Professionalism and Interpersonal Skills in Nursing Assessment Answer

Introduction

Professionalism in nursing is defined as a set of professional behaviour that is aligned with the standards of practice for registered nurses. It reflects professional knowledge and skills in the profession and is associated with nurse empowerment, establishing nursing care standards, and improving the quality of service (Cao et al., 2023). It is paramount that nurses maintain professional conduct at all times informed by the Nursing Council of New Zealand - Te Kaunihera Tapuhi o Aotearoa (NCNZ, 2016) Competencies for Registered Nurses, (Nursing Council of New Zealand, 2016), Code of Ethics (NCNZ, 2019), and the Code of Conduct for Nurses (NCNZ, 2012a). This essay aims to provide understanding regarding interpersonal skills and professionalism in nursing by evaluating the case scenario of Alissa Strong and her peer Stephani. Alissa is a 20-year-old student nurse who has been introduced to the concept of professionalism and NCNZ Competencies for Registered Nurses. She has been asked to demonstrate competencies in 1.1 and 3.1 while making an occupied bed for Mr Small, a patient with a history of diabetes and slow healing ulcer of the left calf. Alisha is working along with her peer, Stephanie to make the bed for the patient. This essay aims to address domain one and domain 3.1 of the competencies of registered nurse by discussing the method of establishing an interpersonal therapeutic relationship between the student nurse and the stimulated patient. In addition, the essay with address the question of student nurses by discussing the difference between personal, social, and therapeutic relationships. In addition, the essay will critically evaluate the concept of professionalism and discuss professional boundaries that govern nurses’ communication.

Professionalism involves awareness of professional values, knowledge, skills, and attitude linked to the profession. The nursing professional standard 1.1 relates to the concept of professional responsibility in nursing. The competency domain 1.1 states that nurses should accept responsibility for meeting the standards of professionalism, ethics, and legislated requirement (NCNZ, 2016). Competency 1.1 is based on five indicators namely practising nursing in accordance with relevant legislations, accepting responsibility for action, identifying breaches of law, and demonstrating knowledge of professional standards of practice (NCNZ, 2016). In the context of the case scenario, Alissa is a student nurse who has recently learnt about the two domains of practice. She needs to make a bed for Mr Small who has been advised to keep her legs elevated due to bilateral oedema. Professionalism is defined by effective communication skills and methods of interaction with patients. It is the number one skill that competent nurses should possess. Through effective communication skills, they can recognize the health needs of the patient, engage in meaningful conversation with patients and develop a therapeutic relationship with them (Fakhr-Movahedi et al., 2016). Moreover, communication is an important part of developing rapport with patients and Kourkouta and Papathanasiou (2014) argue that nurses must support their patients by demonstrating courtesy, kindness and sincerity. Patients should be clear about the role of the nurse in completing an activity and the benefit of completing the activity. Ideal non-verbal behaviour that Alissa and Stephanie can display are conveying empathy, care and warmth to the patient by employing eye contact, nodding, pleasant gestures and maintaining appropriate interpersonal distance to make the client comfortable (Sarla, 2022). When the nursing student will treat Mr Small with dignity and pleasing expression, they will be able to establish a therapeutic interpersonal relationship with patients.

Within their scope of practice, Alissa and Stephanie must develop an interpersonal therapeutic relationship with patients before making her bed. The NCNZ (2016) domain 3.1 signifies establishing, maintaining and concluding therapeutic interpersonal relationships with consumers. The first indicator to achieve this competence is initiating and concluding therapeutic interaction with health consumers. In the context of the case scenario, the role of Alissa and Stephanie would be to introduce themselves to the client, sharing their details about the task to be done and the rationale for the same. It would mean establishing rapport using verbal methods and non-verbal gestures such as smiling, making eye contact, active listening and mirroring the body language of the patient (English et al., 2022). After explaining the need to make the bed, they can seek to get the client's consent to start the procedure. It can reflect respect for client autonomy and an interest to address the consumer’s wish during care delivery. It is aligned with ethical code 1.3 which states that nurses should listen to the health consumers' views about health. The action of taking consent before any action is linked to professional standard 3.2 which emphasizes respecting the consumer’s right to participate in decision-making (NCNZ, 2016). By maintaining ethical standards in practice, Alissa can demonstrate professionalism in their activity.

