Nurse Patient Relationship
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Philosophy
Date
Apr 3, 2024
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docx
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PHI2396 LEC 2024
Meaghan Emilie Jakobi
300382615
Nurse-Patient relationship
Nurse-Patient Relationship
Patients interact not only with physicians but also with nurses in the healthcare system.
Nurses provide more continuous care than physicians, challenging models focusing solely on physician-patient relationships.
The complexity of nurse-patient relationships is not fully captured by models designed for physician-patient interactions.
Healthcare relationships are hieratical and asymmetrical with physicians holding a higher
rank.
The nurse-patient relationship differs from the physician-patient relationship due to these hierarchical dynamics.
Historical images of professional nursing
Nurse images and metaphors historically associated with a female figure.
The international council of nurses outlines various portrayals of nursing, such as mother, sister, friend, lover, guardian angel, and army sergeant.
Nurses were often seen as moral figures.
During world war I, nursing images were used for political and propaganda purposes.
In the post war era, the nurse’s image shifted from a guardian angel to fighters and soldiers addressing social issues. Three classes of Metaphors
1.
Limiting metaphors 2.
Misguided metaphors 3.
Helpful metaphors
1. Limiting metaphors
Do a good job of capturing some aspects, but not others, so limit our view.
o
Nurse as a parent/mother surrogate
o
Nurse as friend
o
Nurse as servant
The family metaphor
Nurse as parent/mother surrogate is based on trust, integrity, promise keeping, dedication and nurturance.
Problems with this model include:
Discounting nursing knowledge, skill, and experience, as it assumes anyone can fulfill
the nurturing role.
Nurse as mother implies a lack of decision-making power, diminishing the nurse’s ability to exercise moral agency.
The friendship Metaphor
PHI2396 LEC 2024
Meaghan Emilie Jakobi
300382615
Nurse-Patient relationship
It is based upon trust, truth-telling, care, and fidelity.
Problems with this model include:
It is unrealistic and misleading.
o
Nurse patient relation is not of an equal type.
Patients have less power and knowledge, asymmetrical power (vulnerability). The servant metaphor
Nurses as servant metaphor emphasizes service to others
and views nurse as professionals
using their knowledge and skills to serve
.
Problems include the potential for serious exploitation
of nurses and the risk of identifying nurses as indentured servants
who merely follow orders.
This metaphor may lead to nurses experiencing “
moral abdication
” ceding their moral agency to health institutions and authorities. 2. Misguided Metaphors
o
Nurses as technician/engineer
o
Nurse as physician extender or surrogate
Nurse as Technician/Engineer
Nurse as technician/engineer model values technical competence
and emphasizes the task aspect of nursing.
The focus on technical aspects may lead to a reduction
of nursing to something it is not, devaluing holistic nursing practice and promoting simplistic solutions.
Nursing involves real knowledge, skills, and the ability to assess multiple factors affecting a patient’s health, which may not be visible to the observer. Nurse as physician extender or surrogate
Nurse as physician extender/surrogate model emphasizes a task-oriented
approach.
The problem lies in the assumption that nursing roles and relationships are identical to those of physicians, whereas nurses have different goals
and follow a distinct process of care.
Physicians may monitor to diagnose, while nurses monitor to plan activities related to the patient’s rest and comfort. 3. Helpful Metaphors
These metaphors approach more closely the morally significant aspects of the nurse-
client relationship
o
Covenant
o
Healer
o
Client Advocate
PHI2396 LEC 2024
Meaghan Emilie Jakobi
300382615
Nurse-Patient relationship
Covenant
The nurse in a covenantal relationship model emphasizes that nurse-patient relationships involve various connections.
Nurses, as members of a health community, are expected to be faithful and use their knowledge and skills to minimize harm and benefit patients.
The covenantal model highlights:
o
Reciprocal indebtedness between the public and the nursing profession
o
Suggesting that professional power is a gift from the public in exchange for expertise and orientation to the service of others. Healer
Utilizes the healing power of nursing presence.
The continuing presence
of nurse can facilitate the patient’s move towards restoration and healing.
Nurse has different but complementary role
to that of the physician.
Nurse as Client Advocate
It is based on nurses direct legal and moral accountability to their patients.
The nursing role is seen as a type of patient advocacy.
o
Intervening, protecting, informing, supporting, speaking for, coordinating, empowering.
Some problems with the model
o
The concept of patient advocacy is unclear.
o
The nursing practise acts must be revised
to allow for this nursing role.
o
It is not clear if patients accept advocacy as a nursing role or not.
o
Concerns about the adversarial nature and conflict of interest in advocacy.
Two forms of Advocacy:
o
Legal advocacy (narrow Sense)
It is narrow (concerned with legal matters) o
Deeper more meaningful advocacy:
Stands alongside, who interprets, understands.
Managing and coordinating services for a client to ensure all services align with the agreed-upon intent for client and family well-being.
Acting as a representative for someone, providing them with a voice
Facilitating appropriate medical interventions for clients
Offering presence and acknowledgment of loss and grief, particularly in end-of-life situations.
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