Assignment 4: Nursing as Relational Practice—a Formal Essay

Running head: NURSING AS A RELATIONAL PRACTICE 1

NURSING AS A RELATIONAL PRACTICE 9

HLTH 3621: Relational Practice

Nursing as a Relational Practice

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Nursing as Relational Practice

Nurses play a critical role in the healthcare system (Oldland et al., 2020; Kumar et al., 2020). According to Elizabeth Oldland et al. (2020) and World Health Organizations (2020), nurses are key personnel in healthcare and play a critical role in the coordination and provision of care, caring for disease persons, promotion of health, optimization of health services, prevention of ailments, and prevention of adverse events. Moreover, nurses are tasks encompass “collaborative care of individuals, families, and groups” (WHO, 2020; Kumar et al., 2020). This means that nurses are involved in the provision of healthcare services to a wide portion of the population. It is because of their role in healthcare that nurses make up to half of the healthcare professionals in the world (WHO, 2020). To effectively perform their roles, nurses required different sets of skills. Among the most important skill set that nurses need to have to be effective is a leadership skill. According to Reem Nassar Al-Dossary (2017), clinical leadership skills are vital for nurses as they enable them to direct and provide support to patients and healthcare teams during the provision of care. In this assignment, I will be presenting a case in which I demonstrated leadership skills while promoting the health of a patient.

Case

Client characteristics. Mickey Jones is a 33-year old male black immigrant who resides in Springfield, Indiana. He is married and has two elementary school-age children. His wife is of Japanese descent and is considerably younger than him. Mr. Jones does not have a stable source of income as he is unemployed. Although Mr. Jones is educated, he was unable to finish his college education due to financial challenges. Moreover, he is reported to have used drugs and alcohol in college. Apart from his wife and children, Mr. Jones does not have any other family members. His mother died three years and he does not know his father.

Situation characteristics. Recently, Mr. Jones was diagnosed with hypertension. At the start, the patient was prescribed Diuril (Chlorothiazide). However, we had to combine it with Altace (Ramipril) as Diuril alone proved to be less effective. One unique about this patient is that he does not have an insurance cover. This is means that he is solely responsible for gathering for his medical fees. Considering his unemployment situation, it was challenging for him to gather for his medical fees. Moreover, the patient had a preference for herbal medicine and was reluctant to take the prescribed medication at the start. During his initial diagnosis, we had to convince him of the benefits of using the prescribed drugs and the dangers of relying on herbal medication. His wife played a critical role in changing his perception of the prescribed medication. 

My role. Hope Methodist hospital has been Mr. Jones preferred medical facility for long. This in part could be because of the proximity of the hospital to his house. Having worked there for more than four years and Mr. Jones being my neighbor, I have managed to attend to Mr. Jones on different occasions. For me, I was involved in his treatment as he is not only my patient but also my neighbor. Being a neighbor and having worked with him before contributes to my caring relationship with Mr. Jones. Maintain this caring relationship would enable me to gather for his medical needs.  

Kind of leadership. Mr. Jones' resistance to medication means that he needs to change his mentality. As a nurse tasked with handling the patient, the kind of leadership that I need is transformational leadership. According to Emma Collins et al. (2019), transformational leaders can motivate and empower followers. In this case, the patient is taken as the follower as the nurse has to influence him through the provision of care. Through its individualized consideration, inspirational motivation, idealized influence, and intellectual stimulation elements; transformational leaders can influence and challenge the perception of medication. For instance, through idealized influence, I can make Mr. Jones understand the dangers associated with over-reliance on herbal medicine and neglecting or not adhering to the prescribed medication. 

Leadership Role, Style and Communication Strategies

Nurses are leaders in providing patient care, as leadership is an important aspect of the delivery of effective care (Al-Dossary, 2017). According to Reem Nassar Al-Dossary (2017), nurses express their leadership qualities through decision making, critical thinking, advocacy, and action.  

