Nursing Fundamentals Communication Assignment

Assignment Task

Nurses must at all times have at the forefront of their minds the purpose of their profession, which is to develop therapeutic relationships in a professional capacity to help health consumers gain autonomy over their own healthcare. Nurses must maintain professional conduct at all times, as governed by the Nursing Council of New Zealand (NCNZ) Code of Conduct (2012a), the Code of Ethics (Clendon & New Zealand Nurses Organisation (NZNO), 2019), and adhering to the Competencies for Registered Nurse Practice (NCNZ, 2016). This will be examined in the scenario of for Mr a health consumer who has had and is suffering from This essay also discusses how establish a therapeutic relationship with while maintaining professional standards and boundaries.

Nursing is a profession which is valued highly by society. This is outlined by the Code of Ethics, stating that ‘nursing is a profession with a defined purpose. It has a special relationship with society, having been established by society’ (Clendon & NZNO, 2019). Nurses are ‘morally accountable and morally responsible for their actions’ and must ‘maintain ethical competence in practice and assume responsibility for nursing judgements’ (Johnstone, 2017). Nurses are committed to the values of respect, trust, partnership and integrity, which underpin the Code of Conduct (NCNZ, 2012a). Nurses must have extensive knowledge and skills gained from a professional degree and from a commitment to ongoing training, as stated by the Code of Conduct standard 4.3: ‘keep your professional skills and knowledge up to date’ (NCNZ, 2012a), and the Competencies for Registered Nurse Practice 2.9: ‘takes responsibility for one’s own professional development and for sharing knowledge with others’ (NCNZ, 2016). Nurses must also have interpersonal skills and communication skills as stated by Competency 3.3: ‘communicates effectively with health consumers and members of the health care team’ (NCNZ, 2016). What sets nursing apart from most professions is the caring and compassion required to carry out their job. Caring ‘represents a core foundational value in professional nursing relationships’ (Arnold & Boggs, 2020). Jean Watson endeavoured to identify and quantify the carative factors nurses should exhibit. These factors are: ‘forming humanistic-altruistic value systems, instilling faith and hope, cultivating a sensitivity to self and others, developing a helping-trust relationship, promoting an expression of feelings, using problem-solving for decision-making, promoting teaching-learning, promoting a supportive environment, assisting with gratification of human needs, and allowing for existential-phenomenological forces’ (Gonzalo, 2019). These carative factors can be used to inform nurses in their professional practice in how they care for health consumers, such as in their care of 

In the scenario asks about the differences between the three main types of relationship: personal, professional, and therapeutic. A personal or social relationship is considered to be a relationship a person has outside of the context of work, such as with a spouse, family or friend. It is a relationship that meets the needs of both individuals involved, can last a lifetime, and is largely equal. A professional relationship is between work colleagues, such as that between an employer and employees, or in the health-system context, between doctors, nurses, and other health professionals. Professional relationship conduct is addressed in the Code of Conduct standard 6.1: ‘treat colleagues with respect, working with them in a professional, collaborative, and co-operative manner’ (NZNC, 2012a). Unlike a social or professional relationship, a therapeutic relationship is always centred on the health consumer. It is ‘purposefully linked to supporting patients in meeting health-related goals’ (Arnold & Boggs, 2020). A therapeutic relationship is the type of relationship will be establishing with as they make his bed.

A therapeutic relationship is established between a health professional such as a nurse and a health consumer According to the Competencies for Registered Nurses 3.1, a health professional ‘establishes, maintains and concludes therapeutic relationships with health consumers’ (NZNC, 2016). The therapeutic relationship has a specific context, time, purpose and conversation focus. It has a goal directed approach to improve the health consumer’s health outcomes. The relationship has an inherent power imbalance, as the nurse has more knowledge and is in a position of trust and respect. Due to this power imbalance, there is an expectation that ‘professionals ought to, and will, submit to a system of rules imposing greater restraint on their professional conduct than would otherwise be imposed on the conduct of ordinary (lay) people’ (Johnstone, 2017), hence the need and function of the Code of Conduct (NCNZ, 2012a). The nurse must engage in rapport and show empathy, while encouraging the health consumer to take charge of their own health. The therapeutic relationship comes to a conclusion when health goals are reached or the patient is discharged. Overall, the therapeutic relationship is a ‘healing relationship [that] consists of an honest connection between the health professional and the patient, marked with respect for the dignity of the patient, and a genuine desire to support the patient to achieve maximum health and well-being through an action plan tailored to patient needs, values, and preferences’ (Arnold & Boggs, 2020).

