Professional Behaviours And Attitudes Of A Registered Nurse Towards Patient Care Are Crucial.

Importance of Professional Boundaries in Nursing

Question:

Describe about the professional behaviours and attitudes of a registered nurse towards the patients and their family members.
 

Professional behaviours and attitudes of a registered nurse towards the patients and their family members are central to the development of an effective therapeutic nurse patient relationship. Professional boundary violations, under or over involvement with patients and their family members can alter best practice into poor practice. A comprehensive knowledge of a patient’s medical condition and the physical and psychological implications of the condition is essential for the nurse to provide adequate patient centred care. Patient knowledge underpins accurate patient assessment, care planning and the implementation of skills (Jones, 2013). Also, the evaluation of pharmacological interventions and other cares cannot be effectively considered without a sound knowledge base in which to base their judgements (Brotto, 2013). It is therefore essential that patient centred care is underpinned by a sound knowledge base which is specific to the patient’s medical condition. Patient neglect can often transmit to a lack of feeling unsafe physiologically, psychologically and culturally.

A registered nurse should ardently collect information about patient’s history, current health conditions. These information need critical analysis for patient’s effective care and well-being. Therefore, a registered nurse must learn these skill timely and rapidly for better performance. The code of professional conduct for nurses in Australia, the code of ethics for nurses in Australia and the code of conduct of nurses set the main principles in the respective regulatory jurisdictions that nurses are expected to maintain both inside and exterior of the professional spheres in order to safeguard the respectable standing of the health professionals in Australia.  Crossing professional boundaries as a registered nurse is very much offensive action and can have negative impact on patient’s health and family members (Palmer, 2013). Professional boundaries in nursing are described as parameters which look after the space concerning power of a professional and susceptibility of the patient. It is a perimeter that spot the edges among a health professional, therapeutic association and a non- professional or professional rapport between nurses and patient in their care. When a nurse crosses a limit they usually act in an unethical style and abuse the power in this relationship. Nurses need to obtain informed agreement from patients in their care before conducting any therapeutic professional dealings. Nursing is a holistic approach and in order to cope with these professional restrictions certain appreciation is needed. An intrinsic power inequity occurs within the relationship between persons receiving treatment and nurses that make the individuals in their maintenance helpless and exposed to exploitation. Nurses actively reserve the dignity of patients and their families through experienced gentleness and admiration for the susceptibility and feebleness of persons under their authority. This vulnerability generates power disparity in the bond between registered nurses and patients in their care that must be recognised and managed.

Inexperienced nurses can commit boundary violations because of lack knowledge.  The greeting interaction of the nurse with the patient as observed in the video is not appropriate. The greening do not shows any concern or respect for the patient in pain. Behaviours like this do not meet the ethical guidelines of showing respect to the patients (4). Casual behaviour and arrogance do not enable patient-nurse relation to establish understanding and trust between them (3). Ignoring patient and the family member’s pleas is very offensive behaviour because it can deteriorate the patient’s condition, make the patient vulnerable for exploitation. Being engage in mobile phone in front of a suffering patient is a massive fault of the nurse in charge. It can withhold communication with a patient which is a serious neglect issue. Extensive non-beneficial revelation to the patient is another damage as it can harm the trust and break the respecting professional boundaries. Accepting gifts or money from any client is very unpleasant act. It soil the image of nursing professionals. A nurse should abstains from obtaining personal gain at the patient’s expenditure (2). Verbal seductive behavior, involving in a romantic and sexual relationship with any existing patient or patient’s family members is considered as extreme violations of nursing practise. Abuse and negligence are dangerous boundary violation as they implicate the treachery of respect and faith within this relationship (Hanna and Suplee, 2012). Often thinking of a patient or any relatives of the patient in a personal way and telling personal things in order to impress them. A nurse must refrains from unfitting immersion in the client's personal relationships. Keeping secrets with a specific patient can reduce confidence. Favouring care of one patient at the expense of another’s is forbidden because every patient need same attention. Every patient and their health should have same importance for a nurse (Gutheil and Brodsky, 2011). 

Essential Patient Care Knowledge

The above described anomalies of nursing practise have lots of negative influence on patient’s health, effective diagnosis and treatment. Improper behaviour have been shown to impact on patient’s sensitivity of safety where patients are uncertain about the nurse in charge (Black, 2014). A proper introduction and communication can built up the trust in patient’s mind. Nurses are liable for commencing, upholding and culminating a relationship with a client in a way that confirms the client’s needs are primary priority. According to The Health Professions Act, nurses do not involve into a companionship, a romantic or sexual relations with patients and their family member. Mostly, nurses do not exchange gifts with clients and return or redirect any significant gift. Use of mobile phones and other devices are forbidden when treating a patient. According to a survey of 2,498 nurses by Wolters Kluwer Health, sixty five percent of nurses use a mobile at workplace for personal purposes and for no less than 30 minutes on a daily basis. Giving priority to a specific patient is offensive because it can lead to neglect of other patient. Patient negligence is found to have dual traits. 1st, practice negligence, which speak of the failures of healthcare nurses to reach objective ethics of care. 2nd, caring negligence, which refers to performances and behaviours that lead patients and witnesses to consider that nurses have uncaring approaches. The grounds of patient mistreatment often relate to issues like lack of experience and lack in organisational guidelines (Reader and Gillespie, 2013). These anomalies must be avoided to make the patient feel safe. Patients who are conscious of their caregiver’s character, feel safe and poised in knowing what care is being delivered by whom (Levett-Jones and Hoffman, 2013). Patients can also share these information with family members and friends and mention the doctor to the right person for conversation where required.

