Intent:
To enable students to identify poor nursing practice, specifically with regards to therapeutic communication and professional boundaries and to relate these concepts to patient safety and the nurse/patient relationship.
Task:
A report based on a video. The report will explain how errors in therapeutic communication and/or professional boundaries made by the nurse in the video impact on patient safety and the nurse/patient relationship
Instructions
- Identify two errors with regards to therapeutic communication and/or professional boundaries that impact on patient safety.
- Discuss the significance –How do these errors impact on patient safety?
- Identify two errors with regards to therapeutic communication and/or professional boundaries that impact the nurse/patient relationship.
- Discuss the significance – How do these errors impact on the nurse/patient relationship?
Solution
In the given video, a student RN casually treats a patient who is having many serious issues. The patient is a 33-year-old female who is in an emergency with PV bleeding. She has a history of other serious diseases. However, the student RN does not treat her professionally where serious issues have emerged regarding communication with the patient. The YouTube video presents many shortcomings and areas for improvements for student RN. Indeed, there are errors concerning therapeutic errors, and there must be a correct action for every wrong or inappropriate action. The following is the discussion on these errors and the right actions.
Four Errors concerning Therapeutic Communication and Professional Boundaries:
The video shows many blunders regarding the communication of RN because she is not displaying behavior sensitive to the needs of the patient. Therefore, it causes severe issues for the safety of the patient and the professionalism of the RN.
The first error in the video is related to therapeutic communication, where the student RN is not adhering to the words and expressions of the patient. It is so unfortunate to observe that student RN starts referring to her stories in response to the words of the patient. Many a time, it is visible that the patient feels upset. She does not protest, but she does not feel at all. It is not wise because communication takes place only when a person perceives the words and meanings of others perfectly. In this case, it has not been the case (Annoni & Miller, 2016).
The second error is also related to therapeutic communication, where she misinterprets the patient’s words. She does not record the information severely collected from the patient. Instead, she only talks awkwardly. The way she writes about the treatment is not the right way of communication because she is only filling the fields in the paper. She shows little or no concern that she is dealing with a patient at a medical center. She puts the register twice for writing about the condition of the patient. It shows that she is not organized and writes the information one by one. It is not the right way to record the data (Gu, et al., 2019).
The third error found in the video is related to professional boundaries. She sets her hair in front of the patient, and the first impression has been completely non-professional. It is not a professional attitude to tie hair before the patient requires medical care. She also seems to see herself in the mirror that does not give a message; she is in the medical setting—professional boundaries of a student RN call for being composed and to-the-point. There might be other ways, to be frank, and it is not indeed the way to act before the patient (Carvalho, 2012).
The fourth error is also related to professional boundaries. She sits on the patient bed that is not professional behavior. Moreover, she shows a text message or a photo to the patient that is also not professional. The way she takes the smartphone out of her shirt was not suitable. It is such an awkward and strange act that is not expected at a medical center. Professional boundaries are essential for a student RN to pose to be a professional. It is not wise to sit on the patient’s bed and to converse with her like a friend. Being a friend should be within the professional limits; otherwise, it is over-acting (Bourgeault & Grignon, 2013).
Two Errors having Impact on Patient Safety:
The above-stated errors have affected the patient. In this section, two errors have been selected that have affected patient safety. First, the student RN does not perceive precisely the words of the patient. The patient communicates and says to the RN, and she does take those words lightly. It poses serious threats or risks for patient safety. When the student RN would not listen to the concerns of the patient, it is not effective. She cannot treat the patient, and the quality of treatment suffers in the end. Therefore, one of the errors that affect patient safety wrongly perceives the words and concerns of the patient (Westbrook, Duffield, Li, & Creswick, 2011).
Another error that can affect patient safety is the repeated recording of information. It has been observed that the student RN records the information twice. It seems that she is not attentive and writes the information as the patient speaks out. It might not be an error if she takes the data in detail. It seems that she does not have the interest and just filling in the form or any outline on the paper. As a result, there is a great chance that patient safety can suffer. If any vital information is not entered, it can raise severe concerns for the patient because diagnoses and treatment would be based on student RN’s views (Ko, Wagner, & Spetz, 2018).
Two Errors having an impact on the Nurse/patient Relationship:
The error that has affected the nurse/patient relationship is the way she behaves before her. She looks casual and awkwardly non-professional. There does not seem any justification for her overacting because she is not supposed to act like that. A proper nurse/patient relationship is highly professional, and there are different ways, to be frank. It is good to be friendly with the patient because it increases confidence. However, there are certain rules and ways to do so. The criterion is the nurse/patient relationship that should take care of patients (Corkin & Kenny, 2017).