 Each of these actions is aligned with the Code of Ethics (NZNZ, 2019). The above action reflects that nurses are morally responsible for their actions and they understand their duty towards establishing therapeutic relationships with patients. The nurse-patient relationship is based on empowerment, compliance, quality, and power. Nurse-patient interaction based on patient autonomy is effective (Molina-Mula & Gallo-Estrada, 2020). The above action is relevant to the values outlined in NCNZ (2012a) such as respect, trust, partnership, and integrity. Treating someone with respect means valuing their worth, dignity, and uniqueness. In addition, nurses like Alissa must establish trusting relationships through physical support, comfort, and information sharing. Being honest in practice is vital as all nurses are accountable for their actions and they should be accountable for any omissions in care too (NCNZ, 2012a). Empathy and respect are components of professionalism too. By the use of communication skills, compassion, and a caring attitude, they develop a therapeutic relationship and display empathy for the patient. It is aligned with Jean Watson’s first Caritas of Kindness to Patients. It may include accepting and offering help and trying to be present for the patient. Another Caritas that can foster therapeutic relationships is trust, nurture and balance the learning process (Wei & Watson, 2019). During bedmaking, Alissa and Stephanie can collaborate by considering the privacy and dignity of the patient. They can display empathy by understanding the current needs of the patient and responding to activities accordingly. For instance, Mr Small had pain in his left leg and has been requested to keep the leg elevated. While making the bed, Alissa can discuss this point and ensure that her needs are maintained even when he is placed on the opposite side of the bed while changing the bed sheet. According to Moudatsou et al. (2020), empathy supports establishing a positive nurse-patient relationship. It involves the ability to understand the personal experience of the patient and make the patient feel safe to express their concerns. By considering this factor, Alissa can give the message to the patient that they have really heard and considered the immediate needs of the consumer.

As Alissa and Stephanie proceed with the task of making the bed for the patient, they need to consider ways to maintain a therapeutic relationship throughout the activity. It is aligned to the NZNC competency domain 3.1 which states that “health care professionals establish, maintain and conclude therapeutic relationship with consumers” (NZNC, 2016, p.10). Having a goal-directed approach while developing a therapeutic relationship is critical. It involves having conscientiousness that each patient has unique needs. The nurse Alissa should use their clinical judgment to ensure that patient transfer and bed-making are done without causing any harm to the patient. The act of being conscious and responsible for one’s actions implies acting professionally too (Ghadirian et al., 2014). Thus, nursing professionalism is a dynamic process determined by cognitive, attitudinal and experiential factors. The benefit and function of the Code of Conduct in this situation is that it provides a clear outline of expectations from nurses and it eliminates an inherent power imbalance in the nurse-patient relationship (NCNZ, 2019). According to Kornhaber et al. (2016), a therapeutic interpersonal relationship involves an environment of interaction that facilitates an effective communication process. It is a type of relationship encompassing a caring and non-judgmental attitude. Alissa can establish such a relationship with Mr Small by displaying warmth, empathy, friendliness and genuine interest. They can use emotions and expressions to display empathy. Such strategies can improve patient satisfaction with care and minimize anxiety due to poor interpersonal relationships. When nurses can establish a successful therapeutic relationship, it leads to genuine healing. However, certain barriers can affect the interaction such as heavy workload, shortage of time and language differences (Norouzinia et al., 2016). Student nurses should be given adequate training to overcome barriers in the therapeutic relationship.

The above discussion gave an insight into the components that are important for establishing an interpersonal therapeutic relationship with patients. While proceeding with the task of making Mr Small’s bed, Alissa and Stephanie need to understand the four phases of the interpersonal relationship too. The first phase is the pre-orientation phase during which the nurse is given the responsibility to initiate any clinical activity with the patient (Wati et al., 2019). It is the stage of planning and thought process while preparing to complete a clinical activity. At this stage, nurses should collect all information related to patient history, their current clinical presentation and important clinical notes (McCarthy et al., 2019). Before undertaking the task of making the bed for the patient, Alissa and Stephanie will have to pre-orient themselves with the patient's needs by looking at the medical chart and other medical histories of Mr Small. The medical history reveals a history of diabetes, bilateral oedema, and a slow-healing ulcer of the left calf. The handover report shows pain in his left leg and the instruction to keep the leg elevated. Alissa can discuss the same with Stephanie to understand things to consider and make plans for patient care during the activity. Alissa can discuss if they need any additional information to complete the activity. Hence, the pre-orientation phase informs the care to be taken while dealing with patients.