Nurses devote a lot of time with patients. They have an important effect on patient’s experiences. To progress patient’s experiences and the quality of care, nurses must know what aspects within the nursing work environment have impact on patient’s health (Kieft et al., 2014). Positive attitude towards work, being more sensitive for patients is very much essential for a charged nurse. The nurse’s behaviour as shown in the video can be changed through a strict organizational guideline and proper implication of professional barriers. A social psychology-based conceptual model is established to clarify the incidence and nature of negligence and mistreatment of patient. This model can help in investigations of differences between patients and healthcare nurses in how they recognise neglect, the connotation with patient carelessness and health outcomes, the comparative significance of system and organisational elements in causing neglect, and the plan of interventions and health policy to diminish patient negligence (Reader and Gillespie, 2013). Patient’s feel safe knowing who their caregivers are and what is their roles and responsibilities are towards them as a patient have been shown to sleep better, feel confident in the care they are receiving, put less energy in expressing concerns with family and friends and feel that the carer they are receiving is patient centred (Black, 2014). Therefore initiating an open relationship with introductions of roles and responsibilities is central to patients’ perspectives of safety and wellbeing (Levett-Jones and Hoffman, 2013). Change is very much needed in cases as shown in the video. A compliant from the patient’s side and necessary steps regarding that compliant can motivate a nurse not to cross the professional boundaries.  Strict guideline implication is mandatory for the nurses and other healthcare professional to behave properly and it can also rectify the image of nursing professionals and the healthcare setting. 

Conclusion

Irrespective of the setting or time span of relations, the therapeutic nurse–patient relationship defends the patient's dignity, independence, confidentiality and allows for the growth of trust and esteem. Professional boundaries are the spaces between the nurse's power and the patient's vulnerability. The nurse requires to be ready to cope with violations. Patient wellbeing essential to be the main concern. If a nurse’s behavior is ambiguous, or if the nurse is uncertain of how to construe a condition, the nurse should access with a reliable administrator or associate. Nurses must practice in a method reliable with professional criteria. Nurses should be well-informed concerning professional boundaries and effort to create and uphold those margins. Nurses should study any boundary-crossing behavior and pursue help and advice from their senior and supervisors when crossings occur. Nurses also need to be conscious of the boundary violations that happen when using social media to discuss patients, their family or their treatment (Dehghani et al., 2013).  

References

Black, B. (2013). Professional nursing: concepts & challenges. Elsevier Health Sciences.

Black, B. (2014). Professional Nursing. Concepts & Challenges. (7th Ed). North Carolina: USA, Elsevier.

Brotto, V. (2013). Ch. 31. Medication therapy (p. 815-887) In Potter and Perry’s Fundamentals of Nursing. (4th Ed). J. Crisp; C. Taylor, C. Douglas & G. Rebeiro. Sydney: Moby Elsevier.

Dehghani, A., Dastpak, M., & Gharib, A. (2013). Barriers to Respect Professional Ethics Standards in Clinical Care; Viewpoints of Nurses. Iranian Journal of Medical Education, 13(5), 421-430.

Finkelman, A., & Kenner, C. (2013). Professional nursing concepts. Jones & Bartlett Publishers.

Gutheil, T. G., & Brodsky, A. (2011). Preventing boundary violations in clinical practice. Guilford Press.

Hanna, A. F., & Suplee, P. D. (2012). Don't cross the line: Respecting professional boundaries. Nursing2015, 42(9), 40-47.

Jones, B. (2013). Ch. 6. Nursing Assessment and diagnosis (p.85-98) and Ch 7. Planning, implementing and evaluating nursing care. (P. 100 – 118). In Potter and Perry’s Fundamentals of Nursing. (4th Ed). J. Crisp; C. Taylor, C. Douglas & G. Rebeiro. Sydney: Moby Elsevier.

Levett-Jones, T. and Hoffman, K. (2013). Ch 1. Clinical reasoning: What it is and why it matters. In Clinical Reasoning. Learning to think like a nurse. T. Levett-Jones (Ed). Austr: Pearson.

Kieft, R. A., de Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC health services research, 14(1), 249.

Palmer, L. (2013). Ch 14. Ethical and legal dimensions of clinical reasoning: Caring for a person who is refusing treatment. In Clinical Reasoning. Learning to think like a nurse. T. Levett-Jones (Ed). Austr: Pearson.

Reader, T. W., & Gillespie, A. (2013). Patient neglect in healthcare institutions: a systematic review and conceptual model. BMC health services research, 13(1), 1.