The Nursing Practice Act NPA includes the "administration of medications or treatments ordered by a physician, podiatrist or dentist" as part of the practice of nursing.
Find articles by Mack Lipkin, Jr. Address correspondence and reprint requests to Dr. The doctor—patient relationship has been and remains a keystone of care: But objective and theoretical bases for genuine concern remain.
This article examines the foundations and features of the doctor—patient relationship, and how it may be affected by managed care.
A robust science of the doctor—patient encounter and relationship can guide decision making in health care plans. We describe problems that exist and are said to exist, we promulgate principles for safeguarding what is good and improving that which requires remediation, and we finish with a brief discussion of practical ways that the doctor—patient relationship can be enhanced in managed care.
The medical interview is the major medium of health care. Most of the medical encounter is spent in discussion between practitioner and patient. The interview has three functions and 14 structural elements Table 1.
For example, a patient who does not trust or like the practitioner will not disclose complete information efficiently. A patient who is anxious will not comprehend information clearly.
The relationship therefore directly determines the quality and completeness of information elicited and understood. It is the major influence on practitioner and patient satisfaction and thereby contributes to practice maintenance and prevention of practitioner burnout and turnover, and is the major determinant of compliance.
Effective use gives patients a sense that they have been heard and allowed to express their major concerns, 17 as well as respect, 18 caring, 19 empathy, self-disclosure, positive regard, congruence, and understanding, 20 and allows patients to express and reflect their feelings 21 and relate their stories in their own words.
The accessibility of personnel, both administrative and clinical, and their courtesy level, provide a sense that patients are important and respected, as do reasonable waiting times and attention to personal comfort. The availability of covering nurses and doctors contributes to a sense of security.
Reminders and user-friendly educational materials create an atmosphere of caring and concern. Organizations can promote a patient-centered culture, 29 or one that is profit- or physician-centered, with consequences for individual doctor—patient relationships.
Organizations as well as whole health care systems can promote continuity in clinical relationships, which in turn affects the strength of in those relationships.
A health plan that includes the spectrum of outpatient and inpatient, acute and chronic services has an opportunity to promote continuity across care settings. The competition to enroll patients is often characterized by a combination of exaggerated promises and efforts to deliver less.
When this happens, an immediate and enduring barrier to a trust-based patient-doctor relationship is created.
The relationship need not involve a difference in power but usually does, 30 especially to the degree the patient is vulnerable or the physician is autocratic.
United States law considers the relationship fiduciary; i. Thus, providing health care, and being a doctor, is a moral enterprise.
An incompetent doctor is judged not merely to be a poor businessperson, but also morally blameworthy, as having not lived up to the expectations of patients, and having violated the trust that is an essential and moral feature of the doctor—patient relationship.
Deception or other, even minor, betrayals are given weight disproportional to their occurrence, probably because of the vulnerability of the trusting party R.
Thus, a single organization may both provide and pay for care.
Organizations as providers have duties such as competence, skill, and fidelity to sick members. Organizations as payers have duties of stewardship and justice that can conflict with provider duties.
Managed care organizations thus have conflicting roles and conflicting accountability. If these constituents somehow share the accountability, how are conflicting interests resolved or balanced?
For example, the use of the primary care clinician to coordinate or restrain access to other services involves the primary care clinician in accountability for resource use as well as for care of individual patients. Although unrestricted advocacy for all patients is never really achievable, the proper balance and the principles of balancing between accountability to individual patients, a population of patients, or an organization need to be made explicit and to be negotiated in new ways.
All mechanisms for paying physicians, including fee-for-service reimbursement, create financial incentives to practice medicine in certain ways. We still lack a calculus to minimize or even describe in fine detail how such conflicts affect our ability to justify trusting relationships.
Even-handed social attention seems appropriate to all the different mechanisms of payment. This is a priority for a new form of empirical, ethical research. Patients correctly wonder if doctors are caring for them, the plan, or their own jobs or incomes the latter is equally problematic in fee-for-service care.
This ambiguity erodes trust, promotes adversarial relationships, and inhibits patient—centered care.The nurse-patient relationship results from a series of interactions between a nurse and patient over a period of time. The nurse will focus on the needs and problems of the person or family while using the scientific knowledge and specific skills of the profession.
Nurse Patient Relationship Nurse-patient relationship According Cutliffe and McKenna (), research, theoretical and educational literature on interpersonal relations between nurses and patients has proliferated since the s. Even though, In terms of providing care within the therapeutic nurse patient’s relationship, nurses do meet ethical conflict, indecision and anxiety in their everyday practice.
Constant changes in areas like the technology and faith in the health care system, add to these ethical dilemmas. the nurse terminates the relationship when the mutually agreed goals are met, the patient is discharged or transferred or the rotation is finished.
The focus of this stage is the growth that has occurred in the client and the nurse helps the patient to become independent . Video: The Nurse-Patient Relationship: Components, Phases & Outcomes A therapeutic nurse-patient relationship is a supportive interaction that moves a patient toward wellness.
It's based on trust. focus of communication in the nurse–patient relationship is the patient’s needs— that is, patient-centered care. To meet these needs, the nurse must take into con-.