This stage is followed by the next stage of the orientation or introduction phase (Wati et al., 2019). It involves the stage when the first interaction with the client or patient takes place. The goal of this phase is to establish rapport with the patient, establish boundaries and develop mutually agreed goals. One tool that can support nurses to introduce themselves to the patient is AI2DET (Kaihe-Wetting, 2012). Alissa learnt about this tool to present herself in a professional with the patient. It involves acknowledging and identifying the self, defining the duration of interaction, enquiring from the patient and thanking the patient at the conclusion (Kaihe-Wetting, 2012). The advantage of introducing oneself to the patient and explaining to them their role in the assessment is that it allows the consumer to feel at peace and have better clarity about the nursing process (Clarke et al., 2017). It is one of the critical steps in a therapeutic relationship as it can promote adhering to the care plan. The above practice aligns with the Code of Conduct standard 3.1 which states the need to share information with health consumers in the most transparent way (NCNZ, 2012a). Alissa and Stephanie should introduce themselves and explain what activity they are going to complete and why. Such a method of sharing information can help avoid confusion and promote the cooperation of patients during the activity (Boggs, 2023). Similarly, Alissa can explain to Mr Small that her bed needs to be changed and this is for hygiene purposes. At this stage, she can also tell the time to complete the activity. Such information helps the client when they are unwell and need rest. Verbal and non-verbal communication techniques such as greeting a patient with a smile at the beginning and ending with a thank you note are important (Sibiya, 2018). During this stage, Alisha should gain consent from Mr Small before moving to the next stage.

The third stage of the therapeutic relationship is the working stage (Levitt, 2022). It is the stage of implementation of a mutually agreed nursing care plan. It involves a problem-solving stage during which progress based on agreed goals is evaluated. At this stage, it is paramount to maintain the beneficence of the patient and ensure that no harm takes place due to the implementation of any intervention. It aligns with the ethical principle of beneficence which is the duty to promote the good of the patient (Varkey et al., 2021). At this stage, Alissa should keep communicating while they are making the bed. They should ensure to take feedback from the patient while he is resting in other places during bedmaking. They need to follow protocol to complete the process safely. It would mean ensuring that the patient’s leg is kept elevated even during transfer to other places. In addition, the use of an aseptic technique before the procedure will be important. This can be followed by the last phase of termination during which the therapeutic relationship comes to an end. In the context of bed making, Alissa can thanks Mr Small for cooperating during the procedure, check with him for any difficulty and then say goodbye and leave the room. At this stage, completing documentation is also important. According to the NCNZ (2012a), standard 4.8, keeping clear and accurate documentation is important.

In the case scenario, Alissa’s peer asked about the difference between a personal, professional and therapeutic relationship. Personal relationship involves a close relationship with loved ones such as spouses, family or friend. It is a relationship that is important and outside the work context. A professional relationship involves a relationship that is established in the workplace such as a relationship with doctors, employees and employers. The duty of a nurse concerning maintaining professional relationships has been defined in NZNC, 2012a), Standard 6.1 which states the need to treat colleagues with respect and work cooperatively. In contrast, a therapeutic relationship is established with the patient or health consumer. It is a form of helping relationship based on mutual trust and nurturing of faith and hope (Boggs, 2023).

Alissa can use the above discussion to explain Stephanie's difference between the three types of relationships. She needs to narrate why a therapeutic relationship is important while handling Mr Small. However, there is a blurred line between a professional relationship and professional boundaries. Novice nurses or student nurses are often unaware of the professional boundaries that need to be maintained during therapeutic interaction with patients. It is a standard that defines boundaries in interaction with patients and understanding over or under-involvement. Under involvement may involve ignoring the basic needs of the patient and neglecting the core needs of the patient. In contrast, over-involvement may involve an interaction outside of the work context which may lead to boundary violation (NZNC, 2012b). For instance, nurses are not supposed to develop personal relationships with patients after work. If they try to exchange phone numbers or personal detail, it may contribute to boundary violation issues. It has been found that patients request something which is out of the professional duties of a nurse. In such situations, nurses can manage boundary transgressions by making the patient understand which requests are beyond the limits of a professional relationship (NCNZ, 2019). Thus, a clear idea of professional boundaries can support nurses to prevent any ethical or legal conflict.

To conclude, the essay provided a summary of the key components of professionalism in nursing through the analysis of the case scenario of Alissa and Stephanie. Based on the use of the NZNC Code of Practice and Nursing competency standards, the key elements important for professionalism were identified. It included components such as effective communication skills, empathy, compassion, respecting patient autonomy and dignity, appropriate nurturing relationships and effective non-verbal gestures. Using the four stages of the therapeutic relationship, the actions that Alissa can take in each stage of bed-making were discussed. In addition, the nurse focused on identifying the blurred line between professional boundaries and how to prevent any form of under-involvement or involvement in patient care. The nursing standards of practice and the Code of Conduct are important documents that can guide nurses to maintain professionalism during interaction with health consumers.

References

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