'The patient narrative has become a core theme in nursing and nurse education and, in our experience, many students report profound learning from narratives. However, recent inquiries concerning bad practice have cited lack of listening to patients’ voices as a core deficit in the services concerned. The third article in this seven-part series explores issues of power and the inherent challenges this poses within professional relationships. It draws on a story that develops previous themes in the series and focuses on the issue of how power manifests within healthcare.
Nurses may possess a number of attributes that place them in a powerful position in comparison with their patients. These include professional status, professional knowledge, being free of pain and fear, and being in a standing position rather than lying in bed. This article explores issues of power and the inherent challenges this poses within professional relationships. The background to using patient narratives in nursing is discussed in detail in part one of this series (Buckley et al, 2016).
The narrative below comes from the field of mental health nursing and illustrates the effect on a service user of a power imbalance between her and the nurses caring for her. After reading the narrative, consider the reflection points that follow, and think about how your patients may be affected by a perceived imbalance of power and how you can minimise the negative effects.'
Adapted from an article discussion piece which appeared in the Nursing Times, March 2016 - https://www.nursingtimes.net/story.aspx?storyCode=7003417&preview=1&hash=C7AFD255C489D73528EE0C371EFCD654
References
Buckley A et al (2016) Using patient stories to reflect on care. Nursing Times; 112: 10, 22-25.
Morgan S (1996) Helping Relationships in Mental Health. Chapman & Hall; London.
Please read the following patient narrative of her experiences on a mental health unit.
“At times, when I’ve been in hospital, I haven’t felt cared about by the nurses. One of the most difficult things to do when I am in hospital is to knock on the office door to ask for help. When I’m feeling vulnerable and need some support from a nurse, and the only option is to knock on the office door – it fills me with dread. Sometimes, I find that when I’ve knocked and everybody’s busy on a computer or telephone, that they all turn around and it makes me feel like I’m bothering them. If a nurse gives me eye contact and a smile it makes me feel that I’m cared about and that I’m not a nuisance. I also think that nurses should spend as much time as possible out of the office, even if they’re just sitting with service users.
“I’ve experienced a lot of nurses that have written my admission care plan without talking to me. This leaves me feeling frustrated. I think ‘how can you know what I need to help me get well without spending time with me or talking to me?’ It’s not as bad if they have started to do the plan but then give me some one-to-one time to read through it and then we discuss any changes I want to make. This is made easier if I have met the nurse before.
“When I’ve been admitted to a ward that I’ve never been to before, and then I’m presented with a finished care plan that I’ve had no input in, it can make me quite angry. Sometimes in this situation when I read the care plan it’s just the same as the last one from a previous admission to another ward and all they’ve done is changed the ward names. This is really upsetting and then makes it even more difficult to approach the nurses to talk and ask for help. I feel that they don’t really want to know how I feel and what I need.
“As a mental health service user I sometimes feel that I’m seen as somebody with problems first and as a woman who’s intelligent and articulate second. The best nurses that I’ve met and worked with have been the ones that have made me feel cared about, important and not just somebody with mental health issues. They’ve been genuinely interested in every aspect of my life and personality.”
Please press the green respond button to answer some reflective questions related to this patient narrative. Repsonses will automatically feed into your VX e-portfolio of learning to evidence your reflective activity related to this subject area.