The nurse patient relationship is central to the delivery of nursing care. By use of verbal and non verbal communication skills, nurses can offer the three core conditions of all therapeutic relationships to patients ??“ empathetic understanding, acceptance and genuineness. This essay will discuss the three core conditions of effective helping skills. These three core conditions of effective helping skills are; genuineness, acceptance (unconditional positive regard) and empathy. It will focus on the importance of empathy in its application to the nurse patient relationship.
Genuineness can be described as being real and honest with other people. For genuineness to be an effective helping skill, the nurse must be able to communicate honestly with the patient (Tamparo, 2000). Egan (1990), cited in French (1994), states that the ???offer of help must not be phoney.??? and that the nurse ???can??™t hide behind the role of the counsellor.??? Genuineness can be communicated by following some guidelines suggested by Egan (1990). These are; not overemphasizing the helping role, being spontaneous, avoiding defensiveness, being consistent and becoming comfortable with the behaviour that helps the patient.
Rogers explains that being genuine ???involves the willingness to be and to express in my words and behaviour, the various feelings and attitudes which exist in me??¦it is only by providing the genuine reality which is in me that the other person can successfully seek for the reality in him.??? Therefore it is important for nurses to be genuine when communicating with the patient as this invites them to consider their own feelings and thoughts and what these are telling the nurse about themselves, the patient and the patient??™s situation.
Acceptance (unconditional positive regard) is seen as a ???deep and genuine caring for the client as a person. The caring is unconditional??? (Corey, 2001). Acceptance also means that no matter what the patient thinks or feels about the situation, the nurse accepts this and is non-judgemental.
Acceptance can also be defined as being the acknowledgement of patients??™ rights to have their own beliefs and feelings; it is not the approval of all behaviour (Corey, 2001). This requires the nurse to set aside attitudes and beliefs so that they do not cloud judgement in the nurse patient relationship.
According to research carried out by Rogers (1977), the greater the degree of caring, accepting and valuing the patient, the greater the chance of communication between the nurse and the patient and so helps the relationship between them. He also makes it clear that it is not possible for the nurse to always genuinely feel acceptance towards the patient but if the nurse has little or no respect for the patient it is not likely that the communication would be productive.
Foster (2005) suggests that the nurse patient relationship is affected by the nurses??™ capability to practice in the correct and desired abilities of communication and reflection, the range of self-awareness, self-knowledge, authentic and relevant empathy, trust and commitment, confidentiality and appreciation of professional boundaries.
Empathy can be defined many ways. For example, Cambridge Learners Dictionary (2007) describes empathy as the ability to imagine what it must be like to be in someone??™s personal situation. Keats (2000) describes empathy as the ???understanding of another person??™s way of looking at the same situation???. Both of these descriptions mean that the nurse has to be able to try and put themselves in the ???patient??™s shoes??™ so that they can relate to how the patient is feeling or thinking and understand why they are doing so. However, Kagan (1995) suggests that according to Rogers (1975, 1980) that the nurse does not have to put themselves into the patient??™s circumstances but that they should comprehend what they are saying from their own angle. Stetler (1977) argues that empathy is ???an ability, a process, a condition, an attitude, a sensitivity, a feeling???.
Empathy may be looked at as a way of allowing the nurse to get closer to understanding the patient??™s situation rather than becoming closer to the patient (Sloan, 1999).
Empathy differs from sympathy in that sympathy incorporates sharing another persons feelings and being influenced in the same way as them (French, 1994). Sympathy is the expression of feelings about someone else??™s situation.
Research on empathy demonstrates that it promotes: therapeutic success (Meissner, 1993); a positive outcome (Rogers, 1967); constructive change (Authier, 1986); and self esteem (Williams, 1989) (Cited in Sloan, 1999). McCabe (2006) explains that empathy is nursing is a patient centred communication skill and is essential for helping relationships and for establishing agreement and trust with the patient. It is important for nurses because most relationships between nurses and patients are temporary and short lived but yet may be very intense in that the nurse is often required to reduce levels of anxiety and deal with emotional aspects of patient??™s lives.
The Nursing and Midwifery Council (NMC, 2007) identifies the significance of the nurse??“patient relationship in the Code of Professional Conduct. Registered nurses are responsible for ensuring that they ???safeguard the interests of their patients and??¦ develop and maintain appropriate relationships???. There is an extreme requirement to advocate nurses to listen to patients and appreciate the patient??™s need for privacy and empathy (Castledine, 2004).
