The Role of the Nurse: Aspects of the Physician-Patient-Family Relationship (Term Paper Sample)

CRITICAL CASE ANALYSIS
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Critical Case Analysis
This report outlines and analyses a critical incident that involved a registered nurse in her third week in the emergency department where she was assigned to take care of four patients admitted in the emergency room for treatment. While three of the four patients were comfortable and with the vital signs stable as they waited for respective diagnostic test results, the other patient, forty-two-year-old Ben Willow accompanied by his wife, was having a persistent headache that had been so intense that he hadn’t slept for two days. The medical officer had seen Ben and the patient was awaiting MRI (Magnetic Resonance Imaging). He was on full neurological observations every hour, and his next set of hourly observations was due. When the nurse got into the darkened cubicle to undertake the observations, before she said anything, the patient’s wife told the nurse that she did not want her husband to be disturbed as he had finally slept. The nurse consulted the information sheet showing the comments of past observations and made out that the last two hourly `checks were inside the patient’s acceptable limits. The nurse opted to abandon the due observations on the patient and noted on the information sheet that the patient had managed to sleep for the first time in two days and that his wife had requested the nurse not to disturb Ben. It was time for the nurse's lunch break. The responsibility of taking care of the four patients was left to the coordinator. On return, the nurse found Ben's cubicle curtain pulled, and she could make out that the cubicle was full of fellow medical practitioners from the many legs she saw underneath the curtain and that the patient's wife was crying outside the curtain. The coordinator approached the nurse and informed her that Ben was unconscious and that the medical officer was demanding an explanation as two why there were no neurological observations made on the patient in the past hour.
Interpretation
The presence of Ben's wife during her husband's diagnosis, observations and treatment present welcome benefits such as the provision of better diagnosis record of the patient, for example, the signs and symptoms shown as well as the impact of medication on his well-being (Boszormenyi-Nagy & Framo, 2013). While the wife’s presence can positively impact on the decision making, she can as well constitute an unsightly liability. Ben’s wife prevents the nurse from making the set hourly observations on the patient, and thus inhibits the nurse from carrying out the professional duty.
Undertaking the hourly neurological observations would have been in the patient's best interests, and it is the best thing to do as a professional (Duncan, 2014). However, unfortunately, the nurse makes the wrong decision by opting to please the patient’s wife and abandoning the observations. The patient’s critical need is to get well, and not to sleep. By blocking the nurse from recording the hourly observations, the wife is impending on the patient’s treatment and recovery process. The nurse should inform the wife the same, telling her importance of carrying out the observations on the patient in order to achieve accuracy in diagnosis as well as treatment (Arnold & Boggs, 2015). Carrying out hourly observations as instructed by the medical officer should not be equated to disturbing the patient. It is legally wrong for the nurse to allow the wife to make all the decisions regarding the patient (Bridges, Nicholson, Maben, Pope, Flatley, Wilkinson & Tziggili, 2013). The nurse ought to have excused the wife and went forth to carry out the observations. Additionally, the nurse could have sought the guidance of the medical officer or, at least, help from another experienced staff regarding the request by the patient's wife not to wake the patient.
Analysis
The practice of nursing largely depends on top quality communication with the patient’s family members (Bridges et al., 2015). Communication between the nurse and the patient’s family members significantly impacts on the patient’s wellbeing, quality as well as results of care. Attaining and maintaining high-quality communication and cooperation between the nurse and the patient's family also hinges on the skills and experience level of the nurse as well as the family members of the patient (Arnold & Boggs, 2015). The effectiveness and quality of care given in intensive care unit (ICU) and emergency rooms is affected by some factors comprising: nursing staff adequacy, availability of specialized nurses, too high levels of nursing documentation, as well as prolonged waiting time.
The relationship between a nurse and the patient forms part of a patient’s bigger social structure and is largely impacted by the family relations of the patient. The presence of a family member may help deduce vital information regarding the health of the patient as well as work together to make the correct diagnosis and work out an effective treatment plan (Shaw, Howard, Clark, Etz, Arya & Tallia, 2013). It is, however, crucial that the physician keeps a proper balance when dealing with the various aspects to attain and maintain the patient, family member and physician collaboration. Patient-centred care is a concept that aims at providing care to the patient while addressing the dynamic and robust collaboration between the patient, clinician, as well as the family member(s) of the patient (Shaw et al, 2013). During a visit to the physician, or during observation and diagnosis as in the critical case above, the collaboration can be impacted by the patient’s and his family’s religion, cultural ideals, beliefs regarding the sickness, as well as ethnicity. While it's crucial for the health provider to note unusual family dynamics during the partnership, maintain neutrality and avoid triangulation, this neutral stance can and should be interrupted to bar negligence and achieve the patient's best interests (Taitsman, Grimm& Agrawal, 2013). Importantly, the patient should have at least some time in privacy to talk to the physician. Taitsman et al (2013) posit that a number of relationship dynamics come into play when a patient is admitted in the emergency department including the dynamics among the care provider and patient, dynamics among patient and patient's family members, dynamics among care provider and patient’s family members, as well as dynamics between the patient and the larger society.
The patient’s family member(s) are there in the examination area for approximately a third of the time (APA, 2013). the presence of family members normally extends examination by only several minutes. The cases with a higher probability of a family member being there comprise of children patients, older patients, patients with low health literacy levels as well as patients with acute illnesses as with the critical case in this paper (Bridges et al, 2015). A patient’s family background such as religion, ethnicity and attitudes regarding the disease play a vital role to reach the decisions made by the patient or his relative. Ben (the patient) and his wife mutually influence one another, as well as impact the relationship between the patient and the physician, thereby forming a therapeutic triangle.
Role of the wife
Some factors can cause the wife or any other family member to accompany the patient to the emergency room (Naylor& Kurtzman, 2010). A family member is an important source of support for the patient. The wife acts as a link in the communication between the physician and patient who is suffering from an acute condition. Undeniably, family members form a crucial part of the team providing care to the patient. In this case, the wife is helping her husband to cope as well as manage the situation. She is also a valuable source of information on the patient’s health and partners with the physician to realize accurate diagnosis as well as plan treatment strategy. The wife advocates the issues of the patient to the care provider (Naylor& Kurtzman, 2010). The wife also ensures that the patient comprehends the nature of the illness and the treatment procedures. Ben’s wife only wants her husband to receive the best form of care. It is a difficult task because she neither has the knowledge nor the experience to know which is the best care for her husband. Clearly, she is sympathetic and worried that that her husband hasn’t slept for two days. When he finally sleeps, she is glad that he is not experiencing pain and that he can rest. This prompts her to tell the nurse that she wouldn't want her husband disturbed, and she would rather have the neurological observations deferred.
The role of the nurse
When a family member is present when examining a patient, the care provider has to demonstrate extended interviewing skills to make correct diagnosis(Naylor & Kurtzman, 2010).The caregiver should understand the role of the family member in providing important information as well as support. The level at which Ben’s wife feels helped and encouraged by the nurse can impact on her burden, attitude, as well as emotional wellbeing. For instance, if she felt that the nurse was supporting her towards achieving the good health of her husband, then maybe she couldn’t have felt that the presence of the nurse would disturb the patient. She would have an attitude that would welcome, and not dispel the nurse. Apart from establishing the role of the wife in decision making, the nurse also ought to have recognized and acknowledged the emoti...