When it comes to healthcare delivery, nurses are considered as frontline personnel. As a result, they are pivotal for the provision of safe and high-quality care: which results in positive patient outcomes. In the case of Mr. Jones, the nurse was required to take a leadership role in ensuring that the patient changes his behavior in regard to medication. As an attending nurse, I had to make sure that Mr. Jones understands the benefit of adhering to the prescribed medication. One way of achieving this is by using my leadership skills to influencing and challenging his beliefs. 

Changing Mr. Jones' behavior and beliefs was a difficult task. This is because his beliefs define who he is (Clark, 2017, P.114). According to Cynthia Clark (2017), our nurses create, shape, influence, and provides a framework for interpreting our reality. This implies that changing Mr. Jones' belief in herbal medicine is difficult. Despite this, as a nurse I had to attempt to change his belief. The best leadership style to challenge and change Mr. Jones’ beliefs is transformational leadership. This is because transformational leadership can motivate, inspire, and challenge him to adopt safe practices (Collins et al., 2017). One advantage that I had in changing the behavior and beliefs of Mr. Jones is that he is literate. Moreover, his wife was collaborative and played a critical role in convincing him to take the prescribed drugs. 

Communication played a critical role in changing Mr. Jones' beliefs. This is because communication was used as a strategy of conveying the necessary change messages. During our interaction, I used different communication strategies. The first communication strategy that I adopted is to include his wife as the caregiver. This was based on the premise that caregivers or relatives play a critical role in communicating with patients. According to Elizabeth Manias (2015), family members can facilitate communication in healthcare by supporting patients in decision making, especially in regards to medication management and the exchange of information with health professionals. Mr. Jones’ wife was critical in convincing Mr. Jones on medication management.

 Another communication strategy that I used is the teach-back method. According to Peggy H. Yen and A. Renee Leasure (2019), the teach-back method is an effective method for reinforcing patient education. The resistance shown by Mr. Jones shows makes it necessary to reinforce the learned items. When using the strategy, I would ask the patient to state the given instructions including the dosage and the stipulated time. Under this strategy, I was able to confirm the patients understanding of the given instructions and the change level. Other communication strategies that I adopted included the use of plain language (language that can easily be understood by the patient); use of multi-disciplinary approach, which involves included other professionals; use of note-taking; use of various teaching materials including written materials, audio and videos; and the use of question and answer. Through the use of different communication strategies, I was able to win the trust of the patient as they facilitated our interaction. Moreover, the use of different communication strategies was important as it portrayed the nurse as someone concerned with the needs of the patient. This trust was critical to changing the beliefs of the patient as it helped clear the uncertainty that the patient had about the use of modern medicine. At the end of our interaction, Mr. Jones accepted to use o the prescribed medication and leave the herbal medication. 

Challenges and enablers 

The relational nursing practice involves understanding the healthcare needs of the patient within complicated contexts (Zhou, 2016). In my dealing with Mr. Jones, the concept of relational practice was critical as it facilitated the delivery of care. However, while engaging in caring relations with the patient, I faced a lot of challenges. First, there was a cultural difference with the patient. In essence, the patient was from a different background from mine. According to Khalid M. Almutairi (2015), cultural misunderstandings between patients and healthcare providers contributes to poor quality of care and patient dissatisfaction. As a leader, this made it difficult to influence and change the belief of the patients. Moreover, it impacted our communication and interaction as misunderstandings were common. For instance, while I failed to understand the logic behind the use of herbal medication to manage his condition, he was convinced that they were the best option for it. However, through the help of other nurses and his wife, I was able to overcome the problem of culture and influence him. Another challenge was the view that the patient had on the cost. According to Jennifer Kim (2018), the cost of medication is one of the contributing factors to non-adherence to medication by patients. Being from a minority group and without insurance, Mr. Jones was reluctant to take medication that he viewed as expensive. Although this can be understandable, it prevented him from understanding the importance of the medication. As a leader, in this case, my focus was on emphasizing the benefits of the medication over the cost. 

