Introduction
Nursing practitioners need to closely with patients, their families, and other relevant parties to deliver patient-centered care. In my nursing practice, I have experienced an episode that required the development of a care plan in partnership with patients and their families. In 2009, Mary, a 79-year-old patient living in London in the company of her daughter and two sons came seeking health care services. After diagnosis and examination of her medical history, she had hypertension, obesity, and high cholesterol levels. As a member of a team of three clinical nursing professionals, I was appointed to help in the development of her care plan that is addressed in detail in this paper.
Professional Skills and Values Necessary in Maintaining Partnerships
Partnerships only work when practitioners comply with a set of professional skills and values, among them respect for others, empathy, honesty, common goals, power-sharing and negotiation, communication, and understanding others in the context of their world views (Baille & Black, 2015). The argument that a care plan is essential, especially to persons with long-term ailments, influenced the decision to help Mary (Betancourt & Daniel, 2015). Under a care plan, a healthcare professional and a client agree to the provision of health care services daily (Giger, 2016). Processes such as the reduction of hypertension and cholesterol to acceptable levels and dealing with obesity demanded Mary to have frequent checkups, monitoring, and evaluation of the realized results by health professionals.
Unfortunately, the patient did not accept to seek such attention for not less than six months. Therefore, it became paramount to enhance the adaptability of the patient to illness. This way, she could learn to accept that she had a clinical condition that required intervention. On achieving this goal, medication and therapeutic interventions were deployed with optimal anticipation that they would work as part of the care plan. The patient needed to develop a positive perception of the need to comply with a developed care plan, failure of which could greatly impair the control and evaluation of the necessary medical and therapeutic interventions. This goal was only possible with the establishment of effective partnerships with her, the clinical nurses, and her family.
Developing and maintaining partnerships between nursing professionals, patients, and their families requires empathy. This value involves listening to patients, caregivers, and the patient’s family to understand their health concerns, medical history, and/or acquire any information that can help to enhance the diagnosis and treatment process. When medical practitioners put themselves in the patients, their (patients) families, or caregivers’ shoes, an environment of trust is created. Hence, it becomes possible to share confidential information such as passwords necessary to access medical records (Fullbrook, 2007). This atmosphere ensures the sufficiency of information necessary in the development of a care plan in collaboration with the patients, their families, and/or carers. In my practice, the importance of empathy as a professional value was approached in the formation of Mary’s nursing care plan. After listening and analyzing her condition from her perspective and bringing her two sons and daughter on board, a commitment to the care plan was developed. Consequently, Mary never missed any visits to the hospital. This cooperation incredibly helped in the management of her condition. Arguably, the outcome was possible since she and her family conceived the care plan as their own.
Effective partnerships thrive in an environment of honesty. In the case of Mary, it would have been impracticable to establish collaboratively an effective care plan if she and her family did not provide honest information about her medical history. Equally important, nurses must be sincere during care delivery. For instance, they should always prescribe an evidence-based care plan in partnership with the patient and her family. Nurses must comply with established care delivery standards. Griffith and Tengnah (2010) support this assertion by noting that 78 percent of 5000 nurses released at Royal Nursing College failed to report that poor patient care standards such as victimization would negatively affect their careers.
Power control is critical in developing partnerships between patients, families, carers, and nursing professionals. For example, in Mary’s case, the diagnostic test results made it clear that the patient suffered from more than one ailment. The findings fit into the category of chronic ailments. Persistent care models advocate for the alteration of how people afflicted by chronic illness are attended. Establishing a central position around health care allowed the patient to participate equally with the nurses in the establishment of the best ways to manage her health concerns. To resolve the old woman’s condition, we found it necessary to put the patient at the center of health care. We deployed the model advocated for by Wagner supporting clinical work teams in conjunction with the patient, as opposed to the physician-centric approach (Taylor & Lillis, 2009). By so doing, the patient became aware and ready to support her care within or outside the doctor’s office. She reserved the autonomy of making vital decisions relating to her health care to foster an effective patient-nurse partnership.
Understanding the patient and his or her health goals requires effectual communication. Such effectiveness occurs when two-way communication is embraced. Such communication entails identifying what others are saying, responding to them, and clearing any misunderstanding or making clarifications where necessary (Arnold & Boggs, 2011; Bach & Grant, 2010). The outcome of such communication entails disseminating comprehensible information and creating opportunities for care continuity and enhanced patient-nurse coordination.
Addressing Areas of Conflict
The nursing work environment brings together people from diverse backgrounds. Healthcare workers also experience different types of challenges in their external and internal environments. Such challenges have the potential of initiating and escalating conflicts. In fact, in any work environment, conflict is inevitable (NHS, 2013). The hospital setting brings patients, their families, and carers who can participate in conflicts with healthcare workers. Potential sources of conflict with patients such as Mary include unreasonable expectations by nurses and other involved parties, the perception of poor services, impediment or difficulties in service access, delays, long queues, and the canceling of patients’ appointments (NHS, 2013). Conflicts may result in verbal and/or physical assault.
Conflicts that hinder effective partnerships between nursing professionals, patients, their families, and caregivers can be addressed through accommodation, evasion, cooperation, competition, and/or compromising (Myatt, 2012). Accommodation involves the decision to cooperate with parties in conflict in the highest possible degree. Often, one party works against its desired goals and/or outcomes. The strategy works well when one party in conflict has a better solution to a given problem (Cloke & Goldsmith, 2005). The approach helps in building strong ties between two or more parties in conflict. Alternatively, one may choose to ignore the need to resolve a given conflict. This plan entails resolving conflict via avoiding it. This style works well when the effective solution is costly, when one perceives that he or she has a minimal probability of winning, or when an issue in conflict is trivial. However, avoiding is not an effective strategy in the long-term (Cloke & Goldsmith, 2005).