The therapeutic relationship consists of four distinct phases: pre-orientation, introduction, working, and termination. Pre-orientation involves reading the health consumer’s chart, talking with colleagues, and drafting a health plan for the health consumer. In the context of the bed-making exercise and are undertaking, pre-orientation would involve looking at chart, which shows that he is recovering from a stroke and has weakness down his left side would establish with colleagues and their supervising registered nurse what demeanor is like, and if there is any additional information they need to know which is not noted on the chart. This will further inform their care and because ‘obstacles are easier to handle when they are anticipated’ (Arnold & Boggs, 2020). The pre-orientation phase is essential because it provides the information they need before they see and they can make a plan for his care before they see him.

The next phase in the therapeutic relationship is the introduction. This lets the client know who the health professional is, why they are there, what they are going to do, and how long they will be. In 2011, Middlemore Hospital introduced a system to aid health professionals in establishing relationships with health consumers called AI2DET- Acknowledge, Introduce, Identify, Duration, Explanation and Thanking the health consumer (Kaihe-Wetting, 2012). The purpose of this system is to help health consumers feel more at ease as they feel acknowledged and part of the process of getting well again. This is underpinned by the ethical principle outlined in the Code of Ethics (Clendon & NZNO, 2019) of Manaakitanga, which is ‘the way in which we make people feel welcome when they are in our company and ensure their mana is maintained’. It also helps with health consumer safety, so they know who they are talking to, and that the health professional has correctly identified them to prevent any mistakes happening, such as performing the wrong procedure. This all adheres to the Code of Conduct standard 1.1, ‘Respect the dignity of health consumers and treat them with kindness and consideration. Identify yourself and your role in their care’ and standard 4.1, ‘use appropriate care and skill when assessing the health needs of health consumers, planning, implementing and evaluating their care’ (NCNZ, 2012a). The health professional must explain the procedure to the client, and ask the client to repeat what they have said in order to show that they understand what will be happening. It also helps clients greatly to know how long a procedure will take, especially if they are unwell and need rest. This adheres to the Code of Conduct standard 3.1, ‘Explain and share information with health consumers that they want and/or need. Give health consumers information that is honest and accurate in a way they can understand and invite questions’ (NCNZ, 2012a). A simple thank you at the conclusion of the procedure helps the client feel a sense of gratitude and that they have been respected will introduce themselves to ask him to identify himself by name and date of birth, explain that they are there to make his bed while he is in it, and that it will only take a certain amount of time. They ask to repeat back what they are there for and if he has any questions. They seek to gain his consent before moving into the working phase.

The working phase is when the bed making procedure will take place. During the working phase, nurses must adhere to the guiding ethical principle of beneficence as outlined in the Code of Ethics (Clendon & NZNO, 2019), ‘beneficence is the performing of actions leading to outcomes that now, or in the future, would be regarded as worthwhile; the concept of doing good.’ It is especially important for and to keep communicating with about what they are doing while they are making the bed, so that can feel more at ease and more in control of the process, and that he has a voice. This adheres to the Code of Conduct standard 1.3, ‘listen to health consumers, ask for and respect their views about their health, and respond to their concerns and preferences where practicable’ (NCNZ, 2012a). Communication should be respectful and professional, and consent should be gained with any need to touch the client. Consent is critical in the working phase as clients need to feel respected, otherwise the health professional risks being accused of assault in accordance with the Code of Conduct standard 7.2, ‘protect vulnerable health consumers from exploitation and harm’ (NCNZ, 2012a will follow the procedure of making the occupied bed, communicating with very step of the way, which adheres to the Competencies for Registered Nurses 2.1, ‘undertakes practice procedures and skills in a safe way’ (NCNZ, 2012a). They will also be establishing a rapport to help him feel at ease while they work, in accordance with the Competencies for Registered Nurses 3.1: ‘establishes rapport and trust with the health consumer’ (NCNZ, 2016). They will be encouraging to bend his knees and roll to the side to help him gain a sense of autonomy and independence, which is critical for health consumers who have had a stroke as they lose a lot of their autonomy with loss of function, which adheres to competency 3.2: ‘recognises and supports the personal resourcefulness of people with mental and/or physical illness’ (NCNZ, 2016).