Enablers played a critical role in ensuring that caring relations succeed when handling Mr. Jones. One enabler of caring relations was the patient himself. Despite his initial resistance, Mr. Jones was very cooperative throughout the medication. According to Lyndon Morley and Angela Cashell (2017), collaborating with the patient is beneficial as it improves the quality of care, improves patient engagement, and addressing the safety of patients. Moreover, he was willing to learn, which made it easy for me to influence his belief. Another item that I can identify as an enable of caring relation was literacy level. Having gone through high school, both Mr. Jones and his wife were easier to teach. This is because it was easier for them to understand the learning materials. Another enabler was his wife. This is because she helped her husband in making a crucial decision about medication. 

Reflection

Nursing relational practice played a critical call in addressing the care needs of Mr. Jones. Through it, the special healthcare needs of Mr. Jones. Looking into our interaction and collaboration throughout the treatment period, I think I can maintain and enhance the caring relation with Mr. Jones. 

From the experience, I think I can draw several lessons. First, I have learned that as leaders, nurses have the role of addressing the needs of patients (Lutz & Green, 2016). This can be challenging because these needs vary and are unique from patient to patient. Secondly, I have learned that communication strategies between nurses and patients determine their working relationship (Sibiya, 2018). Therefore, nurses have the role of designing the best communication strategy for engaging with patients. Lastly, I have learned that nurses need to be advocates of their patients. According to Lois Gerber (2018), nurses are tasked with advocating for the patients. through advocacy, nurses can use their leadership skills to ensure that the interest of their patients is gathered.

References

Al-Dossary, R. N. (2017). Leadership in nursing. Contemporary Leadership Challenges. https://doi.org/10.5772/65308

Almutairi, K. (2015). Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia. Saudi Medical Journal, 36(4), 425-431. https://doi.org/10.15537/smj.2015.4.10133

Collins, E., Owen, P., Digan, J., & Dunn, F. (2019). Applying transformational leadership in nursing practice. Nursing Standard, 35(5), 59-66. https://doi.org/10.7748/ns.2019.e11408

Cynthia Clark, A. (2017). Creating & sustaining civility in nursing education, 2nd ed. Sigma Theta Tau.

Gerber, L. (2018). Understanding the nurseʼs role as a patient advocate. Nursing, 48(4), 55-58. https://doi.org/10.1097/01.nurse.0000531007.02224.65

Kim, J., Combs, K., Downs, J., & Tillman III, F. (2018). Medication Adherence: The Elephant in the Room. US Pharm, 43(1), 30-34. https://www.uspharmacist.com/article/medication-adherence-the-elephant-in-the-room

Kumar, S., Aggarwal, D., Swain, S., Ramachandran, A., & Chaturvedi, V. (2020). Changing role of nursing cadre under emerging zoonotic diseases. Indian Journal of Community Medicine, 45(5), 9. https://doi.org/10.4103/ijcm.ijcm_414_19

Lutz, B. J., & Green, T. (2016). Nursing’s role in addressing palliative care needs of stroke patients. Stroke, 47(12). https://doi.org/10.1161/strokeaha.116.013282

Manias, E. (2015). Communication relating to family members' involvement and understandings about patients' medication management in hospital. Health Expectations, 18(5), 850-866. https://doi.org/10.1111/hex.12057

Morley, L., & Cashell, A. (2017). Collaboration in health care. Journal of Medical Imaging and Radiation Sciences, 48(2), 207-216. https://doi.org/10.1016/j.jmir.2017.02.071

Oldland, E., Botti, M., Hutchinson, A. M., & Redley, B. (2020). A framework of nurses’ responsibilities for quality healthcare — Exploration of content validity. Collegian, 27(2), 150-163. https://doi.org/10.1016/j.colegn.2019.07.007

Sibiya, M. N. (2018). Effective communication in nursing. Nursing. https://doi.org/10.5772/intechopen.74995

Yen, P. H., & Leisure, A. R. (2019). Use and effectiveness of the teach-back method in patient education and health outcomes. Federal Practitioner, 36(6), 284-289. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590951/pdf/fp-36-06-284.pdf

Zou, P. (2016). Relational practice in nursing: A case analysis. Nursing and Health Care, 9-13. https://doi.org/10.33805/2573-3877.102