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Establishing a Strong Nurse-Patient Connection

Melissa-Trolene-and-Suzanne-LeonardAdvances in health treatment and technology have improved patient outcomes but this fast-paced and sometimes stressful environment can take a toll on the nurse-patient relationship. More of nursing now centers on technology, often in the areas of collecting and monitoring. Sometimes that means that nurses have little time to sit down and just talk and connect with patients.

And yet, hospitalizations are a time when that’s exactly what a patient may crave most. “When you come to a hospital, there’s a lot of fear and uncertainty … and a loss of control,” said Anita McGinn-Natali, co-chair of HUP’s Patient and Family Advisory Council. “Think about it. You’re in bed, wearing very little and all kinds of people come in, poking and prodding you. When else would you invite total strangers into your bedroom? Never.”

Now, a new initiative at HUP is turning back the clock, in a sense, to enhance both the patient and nursing experience.

What is a Therapeutic Relationship?

Nursing’s Shared Governance partnered with members of the Patient and Advisory Council to launch this  initiative. The first step was for the Nursing Research Council to review the evidence and create a list of five evidence-based attributes necessary to establish and maintain a therapeutic relationship (see below) . The Nursing Professional Practice Council then drafted 10 nursing standards that translated these attributes into practice and brought them to the Advisory Council for feedback.

The advisors’ responses surprised them. For example, something as simple as a nurse providing 10 minutes of uninterrupted time with a patient “makes me feel important, secure and cared for…. I feel like I’ve been heard.” Maintaining a professional stance means “Don’t sit on my bed. Don’t call me hon. Don’t talk about me outside of my room.”

“We saw that so much of our work -– what we need to accomplish as nurses -– isn’t what’s most important to the patient, what they’re struggling with,” said Karen Anderson, MSN, clinical nurse specialist in Patient and Family Centered Care.

Based on this feedback, the Council created a six-hour educational program. The first two classes Patient-and-Family-Centered-Care focused on learning to identify and incorporate the 10 standards into practice through observation on units and roll playing with the patient advisors. In one scenario, a patient comes on the unit from the ER. “We gave the nurse no clinical details. We just told them to find out what was important to the patient,” said Mauri Sullivan, MSN, clinical director of Oncology Nursing, who took the lead in this initiative. “We saw that nurses are very medically focused. In this situation, we think the hospital admission is what’s important but the patient is telling you that nobody is available to feed her dog and that’s what’s worrying her.”

Another class examined the practices that help facilitate and improve nurse communication, with a focus on nurse-to-nurse shift handoffs. “Patients told us the handoffs cause them the most anxiety – they’re nervous about the stranger who is taking over their care,” said Michelle Otto, BSN, chair of the Nursing Quality Council and  clinical nurse on Rhoads 1. “Sharing some of the patient’s  personal information with the incoming nurse will help ease the transition.”

Nurses also learned the importance of picking up on visual cues, not just verbal. “It’s about noticing. Patients and families feel very vulnerable. Nurses need to notice more about what’s in front of them,” Sullivan said.

Changes in Personal Practice

Jennifer Perno, BSN, chair of the Nursing Professional Development Council and clinical nurse on Founders 14, said the experience “made me change my practice. It helped bring the patient’s perspective to light,” she said. For instance, “nurses are always busy but you can’t look busy when you come into a room. Our goal is for patients to feel that they are our number one priority.”

Also, “it’s important to take the time to compose yourself before entering a patient room. You don’t want other patients to know you were just in an emergency with another patient.”

“When a nurse rushes in, a feeling of panic comes into the room, which brings another level of stress,” agreed McGinn. “Be mindful that each patient is different with a different set of worries.”

Establishing a therapeutic relationship between nurses and patients is a win-win on many levels. Studies show that patients experience less anxiety and fear and feel more empowered and secure. “When you build a relationship, the patient is more likely to comply with and have a better understanding of what needs to be done,” McGinn said. And this, in turn, leads to better outcomes.

“We all take good care of patients but are we meeting their needs?” Otto said. “I learned many things we could do in our daily practice that coincide with the 10 standards. They don’t take longer to do and it’s not harder but they build trust with patients.”

Said McGinn, “A patient wants to be heard, be considered and be reassured that you care, that you’re not forgetting me."

Photo captions:

Top photo: Melissa Trolene of Founders 14 takes time to bond with Suzanne Leonard.

Bottom photo: Anita McGinn-Natali (l.) with Mary Walton, director of Patient/Familyu Centered Care.

Five Attributes of a Therapeutic Relationship

For a nurse-patient therapeutic relationship to be successful, all parties (including family members) must be fully engaged in the process.  Based on research, the five most important attributes are:

*Giving each patient undivided attention.

*Actively listening.

*Showing empathy.

*Remaining non-judgmental.

*Upholding a professional stance.

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