Features of a Good Patient-Nurse Relationship
The relationship between a nurse and a patient is both natural and critically important, emerging when both parties work together to achieve a positive health outcome. Its importance cannot be overstated, as it facilitates productive activities between both parties (Potter et al., 2021). Just as the patient requires the nurse to inform them about options for their health to improve, the nurse needs their patients to comply.
A good patient-nurse relationship features a modicum of trust and cooperation between the two parties. The patient respects the expertise that the health professional brings them and tries their best to follow the prescribed activities. The nurse, on the other hand, respects the patient’s autonomy, gets them involved in decision-making processes related to their health, and respects their choices (Fernández-Ballesteros et al., 2019).
As a result of these actions, not only do the patient and the nurse make working together much more tolerable, but they are also more likely to find better solutions and maintain coordination than in systems where either the doctor or the patient has dominance.
Nursing Code of Ethics on Good and Bad Patient-Nurse Relationships
The nursing code of ethics considers poor patient-nurse relationships an undesirable outcome that runs counter to the mission and purpose of nurses and healthcare organizations. This standard is largely based on the virtues of benevolence and nonmaleficence, meaning that nurses ought to strive to provide aid to patients no matter their attitude, nationality, gender, race, or other attributes (Butts & Rich, 2022).
Even when a patient is potentially dangerous to the nurse, it encourages finding ways to administer medical attention that are least dangerous to the professionals providing it. The principles of psychiatric, military, and emergency medicine are built upon virtue ethics. The Code describes a good or bad relationship through several paradigms, including rights, virtues, and the principle of the greater good.
From a rights perspective, there are dilemmas of the patient having authority over their bodies versus the nurse having greater medical expertise. Virtues of personal autonomy, life, and principles versus survival also come into consideration (Fernández-Ballesteros et al., 2019). The Code of Ethics does not offer absolute solutions to these ethical dilemmas, but rather provides guidelines for nurses to follow so they can make decisions when situations demand it.
Personal Experience and Extreme Cases
My experience told me that respect and mutual understanding form the basis of any relationship. When it comes to patients, treating them as experts in their own bodies helps them respond well and be more receptive to seeing the nurse as an expert in medicine rather than an opposing force. Extreme cases serve to test the limits of healthy, mutually beneficial bonds between the two parties (Potter et al., 2021). When irreconcilable issues arise, the patient would have to weigh their own autonomy versus the expertise and trust they have found in the healthcare professional.
Likewise, the nurse would have to decide between their duties to assist the patient, no matter the circumstances, and endure various difficulties imposed by their charge. Incidents where doctors ignore or forgo a patient’s right to autonomy to save them are examples of such extreme cases (Potter et al., 2021). I remember hearing about an instance in which a nurse argued with a patient about a blood transfusion, which the patient opposed. She was very adamant about going through with the procedure and, in her own words, was willing to violate the rules of informed consent to do so. That case was an example of a patient-nurse relationship that crumbled under duress in an extreme scenario.
Autonomy vs. Paternalism
The situation described in the previous section relates to the frequent clash between autonomy and paternalism. In that scenario, the nurse believed her knowledge and qualifications allowed her to make decisions on the patient’s behalf, disregarding the patient’s personal views and beliefs. The conflict between paternalism and autonomy lies in the fact that a patient may not always be in the right state of mind to make informed decisions about their health (Potter et al., 2021).
In addition, broader considerations of society, ethics, and family need to be taken into account (Fernández-Ballesteros et al., 2019). Even if a patient is conscious and aware, their choices may affect a wide range of other individuals, including children in their care. In extreme cases, it becomes a “we versus them” kind of conflict (Potter et al., 2021). In it, patients and doctors cease to see each other as partners to solve a health-related emergency, but rather as adversaries who seek to make each other’s lives and work more difficult.
Paternalism in medicine is described as the practice of putting the professional opinion of a healthcare worker over the wants and desires of the patient. There are different types of paternalism, each offering a variety of justifications for why paternalism is necessary and justified (Potter et al., 2021). The first type of paternalism in medicine is knowledge-based. In this instance, nurses and doctors disregard the patient’s wishes because they have more medical experience.
The second type of paternalism is necessity – when a patient is unconscious or otherwise incapable of making informed decisions, a nurse must make one for them. Finally, there is paternalism of convenience, in which medical professionals disregard patients’ opinions, wants, and desires, for the sake of their own personal convenience (Butts & Rich, 2022). The latter is widely considered unethical by most medical professionals.
Goldman’s Arguments
Goldman’s arguments for and against paternalism are described as follows: the nurse emphasizes the collective common good and the patient’s survival (For); the patient may not see their own survival as a supreme value (Against) (Fernández-Ballesteros et al., 2019). Religious beliefs or a desire to escape suffering may be considered legitimate reasons to end one’s life.
An example of such can often be seen when patients issue a demand not to be resuscitated. In some religions, the ability of doctors to save a person dying from natural causes is seen as an encroachment on the territory of God or Gods responsible for ending a person’s life. Doing so may doom the soul of the patient in question, and in their refusal, they seek to save themselves from eternal damnation (Butts & Rich, 2022).
Alternatively, the individual may be suffering from a chronic and painful ailment, and there is no cure and no hope for living a normal and enjoyable life. In refusing resuscitation, they seek to avoid further suffering (Butts & Rich, 2022). In both examples, nurses may be driven by the desire to save someone regardless, and view religious beliefs as nothing but superstition.
Relationship Response
A good nurse-patient relationship, as described above, would address Goldman’s dilemma together, reviewing all available treatment options and procedures before making a decision. Ultimately, though, if the patient is lucid and capable of making decisions about their health, they would be the ones to decide their own fate, making autonomy a more respected virtue over all other considerations (Butts & Rich, 2022). A nurse would have to be not only knowledgeable and capable, but also persuasive, to achieve an outcome desirable to both parties.
Before that, however, the nurse would have to engage in thorough self-reflection to determine whether her desire to oppose the patient’s wishes is driven by concern for the patient or by her own, potentially selfish desires (Butts & Rich, 2022). The premises of beneficence and nonmaleficence are solely focused on the patient’s benefit, but what is deemed beneficial is ultimately subjective and within the purview of the individual receiving treatment.
References
Butts, J. B., & Rich, K. L. (2022). Nursing ethics: Across the curriculum and into practice. Jones & Bartlett Learning.
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. (2021). Fundamentals of nursing. Elsevier Health Sciences.
Fernández-Ballesteros, R., Sánchez-Izquierdo, M., Olmos, R., Huici, C., Ribera Casado, J. M., & Cruz Jentoft, A. (2019). Paternalism vs. autonomy: Are they alternative types of formal care? Frontiers in Psychology, 10, 1460.