After the working phase, the interaction enters the termination phase. The termination phase in therapeutic relationships is the predetermined ending and it ‘typically ends when treatment outcomes are achieved, [or] the patient has been discharged’ (Arnold & Boggs, 2020). In the context of making bed, the total interaction has been very brief but still meaningful, and requires a respectful termination will thank to acknowledge him for his time and patience, and ask if he has any questions or concerns. They will make sure he has his call button in a place he can easily reach or placed in his hand, and if possible, let him know when someone will be by to check on him. They will then say goodbye and leave the room, making sure to fill out any relevant paperwork in accordance with the Code of Conduct standard 4.8, ‘keep clear and accurate records’ (NCNZ, 2012a). They will let their supervising registered nurse know that they have completed the bed-making task and pass on any questions may have had. may also comment on general demeanor to help inform their supervisor of what to expect when they see him next.

An important aspect of therapeutic relationships is maintaining professional boundaries. Professional boundaries ‘represent invisible structures imposed by legal, ethical, and professional standards of nursing that respect the rights and privacy of the patient, and protect the functional integrity of the alliance between nurse and patient’ (Arnold & Boggs, 2020). The boundary is maintained by the therapeutic relationship being for a specific purpose, for a predetermined length of time and by the professional manner in which the health professional communicates with the health consumer. Professional boundaries are essential in therapeutic relationships as they protect both the health professional and the health consumer from over- or under-involvement. Most often, due to the caring nature of nurses, over-involvement is the most likely scenario when it comes to boundary crossing. Over-involvement means giving extra time and attention, helping health consumers with things they could do themselves, or accepting gifts or money. However, ‘these boundary crossings have the potential to harm the health consumer by changing the focus from the therapeutic needs of the health consumer to meeting the nurse’s own needs e.g. to be “special” or helpful or needed, or to be close to someone or to have other personal, financial or sexual needs met’ (NCNZ, 2012b). Under-involvement is when the health professional disengages emotionally from a health consumer, and withdraws and minimises their care, making the health consumer feel isolated and abandoned (Arnold & Boggs, 2020). It is often a symptom of compassion fatigue, which results from burnout or heightened stress (Arnold & Boggs, 2020). It is up to the health professional, not the patient, to ensure that the boundary is maintained (Arnold & Boggs, 2020). In the context of the scenario involving professional boundaries would be maintained by adhering to the Code of Conduct standard 7.13: ‘maintain a professional boundary between yourself and the health consumer’ (NCNZ 2012a). They would act in a professional manner at all times and uphold and respect the boundaries of the relationship while undertaking their duty of making bed.

Nursing is a profession which is upheld by high professional and ethical standards set by the Code of Ethics (Clendon & NZNO, 2019), the Code of Conduct (NCNZ, 2012a), and the Competencies for Registered Nurses (NCNZ, 2016). It is a profession underpinned by the values of respect, partnership, trust and integrity, and connected through the value of caring have established what the differences are between personal, professional and therapeutic relationships, and that they all have different values and purposes. They have established an effective therapeutic relationship with by using AI2DET and competency 3.1: ‘establishes, maintains and concludes therapeutic relationships with health consumers.’ (NCNZ, 2016). have also maintained professional boundaries with during their therapeutic relationship by adhering to the Code of Conduct (NCNZa, 2012). Therapeutic relationships are central to the nursing profession, and it is up to the nurse to uphold the values of their profession while performing their duty of care.

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