As Burger (2018) puts it, “Nurses must get buy-in from patients when it comes to their care. As any nurse will tell you, it’s nearly impossible to work with a non-compliant patient. Little to no improvement is made. Encouraging participation and educating patients is paramount.” This paper will reflect on the nature of the collaborative (therapeutic) nurse-client treatment relationship, show what it is, what it should look like, why it is advantageous, when it might be disadvantageous, how it is established, and whether there are any barriers to this type of care approach.
What is CNCR?
Pullen and Mathias (2010) state that the therapeutic nurse-patient relationship is defined as “a helping relationship based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patient’s physical, emotional, and spiritual needs through your knowledge and skill” (p. 4). As every patient and client is going to be different, the nurse should be aware of the personal tastes and needs of the client-patient. The nurse may ask questions to identify likes and dislikes, but should do so in a way that is respectful rather than pushy. The nurse should not come across as invasive but should use empathy, emotional and social intelligence skills, and communication tools to evaluate the patient’s preferences before engaging the patient in a manner that may not align with the client’s particular values. For instance, some patients may prefer to be comforted through words, touch or the sharing of information. Others may prefer time to think in silence, reflect in private, or talk to others in their support system. All of these are acceptable in CNCR, but the nurse must recognize which is preferred by the client at the time because that is how trust and respect are developed—through nurse awareness of patient preferences.
Pros and Cons of CNCR
Pros
The benefits of CNCR are that it allows the nurse to get to the heart of patient-centered care, which Chiaramonte et al. (2018) note are very helpful in building trust and empowerment among clients. CNCR focuses on putting the patient’s needs first and foremost in care providing process. It means that the patient is likely to have questions, cultural inputs, unique wants and ideas about what care means to him or her. By collaborating with the patient to develop a unique and personalized care approach, the nurse can empower the patient and make the patient feel that he or she is truly part of the decision making process. The aim, here, is to get the patient involved in taking care of his or her own health in such a way and to such an extent that the patient becomes empowered to do more, know more, and be healthier all the way around. Increasing the patient’s health literacy through collaboration is one of the best ways to ensure that this goal is reached on a patient to patient basis year round. CNCR can help to overcome non-compliance in patients by way of communication, respect, trust building, and support.
Cons
There are no real cons to CNCR as it is the essence of nursing. However, there are cases in which it may be inappropriate. Not every patient for instance is going to want to develop a nurse-patient relationship. This has to be understand and these cases must be identified quickly so that the patient is not offended or does not feel intruded upon by a nurse who tries to engage the client in too many matters. Some clients are not going to be a physically healthy enough state to develop such a relationship. They will either lack the mental capacity or physical capacity to acknowledge their own role in the care process. In these cases, the nurse should be mindful of the simply attending to the patient’s most basic needs and letting the client know that she will be available to assist in whatever is necessary. There may also be the temptation to establish a personal relationship with a client: this is to be avoided, and if a nurse is unable to resist this temptation, CNCR could be viewed as a con for that particular care provider. Over-involvement is always a risk with CNCR as well. The nurse must be careful to maintain professional lines and boundaries not engage in selective reporting, the sharing of overly personal information, or paying more attention to one client over the others that are also in need (Holder & Schenthal, 2007).
How CNCR is Established
CNCR is established when the nurse and patient come together “in the moment” in a collaborative spirit in which both offer input to the decision making and care process (Pullen & Mathias, 2010, p. 4). The two view themselves as partners in the process rather than as one having an active role (the nurse) and one having a passive role (the patient). CNCR is established through a few basic, routine steps that can allow the nurse to gain understanding of the patient’s needs and open a doorway into the patient’s circumference of trust. Active listening is a must—but it is also critical to take notice of the patient’s cultural background and beliefs before making assumptions as to the type of care the patient would like to receive.
To begin, the nurse should greet the client by name, make eye contact, and demonstrate confidence and a professional manner. The nurse should take a moment to explain why she is there, what she will be doing with the patient, and include the patient in the decision making process while reviewing the care plan. This occurs by asking for the patient’s preferences and explaining the options. The patient’s privacy should always be maintained and cultural sensitivity should be a top priority. The nurse, therefore, should be trained in transcultural nursing or have some degree of cultural competency in order to be proficient in this respect. By listening actively to what the patient is saying and using both social and emotional intelligence to establish rapport with the patient, the nurse can build on the client’s trust and create a positive and healthy nurse-client relationship.
Client Populations for Which CNCR is Most Appropriate and Inappopriate
Most Appropriate
CNCR is appropriate for all clients, from children to adults, suffering from all types of illnesses or medical issues. CNCR is not specific to any one group or people of particular ethnic or cultural background. It is inclusive to the core and can be applied as a general role with all patients. As the key to CNCR is communication and trust-building, the nurse should focus on the patient and seek to ease the client’s worries and fears about the care process by explaining as much as possible about what will be going on with the client throughout it. CNCR can be especially helpful for clients who are non-compliant: simply taking the time to explain why a certain recommended care treatment should be adopted by the patient can make all the difference. For example, a client suffering from type 2 diabetes may not even realize that skipping meals can have a negative physiological effect—so by employing the CNCR approach, the nurse can explain to the patient why it is important to eat during every meal period as this is what helps to keep the body regulated. Though it might seem counter-intuitive, non-compliant patients are definitely part of the population for whom CNCR is appropriate. Indeed, as long as the patient is functioning, able to communicate, and has not given any signals of wanting to be left entirely alone, the patient may be considered as part of the population for whom CNCR is an important treatment method.
Least Appropriate
Patients who refuse to communicate, will not make eye contact, and will not offer up any voluntary information about themselves, either because of their own desire not to or because of some incapacitation, are the population for whom CNCR is least appropriate. These patients would not benefit from a nurse-client relationship that focuses on getting the patient involved in the care process and in the decision-making process, specifically because the patient is either totally unwilling to cooperate or is completely unable to cooperate. A patient’s wishes should always be respected, and a patient who cannot make decisions on his or her own should always be treated according to the best practice guidelines that apply.
Barriers
Barriers to CNCR include a lack of training on the part of nurses, a lack of communication skills, a lack of social and emotional intelligence, a lack of cultural understanding, and a lack of education on the part of the patient. Most patients fail to take part in the decision making process and in the ownership process of care because they lack education. Sometimes this failure occurs because they lack support. The nurse must be able to provide both of these consistently and selflessly so that the patient is involved, informed and included in the care process. Communication barriers occur when nurses lack a grounded approach to patient-centered care (Mulder, Lokhorst, Rutten & van Woerkum, 2015)—so training nurses in how to acquire this approach is important in overcoming barriers to CNCR.
Conclusion
The collaborative nurse-client relationship is helpful in providing client-patients with the quality of care they require through the care process. Nurses can use CNCR to give the patients support, information, education, and ownership in the care process itself by including them in decision-making. This approach can be especially helpful in cases on non-compliance, but it is not effective with every population—particularly those patients who are incapable of engaging or interacting with the nurse because of incapacitation. Barriers to CNCR include a nurse’s lack of training, lack of emotional or social intelligence, lack of cultural competency, and the patient’s lack of education. Focusing on overcoming these barriers can help to enhance quality of care.


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