According to Wiseman (1996) the basic concepts for the ability to be empathetic are; the ability to listen, the ability to imagine what it is like to be the patient, the ability to understand and be non judgemental, and the ability to communicate that understanding. Empathy in a helping relationship like the nurse patient relationship, it adds an extent of real understanding between the nurse and the patient.
Sundeen et al (1998) states that ???empathy signifies a central focus and feeling with and in the patient??™s world. It involves accurate perception of the patient??™s world by the helper, communication of this understanding to the patient, and the patient??™s perception of the helper??™s understanding.??? Rogers (1975) similarly identifies that empathy is one of the most important aspects of the relationship between the nurse and the patient.
Morse et al (1992) examined the use of empathy in nursing, believing empathy to be a fundamental element of the nurse/patient relationship (Cited in Kacperek, 1997).
Empathy can be communicated both verbally and non verbally. Non verbal behaviours include; facing the patient, maintaining eye contact, leaning forward, smiling and nodding. Using the SOLER position uses these key non verbal skills (Egan, 1986, cited in Newson, 2006). SOLER stands for Sit Squarely, Open posture, Lean forward, Eye contact, Relaxed. Sitting squarely means to adopt a posture that signifies involvement. Adopting an open posture means that you are open to the patient and to what they have to say, it shows a non defensive approach. Sitting with your arms and legs crossed can be a sign of reduced involvement to the patient and can come across as not being interested. Leaning forward to a certain magnitude shows the patient that you are interested in what they are saying. If the nurse was to lean back or slouch it could display to the patient that they are not interested or that they are bored. Maintaining good eye contact with the patient is another way of telling the patient that you are interested in what they are saying. Trying to stay some what relaxed when communicating with the patient means that the nurse is comfortable with the patient. This also means that the patient will relax and be more comfortable with the nurse. This will allow the patient to speak more and feel more at ease (Egan, 2002).
To develop an empathetic nature, the nurse must take time to explore feelings and thoughts with the patient, so that they can overcome any issues that may arise or help achieve goals in the patient??™s life (Heath, 2004). Empathy develops as the nurse patient relationship evolves. It is not an experience that can be approached deliberately; a more realistic approach would be to communicate with the patient with an attitude of openness. Another factor which may help the nurse to develop empathy is having greater and more varied life experiences (Sundeen, 1998).
Ehmann (1971) described a model for the application of the process of empathy to the nurse patient relationship. There are four steps in this process;
Step 1: identification. This means that the nurse must be able to identify the situation and the feelings of the patient.
Step 2: incorporation. This means that the nurse has taken on board the situation of the patient but realises it is still the patient??™s experience. This step helps the nurse closer to the reality of the patient??™s situation.
Step 3: reverberation. This is when the nurse experiences interaction between personal feelings, which are based on past experience, and the feelings incorporated from the patient. This step leads to understanding of the patient??™s feelings.
Step 4: detachment. Finally the nurse can return to being the helper. The result of the previous three steps can be combined with previous knowledge of the patient and is then used as a basis for responding to the patient. This means that if the nurse has picked up on any feelings or parts of the situation that are wrong, the patient can correct them and the nurse can then help alter situation, feelings and alternative approaches, depending how the patient reacts.
It must be noted that for this to be a successful process, the nurse must never lose a sense of self. This is so that they can then step back and look at the situation objectively.
To conclude, it is evident that empathy is not always easy to achieve, as it requires complex conceptualisation of behaviours, feelings and experiences. However it allows the nurse a greater range and depth of understanding. As the nurse expands this understanding, the relationship between the nurse and the patient is likely to improve and be maintained. It is also clear that being able to empathise with a patient is normally a very helpful experience for both the nurse and the patient, one that brings them closer together and strengthens the caliber of caring in the relationship.
Together with acceptance and genuineness, the nurse can use empathy to build the relationship with the patient and can improve the psychological status of the patient, whether it is at home in the community or in the hospital setting. The nurse patient relationship is a fundamental element of a successful health care experience for the patient. It is based on the foundations of the helping relationship. Concepts such as trust, empathy, and caring are relevant to the relationship process. Empathy provides depth and meaning to the relationship. When nurses respond benevolently to patients in their care, they recognise their need for comfort and are able to do so because they have an empathetic understanding of their needs.
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