Collaboration involves partnering to follow a goal pursued by another party. During the collaboration, the effort is made to accommodate all people’s ideas for synthesis in the attempt to develop a single superior idea of resolving a conflict. Such an idea also needs to take into consideration all points of agreement and disagreement between the collaborating parties (Cloke & Goldsmith, 2005). This way, it becomes possible to break away from the win-lose plan to explore the win-win strategy. This approach requires an incredibly high capacity to trust one another in the development of a superior idea of managing conflict. The method is opposed to the competing technique in which the focus is on the win-lose approach to conflict resolution (Gramberg, 2005). The competing method works well in times of dire need to make quick decisions. In the case of compromising, parties in conflict focus on the lose-lose strategy. The approach is best suited whenever parties in conflict pursue goals and objectives, which have no probability of converging.
Legal and Ethical Principles in Partnership Formation
Forming working partnerships with caregivers, patients, and their families require nursing professionals to have a sufficient understanding of various legal and ethical principles. Ethics constitutes a set of guidelines that define acceptable behavior or courses of action in any profession (Lewis & Soule, 2010). Nursing professionals deliver patient-centered care. Therefore, as Lewis and Soule (2010, p.66) suggests, they have an ethical obligation to listen and respond to people’s concerns and preferences. This responsibility can only be realized when partnerships operate under the premise of patient recognition, respecting contributions, empowering, and encouraging people to be actively involved in health care processes and goals.
A goal entails what the nurse expects upon the implementation of the planned nursing orders. The most important goal in the nursing context is the capacity to make a patient adapt proactively to illness (Wills & Melanie, 2011). Equally important is how the potential or actual stress can build up and influence the patient to cope with the sickness. The inception of the healing process requires the willingness of the patient to obey the care plan as spelled out by the healthcare personnel. In the case of my experience with Mary, a patient and his or her carer or family need to understand fully that the ultimate shared goal of the nursing practitioner is the commencement of the healing process and the hope of full recovery. Such understanding enhances the patient’s commitment to the developed care plan.
Nurses have an ethical responsibility for maintaining patient autonomy. Under this principle, they need to respect, document the acceptance of any care refusal, and/or respond to patients, their families, and carers’ needs compassionately. For example, in Mary’s case scenario, she did not accept to undergo checkups within not less than six months. We not only documented this refusal but also engaged Mary and her family in a compassionate discussion on the need for urgent diagnosis. Diagnosis constitutes the most important aspect of developing an effective care plan (Wilson et al., 2013). In the discussion, we assured Mary that the information provided would be treated with the utmost confidentiality. This revelation was necessary to comply with the ethical principle of non-malfeasance. The principle seeks to eliminate any harm during care delivery (Francis, 2013; Keogh, 2013). It is also unethical for nurses to engage in any practice that prejudices the principle of justice and beneficence. Justice ensures equitable distribution of various benefits, costs, and risks to all patients (Doody & Noonan, 2016). Beneficence calls upon the nurse to reduce harm by promoting the individual’s best interests (Webb & Dening, 2016).
Legal principles consist of a set of written down guidelines that attract civil or criminal responsibility once they are breached (Griffith & Tengnah, 2014). Nations have both legal frameworks and policy directives to ensure effective partnerships in healthcare delivery. For example, in the UK, the National Health Service continuously pledges and promises the establishment of partnerships with families, carers, and the sick through their involvement and consultation in health care decisions, treatment, and in tailoring services that seek to promote and manage patients’ health care (NHS, 2015). The body encourages nurses to work collaboratively with communities, patients, the public, caregivers, and family members. The Health and Social Care Act of 2012 advocates for the involvement of patients and their relatives, including any other relevant party, in the care delivery at individual and national levels. Indeed, the legal principle influences nursing practice in the form of various clauses such as the Sexual Offences Act of 2003, the Mental Capacity Act of 2005, the 2000 Freedom of Information Act, Human Rights Act of 1998, Equality Act of 2010, and the Human Tissue Act among others.
From a patient-based perspective, nursing partnerships involve permitting the sick to be involved fully in their care where caregivers allow them (patients) to engage in the development of any therapy-related decisions in line with the set patient protection rules (Brown, 2013). This view discourages clinicians from participating in the process alone since they may fall victim to lawsuits from families of the various patients who claim to have been excluded in the care plan. Nursing care partnerships thrive in an environment of shared goals. In nursing care plans, collective goals are presented in terms of the anticipated client’s responses. An effective mechanism for handling conflicts that may lead to lawsuits in healthcare facilities starts with the identification of the conflict causes. Initiatives are then adopted in line with the laid-down laws to deal with the challenge. Effective communication is one of the best ways of avoiding and handling conflicts in healthcare facilities (Casey & Wallis, 2011). Good communication strategies have multiple benefits that range from enhancing workforce motivation to an effective medical practitioner-patient partnership. Therefore, it is crucial to point out that effective nurse-patient-family partnership is only attainable if the parties comply with the set legal and ethical principles, conflict resolution approaches, and the nursing professional standards.
Conclusion
The approach to establishing partnerships among nurses, the sick, and their families in the care delivery process does not conform to the traditional paternalistic approach to nursing services. Under the traditional approach, patients coupled with their families were only consumers of nursing care plans, which they never participated in their development. The outcome was lower rates of recovery. Patients lacked full commitment to caring plans, especially where they did not understand the anticipated outcomes of the plans. Consequently, such drawbacks are overcome by the new approach to establishing and maintaining effective collaboration among the parties involved in the healing process.
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