Another error that affects the nurse/patient relationship is about sharing a private conversation with the patient. There is no need to share personal stories and conversation with the patient because it is meaningless. The student RN shows a private message on the smartphone that is not professional. The relationship between a nurse and the patient is not casual and everyone should need to have a personal bond. Instead, the nurse should take care of the patient, and the patient should be responsive to the nurse. Otherwise, the relationship would not be appropriate or effective (Brauner, Werner, Shippee, Cursio, Sharma, & Konetzka, 2018).
Correction Action for each Error:
The four errors have been explained above. Each error should be replaced by the correct action. First, the correct action for the nurse is to be a good listener. Proper communication starts with listening because it is the input. The nature of a nurse job calls for strictly following this rule. She must know that she can treat the patient only when she knows about her condition. It would be possible through listening. The patient and nurse relationship should know the value of communication that is of central importance for effective treatment (Mansour & Mattukoyya, 2019).
The second correct action for an error is to interpret the concerns and words of the patient suitably. It is not right that the nurse gives her meaning to words and expressions of the patient. It has occurred in this case with the Youtube video that student RN gives her meanings to words of the patient. It is not professional, and it lacks feelings. Misinterpretation of words cannot help nurses to treat the patient effectively because she cannot find the problem or issue. It is better to let the patient explain the meanings of her words and expressions. It would make the relationship between the two perfect and free from defects (Gopee, 2012).
There should be a code of conduct for the behavior of the nurse. In the given video, the student RN presents the behavior where she sets her hair before the patient. The correct action is that the student RN only remains within the professional limit. She does not need to present her personality or appearances. Instead, she should wear professional apparel that gives her a serious look.
The student RN sits on the patient bed and shows her message from her smartphone. The correct action is to have a professional distance from the patient. It is not suitable to sit close to the patient because it is not necessary. Therefore, a student RN should maintain a suitable decision that does not affect the effectiveness of her duty. The medical center should display and implement the code of conduct so that the right behavior can be implemented at the medical center.
Conclusion:
The Youtube video presents different errors regarding the therapeutic communication and professional boundaries of a student nurse. It highlights many areas for improvement because the student RN takes her job casually. Her non-professional behavior has given rise to many issues that should be cured. The fundamental aspect of a good and effective relationship between nurse and patient is related to effective communication. The communication should consider others’ views important so that the process can benefit from both parties. The relationship between a nurse and patient should be two-way, and it is the lesson learned through this video.
References
Annoni, M., & Miller, F. G. (2016). Placebo Effects and the Ethics of Therapeutic Communication: A Pragmatic Perspective. Kennedy Institute of Ethics Journal, 26 (1), 79-VI.
Bourgeault, I. L., & Grignon, M. (2013). A Comparison of the Regulation of Health Professional Boundaries across OECD Countries. The European Journal of Comparative Economics, 10 (2), 199-223.
Brauner, D., Werner, R. M., Shippee, T. P., Cursio, J., Sharma, H., & Konetzka, R. T. (2018). Does Nursing Home Compare Reflect Patient Safety in Nursing Homes? Health Affairs, 37 (11), 1770-1778.
Carvalho, T. (2012). Managerialism and professional strategies: a case from nurses in Portugal. Journal of Health Organization and Management, 26 (4), 524-541.
Corkin, D., & Kenny, J. (2017). Quality patient care: challenges and opportunities. Nursing Management (2014+), 24 (7), 32-36.
Gopee, N. (2012). Communication & Interpersonal Skills in Nursing. Nursing Management (through 2013), 19 (2), 1-9.
Gu, L., Deng, J., Xu, H., Zhang, S., Gao, M., Qu, Z., et al. (2019). The impact of contract service policy and doctor communication skills on rural patient-doctor trust relationship in the village clinics of three counties. BMC Health Services Research, 19, 1-9.
Ko, M., Wagner, L., & Spetz, J. (2018). Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training. Inquiry: The Journal of Health Care Organization, Provision, and Financing, 55, 1-11.
Mansour, M., & Mattukoyya, R. (2019). Development of assertive communication skills in nursing preceptorship programmes: a qualitative insight from newly qualified nurses. Nursing Management (2014+), 26 (4), 29-35.
Westbrook, J. I., Duffield, C., Li, L., & Creswick, N. J. (2011). How much time do nurses have for patients? a longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals. BMC Health Services Research, 11, 1-13.
